Neuroprotection: a therapeutic strategy to prevent deterioration associated with schizophrenia.
Schizophrenia is a neurodevelopmental disorder associated with persistent symptomatology, severe functional disability, and residual morbidity characteristic of neurodegenerative brain diseases. The illness begins with genetic susceptibility and generally expresses itself after puberty through subtle changes that begin during the prodromal stage. Symptoms get progressively worse and tend to become more resistant to treatment with each relapse. Evidence for a neuroprotective effect of some forms of early treatment is beginning to emerge. While the underlying mechanisms remain uncertain, atypical antipsychotics may counteract some of the progressive deteriorative effects by enhancing synaptic plasticity and cellular resilience. However, identifying and treating patients in the earliest disease states presents methodological challenges as there is no consensus on the best methods of intervention and differences in at-risk children are not readily detectable or substantial enough to predict which ones will develop schizophrenia. In this expert roundtable supplement, Jeffrey A. Lieberman, MD, reviews the historical context of progressive deterioration in schizophrenia. Next, Diana O. Perkins, MD, MPH, reviews some of the challenges to early identification of illness as well as the impact of early versus delayed treatment. Finally, L. Fredrik Jarskog, MD, focuses on the neurobiology of functional progression in schizophrenia as well as pharmacology and the potential for neuroprotection.
Lieberman
Jeffrey A
JA
Columbia University College of Physicians and Surgeons, New York, NY, USA.
Perkins
Diana O
DO
Jarskog
L Fredrik
LF
D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001284:Atrophy; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D002540:Cerebral Cortex / Q000187:drug effects / Q000473:pathology; D002648:Child; D003072:Cognition Disorders / Q000175:diagnosis / Q000188:drug therapy; D018450:Disease Progression; D006220:Haloperidol / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D019636:Neurodegenerative Diseases / Q000175:diagnosis / Q000188:drug therapy*; D018696:Neuroprotective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D009483:Neuropsychological Tests; D000077152:Olanzapine; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy*; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D012569:Schizotypal Personality Disorder / Q000175:diagnosis / Q000188:drug therapy
D014150:Antipsychotic Agents; D018696:Neuroprotective Agents; D001569:Benzodiazepines; D006220:Haloperidol; D000077152:Olanzapine