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Neuroprotection: A New Strategy in the Treatment of Schizophrenia

Published online by Cambridge University Press:  07 November 2014

Jeffrey A. Lieberman ,
Peter F. Buckley  and
Diana O. Perkins
Jeffrey A. Lieberman
Affiliation:
Dr. Lieberman is chairman of the Department of Psychiatry at, Columbia University College of Physiciansand Surgeons, director of the New York State Psychiatric Institute and the Lieber Center for Schizophrenia Research, and psychiatrist-in-chief of the New York-Presbyterian Hospital and Columbia University Medical Center in New York City.
Peter F. Buckley
Affiliation:
Dr. Buckley is professor and chairman in the Department of Psychiatry and Health Behavior at the, Medical College of Georgia, in Augusta.
Diana O. Perkins
Affiliation:
Dr. Perkins is professor of psychiatry, medical director of Outreach and Support Intervention Services, and director of the Schizophrenia Treatment and Evaluation Program at the, University of North Carolinaat Chapel Hill.
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Abstract

Intervention in the progression of schizophrenia is an effort not just to deter psychosis but also to protect the brain from physiologic deterioration. Neurodegeneration is believed to result from neurochemical dysregulation during the onset of schizophrenia. Deterioration accrued over recurring psychotic episodes causes cumulative loss of cell processes, loss of gray matter volume, and apoptosis. Neurodegeneration ultimately results in persistent symptomology and functional impairment. Functional decline occurs early in the course of schizophrenia, and the symptoms that emerge during the prodromal stage may derail the normal adolescent neurodevelopment. Both first-episode psychosis and the prodrome may be opportunities to forestall neurodegeneration. Unfortunately, people with schizophrenia often experience a long duration of untreated psychosis. Treatment of first-episode psychosis with antipsychotic agents shows robust response. However, early-stage patients have very high rates of medication noncompliance. Treatment in the prodrome may offer the best chance to delay the onset of illness, mitigate its severity after onset, or even prevent onset of symptoms entirely. Nonpharmacologic treatments during the prodrome, such as education, treatment for substance use, and cognitive-behavioral therapy, are low-risk interventions that are potentially beneficial. Pharmacologic interventions during the prodrome are also effective in delaying onset of illness, but carry the risk of adversely affecting patients who are false positives for prodromal schizophrenia.

In this Expert Roundtable Supplement, Jeffrey A. Lieberman, MD, provides an overview of the neurobiological basis of neurodegeneration and the concept of neuroprotection. Next, Peter F. Buckley, MD, reviews the importance of first-episode psychosis, including duration of untreated illness and medication adherence. Finally, Diana O. Perkins, MD, MPH, reviews treatment strategies for prodromal schizophrenia.

Type
Research Article
Information
CNS Spectrums , Volume 12 , Issue S18 , 2007 , pp. 1 - 16
Copyright
Copyright © Cambridge University Press 2007

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