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Early Identification and Treatment of Schizophrenia

Published online by Cambridge University Press:  07 November 2014

Diana O. Perkins
Diana O. Perkins*
Affiliation:
Dr. Perkins is professor of psychiatry and medical director of the Outreach and Support Intervention Services and the Schizophrenia Treatment and Evaluation Program at the, University of North Carolina, Chapel Hill School of Medicine
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Abstract

Schizophrenia is a neurodevelopmental disorder associated with persistent symptomatology, severe functional disability, and residual morbidity characteristic of neurodegenerative brain diseases. The illness begins with genetic susceptibility and generally expresses itself after puberty through subtle changes that begin during the prodromal stage. Symptoms get progressively worse and tend to become more resistant to treatment with each relapse. Evidence for a neuroprotective effect of some forms of early treatment is beginning to emerge. While the underlying mechanisms remain uncertain, atypical antipsychotics may counteract some of the progressive deteriorative effects by enhancing synaptic plasticity and cellular resilience. However, identifying and treating patients in the earliest disease states presents methodological challenges as there is no consensus on the best methods of intervention and differences in at-risk children are not readily detectable or substantial enough to predict which ones will develop schizophrenia.

In this expert roundtable supplement, Jeffrey A. Lieberman, MD, reviews the historical context of progressive deterioration in schizophrenia. Next, Diana O. Perkins, MD, MPH, reviews some of the challenges to early identification of illness as well as the impact of early versus delayed treatment. Finally, L. Fredrik Jarskog, MD, focuses on the neurobiology of functional progression in schizophrenia as well as pharmacology and the potential for neuroprotection.

Type
Research Article
Information
CNS Spectrums , Volume 12 , Issue S4 , 2007 , pp. 5 - 8
Copyright
Copyright © Cambridge University Press 2007

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References

1.Isohanni, M, Murray, GK, Jokelainen, J, Croudace, T, Jones, PB. The persistence of developmental markers in childhood and adolescence and risk for schizophrenic psychoses in adult life. A 34-year follow-up of the Northern Finland 1966 birth cohort. Schizophr Res. 2004;71(2-3):213–225.CrossRefGoogle ScholarPubMed
2.Bilder, RM, Reiter, ZG, Bates, J, et al.Cognitive development in schizophrenia: follow-back from the first episode. J Clin Exp Neuropsychol. 2006;28(2):270–282.CrossRefGoogle ScholarPubMed
3.Yung, AR, Phillips, LJ, Yuen, HP, et al.Psychosis prediction: 12-month follow up of a high-risk (“prodromal”) group. Schizophr Res. 2003;60(1):21–32.CrossRefGoogle ScholarPubMed
4.Keefe, RS, Perkins, DO, Gu, H, Zipursky, RB, Christensen, BK, Lieberman, JA. A longitudinal study of neurocognitive function in individuals at-risk for psychosis. Schizophr Res. 2006;88(1-3):26–35.CrossRefGoogle ScholarPubMed
5.Fuller, R, Nopoulos, P, Arndt, S, O'Leary, D, Ho, BC, Andreasen, NC. Longitudinal assessment of premorbid cognitive functioning in patients with schizophrenia through examination of standardized scholastic test performance. Am J Psychiatry. 2002;159(7):1183–1189.CrossRefGoogle ScholarPubMed
6.Pantelis, C, Velakoulis, D, McGorry, PD, et al.Neuroanatomical abnormalities before and after onset of psychosis: a cross-sectional and longitudinal MRI comparison. Lancet. 2003;361(9354):281–288.CrossRefGoogle ScholarPubMed
7.Perkins, DO, Gu, H, Boteva, K, Lieberman, JA. Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. Am J Psychiatry. 2005;162(10):1785–1804.CrossRefGoogle ScholarPubMed
8.Gitlin, M, Nuechterlein, K, Subotnik, KL, et al.Clinical outcome following neuroleptic discontinuation in patients with remitted recent-onset schizophrenia. Am J Psychiatry. 2001;158(11):1835–1842.CrossRefGoogle ScholarPubMed
9.Lieberman, JA, Phillips, M, Gu, H, et al.Atypical and conventional antipsychotic drugs in treatment-naive first-episode schizophrenia: a 52-week randomized trial of clozapine vs chlorpromazine. Neuropsychopharmacology. 2003;28(5):995–1003.CrossRefGoogle ScholarPubMed
10.Lieberman, JA, Malaspina, D, Jarskog, LF. Preventing clinical deterioration in the course of schizophrenia: the potential for neuroprotection. CNS Spectr. 2006;11(4 suppl):1–16.Google ScholarPubMed
11.Perkins, D, Lieberman, J, Gu, H, et al.Predictors of antipsychotic treatment response in patients with first-episode schizophrenia, schizoaffective and schizophreniform disorders. Br J Psychiatry. 2004;185:18–24.CrossRefGoogle ScholarPubMed
12.Lieberman, JA, Tollefson, GD, Charles, C, et al.Antipsychotic drug effects on brain morphology in first-episode psychosis. Arch Gen Psychiatry. 2005;62(4):361–370.CrossRefGoogle ScholarPubMed
13.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar