- Email: [email protected]
Converging Perspectives on Schizophrenia
Schizophrenia: Advances and Current Management
Preface C o n v e r g i n g P e r s p e c t i v e s on Schizophrenia
Peter F. Buckley, MD Editor
This issue brings together an international group of stellar schizophrenia-focused clinicians and researchers to provide contemporary perspectives on the biology and treatment of schizophrenia. While the condition remains enigmatic, this issue chronicles progress in both understanding of what is, and what is not, schizophrenia and, accordingly, how best to approach care. In the opening article, Pearlson and colleagues thoroughly review and challenge symptom-based approaches to the diagnosis of schizophrenia. They describe current efforts to define neurobiological signatures between psychosis and mood disorders. Waddington and colleagues highlight information on duration of untreated psychosis (DUP), the critical time period between the emergency of clear psychotic symptoms and the initiation of psychiatric care. They critically review extant literature, as well as highlight model programs for early intervention, on DUP from a longitudinal perspective. Turning over to biological perspectives, our colleague, Dr Miller, and I speculate on neuroinflammation and schizophrenia ... a kind of “old wine in a new bottle.” There are longstanding relationships between infections, especially viruses, and schizophrenia. Recent studies now point to a more systematic pattern of immunologic disturbances in schizophrenia, thereupon, now prompting nascent attempts at novel immune-based approaches to treatment. These opportunities are highlighted in this article. While such biological theories are exciting, readers and clinicians are of course more focused on the “nuts and bolts” of clinical care and what can be done to make real improvements. To that end, medication adherence is, unquestionably, central to clinical care. Weiden reminds us just how a multifaceted and major dilemma nonadherence is in the treatment of patients with schizophrenia. This article covers recent innovations and pragmatic approaches that focus on detecting and enhancing adherence for this patient group. This article also forms the back-drop for considering innovations in clinical therapeutics. To that end, Lauriello and colleagues “take stock” of currently available antipsychotics and evaluate the potential role(s) of Psychiatr Clin N Am 39 (2016) xiii–xiv http://dx.doi.org/10.1016/j.psc.2016.02.001 0193-953X/16/$ – see front matter Ó 2016 Published by Elsevier Inc.
psych.theclinics.com
xiv
Preface
other putative agents that are in development. Helio Elkis and I, even in the face of the advances of psychopharmacology described by Lauriello and colleagues, also remind us that there is still a substantial minority of patients with schizophrenia who remain recalcitrant to standard treatments, up to and including clozapine. Options for clinicians are reviewed in this article as well as combinations of medications and use of old and new neuromodulatory therapies. In addition to limitations of pharmacotherapy, the extent of comorbidities and schizophrenia also complicates the care of people with schizophrenia. Comorbidities, whether they are psychiatric, physical, or a combination of both, are now more the rule than the exception among people with schizophrenia. There are many reasons that may explain this robust association, and these are detailed in the article by Hwang and colleagues. Returning to medication nonadherence and the limitations of pharmacotherapy, we know that detecting and managing adverse effects of antipsychotic medications are key to effective care. Accordingly, Ames and colleagues describe how the complexities in adverse effects of currently available antipsychotic medications represent a substantial health care burden to the patient and a therapeutic challenge to the treating provider. Given the diverse adverse effect profiles, Ames and colleagues highlight current management strategies. Shifting gears from medications, Ahmed and colleagues focus on recovery and schizophrenia. The involvement of people in recovery from schizophrenia provides complementary and powerful synergies with “traditional” clinic-based treatment of schizophrenia. This article reviews how far we have come toward incorporating recovery principles with clinical practice. Recovery also represents a shift in health care focus, in the context of emergent health care reform. Bartlett and Manderscheid illustrate how health care reform could realize the potential of the mental health parity act that was passed several years ago. They evaluate the challenges and opportunities that could exist for the provision of services for the seriously mentally ill. Finally, our US colleagues who reside in Australia, Drs Cyndi and Tom Weickert, provide a timely and critical appraisal of the most pertinent research findings in schizophrenia. Areas that have “fallen out of favor” and/or appear to be “blind alleys” are also briefly mentioned so that the discerning reader comes away succinctly informed of “the big picture” of schizophrenia research. Collectively, these stellar colleagues provide a cogent and comprehensive synthesis of the biology and treatment of schizophrenia. As guest editor, I express my sincerest gratitude for their efforts, which come together so nicely in this timely issue of Psychiatric Clinics of North America. We are also grateful to Kristen Helm, our publishing collaborator at Elsevier, for her consistency with this issue of Psychiatric Clinics of North America. Peter F. Buckley, MD Medical College of Georgia Augusta University 1120 15th Street, AA-1002 Augusta, GA 30912, USA E-mail address: [email protected]
Preface C o n v e r g i n g P e r s p e c t i v e s on Schizophrenia
Peter F. Buckley, MD Editor
This issue brings together an international group of stellar schizophrenia-focused clinicians and researchers to provide contemporary perspectives on the biology and treatment of schizophrenia. While the condition remains enigmatic, this issue chronicles progress in both understanding of what is, and what is not, schizophrenia and, accordingly, how best to approach care. In the opening article, Pearlson and colleagues thoroughly review and challenge symptom-based approaches to the diagnosis of schizophrenia. They describe current efforts to define neurobiological signatures between psychosis and mood disorders. Waddington and colleagues highlight information on duration of untreated psychosis (DUP), the critical time period between the emergency of clear psychotic symptoms and the initiation of psychiatric care. They critically review extant literature, as well as highlight model programs for early intervention, on DUP from a longitudinal perspective. Turning over to biological perspectives, our colleague, Dr Miller, and I speculate on neuroinflammation and schizophrenia ... a kind of “old wine in a new bottle.” There are longstanding relationships between infections, especially viruses, and schizophrenia. Recent studies now point to a more systematic pattern of immunologic disturbances in schizophrenia, thereupon, now prompting nascent attempts at novel immune-based approaches to treatment. These opportunities are highlighted in this article. While such biological theories are exciting, readers and clinicians are of course more focused on the “nuts and bolts” of clinical care and what can be done to make real improvements. To that end, medication adherence is, unquestionably, central to clinical care. Weiden reminds us just how a multifaceted and major dilemma nonadherence is in the treatment of patients with schizophrenia. This article covers recent innovations and pragmatic approaches that focus on detecting and enhancing adherence for this patient group. This article also forms the back-drop for considering innovations in clinical therapeutics. To that end, Lauriello and colleagues “take stock” of currently available antipsychotics and evaluate the potential role(s) of Psychiatr Clin N Am 39 (2016) xiii–xiv http://dx.doi.org/10.1016/j.psc.2016.02.001 0193-953X/16/$ – see front matter Ó 2016 Published by Elsevier Inc.
psych.theclinics.com
xiv
Preface
other putative agents that are in development. Helio Elkis and I, even in the face of the advances of psychopharmacology described by Lauriello and colleagues, also remind us that there is still a substantial minority of patients with schizophrenia who remain recalcitrant to standard treatments, up to and including clozapine. Options for clinicians are reviewed in this article as well as combinations of medications and use of old and new neuromodulatory therapies. In addition to limitations of pharmacotherapy, the extent of comorbidities and schizophrenia also complicates the care of people with schizophrenia. Comorbidities, whether they are psychiatric, physical, or a combination of both, are now more the rule than the exception among people with schizophrenia. There are many reasons that may explain this robust association, and these are detailed in the article by Hwang and colleagues. Returning to medication nonadherence and the limitations of pharmacotherapy, we know that detecting and managing adverse effects of antipsychotic medications are key to effective care. Accordingly, Ames and colleagues describe how the complexities in adverse effects of currently available antipsychotic medications represent a substantial health care burden to the patient and a therapeutic challenge to the treating provider. Given the diverse adverse effect profiles, Ames and colleagues highlight current management strategies. Shifting gears from medications, Ahmed and colleagues focus on recovery and schizophrenia. The involvement of people in recovery from schizophrenia provides complementary and powerful synergies with “traditional” clinic-based treatment of schizophrenia. This article reviews how far we have come toward incorporating recovery principles with clinical practice. Recovery also represents a shift in health care focus, in the context of emergent health care reform. Bartlett and Manderscheid illustrate how health care reform could realize the potential of the mental health parity act that was passed several years ago. They evaluate the challenges and opportunities that could exist for the provision of services for the seriously mentally ill. Finally, our US colleagues who reside in Australia, Drs Cyndi and Tom Weickert, provide a timely and critical appraisal of the most pertinent research findings in schizophrenia. Areas that have “fallen out of favor” and/or appear to be “blind alleys” are also briefly mentioned so that the discerning reader comes away succinctly informed of “the big picture” of schizophrenia research. Collectively, these stellar colleagues provide a cogent and comprehensive synthesis of the biology and treatment of schizophrenia. As guest editor, I express my sincerest gratitude for their efforts, which come together so nicely in this timely issue of Psychiatric Clinics of North America. We are also grateful to Kristen Helm, our publishing collaborator at Elsevier, for her consistency with this issue of Psychiatric Clinics of North America. Peter F. Buckley, MD Medical College of Georgia Augusta University 1120 15th Street, AA-1002 Augusta, GA 30912, USA E-mail address: [email protected]