Schizophrenia Current science and clinical practice

by Gaebel, Wolfgang

• ISBN13: 9780470710548
• ISBN10: 0470710543
• Edition: 1st
• Format: Hardcover
• Copyright: 2011-04-18
• Publisher: Wiley-Blackwell

Summary

The first book in a new series from the World Psychiatric Association, Schizophrenia: current science and clinical practice presents recent information on the diagnosis, neurobiological foundations, and management of schizophrenia. It evaluates the findings obtained with modern techniques like magnetic resonance imaging, genetics and network analyses. The book reviews the importance of neurocognitive functioning in schizophrenia and its predictive value for functional capacity. It covers the key areas of early recognition, prevention, rehabilitation and stigma. There is also a critical discussion of diagnostic classification and the revision of the two major international systems. Written by experts in the field who have a track record of being engaging authors, this book provides a rapid overview of the current state of the art in schizophrenia research and clinical management. It will be invaluable to all psychiatrists, psychologists, neuropharmacologists, researchers in psychiatry and psychopharmacology in academia and in industry, and clinical and behavioural neuroscientists.

Author Biography

Prof. Dr. med. Wolfgang Gaebel is Professor of Psychiatry at the Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany. He was Chairman of the German Society for Biological Psychiatry and of the German Society for Psychiatry, Psychotherapy and Neurology.  He is a Member of the scientific Advisory Board of the German Medical Association.  He is active in various roles within the World Psychiatric Association, including as Chairman of the German Anti-Stigma Association and of the Section on Schizophrenia.

Table of Contents

List of Contributors	p. xi
Preface	p. xv
Diagnosis and revision of the classification systems	p. 1
Introduction	p. 1
Origin and evolution of the concept of schizophrenia	p. 2
Kraepelin's 'clinical forms'	p. 3
Bleuler's 'group of schizophrenias'	p. 4
Leonhard's 'endogenous psychoses'	p. 5
Classification of psychoses in French psychiatry	p. 5
Other post-Kraepelinian and post-Bleulerian subtypes and dichotomies	p. 5
The schizophrenia spectrum concept	p. 8
Statistically derived clusters and symptom dimensions	p. 8
Schizophrenia in ICD-10 and DSM-IV	p. 9
Origins of the two classifications	p. 10
Both DSM-IV and ICD-10 are descendants of the Kraepelinian nosology	p. 10
Criteria for assessing the diagnostic classification of schizophrenia	p. 13
Positive impact and unintended adverse effects	p. 13
Clinical relevance and cognitive ease of use	p. 14
Utility in research	p. 15
Reliability	p. 16
Concepts of validity	p. 16
Predictive validity: course and outcome	p. 17
Criterion validity: genetics	p. 19
Aspects of culture	p. 21
Reducing stigma	p. 21
Revision of the classifications: prospects for schizophrenia	p. 22
One classification or many?	p. 22
Critical issues in the revision process	p. 22
Disease or a broad syndrome?	p. 22
'Deconstructing' schizophrenia: categories or dimensions?	p. 23
Endophenotypes	p. 23
The concept of utility	p. 24
Conclusion	p. 25
References	p. 26
Pathophysiology of schizophrenia	p. 31
Introduction	p. 31
Major findings and related pathophysiological hypotheses	p. 32
Symptom domains and neurotransmitter hypotheses	p. 32
From domains to disturbed neuronal networks	p. 38
From networks to the cellular level	p. 42
Hypothesis of disturbed synaptogenesis and neurogenesis	p. 48
Effects of antipsychotics	p. 50
Summary and conclusions	p. 51
References	p. 51
Neurocognition, social cognition and functional outcome in schizophrenia	p. 67
Introduction	p. 67
Neurocognition in schizophrenia	p. 68
Domains, measurement and magnitude of impairment	p. 69
Neurocognition as a core deficit of schizophrenia	p. 69
Associations with functional outcome	p. 71
The NTMH-MATRICS initiative and current research directions	p. 72
Social cognition	p. 74
Domains, measurement and magnitude of impairment	p. 75
Social cognition as a core feature of schizophrenia	p. 79
Association with functional outcome	p. 80
Current research directions	p. 80
Relationships among neurocognition, social cognition and functional outcome	p. 81
Distinctiveness of neurocognition and social cognition	p. 81
Social cognition as a mediator	p. 82
Future directions	p. 91
References	p. 95
The genetics of schizophrenia	p. 109
Introduction	p. 109
Genetic epidemiology of schizophrenia	p. 110
Family, twin and adoption studies of schizophrenia	p. 110
Genetic epidemiology - informing diagnosis?	p. 111
Molecular genetics of schizophrenia	p. 113
Linkage	p. 114
Positional candidate studies	p. 115
Functional candidate studies	p. 116
Chromosomal abnormalities	p. 120
Genome wide association studies	p. 121
GWAS in schizophrenia	p. 122
Copy number variation	p. 126
The future of schizophrenia genetics	p. 130
Schizophrenia genetics in the clinic?	p. 133
Conclusions	p. 134
Acknowledgements	p. 134
References	p. 134
Early recognition and prevention of schizophrenia	p. 141
The context for early recognition and prevention	p. 141
The prodromal stage: definition and assessment	p. 143
Treatment during the prodromal stage	p. 146
The psychosis risk syndrome: a novel diagnostic entity?	p. 150
Ethical issues	p. 154
Summary and conclusions	p. 155
References	p. 156
Pharmacological treatment	p. 161
Introduction	p. 161
Current state of pharmacological treatment	p. 162
Phases of schizophrenia	p. 163
Acute phase treatment	p. 163
Stabilization phase treatment	p. 166
Maintenance phase treatment	p. 166
Treatment resistant patients	p. 167
Managing first episodes	p. 168
Newer antipsychotics	p. 168
Personalising drug treatment in schizophrenia	p. 169
Cognition and negative symptoms as therapeutic targets	p. 170
Glutamatergic targets	p. 171
Dopamine targets	p. 172
Cholinergic targets	p. 174
Histamine targets	p. 176
Summary	p. 178
References	p. 178
Cognitive-behavioural interventions	p. 185
Introduction	p. 185
The development of cognitive behavioural approaches to schizophrenia-spectrum psychosis	p. 186
Cognitive behavioural models of psychosis	p. 186
Biopsychosocial vulnerability	p. 186
Life events and schematic beliefs	p. 187
The role of affect	p. 188
The central role of appraisal	p. 189
Reasoning biases	p. 190
Anomalous experiences	p. 191
The role of behaviour	p. 192
Insight and illness appraisals	p. 192
Cognitive behavioural therapy in schizophrenia	p. 193
Psychotherapy in schizophrenia: more than unspecific learning?	p. 196
Combining psychotherapy and pharmacotherapy	p. 197
Efficacy of cognitive behavioural therapy for psychosis (CBTp)	p. 198
Future developments	p. 201
Conclusions	p. 203
Acknowledgements	p. 203
References	p. 203
Management, rehabilitation, stigma	p. 217
Introduction	p. 217
Managing schizophrenia: integrative approaches	p. 218
Burden for patients, families and communities	p. 218
Gender issues	p. 220
Mortality	p. 222
Legal problems	p. 223
Health care settings for schizophrenia patients: which setting is optimal?	p. 225
Psychiatric rehabilitation	p. 227
The international classification of functioning, disability and health	p. 227
Target population	p. 229
Conceptual framework	p. 229
Current approaches	p. 230
Individual-centred rehabilitation	p. 230
Cognitive behavioural therapy	p. 231
Social skills training	p. 232
Ecological approach to rehabilitation	p. 233
Housing	p. 233
Work	p. 234
Participation in community life with full rights	p. 235
The contribution of mental health professionals to stigma and discrimination	p. 237
The role of the psychiatrist in the management and rehabilitation of schizophrenia patients	p. 238
Outlook	p. 239
References	p. 239
Index	p. 247
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