Site maintenance Wednesday, November 13th, 2024. Please note that access to some content and account information will be unavailable on this date.
Skip to main content
Full access
From the Guest Editor
Published Online: 13 July 2016

Schizophrenia: Advances in Understanding and Treatment

In 2004, I served as the guest editor for the Focus issue on schizophrenia; now, a decade later, I am honored to once again oversee an issue on the same topic. As I executed this task, I reflected on how much has changed or, in some cases, not changed in the intervening years. In 2004, Jibson et al. wrote a comprehensive review of schizophrenia for our issue (1). Today, nearly all of their topic sections would need to be revised to reflect everything from the elimination of the schizophrenic subtypes in DSM-5, to the advances in genetics and brain imaging, to the remarkable growth in the number of available antipsychotics, including a number of second-generation long-acting injectables.
Psychosocial treatments were emphasized in 2004, although the evidence has not been wholly embraced by providers and their use is often discouraged by payers. Recent seminal studies, like the National Institute of Mental Health’s Recover After an Initial Schizophrenia Episode (RAISE) early treatment program, have shown that medication alone (treatment as usual) is inferior to a more comprehensive, multidisciplinary team–based approach of medication and psychosocial supports (2). A decade ago, the concept of cognitive remediation was the purview of traumatic neurologic illnesses; now, it is being critically used and investigated for less radiographically or electrophysiologically overt illnesses like schizophrenia (3).
In 2004, I coauthored the Focus lead article on the first interview of patients with psychosis. We discussed how to evaluate symptoms, develop a differential diagnosis, and form an initial treatment plan (4). In retrospect, that article remains current and applicable, needing only minor updating. A diagnosis of schizophrenia still largely rests on the history and interview. Advances in the field include attempts to merge imaging, genetic, and neurophysiologic measures, with the aim of confirming the diagnosis and better predicting prognosis. We have been teaching medical students and residents for years that schizophrenia is most likely a number of disorders (phenotypes) grouped into a common nomenclature. We are on the verge of being able to prove that these disorders exist as distinct entities. The implications of these findings are significant. Distinct illness patterns may require distinct category-based treatment interventions. We see this now in the individualized treatment of cancer. In the next 10 years, we may see it transform the treatment of psychiatric illnesses, including schizophrenia. The 2025 Focus issue on schizophrenia will undoubtedly include those advancements. I hope to once again have the honor of reporting them.

References

1.
Jibson MD, Glick I, Tandon R: Schizophrenia and other psychotic disorders. Focus 2004; 2:17–30
2.
Kane JM, Robinson DG, Schooler NR, et al: Comprehensive versus usual community care for first-episode psychosis: 2-year outcomes from the NIMH RAISE early treatment program. Am J Psychiatry 2016; 173:362–372
3.
Keefe RS, Vinogradov S, Medalia A, et al: Feasibility and pilot efficacy results from the multisite Cognitive Remediation in the Schizophrenia Trials Network (CRSTN) randomized controlled trial. J Clin Psychiatry 2012; 73:1016–1022
4.
Lauriello J, Bustillo J, Shingler KC: The first interview of a patient with psychosis: symptoms safety and stabilization. Focus 2004; 2:7–12

Information & Authors

Information

Published In

History

Published in print: Summer 2016
Published online: 13 July 2016

Authors

Details

John Lauriello, M.D.
Dr. Lauriello is professor and chairman of the Department of Psychiatry and a Robert J. Douglas, M.D., and Betty Douglas Distinguished Faculty Scholar in Psychiatry, University of Missouri, Columbia.

Metrics & Citations

Metrics

Citations

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

For more information or tips please see 'Downloading to a citation manager' in the Help menu.

Format
Citation style
Style
Copy to clipboard

View Options

View options

PDF/EPUB

View PDF/EPUB

Get Access

Login options

Already a subscriber? Access your subscription through your login credentials or your institution for full access to this article.

Personal login Institutional Login Open Athens login
Purchase Options

Purchase this article to access the full text.

PPV Articles - Focus

PPV Articles - Focus

Not a subscriber?

Subscribe Now / Learn More

PsychiatryOnline subscription options offer access to the DSM-5-TR® library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Media

Figures

Other

Tables

Share

Share

Share article link

Share