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

Editorial accepted for publication May 2011.
American Journal of Psychiatry (Impact Factor: 12.3). 08/2011; 168(8):761-3. DOI: 10.1176/appi.ajp.2011.11050765
Source: PubMed

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    • "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. "
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    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.
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    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.
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    ABSTRACT: Most individuals with schizophrenia retrospectively report a prodromal period characterized by increasing problems in thinking, feeling, and behaving. However, it is less clear how many individuals who display prodromal symptoms will subsequently develop a psychotic illness. Thus, a precondition for early intervention in psychosis is the accurate detection of those who may be at true risk of developing a psychotic illness. The aim of this article is to review current work addressing prediction and prevention in the prodrome to psychosis. First, we describe research efforts to develop and test operational criteria for prospectively assessing psychosis liability over time. Second, the clinical, functional, and biological features of the prodrome are presented, along with a discussion of the variables most frequently associated with psychosis onset. Next, treatment studies are reviewed. The review concludes with a framework for future early identification and treatment studies.
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