C° ešková et al improve. Low doses of antipsychotics, ie, 2–6 mg of haloperidol or its equivalent, are effective and patients are more sensitive to extrapyramidal side effects (Remington et al 1998). Atypical antipsychotics represent a great advance in the treatment of first-episode schizophrenia, as there is strong evidence for greater tolerability with equal or better therapeutic efficacy. Still, many patients optimally treated with atypicals are not able to return to their premorbid functioning and experience significant and persistent morbidity. The Department of Psychiatry of Brno has long-standing experience with patients suffering from first-episode schizophrenia. In addition to a detailed clinical evaluation and a neurological examination focused on soft neurological signs; endocrine, neuroanatomical, and functional brain parameters are monitored and cognitive dysfunction is evaluated (C° ešková et al 2002). This article reports the results of the response of patients with first-episode schizophrenia to treatment based on the psychopathology of the initial treatment phase. The objectives of the study were: (1) to assess in detail the psychopathology before and after the acute antipsychotic treatment; and (2) to evaluate the response to short-term treatment. Methods Subjects Male patients consecutively hospitalized between November 1997 and March 2004 in the psychotic ward of the Department of Psychiatry were included if they: (1) were experiencing their first admission for first-episode schizophrenia (according to ICD-10); (2) provided written informed consent; and (3) were drug-naive or had a maximum of four weeks of cumulative exposure to antipsychotic treatment before admission. The exclusion criteria included a history of drug abuse, evidence of organic brain disorder including mental retardation, severe somatic disease, or premature discharge before completing inpatient treatment. The history of previous psychopharmacological treatment was carefully documented in interviews with each patient and the patients’ relatives. ICD-10 diagnoses were made on the basis of a comprehensive assessment of symptoms and history and all other available information about the patients. The diagnosis was confirmed by consensus of two psychiatrists during separate interviews. Clinical assessment The psychic state of the patients using the Positive and Negative Syndrome Scale (PANSS; Kay et al 1987) was evaluated after admission (before treatment) and at discharge. Patients meeting inclusion criteria completed a semistructured interview for PANSS with two of the authors (RP and MO rated approximately half the patients each). High interrater reliability for clinical assessment was repeatedly confirmed during raters’ participation in international multicenter clinical trials and in regular training sessions at the psychiatric department performed by a skilled clinical researcher (first author EC). The study was designed as an open study. The patients’ psychopathology was evaluated on admission, before they started antipsychotic treatment, and on discharge. The response rate (defined as minimally 30% reduction from baseline in the PANSS total score) and achievement of symptomatic remission was also evaluated on discharge. The criteria used were PANSS based, including only severity not duration. The score of 3 (mild) or less was required on all eight of the following PANSS items: P1 delusions, P2 conceptual disorganization, P3 hallucinatory behaviour, G5 mannerisms and posturing, G9 unusual thought content, N1 blunted affect, N4 passive/apathetic social withdrawal, and N6 lack of spontaneity and flow of conversation (Kane 2003). Treatment Following baseline assessment on admission, all patients were treated openly by monotherapy with an antipsychotic chosen by the patient’s treating clinician. Since becoming available in the Czech Republic, risperidone has been the first drug choice. Other choices were made according to clinical judgment and drug availability. The only concomi- tant treatments allowed were benzodiazepines for tension, anxiety, and insomnia, and biperidene for extrapyramidal symptoms. The medication was administered by psychiatric nurses to ensure medication adherence. Data analysis The statistical analysis was made by comparison of sample means (the paired t-test for comparison of data after admission and before discharge, and t-test for comparison of responders and nonresponders). For correlations between the positive and negative symptoms the Spearman correlation coefficient was used. 180 Neuropsychiatric Disease and Treatment 2005:1(2)