Progress in Defining Optimal Treatment Outcome in Schizophrenia

Remington, Gary; Foussias, George; Agid, Ofer

doi:10.2165/11530250-000000000-00000

Cited by 74 publications

(34 citation statements)

References 142 publications

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“…They show efficacy for positive symptoms, such as hallucination and delusions, but are less effective in treating patients' cognitive impairments (Keefe et al 2004;Purdon et al 2000;Remington et al 2010). …”

Section: Introductionmentioning

confidence: 99%

Effects of modafinil on cognitive functions in first episode psychosis

et al. 2011

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Section: Introductionmentioning

confidence: 99%

Effects of modafinil on cognitive functions in first episode psychosis

et al. 2011

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“…Teams include peer support specialists and practitioners with expertise in psychiatry, substance abuse treatment, and employment. Although ACT reduces time in the hospital for mental illnesses in general [112], it seems specifically to improve housing stability [113] and reduce hospitalization rates, especially in patients with higher baseline hospitalization rates [113]. …”

Section: Psychosocial Treatmentsmentioning

confidence: 99%

Recent advances in understanding schizophrenia

Haller¹,

Padmanabhan²,

Lizano³

et al. 2014

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Schizophrenia is a highly disabling disorder whose causes remain to be better understood, and treatments have to be improved. However, several recent advances have been made in diagnosis, etiopathology, and treatment. Whereas reliability of diagnosis has improved with operational criteria, including Diagnostic and Statistical Manual of Mental Disorders, (DSM) Fifth Edition, validity of the disease boundaries remains unclear because of substantive overlaps with other psychotic disorders. Recent emphasis on dimensional approaches and translational bio-behavioral research domain criteria may eventually help move toward a neuroscience-based definition of schizophrenia. The etiology of schizophrenia is now thought to be multifactorial, with multiple small-effect and fewer large-effect susceptibility genes interacting with several environmental factors. These factors may lead to developmentally mediated alterations in neuroplasticity, manifesting in a cascade of neurotransmitter and circuit dysfunctions and impaired connectivity with an onset around early adolescence. Such etiopathological understanding has motivated a renewed search for novel pharmacological as well as psychotherapeutic targets. Addressing the core features of the illness, such as cognitive deficits and negative symptoms, and developing hypothesis-driven early interventions and preventive strategies are high-priority goals for the field. Schizophrenia is a severe, chronic mental disorder and is among the most disabling disorders in all of medicine. It is estimated by the National Institute of Mental Health (NIMH) that 2.4 million people over the age of 18 in the US suffer from schizophrenia. This illness typically begins in adolescence and derails the formative goals of school, family, and work, leading to considerable suffering and disability and reduced life expectancy by about 20 years. Treatment outcomes are variable, and some people are successfully treated and reintegrated (i.e. go back to work). Despite the effort of many experts in the field, however, schizophrenia remains a chronic relapsing and remitting disorder associated with significant impairments in social and vocational functioning and a shortened lifespan. Comprehensive treatment entails a multi-modal approach, including psychopharmacology, psychosocial interventions, and assistance with housing and financial sustenance. Research to date suggests a network of genetic, neural, behavioral, and environmental factors to be responsible for its development and course. This article aims to summarize and explain recent advancements in research on schizophrenia, to suggest how these recent discoveries may lead to a better understanding and possible further development of effective therapies, and to highlight the paradigm shifts that have taken place in our understanding of the diagnosis, etiopathology, and treatment.

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“…43 There is a doubling of the standardized mortality ratio for death from cardiovascular disease, and people with schizophrenia have a lifespan that is shortened by as much as 25%, independent of suicide risk. 44 The atypical antipsychotics, with their increased liability for weight gain and associated metabolic disturbances, 44,45 provide a clear illustration of how these issues are impacted in psychiatry.…”

Section: The Association Between Schizophrenia and Obesitymentioning

confidence: 99%

Beyond Pharmacotherapy: Understanding the Links between Obesity and Chronic Mental Illness

et al. 2012

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While differences in weight-gain potential exist, both between and within classes of psychiatry medications, most commonly used atypical antipsychotics, mood stabilizers, and antidepressants result in some degree of weight gain. This is not new information and it requires an understanding of the tolerability profiles of different treatments and their goodness of fit with specific patient phenotypes. However, this iatrogenic association represents only a piece of this obesity-mental illness dyad. The complex interplay between psychiatric illness and weight involves neurobiology, psychology, and sociological factors. Parsing the salient variables in people with mental illness is an urgent need insofar as mortality from physical health causes is the most common cause of premature mortality in people with chronic mental illness. Our review examines issues associated with common chronic mental illnesses that may underlie this association and warrant further study if we hope to clinically intervene to control this life-threatening comorbidity. W W WBien que les différences de potentiel de gain de poids existent, à la fois entre les classes de médicaments psychiatriques et au sein de celles-ci, les antipsychotiques atypiques, les psychorégulateurs et les antidépresseurs les plus fréquemment utilisés entraînent à un certain degré une prise de poids. Cette information n'a rien de neuf et elle demande une compréhension des profils de tolérabilité de différents traitements et de leur qualité d'ajustement aux phénotypes spécifiques du patient. Cependant, cette association iatrogène ne représente qu'une pièce de ce tandem obésité-maladie mentale. L'action réciproque complexe entre la maladie psychiatrique et le poids met en jeu la neurobiologie, la psychologie et les facteurs sociologiques. L'analyse des variables prépondérantes chez les personnes souffrant de maladie mentale est un besoin urgent pour autant que la mortalité attribuable à des causes de santé physique est la cause la plus commune de mortalité prématurée chez les personnes souffrant de maladie mentale chronique. Notre étude examine les questions associées aux maladies mentales chroniques communes qui peuvent sous-tendre cette association et justifient plus de recherche si nous souhaitons intervenir cliniquement pour contrôler cette comorbidité qui met la vie en danger.

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Progress in Defining Optimal Treatment Outcome in Schizophrenia

Cited by 74 publications

References 142 publications

Effects of modafinil on cognitive functions in first episode psychosis

Effects of modafinil on cognitive functions in first episode psychosis

Recent advances in understanding schizophrenia

Beyond Pharmacotherapy: Understanding the Links between Obesity and Chronic Mental Illness

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