Back to the Future

McGorry, Patrick D.; Yung, Alison R.; Bechdolf, Andreas; Amminger, G. Paul

doi:10.1001/archgenpsychiatry.2007.9

Cited by 73 publications

(14 citation statements)

References 36 publications

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“…This can be achieved through patients’ engagement in combined pharmacological and psychosocial interventions. However, here we find a huge TG between what is needed and what is provided, even in most developed countries113,114 (see section on Community Care for those reluctant to maintain contact with mental health service).…”

Section: The Clinical Staging Modelmentioning

confidence: 76%

Unmet needs in the management of schizophrenia

Torres-González¹,

Ibanez-Casas²,

Saldivia³

et al. 2014

NDT

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Studies on unmet needs during the last decades have played a significant role in the development and dissemination of evidence-based community practices for persistent schizophrenia and other severe mental disorders. This review has thoroughly considered several blocks of unmet needs, which are frequently related to schizophrenic disorders. Those related to health have been the first block to be considered, in which authors have examined the frequent complications and comorbidities found in schizophrenia, such as substance abuse and dual diagnosis. A second block has been devoted to psychosocial and economic needs, especially within the field of recovery of the persistently mentally ill. Within this block, the effects of the current economic difficulties shown in recent literature have been considered as well. Because no patient is static, a third block has reviewed evolving needs according to the clinical staging model. The fourth block has been dedicated to integrated evidence-based interventions to improve the quality of life of persons with schizophrenia. Consideration of community care for those reluctant to maintain contact with mental health services has constituted the fifth block. Finally, authors have aggregated their own reflections regarding future trends. The number of psychosocial unmet needs is extensive. Vast research efforts will be needed to find appropriate ways to meet them, particularly regarding so-called existential needs, but many needs could be met only by applying existing evidence-based interventions. Reinforcing research on the implementation strategies and capacity building of professionals working in community settings might address this problem. The final aim should be based on the collaborative model of care, which rests on the performance of a case manager responsible for monitoring patient progress, providing assertive follow-up, teaching self-help strategies, and facilitating communication among the patient, family doctor, mental health specialist, and other specialists.

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Section: The Clinical Staging Modelmentioning

confidence: 76%

Unmet needs in the management of schizophrenia

Torres-González¹,

Ibanez-Casas²,

Saldivia³

et al. 2014

NDT

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“…Ethical considerations58 govern the use of genetic risk prediction, but to some extent these issues have been bypassed through the availability of direct to consumer testing (necessarily with very limited efficacy at this point). Despite ethical concerns, prediction of genetic risk may be an important tool for identifying schizophrenia in its prodromal phase that is the key to early intervention 59. Around the world, protocols have been developed for identification of patients at ultrahigh risk of developing psychosis60 that includes genetic risk through family history; but, as we have shown, a very high proportion of schizophrenia case subjects will have no close relatives with the disorder.…”

Section: Prediction Of Genetic Riskmentioning

confidence: 99%

Narrowing the Boundaries of the Genetic Architecture of Schizophrenia

Wray

Visscher

2009

Schizophrenia Bulletin

103

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Genetic architecture of a disease comprises the number, frequency, and effect sizes of genetic risk alleles and the way in which they combine together. Before the genomic revolution, the only clue to underlying genetic architecture of schizophrenia came from the recurrence risks to relatives and the segregation patterns within families. From these clues, very simple genetic architectures could be rejected, but many architectures were consistent with the observed family data. The new era of genome-wide association studies can provide further clues to the genetic architecture of schizophrenia. We explore models of genetic architecture by description rather than the mathematics that underpins them. We conclude that the new genome-wide data allow us to narrow the boundaries on the models of genetic architecture that are consistent with the observed data. A genetic architecture of many common variants of moderate (relative risk > approximately 1.2) can be excluded, yet there is evidence that current generation genome-wide chips do tag an important proportion of the genetic variation for schizophrenia and that the underlying causal variants will include common variants of small effect as well as rarer variants of larger effect. Together, these observations imply that the total number of genetic variants is very large—of the order of thousands. The first generation of studies have generated hypotheses that should be testable in the near future and will further narrow the boundaries on genetic architectures that are consistent with empirical data.

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“…Data from controlled studies suggest that clinical intervention may be effective in delaying or preventing exacerbation into psychosis, but evidence to date is very weak 9,10. Screening for psychosis risk is certainly controversial 11,12. Nonetheless, there is a clinical need for methods of identification and intervention preceding fully manifest psychosis.…”

mentioning

confidence: 99%