Handbook of Schizophrenia Spectrum Disorders, Volume III (eBook)

Foreword 5
Schizophrenia Spectrum Disorders: Insights from Views Across 100 years 5
Contents 9
Contributors 12
1 Recovery in Schizophrenia: Perspectives, Evidence, and Implications 16
Introduction 17
What Is Recovery? 17
Part I: The Medical Model of Recovery 18
Part II: The Consumer Model of Recovery 22
SAMHSA Recovery Domains 24
Qualitative Studies of the Consumer Conception of Recovery 26
Part III: Integrating Medical and Consumer Models of Recovery 29
Part IV: Implications of the Consumer Model of Recovery for Practice, Education, and Research 31
Implications for Practice 31
Implications for Education 32
Implications for Research 33
Conclusions 34
References 34
2 The Magic Shotgun: Does It Fit the Clinician and Will It Point at Schizophrenia? 38
Introduction 39
Taking the Analogy Further 40
Mechanisms of Action and "Pipeline" Antipsychotic Drugs 41
Dopamine Receptors 41
Glutamate Receptors 42
Muscarinic Receptors 43
Serotonin Receptors 44
Other Potential Substrates for Antipsychotic Action 45
Current Approximations to the Magic Shotgun: Are They Any Good? 46
More than One Antipsychotic Drug 47
Augmentation with Other Psychotropic Drug Classes 48
Mood Stabilizers: Lithium and Anticonvulsant Drugs 48
Antidepressant Drugs 48
Benzodiazepines 49
Anti-dementia Drugs 49
Drugs for Substance Abuse 50
Atomoxetine 50
Augmentation and Supplementation on a Theoretical Basis 51
Purinergic Drugs 51
Anti Inflammatory/Immunological Drugs 51
Sexual Hormones 51
Antihistaminergic Drugs 52
Serotonin Antagonism 52
Cortisol Antagonism 52
Nitric Oxide Deficiency 52
Retinoid Dysregulation 53
Miscellaneous 53
Olanzapine 53
Mirtazapine 53
Modafinil 53
Selegiline 54
Pergolide 54
Valacyclovir 54
S-Adenosyl Methionine 54
Ginkgo Biloba 54
N-Acetyl Cysteine 54
Vitamin C 55
Integrating Multiple Mechanisms 55
Conclusions and Future Directions 56
References 56
3 Advancing Neuroprotective-Based Treatments for Schizophrenia 65
Introduction 67
Neuroprotective Treatment Strategy 67
Neurosteroids as Neuroprotective Agents 69
Clinical Trials with Neurosteroids 69
Vitamins as Neuroprotective Agents 74
Clinical Trials with Vitamins 75
Vitamin A 75
Vitamin B6 (Pyridoxine) 77
Vitamin C (Ascorbic Acid) 77
Vitamin D 78
Vitamin E (a-Tocoferol) 79
Vitamin B12 and Folic Acid 80
Omega -3 81
Ginkgo Biloba 82
L-theanine 83
Conclusions and Future Directions 85
References 86
4 Prevention and Early Intervention in At-Risk States for Developing Psychosis 95
Introduction 96
Prevention Studies 97
Prevention Studies Focusing on Pharmacological Intervention 97
Randomized Controlled Trials of Antipsychotics 97
Naturalistic Treatment Study of Antipsychotics and Antidepressants 99
Neuroprotective Treatment Trials 99
Prevention Studies Focusing on Psychotherapy 100
Treatment Approaches 101
Conclusions and Future Directions 102
References 103
5 Early Improvement and Its Predictive Validity in First-Episode Schizophrenia Patients 107
Introduction 108
Early Improvement in FES Patients and Its Predictive Validity Regarding Outcome 109
Clinical Data 109
General Aspects on Early Improvement in FES Patients 109
Antipsychotic Treatment and Early Improvement 110
A Standardized Definition of Early Improvement in FES Patients 110
Functional, Biological and Experimental Data 112
EEG Data 112
Imaging Data 112
Genetic Data 113
Data Considering the Long-Term Course of the Illness 114
What Actions Should We Take in Patients Not Achieving Early Improvement? 116
Conclusions and Future Directions 119
References 119
6 Antioxidants as a Treatment and Prevention of Tardive Dyskinesia 122
Introduction 123
Piracetam in Treatment of TD 124
Vitamin B6 (Pyridoxine) in Treatment of TD 126
Vitamin E (Alpha-Tocopherol) 135
Melatonin in Treatment of TD 138
Ginkgo Biloba in Treatment of TD 139
Omega-3 in Treatment of TD 140
Conclusions 141
References 142
7 Electrophysiological Imaging Evaluation of Schizophrenia and Treatment Response 148
Introduction 149
LORETA Imaging of EEG in Schizophrenia 149
P300 Current Source Imaging and Psychopathology 151
ERPs Activity in Discrete Brain Regions and Effect of Neuroleptic Treatment 153
Conclusions and Future Directions 157
References 158
8 Coping with Schizophrenia: Measuring Coping Styles, Patterns and Temporal Types 162
Introduction 163
Study 1: Coping Styles Among Persons with Schizophrenia: Associations with Outcome 165
Study 2: Coping Patterns Across Acute and Post Acute Phases of Illness 171
Study 3: Pattern of Change and Stability in Coping Strategies Among Persons with Schizophrenia: Associations with Psychosocial Function and Symptoms 174
Conclusions and Future Directions 180
References 182
9 Interventions Targeting Social and Vocational Dysfunction in Individuals with a Schizophrenia Spectrum Disorder 185
Introduction 187
Defining ''Functional Outcome'' in Schizophrenia 188
Effects of Standard Treatment on Functional Outcome 189
Historical Approaches to Treatment of Social Disability 191
Social Cognition in Psychosis and Links to Functional Outcome 196
Social Cognitive Deficits are Widespread in Schizophrenia-Spectrum Disorders 196
Genesis: Getting at the Root of Social Cognitive Deficits 197
The Impact of Social Cognition on Functioning 198
Interventions Targeting Social Cognition and Social Functioning in Psychosis 199
Neurocognitive Enhancement Therapies with an Adjunctive Social Component 199
Targeted Training for Specific Social Cognitive Impairments 200
Training Programs with a Focus on Social Cognition 201
Interventions Targeting Vocational Outcome 203
Conclusions and Future Directions 204
Functional Outcome Measures: Past Issues and Future Challenges 204
New Approaches to Intervention Programs 206
The Way Forward Lies at the Beginning 207
References 208
10 Revisiting Cognitive Remediation for Schizophrenia: Facing the Challenges of the Future 220
Cognition as a Key Factor in Schizophrenia 221
Efficacy of Cognitive Remediation Therapy in Schizophrenia 223
Computerized Cognitive Rehabilitation Programmes 224
How Do We Measure Effectiveness in Cognitive Remediation? 225
Critical Analysis of Neuropsychological Measures 226
How Big a Change in Cognition Do We Need? 228
Challenges for the Future: What Works for Whom? 229
What Is the Next Generation of Research? 229
Additional Considerations for Evaluations of Cognitive Remediation Therapies 231
Conclusion 232
References 232
11 Individual Psychotherapy for Schizophrenia: An Overview of Its History, Recent Developments and New Directions 235
A Brief History of the Psychotherapy of Schizophrenia 238
Schizophrenia and Sense of Self: Related Links with Narrative and Metacognition 240
Addressing Narrative and Metacognition within a Psychotherapy for Schizophrenia 243
Future Research: Three Related Foci 246
Summary and Conclusions 249
References 249
12 An Overview of Cognitive Behaviour Therapy in Schizophrenia Spectrum Disorders 255
Overview 256
What Is CBT? 256
CBT Tailored for Specific Biases and Deficits 258
Meta-Cognitive Approaches 259
Group vs Individual Therapy 260
Adapting CBT to Poor Insight 260
Adapting CBT to Poor Compliance 260
Does CBT Work Equally with All Symptoms? 261
Use of CBT in Different Stages of Psychosis 261
Medication and CBT 263
Evaluating CBT Gains 263
CBT for Negative Symptoms 265
Predictors of Outcome 266
Additions to CBT 267
Conclusions and Further Questions 268
References 271
13 Schizophrenia and Medical Illness: Is Medical Illness the Consequence of Schizophrenia or Its Treatment? 276
Introduction 277
Overall Mortality 277
Lifestyle of Patients with Schizophrenia 278
Access to Somatic Treatment 279
Cardiovascular Disease and Metabolic Syndrome 280
Sudden Death 285
Cardiomyopathy and Myocarditis 286
Cancer 287
Venous Thromboembolism 288
Movement Disorder 289
Conclusion and Clinical Recommendations 291
References 291
14 The Interface of Cannabis Misuse and Schizophrenia-Spectrum Disorders 297
Introduction 298
The Plant, Methods of Intake, and Centrally Active Constituents 299
The Central Endocannabinoid System 300
Cannabis Use and Misuse in the General Population 302
Prevalence of Cannabis Misuse in the General Population 302
Consequences of Cannabis Misuse in the General Population 302
Cannabis Abuse and Dependence 302
Impaired Academic Performance 303
Criminal Behavior, Suicidality, and Unintentional Injuries 304
Impairments in Neurocognition 304
Psychotomimetic Effects and Psychiatric Symptoms 305
Cannabis-Induced Psychosis 305
Cannabis Use and Misuse among Individuals with Schizophrenia-Spectrum Disorders 306
Broadly Defined Substance Abuse and Dependence in the Context of Schizophrenia-Spectrum Disorders 306
Prevalence of and Motivations for Cannabis Misuse Among Individuals with Schizophrenia-Spectrum Disorders 306
Clinical Consequences of Cannabis Misuse Among Individuals with Schizophrenia-Spectrum Disorders 307
Effects on Positive and Negative Symptoms 307
Effects on Neurocognition 309
Effects on the Age at Onset and Mode of Onset of Psychosis 309
Effects on Long-Term Course and Outcomes 310
Cannabis Use as a Cause of Schizophrenia-Spectrum Disorders: The Ongoing Debate 310
Studies Implicating Cannabis Use in Adolescence as a Component Cause 310
Criteria for Establishing Causality 312
Strength 312
Consistency 313
Specificity 313
Temporality 313
Biological Gradient 314
Biological Plausibility 314
Experiment 315
Analogy/Coherence with Existing Theory and Knowledge 315
Coherence and Consideration of Alternate Explanations 315
The Balance of the Evidence: Cannabis Use Appears to Be a Component Cause 316
Treatment and Prevention Implications Pertaining to the Interface of Cannabis Misuse and Schizophrenia-Spectrum Disorders 317
Treatment Implications 317
Prevention Implications 319
Conclusions and Future Directions 320
References 321
15 Schizophrenia and Comorbid Substance Abuse – Pathophysiological and Therapeutic Approaches 329
Introduction 331
Neurobiological Background and Pathophysiology 332
Neurocognitive Function 332
Neurocognitive Function in Chronic Schizophrenia with Comorbid Substance Abuse 333
Neurocognitive Function in First-Episode Patients with Comorbid Substance Abuse 333
Brain Morphology and Neuroimaging 334
Volumetric sMRI Studies in Schizophrenia 334
Volumetric sMRI Studies in Patients with Cannabis Abuse 334
Volumetric sMRI Studies in Schizophrenia with Comorbid Substance Abuse 335
Neurophysiological Findings 336
Event-Related Potentials (ERP) 336
Mismatch Negativity (MMN) 336
Transcranial Magnetic Stimulation (TMS) 336
Genetics 337
The Role of the Endogenous Cannabinoid System 338
Treatment Issues 339
Assessment of Substance Abuse 339
Integrated Treatment 340
Pharmacological Treatment 340
Reviewing the Evidence 340
Treatment with Antipsychotics 340
Orally Administered Antipsychotics 341
Depot Antipsychotics 348
Antidepressive Agents 348
Mood Stabilizers 348
Anti-craving Agents 350
Disulfiram 350
Treatment Recommendations 351
Treatment with Antipsychotics 351
Augmentation Strategies to Reduce Substance Use and Craving 352
Management of Intoxication and Withdrawal 353
Minimizing Side Effects 353
Psychological and Psychosocial Interventions 354
Steps to Begin with Treatment 354
Motivational Interviewing (MI) 355
Cognitive Behavioural Therapy (CBT) 356
Social Skills Training 356
Psychological Intervention Manuals 357
Other Psychosocial Interventions 357
Conclusions and Future Directions 358
References 360
16 Suicidality and Outcome in Schizophrenia Patients 372
Introduction 373
Suicidality in Schizophrenia 374
Biological Aspects of Suicidality in Schizophrenia 374
Genetics 374
Imaging Data 374
Correlates of Suicidality in Schizophrenia 375
Sociodemographic Variables 376
Clinical and Course Related Variables 376
Psychopathological Variables 377
Treatment Related Variables 377
Measuring Suicidality in Schizophrenia Patients 378
Suicidality in Schizophrenia Patients and Outcome 379
Clinical Implications and Treatment of Suicidality in Schizophrenia Patients 384
Pharmacological Treatment 384
Non-pharmacological Treatment 385
Conclusions and Future Directions 385
References 386
17 Religiousness/Spirituality and Schizophrenia: Implications for Treatment and Community Support 390
Introduction and Background 391
Religion and Mental Health 393
Conceptualization of Religion and Spirituality 394
Religion and Mental Health Outcomes 394
Depression 395
Anxiety 396
Suicide 397
Substance Abuse 398
Religion and Spirituality in Psychosis 399
Diagnosing Delusions with Religious Content 400
Impact of Religious Delusions on Course of Psychotic Disorder 402
Treatment for Patients with Religious Delusions 402
Cultural and Religious Context of Psychotic Illness 403
Past and Current Research on Religion in Severe Mental Illness 404
Religious Coping 405
Adherence to Treatment 408
Suicide 409
Substance Use/Abuse 410
Cigarette Smoking 411
Quality of Life (QOL) 412
Comorbidity with HIV/AIDS 412
Directions for Future Research 413
Implications for Treatment and Community Interventions 416
Treatment Interventions 417
Community Interventions 418
Summary and Conclusions 420
References 421
18 The Ethical Ramifications of Biomarker Use for Mood Disorders 428
Introduction 429
Current Psychiatric Diagnostic Tools 430
Potential Biomarkers for Depression 431
Genetic Biomarkers and Depression 431
Protein Biomarkers and Depression 432
Metabolomic Biomarkers and Depression 434
Other Biochemical Biomarkers for Depression 434
Epigenetic Biomarkers and Depression 435
Neuroimaging and Electrophysiological Biomarkers and Depression 435
Current Biomarkers for Anxiety 436
Pharmacogenomics 437
Ethical Issues Associated with Biomarker Use in Psychiatry 438
Is It Ethical to Screen Healthy Individuals for Disorders When They Do Not Have Any Symptoms? 439
Should Clinicians Test Patients Previously Diagnosed with Depression If They Ask? What If the Test Comes Back Negative? 440
Conclusions and Future Directions 440
References 441
Afterword 445
The Future of the Schizophrenia Construct and Acquisition of New Knowledge 445
References 448
Contents to Volume I 449
Contents to Volume II 451
Contributors to Volume I 453
Contributors to Volume II 458
Index 463