Indicated Prevention of Schizophrenia

Klinik für Psychiatrie und Psychotherapie, Universität zu Köln, Kerpener Strasse 62, Köln, Germany.
Deutsches Ärzteblatt International (Impact Factor: 3.52). 08/2008; 105(30):532-9. DOI: 10.3238/arztebl.2008.0532
Source: PubMed


Despite recent advances in their treatment, schizophrenic disorders are still among the diseases that most severely impair patients' quality of life. For this reason, centers for the early recognition of schizophrenic disorders have come into existence worldwide. In these centers, much effort is devoted to the development and testing of suitable preventive strategies.
In this article, we selectively review the literature on the currently available means of assessing the individual risk of becoming ill with schizophrenia and of preventing the imminent onset of the disease.
The currently recognized neurobiological and psychosocial risk factors are not predictive enough to enable the development and application of selective prevention measures for asymptomatic persons at risk. The imminent onset of schizophrenia can be predicted with high accuracy, however, in cases where an initially non-psychotic patient develops early cognitive symptoms that imply a risk of schizophrenia and then, later on in the prodrome of the disease (which typically lasts about five years), goes on to develop high-risk symptoms with mild psychosis. At this point, a differential strategy of indicated prevention can be put into action, including cognitive behavioral therapy, atypical antipsychotics in low doses, and neuroprotective agents.
The current state of knowledge in this innovative field of research leads us to expect that it will soon be possible to offer individually tailored preventive measures to persons seeking medical help and advice because of the early warning signs of schizophrenia.

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    • "This applies not only to anxiety disorders (13), but also to mood disorders (14). In contrast, efforts in the prevention of borderline personality disorder (15), psychosis, and schizophrenia (16, 17) are mostly limited to selective prevention (addressing persons at risk) or to indicated prevention (addressing persons with symptoms or subthreshold diagnoses) even though the potential for universal prevention should not be underestimated (18, 19). "
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    ABSTRACT: This article takes four looks at the status of prevention in psychiatry. The first glance is critical, shaped by disappointment at the slow progress in the understanding of psychiatric diseases and the lack of promise in prevention. The second look is less humble. It characterizes and acknowledges the efforts made so far. The third and the fourth perspectives optimistically announce a new age in research and prevention. Breakthroughs, whose contours are already appearing on the horizon today, will transform the prevention of psychiatric diseases into a success story within the next 10-15 years.
    Full-text · Article · Jun 2014 · Frontiers in Public Health
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    • "Some schizophrenic patients show reduced compliance in taking the prescribed antipsychotic drug, partly due to adverse effects. As a consequence, psychotic symptoms may reoccur [1]. In this review, we summarize the alterations of classical neurotransmitters and neuropeptides in the brain regions -i.e. the mesolimbic system, the hippocampus and the prefrontal cortex (PFC) -involved in schizophrenia. "
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    ABSTRACT: We summarize the alterations of classical neurotransmitters and neuropeptides, including their specific subreceptors, involved in schizophrenia. The essential susceptibility genes in schizophrenia and their coherence to neurotransmitter alterations are highlighted. In this sense, dopamine and serotonin hyperactivity in the mesolimbic system and the hippocampus is due to a reduced presynaptic inhibition carried out by GABA and glutamate, which is due to the susceptibility genes. A neuronal network in the brain regions involved in schizophrenia is developed in order to derive novel therapeutic approaches. A survey of the mechanisms of action of conventional and newer antipsychotic drug is given. We suggest the appropriate antipsychotic drugs considering the symptoms of schizophrenic and their possible side effects. It is important to examine the susceptibility genes in a cohort of patients in order to find out which patients profit more from antipsychotic drugs: those that exert a stronger D2 antagonistic effect or those that exert a stronger 5HT2A antagonistic effect. One question to be answered is whether refractory symptoms such as persistent acoustic hallucinations could be improved with novel antipsychotic drugs.
    Full-text · Article · Sep 2013 · Current Drug Therapy
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    • "The first 2 to 5 years of illness are considered a critical period in the development of psychotic disorders. It is during this period that adequate treatment may substantially impact the course and outcome of illness [2,3]. A recent meta-analysis [4] however indicates a drop-out rate of 13% for the psychosocial treatment of schizophrenia spectrum disorders. "
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    ABSTRACT: Background The therapeutic alliance is related to better course and outcome of treatment in schizophrenia. This study explores predictors and characteristics of the therapeutic alliance in recent-onset schizophrenia spectrum disorders including the agreement between patient and therapist alliance ratings. Methods Forty-two patients were assessed with demographic, neurocognitive, and clinical measures including the Positive and Negative Syndrome Scale (PANSS). The therapeutic alliance was measured with the Working Alliance Inventory - Short Form (WAI-S). Results Patient WAI-S total scores were predicted by age and PANSS excitative symptoms. Therapist WAI-S total scores were predicted by PANSS insight. Patient and therapist WAI-S total scores were moderately associated. Neurocognition was not associated with working alliance. Conclusion Working alliance is associated with specific demographic and symptom characteristics in patients with recent-onset schizophrenia spectrum disorders. There is moderate agreement between patients and therapists on the total quality of their working alliance. Findings highlight aspects that may increase therapists’ specificity in the use of alliance-enhancing strategies.
    Full-text · Article · May 2013 · Annals of General Psychiatry
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