ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewSchizophrenia is a severe mental disorder that affects nearly 1% of the general population and has long been a challenge for both clinicians and researchers in terms of treatment and etiology. More recently, evidence has amassed that suggests that schizophrenia is a brain disorder, and that some aspects of this disorder appear to be genetic. It has only been in the past decade, however, that adequate neuroimaging tools have become available to study brain abnormalities in schizophrenia. These technologic advances have led to a much better understanding of both structural and functional brain abnormalities in schizophrenia, and allowed construction of comprehensive theories regarding the neural underpinnings of schizophrenia. The present review provides an account of research activities in the fields of structural magnetic resonance imaging (MRI), functional MRI, and diffusion tensor imaging during the past year, dating from August 2001 to August 2002.Recent findingsIn the review we discuss MRI findings in chronic schizophrenia and in first episode schizophrenia, and we include information on family studies. We note that the two major hypotheses regarding schizophrenia (neurodevelopmental and/or neurodegenerative) provide a theoretical framework for most studies. For the functional MRI studies, we note that questions focus on identifying networks of brain regions that are abnormal and contribute to functional abnormalities.SummaryJointly, MRI, functional MRI, and diffusion tensor imaging research suggests that schizophrenia is a disorder that impacts on several brain regions, leading most notably to abnormalities in both frontal and temporal lobes, as well as to abnormal connections between those two major structures.

ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThe treatment of schizophrenia has presented many challenges. Despite the fact that 70% of patients are partially or fully treatment responsive, i.e. positive symptoms such as delusions and hallucinations are significantly reduced by antipsychotic medication, many of these responders are left with debilitating thought disorganization, motivational deficits, and disabilities in multiple cognitive domains. The latter disabilities are now thought to be strongly related to clinical outcome, perhaps more than positive and negative symptoms. This article will review recent studies addressing these deficits.Recent findingsIn the past year, studies have demonstrated that cognitive disorders in schizophrenia are widespread, with particular problems noted in attention, declarative memory, and higher-order problem-solving. These deficits appear at the onset of the illness and are stable throughout, but may interact with the aging process, as there is some evidence of cognitive deterioration in older patients. Evidence is accumulating that these deficits are related to abnormalities in the frontal and limbic brain structures, genetic markers, and to social and work outcomes. Atypical antipsychotic medications, cognitive enhancers, and cognitive rehabilitation appear promising as possible treatment approaches.SummaryAs a core symptom, neuropsychological dysfunction specific to the disorder must be precisely defined and targeted for remediation if these patients are to be treated effectively. Because of the heterogeneity of the disorder, different treatments may be effective in certain subgroups, and certain cognitive abilities may be more responsive to intervention and more relevant to clinical outcome than others. There is much to accomplish in the treatment of this disabling disorder.

ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThe recent literature on the molecular genetics of schizophrenia is reviewed, to familiarize the reader with several important developments as well as a broad range of research efforts in a rapidly progressing field.Recent findingsNew genome scan projects, seen in the light of previous scans, provide support for schizophrenia candidate regions on chromosomes 1q, 2q, 5q, 6p, 6q, 8p, 10p, 13q, 15q and 22q. Linkage disequilibrium mapping studies of several of these regions have produced evidence from relatively large samples supporting the association of schizophrenia to neuregulin-1 (NRG1, 8p21-p12), dysbindin (DTNBP1, 6p22.3), proline dehydrogenase (PRODH2, 22q11.21),G72(13q34) with weaker evidence implicating its interacting gene D-amino acid oxidase (DAAO, 12q24), and catechol-O-methyltransferase (COMT, 22q11.21). Other reports have described including the application of microarray techniques to schizophrenia post-mortem tissue, candidate gene studies in diverse regions, efforts to develop quantitative phenotypes (e.g. neuroimaging and neuropsychological variables) and proposed models of schizophrenia pathogenesis.SummarySchizophrenia linkage findings are beginning to converge on a number of chromosomal regions. Linkage disequilibrium mapping studies are beginning to produce findings of great interest in some of these regions, and additional findings should be expected. Enlarged linkage and association samples, combined with rapidly evolving technologies, hold out the promise that in the next 5-10 years, the role of some specific schizophrenia susceptibility genes will be confirmed resulting in an initial understanding of the pathogenesis of schizophrenia.

ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewPharmacogenetic studies on responses to antipsychotic drugs may lead to the identification of biological predictors of drug efficacy and a better understanding of the molecular underpinnings of antipsychotic drug action. The present review discusses early studies of antipsychotic drug response and highlights ongoing work in this rapidly developing area.Recent findingsRecently conducted studies have expanded prior work on clozapine to the consideration of newer atypical antipsychotic agents. Studies of genetic variation in the dopamine D2 receptor and the serotonin (5-hydroxytryptamine) 2A receptor are the most promising in terms of prediction of clinical efficacy. Moreover, studies of antipsychotic drug-induced side-effects such as tardive dyskinesia and weight gain also point to variation in dopamine and serotonin receptor genes. New study designs that incorporate first-episode drug-naïve subjects may be especially informative for future work on pharmacogenetics.SummaryThe rapidly growing body of genomic information and the new study designs that incorporate pharmacogenetic strategies may provide the data necessary to begin to unravel the complex phenotype of response to antipsychotic drugs. Future studies will focus on more comprehensive genomic analyses as well as sample sizes that are significantly larger than currently available datasets.

ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewOver the last decade, a growing interest in early intervention in psychosis has been generated by studies suggesting that early treatment might improve the outcome for subjects with psychotic disorders. However, a large number of questions remain unanswered regarding the usefulness of early intervention programmes. The aim of this paper is to review the recent literature on early intervention.Recent findingsThe most important findings supporting early intervention are those obtained in a population-based study demonstrating that educational campaigns may help to reduce the duration of untreated psychosis, together with those obtained in a randomized, controlled trial study showing that transition rates were lower in subjects with at-risk mental states treated with low doses of antipsychotic drugs and cognitive therapy than those in subjects treated with supportive psychotherapy. However, the existence of a causal link between duration of untreated psychosis and outcome, the case definition of ‘prodromal psychosis with need of care’, and the risk of early intervention for the subjects with prodromal psychosis are not completely established. From a public health perspective, the adequacy of screening tests, the target population, and the risks and benefits of early intervention for the target population are also unclear. There is also a growing concern regarding the ethical questions raised by early intervention research.SummaryCurrent evidence is insufficient to clarify whether early intervention programmes for psychotic disorders are useful. More research is needed to provide relevant answers to the unsolved questions regarding the usefulness and efficacy of early intervention in psychosis.

ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewGiven that the olfactory system projects to brain regions frequently implicated in the pathophysiology of schizophrenia, the past few years have witnessed growing interest in olfactory processing in this disorder. Studies of olfactory functioning reported since June 2001 are reviewed.Recent findingsNew research has focused primarily on consistently reported impairments in odor identification in schizophrenia. It reflects clinically relevant issues that have been described in the assessment of olfactory dysfunction in schizophrenia, including the following: the potential of a vulnerability marker; a tool for assisting localization of cerebral pathology; and the possibility of classifying patients into meaningful discrete subtypes.SummaryDespite the progress that has been made, significant challenges lie ahead. A new intriguing avenue for further investigation may be the assessment of various types of olfactory processing in schizophrenia, such as odor judgements, that are believed to represent steps in the process of odor identification. Further research utilizing comprehensive behavioural as well as neuroimaging measures in the assessment of olfactory processing is needed, and may provide useful theoretical and diagnostic information in schizophrenia.

ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewRecent research increasingly points to the importance of oestrogens and the hypothalamic-pituitary-gonadal axis in schizophrenic psychoses. The most important findings of the past year are reviewed.Recent findingsReports of gonadal dysfunction and states of oestrogen deficiency in women with schizophrenia are increasingly common. Also, there is mounting evidence from clinical as well as from epidemiological and basic research that oestradiol, the main component of oestrogens, exerts protective effects in schizophrenia. Possible modes of action of this hormone in the brain have been detected. Clinical intervention studies have reported the first positive results.SummaryFurther research into this area appears warranted, because if the clinical effects of oestradiol can be confirmed then this could have important implications for prophylaxis and therapy in schizophrenia. Furthermore, relevant pathogenetic mechanisms that underlie some forms of these psychoses might be detected.

ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThere has been a recent resurgence of interest in better understanding the nature of suicidal behavior in schizophrenia, and numerous publications in the years 2000-2002 have addressed this topic. All studies are critically reviewed, the current status of the field is summarized, key issues for clinical practice are emphasized, and likely future directions and developments are outlined.Recent findingsSeveral reports published over the past year described studies that attempted to define clinical correlates of suicidal behavior in schizophrenia, clarify its epidemiology, delineate subtypes, and identify predictors of such behavior. A variety of risk factors for suicidal behavior in patients suffering from schizophrenia were identified and these were found to differ across age, gender, treatment setting, and race. Other studies attempted to elucidate the neurobiology of suicidal behavior in schizophrenia and explore the commonalities with the neurobiological underpinnings of suicidal behavior in other conditions. A third set of studies evaluated the impact of treatment on suicidal behavior in schizophrenia, with an emphasis on the role of the newer generation ‘atypical’ antipsychotics, and, perhaps uniquely, clozapine, in this regard.SummaryThere is clearly a high prevalence of suicidal behavior in individuals suffering from schizophrenia, and studies conducted over the past year add substantially to our knowledge about this problem and provide useful insights about clinical risk factors, the underlying neurobiological basis, and the impact of various treatments on reducing such behavior. Effectively treating positive symptoms and depression, reducing substance abuse, avoiding akathisia, addressing demoralization and instilling hope are important elements in this treatment approach. The newer generation of antipsychotics and developing psychological approaches (particularly cognitive-behavioral therapy) appear to be useful in reducing suicidality in schizophrenia; it is important to monitor the precise impact of these interventions carefully, however. The significant advances in defining the neurobiological basis of suicidality may enable the development of more effective treatments. Over the past year, much has been learned; hopefully this momentum will be maintained over the next few years.

ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewComorbid substance-use disorders are present in at least 25% of patients with schizophrenia, and 70-80% of these patients smoke. It is important to understand how substance-use disorders affect outcomes in this already impaired population.Recent findingsSubstance-use disorders occur most commonly in males, and are most prevalent in the young. Substance-use disorders are associated with bad outcomes, including medication non-compliance, rehospitalization, homelessness, contact with the criminal justice system, medical morbidity and suicide, and these bad outcomes seem to be more likely among those patients who utilize multiple drugs rather than alcohol alone. Psychosocial and behavioral treatments produce few successes. Early indications suggest that clozapine may reduce substance-use disorders. Nicotine corrects certain neurophysiological deficits (e.g. eye-tracking abnormalities) in patients with schizophrenia. Maternal smoking during pregnancy may increase the likelihood of antisocial behavior and substance-use disorder in the offspring. Atypical antipsychotics plus bupropion increase the likelihood of smoking reduction/cessation in patients with schizophrenia.SummaryThe recent literature clearly documents the devastating effects of comorbid substance-use disorders in schizophrenia. Promising new treatment options will require further study.

ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID