Early Intervention for Schizophrenia: The Risk-Benefit Ratio of Antipsychotic Treatment in the Prodromal Phase

ArticleinAmerican Journal of Psychiatry 168(8):761-3 · August 2011with4 Reads
DOI: 10.1176/appi.ajp.2011.11050765 · Source: PubMed
    • "Many continue to show a range of psychiatric problems and nonpsychotic Axis I diagnoses, such as mood and anxiety disorders. These figures emphasize that while many individuals do not go on to develop primary psychotic disorders, they are often not well, either, and experience significant psychiatric disorders [McGorry et al., 2011; Weiser, 2011; Addington and Heinssen, 2012; Fusar-Poli et al., 2012a]. To an extent, the diversity of clinical outcomes is also a reflection of the diversity of underlying etiological factors. "
    [Show abstract] [Hide abstract] ABSTRACT: Three decades after Paul Meehl proposed the term "schizotaxia" to describe a conceptual framework for understanding the liability to schizophrenia, Ming Tsuang et al. at Harvard University reformulated the concept as a clinical syndrome with provisional research criteria. The reformulated view relied heavily on more recent data showing that many non-psychotic, un-medicated biological relatives of individuals with schizophrenia showed difficulties in cognitive and other clinical functions that resembled those seen in their ill relatives. The reformulation raised questions about both whether and when liability could be assessed validly in the absence of psychosis, and about the extent to which symptoms of liability are reversible. Both questions bear on the larger issue of early intervention in schizophrenia. This article reviews the efforts of Tsuang et al. to conceptualize and validate schizotaxia as one such syndrome of liability. Towards this end, liability is considered first more generally as an outcome of interactive genetic and environmental factors. Liability is then considered in the context of endophenotypes as a concept that is both broader and is potentially more specific (and predictive) than many DSM or ICD diagnostic symptoms. Liability syndromes are then considered in the context of their proximity to illness, first by reviewing prodromal syndromes (which are more proximal), and then by considering schizotaxia, which, as it is currently formulated, is pre-prodromal and, therefore, less proximal. Finally, challenges to validation and future directions for research are considered. © 2013 Wiley Periodicals, Inc.
    Article · Oct 2013
    • "Although our data are clearly limited by the small sample size as discussed below, the distribution of the anterior cingulate gray matter volume (Figure 2) implies that ARMS subjects with later transition may have morphological changes of the cingulate gyrus to the same degree as those with overt schizophrenia. There has been debate about the riskbenefit ratio of antipsychotic treatment in prodromal patients (Woods et al., 2007; Weiser, 2011 ). However, given the hypothesized active brain pathology in the early phases of psychosis, which could affect the subsequent course of the illness (Birchwood et al., 1998 ), and the potential ameliorating effects of atypical antipsychotics for brain structural abnormalities (Lieberman et al., 2005; Girgis et al., 2006 ), intervention before the expression of frank psychosis may reduce neurobiological deterioration as well as the transition rate to psychosis (McGorry et al., 2002; McGlashan et al., 2006), especially in subjects with neurobiological risk markers. "
    [Show abstract] [Hide abstract] ABSTRACT: Objectives: The aim of the present study was to use a voxel-based magnetic resonance imaging method to investigate the neuroanatomical characteristics in subjects at high risk of developing psychosis compared with those of healthy controls and first-episode schizophrenia patients. Methods: This study included 14 subjects with at-risk mental state (ARMS), 34 patients with first-episode schizophrenia, and 51 healthy controls. We used voxel-based morphometry with the Diffeomorphic Anatomical Registration through Exponentiated Lie Algebra tools to investigate the whole-brain difference in gray matter volume among the three groups. Results: Compared with the healthy controls, the schizophrenia patients showed significant gray matter reduction in the left anterior cingulate gyrus. There was no significant difference in the gray matter volume between the ARMS and other groups. Conclusion: The present study suggests that alteration of the anterior cingulate gyrus may be associated with development of frank psychosis. Further studies with a larger ARMS subjects would be required to examine the potential role of neuroimaging methods in the prediction of future transition into psychosis.
    Full-text · Article · Mar 2013
  • [Show abstract] [Hide abstract] ABSTRACT: The treatment and understanding of first-episode schizophrenia belongs to the greatest challenges in clinical psychiatry and psychiatric research. Antipsychotic drugs revolutionised the therapy of schizophrenia since their first introduction in the 1950s. However, there are still unsolved questions about an evidence-based and improved treatment of first-episode patients, which neurobiological and clinical studies can help answering.
    Article · Apr 2011
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