Front Matter

Contributors

Preface

Part I

Presentation of Schizophrenia

1 Epidemiology

2 Natural History

3 Psychopathology

4 Cultural Variations

Part II

Etiology and Pathophysiology

5 Causes

6 Pathophysiological Theories

7 Neurobiology

Part III

Treatment and

Rehabilitative Therapies

8 Pharmacological and Somatic Therapies

9 Psychosocial and Rehabilitative Therapies

10 Co-occurring Disorders and Conditions

11 Evidence-Based Models of Service Delivery

12 Person- and Family-Centered Care

Index

Assistant Professor of Clinical Psychiatry, Department of Psychiatry, Columbia University Medical Center; Research Psychiatrist, New York State Psychiatric Institute, New York, New York

Professor of Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland

Associate Professor of Psychiatry, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

Professor of Psychiatry, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons; New York State Psychiatric Institute, New York, New York

Edna L. Edison Professor of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons; Director, Division of Behavioral Health Services and Policy Research and Center for Practice Innovations, New York State Psychiatric Institute, New York, New York

Professor of Clinical Psychiatry, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York

Assistant Professor of Clinical Psychiatric Social Work (in Psychiatry), Columbia University Irving Medical Center, New York, New York

Marvin Stern Professor of Psychiatry and Vice Chair for Research, Department of Psychiatry, NYU School of Medicine, New York; Director, Nathan Kline Institute for Psychiatric Research, Orangeburg, New York

Research Assistant Professor of Psychology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

Professor and Director, North Carolina Psychiatric Research Center, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

Professor of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York; Director, Division of Experimental Therapeutics, New York State Psychiatric Institute; Director, Schizophrenia Research, Nathan Kline Institute for Psychiatric Research, Orangeburg, New York

Assistant Professor, Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, Florida

Stanley Cobb Professor and Vice-Chair for Public Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Harvard Medical School, Boston, Massachusetts

Associate Professor and Director, Outpatient Psychiatric Services, Hillcrest; Director, Community Psychiatry Program; Director, TeleMentalHealth Program, University of California, San Diego, California

Assistant Professor, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York

Professor of Clinical Psychiatry, Department of Psychiatry, Columbia University Medical Center; Director, New York State Center of Excellence for Cultural Competence, New York, New York

Professor of Psychiatry, Pharmacology, and Medicine; Dean, College of Medicine; and Senior Vice President and Executive Dean, SUNY Upstate Medical University, Syracuse, New York

Lawrence C. Kolb Professor and Chairman of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons; Director, New York State Psychiatric Institute; Psychiatrist-in-Chief, NewYork-Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York

Instructor in Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts

Clinical Assistant Professor, Department of Psychiatry, New York University School of Medicine, New York, New York

Resident Physician, Department of Psychiatry, University of California, San Diego, California

Professor of Medical Psychology, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York

Medical Director, Sun Valley Behavioral and Research Centers; Clinical Assistant Professor, Department of Psychiatry, University of California, San Diego, California

Professor, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina

Associate Professor of Psychiatry and of Neuroscience and Physiology, College of Medicine, SUNY Upstate Medical University, Syracuse, New York

Associate Professor, Departments of Psychiatry and Bioengineering, University of Pittsburgh; Investigator, Veterans Affairs Pittsburgh Health System, Pittsburgh, Pennsylvania

Assistant Professor of Psychiatry, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

Assistant Professor of Medical Psychology, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York

Professor of Psychiatry and Vice Chair for Academic Affairs and Faculty Development, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York

Professor and Chairman, Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico

Director, Laboratory of Cellular Neuropathology, Department of Psychiatry, Harvard Medical School, Boston, Massachusetts

The following contributors to this book have indicated a financial interest in or other affiliation with a commercial supporter, a manufacturer of a commercial product, a provider of a commercial service, a nongovernmental organization, and /or a government agency, as listed below:

Michael B. First, M.D. Faculty member: Lundbeck International Neuroscience Foundation; Author: Chapter in the Merck Manual

L. Fredrik Jarskog, M.D. Research grant support: In past 12 months from Teva/Auspex, Boehringer Ingelheim, Otsuka, and National Institutes of Health

Matcheri S. Keshavan, M.D. Consultant: Alkermes Pharmaceuticals

Alice Medalia, Ph.D.Oxford University Press, Boehringer Ingelheim, Otsuka America Pharmaceutical

Diana O. Perkins, M.D., M.P.H. Consultant: Alkermes; Funding support: Boehringer Ingelheim for a sponsored research study

Alice Saperstein, Ph.D. Royalties: Oxford University Press

T. Scott Stroup, M.D., M.P.H. Participant: CME presentation for Medscape, sponsored by an independent educational grant from Intra-Cellular Therapies, Inc.

Neil Krishan Aggarwal, M.D., M.B.A., M.A.; Melanie Bennett, Ph.D.; Mary F. Brunette, M.D.; Michael T. Compton, M.D., M.P.H.; Lisa B. Dixon, M.D., M.P.H.; James E. Gangwisch, Ph.D.; Donald C. Goff, M.D.; Paul Grant, Ph.D.; Steve Koh, M.D.; Ryan E. Lawrence, M.D.; Roberto Lewis-Fernández, M.D., M.T.S.; Julio Licinio, M.D., Ph.D.; Jeffrey A. Lieberman, M.D.; Paulo L. Lizano, M.D., Ph.D.; Marc W. Manseau, M.D., M.P.H.; Stephanie Martinez, M.D.; Bernardo Ng, M.D., D.F.A.P.A.; Seth W. Perry, Ph.D.; Konasale M. Prasad, M.D.; Sarah Pratt, Ph.D.; Mauricio Tohen, M.D., Dr.P.H., M.B.A.; T. Wilson Woo, M.D., Ph.D.

Schizophrenia remains the most challenging of mental disorders confronted by psychiatrists and other mental health providers. Its primary manifestations—psychotic symptoms and cognitive impairment—profoundly affect functioning. Because schizophrenia typically begins as people approach or enter adulthood and persists indefinitely, it is one of the leading causes of disability worldwide. Researchers have made substantial but uneven progress in understanding this brain disorder since the first edition of this textbook was published in 2006. Rapid progress in knowledge about genetics and neurobiology has not been accompanied by breakthroughs in pharmacotherapy. However, new models of service delivery and psychosocial treatments are making a difference in people’s lives.

An updated textbook covering the current state of knowledge about schizophrenia, including its causes, nature, and treatment, is now warranted. We invited a roster of experts to join us in creating this work by writing chapters on specific topics. We are grateful to them for their outstanding scholarly contributions.

Part I, “Presentation of Schizophrenia,” begins with a chapter on epidemiology that discusses risk factors and outcomes in addition to descriptive epidemiology. Chapter 2 focuses on stages of illness and the course of schizophrenia, including how antipsychotics and other factors affect prognosis. The symptoms of schizophrenia and its diagnosis are described in Chapter 3. Chapter 4 examines how culture influences the presentation of schizophrenia from the perspective of experts in cultural psychiatry who developed the DSM-5 Cultural Formulation Interview.

Part II, “Etiology and Pathophysiology,” is largely based on research conducted since the first edition of this textbook was published in 2006. Chapter 5 describes genetic, environmental, and epigenetic causes of schizophrenia. Chapter 6 reviews pathophysiological theories of schizophrenia, including genetic, molecular, and circuit models. Chapter 7, on neurobiology, discusses schizophrenia’s histopathology and neurochemistry.

Part III, “Treatment and Rehabilitative Therapies,” explores clinical aspects of schizophrenia and interventions. Chapter 8 focuses on medications and somatic therapies; although there have been no breakthroughs with new pharmacotherapies, more is now known about how to use existing treatments, including adjunctive medications and combinations of antipsychotics. The promising field of neuromodulation is also discussed. Chapter 9 shifts attention to evidence-based psychosocial treatments and their deployment. Chapter 10 covers the evaluation and treatment of comorbidities, including substance use disorders and psychiatric conditions. Chapter 11 describes service delivery models with a focus on how to provide services to individuals with schizophrenia; included are assertive community treatment, critical time intervention, coordinated specialty care for early psychosis, and integrated dual diagnosis treatment. Finally, Chapter 12 presents the rationale and evidence for actively involving patients and family members in interventions and in decision making about treatments.