The Early Stages of Schizophrenia

Recent studies of the early stages of schizophrenia offer tantalizing clues to pathophysiology, brain plasticity, prevention, drug treatment, and coping strategies for this disorder. Drs. Zipursky and Schulz have compiled pivotal contributions to this burgeoning field, including their own, and translated them into practical treatments offering new hope that the course of schizophrenia can be changed. It is a timely and representative sampling of the exciting current progress with schizophrenia. Thomas H. McGlashan, M.D., Professor of Psychiatry, Yale University School of Medicine, New Haven, Connecticut The greater safety and better efficacy on negative, cognitive, and affective symptoms of schizophrenia produced by some atypical antipsychotics offer the hope that the early treatment of this disease at or before the first full episode can stop schizophrenic deterioration before it starts. This book tells us the state of the art of how to prevent schizophrenic deterioration, both by pharmacological and by psychosocial treatment. The later is important because it may prevent the breaking of family ties and resume the normal course of vocational development to the patient. John M. Davis, M.D., The Psychiatric Institute, University of Illinois, Chicago Drs. Zipursky and Schulz have seized the publishing high ground with this concise, lucid, and authoritative summary of a very important emerging area of schizophrenia research and treatment. Recent developments in characterizing genetic and environmental factors associated with the risk for early-onset psychosis and the importance of early treatment have made it increasingly critical that we understand the biology and treatment of the first episode. This volume brings together investigators and clinicians at the cutting edge of this aspect of the schizophrenia syndrome. The chapters are scholarly and comprehensive. This book is an important addition to the library of clinicians and researchers interested in the evolution of the schizophrenia syndrome. Daniel R. Weinberger, M.D., Chief, Clinical Brain Disorders Branch, Division of Intramural Research Programs, National Institute of Mental Health, Bethesda, Maryland This should be a useful compilation of mostly published material and clinical experience in the area of early schizophrenia. The chapters on prediction of psychosis in individuals at high risk, childhood-onset schizophrenia, and pharmacological management should prove to be particularly useful to both adult and child/adolescent psychiatric clinicians. The book should reinforce the hope engendered by the recent increase in early stages of psychosis in general and schizophrenia in particular. Ashok Malla, MBBS;FRCPC;MRCPsych;DPM, Professor, Depts Psychiatry, Family Med, & Epidemiology, Director, Prevention & Early Intervention Psychoses Univ Western Ontario & London Health Sciences Centre

This book introduces the concept of early intervention and describes the clinical approaches most likely to facilitate the fullest degree of recovery. This overview is organized into three major parts: early intervention, epidemiology, and natural history, management of the early stages, and neurobiological investigations of the early stages.

In sharp contrast to the prevailing belief during the past century that schizophrenia inevitably results in a progressive deteriorating clinical course, research since the early 1980s shows that early intervention can significantly improve the long-term outcome of this complex illness. With very early treatment, many affected individuals can achieve an excellent recovery.

This research has set off an explosion of interest in—and optimism about—early intervention in what was once thought to be an intractable illness. The work of 19 top experts in the field of schizophrenia research is available in this single, powerful volume that introduces the concept of early intervention and describes the clinical approaches most likely to facilitate the fullest degree of recovery. Contributors review the clinical and epidemiological evidence that supports the importance of comprehensive and optimal treatment during the early stages of schizophrenia—treatment that must encompass emotional, family, and vocational as well as pharmacological needs of affected individuals.

This rich overview is organized into three major parts:

• Early Intervention, Epidemiology, and Natural History of Schizophrenia, which presents an overview of important concepts in early intervention and reviews our current understanding of the outcome from a first episode of schizophrenia, including which features predict the onset of first-episode psychosis
• Management of the Early Stages of Schizophrenia, which reviews the critical management issues in providing specialized and optimal care to this complex patient group and their families, including meeting the patient's emotional needs
• Neurobiological Investigations of the Early Stages of Schizophrenia, which describes important specialized topics that contribute to our understanding of the first episode of schizophrenia, including schizophrenia in childhood and adolescence and cognitive dysfunction in the early stages of schizophrenia

This ground-breaking volume provides reason for new optimism about the treatment and outcome of schizophrenia. With its dramatically different perspective on the potential long-term outcome of a still-baffling illness, this volume is a must-read for mental health practitioners and educators, psychiatry residents, and family members of affected individuals.