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Return to New Research to Identify and Treat Schizophrenia Early Overview

More on New Research to Identify and Treat Schizophrenia Early

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Return to New Research to Identify and Treat Schizophrenia Early Overview

More on New Research to Identify and Treat Schizophrenia Early

New Research to Identify and Treat Schizophrenia Early

New York (Apr 27, 2010)

Pensive man with hands on his chin

Schizophrenia is an illness that often strikes in the college or young adult years, just as people are entering the prime of life. Although patients can recover from the disease, many experience lifelong disability that can result in unemployment, homelessness, and incarceration.

Healthcare professionals believe that if they can diagnose the disease earlier – during the prodromal stage – and predict who is most likely to develop psychotic symptoms, they can initiate early interventions that can either prevent the disease from progressing or minimize its impact on patients' lives. NewYork-Presbyterian Hospital physicians and researchers are leading such efforts, both in the laboratory and at the national level.

"Schizophrenia is a devastating disease that is costly for society," said Jeffrey A. Lieberman, M.D. "Research has shown that early intervention and treatment can prevent the debilitating effects of schizophrenia by dramatically slowing progression, reducing mortality and disability, and increasing recovery."

Recovery After an Initial Schizophrenia Episode (RAISE)

A renowned expert in the field of schizophrenia, Dr. Lieberman was recently selected by the National Institute of Mental Health (NIMH) of the National Institutes of Health to lead a nationwide effort to develop an optimal early intervention strategy for treating people experiencing a first-episode of the psychotic symptoms of schizophrenia. Called Recovery After an Initial Schizophrenia Episode (RAISE), the multicenter study seeks to fundamentally change the way schizophrenia is treated by developing and evaluating innovative and coordinated intervention approaches in the early stages of the illness, when symptoms may be most responsive to treatment. Ultimately, the findings of the project could change the standard of care for the disease and influence reimbursement policies for early interventions.

Jeffrey Lieberman, M.D.
Jeffrey Lieberman, M.D.

RAISE investigators will begin by testing and refining the assessments and interventions to be used with patients who have experienced their first psychotic episode in four community-based sites in New York and Maryland. In the next phase of the study, participants will be randomized to receive either an experimental intervention consisting of a team-based multi-element therapeutic program, or treatment managed by a clinical case manager who will link patients to appropriate community support and rehabilitation services.

Schizophrenia and the Brain

Schizophrenia can cause irreversible destruction of neural synapses which can be visualized on magnetic resonance imaging as loss of grey matter. "The whole thrust of early intervention is to prevent this loss from occurring," noted Dr. Lieberman.

NewYork-Presbyterian investigators are also seeking to identify biomarkers to predict which individuals experiencing prodromal symptoms – such as illusions (hearing one's name in the wind) rather than hallucinations (hearing voices), or overvalued unusual ideas that lack the conviction of clear delusions – are at greatest risk for progressing to psychosis. People in the prodromal stage may also experience anxiety and social withdrawal.

Cheryl Corcoran, M.D.
Cheryl Corcoran, M.D.

Only about 30 percent of individuals with such attenuated psychotic symptoms progress to psychosis. Neurologists and psychiatrists at Columbia University College of Physicians and Surgeons published a study in the September 7, 2009 issue of the Archives of General Psychiatry identifying a specific region of the hippocampus that is more active in high-risk individuals who developed schizophrenia than in those who did not. Using a novel high-resolution form of functional MRI, they found that the CA1 subfield of the hippocampus was abnormally active in young people with prodromal symptoms who went on to develop schizophrenia.

New Ways to Diagnose

There are currently no tests available to diagnose schizophrenia. "Right now, our ability to predict who will go on to develop schizophrenia from the prodromal stage is only a little better than a coin toss," said Scott A. Schobel, M.D., first author of the study. "These new fMRI findings may give us an early snapshot of the disease."

Scott Schobel, M.D.
Scott Schobel, M.D.

The development of such biomarkers could provide investigators not only with a new diagnostic tool, but also a better understanding of the pathophysiology of psychosis – information which could lead to the development of better treatments. Cheryl Corcoran, M.D., Director of the Center for Prevention and Evaluation (the Cope Clinic, a prodromal research program at Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute), noted that the elevated hippocampal activity observed in the fMRI study may signal a role for glutamate in the physiology of the disease. If so, drugs that target glutamate could potentially be evaluated as possible therapies.

Dr. Corcoran added that she and her colleagues at the COPE Clinic offer prodromal patients individual psychotherapy containing elements of both cognitive behavioral therapy and supportive therapy, and medication only when necessary. (Anti-psychotic medications are associated with side effects and are reserved for those diagnosed with psychosis.) "We offer individual supportive therapy with a focus on getting patients the resources they need," she said. "Our goals are to improve function and reduce the stigma associated with the label of being at increased risk for psychosis."

Adam Savitz, M.D., Ph.D.
Adam Savitz, M.D.,
Ph.D.

"Cognitive behavioral therapy can teach patients how to deal with stress, help them learn how to ignore unusual thoughts, and give them the social skills they need to interact with other people in their lives," added Adam Savitz, M.D., Ph.D. "It's an approach that can be applied to a broad group of people."

Dr. Savitz leads NewYork-Presbyterian's Second Chance Program, an inpatient program for people with schizophrenia that is refractory to standard therapies. "If we can learn how to diagnose and treat schizophrenia earlier, before people progress to psychosis, we can put programs like mine out of business," he said. "That would be a good thing."

Contributing faculty for this article:

Jeffrey A. Lieberman, M.D. is Director of the New York State Psychiatric Institute and its Lieber Center for Schizophrenia Research, and an Attending Psychiatrist at NewYork-Presbyterian Hospital/Columbia University Medical Center. He is also the Lawrence E. Kolb Professor and Chairman of the Department of Psychiatry at Columbia University College of Physicians and Surgeons.

Scott Schobel, M.D. is an Assistant Attending Psychiatrist at the New York State Psychiatric Institute and NewYork-Presbyterian Hospital/Columbia University Medical Center. He is also an Assistant Professor of Clinical Psychiatry at Columbia University College of Physicians and Surgeons.

Cheryl Corcoran, M.D. is an Assistant Attending Psychiatrist at the New York State Psychiatric Institute and NewYork-Presbyterian Hospital/Columbia University Medical Center. She is also the Irving Assistant Professor of Clinical Psychiatry and Director of the Center for Prevention and Evaluation at Columbia University College of Physicians and Surgeons.

Adam Savitz, M.D., Ph.D. is an Assistant Attending Psychiatrist and Director of the Second Chance Program at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. He is also an Assistant Professor of Psychiatry and Director of Clinical Schizophrenia Research at Weill Cornell Medical College.

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