Gary Remington1, Ofer Agid2, George Foussias3, Gagan Fervaha4, Hiroyoshi Takeuchi5, Jimmy Lee6, Margaret Hahn3. 1. Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario; Lead, Subspecialty Clinics, Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, Ontario; Senior Scientist, Campbell Family Mental Health Research Institute, Toronto, Ontario; Faculty, Institute of Medical Science, Toronto, Ontario. 2. Associate Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario; Medical Leader, Home Intervention Program, Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, Ontario; Faculty, Institute of Medical Science, Toronto, Ontario. 3. Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario; Staff Psychiatrist, Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, Ontario; Scientist, Campbell Family Mental Health Research Institute, Toronto, Ontario. 4. Student, Institute of Medical Science, Toronto, Ontario. 5. Post-doctoral Fellow, Department of Psychiatry, University of Toronto, Toronto, Ontario; Assistant Professor, Department of Neuropsychiatry, Keio University, Tokyo, Japan. 6. Post-doctoral Fellow, Department of Psychiatry, University of Toronto, Toronto, Ontario; Psychiatrist and Consultant, Department of General Psychiatry, Institute of Mental Health, Singapore, Singapore; Assistant Professor, Office of Clinical Sciences, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore.
Abstract
OBJECTIVE: To examine how advances in our understanding of schizophrenia have shaped thinking about antipsychotics (APs) and their role in treatment. METHOD: Three specific developments in the field of schizophrenia are highlighted: advances in knowledge related to the earliest stages of schizophrenia, specifically the prodrome; reconceptualization of schizophrenia as an illness of multiple symptom domains; and greater clarification regarding the efficacy of clozapine and a new generation of APs. RESULTS: Evidence indicating that negative and cognitive symptoms are present during the prodrome suggests that intervention at the time of first-episode psychosis constitutes late intervention. The limited efficacy of APs beyond psychosis argues against a magic bullet approach to schizophrenia and for polypharmacy that is symptom domain-specific. Clozapine's unique, but limited, efficacy in treatment resistance supports subtyping schizophrenia based on treatment response. CONCLUSIONS: Advances in our understanding of schizophrenia have important implications regarding the current use of APs, expectations regarding response, and future drug development.
OBJECTIVE: To examine how advances in our understanding of schizophrenia have shaped thinking about antipsychotics (APs) and their role in treatment. METHOD: Three specific developments in the field of schizophrenia are highlighted: advances in knowledge related to the earliest stages of schizophrenia, specifically the prodrome; reconceptualization of schizophrenia as an illness of multiple symptom domains; and greater clarification regarding the efficacy of clozapine and a new generation of APs. RESULTS: Evidence indicating that negative and cognitive symptoms are present during the prodrome suggests that intervention at the time of first-episode psychosis constitutes late intervention. The limited efficacy of APs beyond psychosis argues against a magic bullet approach to schizophrenia and for polypharmacy that is symptom domain-specific. Clozapine's unique, but limited, efficacy in treatment resistance supports subtyping schizophrenia based on treatment response. CONCLUSIONS: Advances in our understanding of schizophrenia have important implications regarding the current use of APs, expectations regarding response, and future drug development.
Authors: Lisa P Henry; G Paul Amminger; Meredith G Harris; Hok Pan Yuen; Susy M Harrigan; Amy L Prosser; Orli S Schwartz; Simone E Farrelly; Helen Herrman; Henry J Jackson; Patrick D McGorry Journal: J Clin Psychiatry Date: 2010-06 Impact factor: 4.384
Authors: Paolo Fusar-Poli; Stefan Borgwardt; Andreas Bechdolf; Jean Addington; Anita Riecher-Rössler; Frauke Schultze-Lutter; Matcheri Keshavan; Stephen Wood; Stephan Ruhrmann; Larry J Seidman; Lucia Valmaggia; Tyrone Cannon; Eva Velthorst; Lieuwe De Haan; Barbara Cornblatt; Ilaria Bonoldi; Max Birchwood; Thomas McGlashan; William Carpenter; Patrick McGorry; Joachim Klosterkötter; Philip McGuire; Alison Yung Journal: JAMA Psychiatry Date: 2013-01 Impact factor: 21.596