Recent Advances in Schizophrenia

I am honored to introduce readers to this extraordinary volume, the first in the annual International Perspectives Series: Psychiatry, Psychology, and Neurosciences. This particular volume on the Recent Advances In Schizophrenia stems from the Third Annual Pennsylvania Conference on Schizophrenia, held in March, 1988. At that international meeting, some of the most esteemed researchers in the field surveyed our current under standing of schizophrenia. Collectively, their presentations capture the excitement of a research field launching into a stage of rapid worldwide advancement. The last decade has seen an enormous refocusing of scientific effort on schizophrenia, directed, in large measure, by the National Institute of Mental Health (NIMH). Our understanding of this mysterious, disabling disorder in all its diversity has been enhanced by a host of technologies, including new neuroimaging techniques, cognitive psychology, molecular genetics, and anatomical, biochemical, and molecular neuropathology. The resulting growth spurt in our knowledge constitutes the essence of the conference and of this volume. As the following pages amply docu ment, it has been a decade of great progress, one in which we can take great pride. The science of our field has matured to the point that a major research thrust is now feasible-one likely to have enormous benefits for schizophrenic patients and their families. It is a very exciting time to be in this field and to participate in accelerating its advances.

Contenu

I. Conceptualization of Schizophrenia.- 1.Schizophrenia: Historical Perspectives.- Prehistoric times.- Dawn of civilization.- Ancient times.- Medieval times.- Renaissance.- Era of enlightenment.- The beginning of the concept of schizophrenia.- 2.On the Concept of Schizophrenia.- The concept over the ages.- Current developments in classification.- Universality of the concept.- Other issues related to the concept.- 3.Modular Disjunction in Schizophrenia: A Framework for a Pathological Psychophysiology.- Cognitive modules.- Psychotic symptoms and modular disjunction.- Information processing, perseveration, and modularity.- Neurophysiology of program selection and activation and brain imaging.- Neuropharmacology of tuning and switching.- Localized and distributed neuroanatomical systems.- 4.Meaning of Structural Changes in the Brain in Schizophrenia.- Age disorientation.- Structural brain changes.- Clinical correlates of structural change: The two syndrome concept.- Age of onset as a predictor.- Postmortem brain studies.- The genetics of laterality and psychosis.- 5.Conceptual Approaches to the Study of Schizophrenia.- The medical model.- The syndromal status of schizophrenia.- Domains of psychopathology.- Course of illness.- Prevention of relapse.- II. Recent Advances in the Diagnosis and Treatment of Schizophrenia.- 6.Risk Factors in Schizophrenia: Interaction Between Genetic Liability and Environmental Factors.- Historical perspectives of genetic studies.- Longitudinal prospective research: The Copenhagen high risk study.- Interaction between high risk and stress: Prospective study design.- High risk research and development of classical schizophrenia concept.- 7.The Role of Molecular Genetics in Psychiatry: Unraveling the Etiology for Schizophrenia.- Evidence for a genetic cause for psychosis.- Biological marker and heritability studies.- Genetic marker studies.- Cytogenetic abnormalities as genetic markers.- DNA polymorphisms as genetic markers.- The "candidate gene" approach.- Statistical analyses of genetic data.- 8.Diagnostic Advances in Anatomical and Functional Brain Imaging in Schizophrenia.- Structural brain imaging.- X-ray computed tomography.- Magnetic resonance imaging.- Functional brain imaging.- Cortical probe blood flow measurement.- Single photon emission computed tomography.- Positron emission tomography.- 9.Risk Factors and Prevention in Schizophrenia.- Vulnerability stress model.- Childhood and adolescent markers of vulnerability high-risk studies.- Family environmental stressors.- Stress factors and the course of schizophrenia.- Research on expressed emotion.- Family intervention studies.- 10.Psychosocial Interventions in Schizophrenia.- Stress vulnerability coping model.- Traditional psychosocial therapies.- Psychosocial outreach programs.- Behavioral therapies.- Bridging the gap from innovation to practice.- 11.Clozapine: Mechanism of Action in Relation to its Clinical Advantages.- Selective effects on mesolimbic vs. mesostriatal dopamine neurons.- Effect of chronic administration on dopamine receptors.- Neuroendocrine effects of clozapine on tuberoinfundibular dopamine neurons.- Effects on D-l mechanisms.- Clozapine and serotonin.- Dopaminergic-serotonergic interaction.- 12.Psychopharmacologic Treatment of Schizophrenia.- General principles of pharmacotherapy.- Predictors of response and role of alternative treatments.- Strategies for managing antipsychotic drug nonresponders.- Clozapine for the treatment-refractory patient.- Pharmacologic treatment of negative symptoms.- Maintenance treatment.- III. Delivery Systems for Managing Schizophrenic Patients.- 13.Current Perspectives in the United States on the Chronically Mentally III.- Historical background.- Problems of deinstitutionalization.- Attempted and proposed solutions.- The future.- 14.Policy on Chronic Mental Illness in Canada: Current Status and Future Directions.- General background on health care in Canada.- The care of schizophrenic patients in Canada.- Follow-up study of schizophrenic patients.- The mental health policy of Quebec.- 15.Psychiatric Reform in Italy: Implications for the Treatment of Long-Term Schizophrenic Patients.- Models of community psychiatry: Complementary or alternative community services.- Implementation of the Italian reform: Some quantitative evidence.- Treating patients with schizophrenic psychosis in an area with a community-based system of care.- Is the community-based system more suitable than the hospital-based system of care?.- 16.Mental Health Services and New Research in England: Implications for the Community Management of Schizophrenia.- Mental health services in Great Britain.- Environmental stress and its effects on the course of schizophrenia.- Psychosocial family intervention studies.- Implications for service provision.- 17.Delivery Systems for the Care of Schizophrenic Patients in Africa-Sub-Sahara.- General background.- Personnel.- Psychiatric services.- Community-based psychiatric services.- Traditional healers.- Forensic issues and facilities for the criminal schizophrenics.- 18. Delivery Systems and Research for Schizophrenia in China.- Epidemiology.- Diagnostic criteria and treatment.- Sociocultural aspects of developing mental health delivery systems.- Different schemes of the mental health care system.- General conduct of clinical and laboratory research.- Author Index.