| Vol 7 n° 1 - Early stages of schizophrenia |
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I n
t h i s i s s u e . . .
This issue of Dialogues
in Clinical Neuroscience is devot-
ed to the role of the emotional,
behavioral, and patho-
physiological features that
characterize the period pre-
ceding and immediately following
the manifestation of
psychosis and schizophrenia.
The first part of the State
of the art article by Michael
Davidson, Asaf Caspi, and
Shlomo Noy (page 7) reviews
the genes, markers, and
environmental effects that, via
complex interactions, determine
the manifestation of
abnormal behaviors, perceptions,
and emotions on a con-
tinuum of mental illness
including psychosis. Reaching the
conclusion that the state-of-the-art
knowledge on genet-
ic and other markers, as
well as environmental influences
contributing and leading
to psychosis, is too limited to be
applied to clinical treatment,
the second part of this
review focuses of the treatment
of the early phases of
psychosis.
The first article in the
Basic research section by Robert
Freedman et al (page 17)
links a physiological electroen-
cephalographic marker P50
to attention abnormality in
schizophrenia, and
attributes it to mutations on the
15q14 locus of the gene
CHRNA7. The authors point out
that physiological and
genetic markers could be utilized
to treat schizophrenia
and psychosis. The second Basic
research
article from Avi Reichenberg (page 31) focuses
on the role of the cognitive
impairment in schizophrenia
and makes a strong argument
that it is independent of
psychosis, yet on the causative
pathway to the syndrome
of schizophrenia.
In the Pharmacological
aspects article, Barbara Corn-
blatt and Andrea Auther
(page 39) discuss the ethical
dilemma of treating mildly
symptomatic, but not unequiv-
ocally psychotic, youngsters
with antipsychotic drugs. The
authors also offer alternative
pharmacological and non-
pharmacological treatment
alternatives.
The Poster by
Mihai Gheorghe et al (page 50) is a single-
photon emission computed
tomography (SPECT) depic-
tion of the effects of
classic and novel neuroleptics in first-
episode psychosis patients.
The authors attempt to use
the SPECT exam to understand
the mechanism mediating
the drug antipsychotic
effect, as well as to explain the dif-
ferences between the classic
and the novel drugs.
The first article in
Clinical research is by Jim Van Os and
Philippe Delespaul (page
53), who argue that a rare dis-
ease such as schizophrenia
cannot be accurately predict-
ed on the basis of premorbid
and prodromal manifesta-
tions, which are both
nonspecific to schizophrenia and
frequent in the general
population. Instead of trying to
predict psychosis in the
general population, the authors
suggest sample enrichment
as an alternative. Specifically,
the authors suggest the
creation of referral and assess-
ment “filters”
of general practitioners, mental health cen-
ters, and specialized
clinics, where patients will be diag-
nosed and receive special
attention and treatment. The
second Clinical research
article by Kimberlie Dean and
Robin M. Murray (page
69) reviews the environmental
risks factors and effects
associated with psychosis and
schizophrenia. The last
article in the Clinical research
section is by Mark Weiser
and Shlomo Noy (page 81),
who examine one of the
most replicated effects preced-
ing the first psychotic
episode: the use of cannabis. The
authors consider both
hypotheses, the use of cannabis as
a risk for psychosis,
and the possibility of an abnormality
of the cannabis receptors
common to both psychosis and
prevalent use of cannabis.
Michael Davidson, MD
