Early Clinical Intervention and Prevention in Schizophrenia
http://www.100md.com
《新英格兰医药杂志》
This book contains an immense amount of information about research on patients with schizophrenia or schizotypal disorders, and on relatives of patients with schizophrenia; it covers epidemiology, genetics, neurobiology, neuropsychology, psychophysiology, and psychopathology. The editors invited experts to contribute chapters on topics relevant to early clinical intervention and prevention of schizophrenia. In the preface, the editors state that they consider the development of strategies to prevent the onset of schizophrenia to be a task of the highest priority. This priority has directed the selection of topics.
(Figure)
An Artist's Interpretation of a Person with Schizophrenia.
By permission of Adrian Cousins/Wellcome Photo Library.
Several chapters describe the schizophrenia-liability syndrome schizotaxia, which is defined as a syndrome with neuropsychological and psychophysiological deficits and "negative symptoms" (e.g., apathy, abulia, and blunted affect) that, on the whole, characterize biologic relatives of patients with schizophrenia. As long as the genetic pathways to the illness are not fully elucidated, these findings will be diluted with data from unaffected relatives. The research on adult relatives (often siblings) of patients with schizophrenia is an evolving area that can provide interesting contributions to the understanding of the core features of the illness. There seems to be convincing evidence that adult relatives of patients with schizophrenia differ from people who are not related to patients with schizophrenia with regard to neuropsychological and psychophysical functions and perhaps also structural, functional, and chemical abnormalities of the brain. Research in this area ought to be not only summarized but also subjected to meta-analysis. There are some caveats in this kind of research, which are given little attention in the book: factors such as common rearing of siblings, common prenatal and perinatal exposure to neurotoxic agents, and the effect of being raised in a family in which schizophrenia is developing in a family member need to be taken into account when studies are conducted. The consequences of the research in this area are as yet uncertain, and more research is necessary before a targeted preventive strategy can be developed.
To identify early predictors of schizophrenia is a difficult task, and an ideal design for doing so does not exist. Various strategies have been developed (e.g., adoption studies, twin studies, longitudinal studies of high-risk patients, birth-cohort studies, and case–control studies), and in each study design, methodologic considerations are crucial — for instance, when there is uncertainty about the direction of the associations. In one chapter, Marenco and Weinberger mention that when obstetrical complications are found to be predictors of later schizophrenia, it should be kept in mind that women with schizophrenia have less healthy lifestyles than other women during pregnancy and have more obstetrical complications. Thus, part of the observed association between obstetrical complications and later schizophrenia could be genetically mediated if a family history of schizophrenia were taken into consideration. This type of consideration is important and would have been a useful addition to the chapters that discuss risk factors for schizophrenia.
The chapters are narrative reviews, and the authors provide information about the most recent findings in a range of fields, with extensive citations of almost 200 references in some chapters. Often, the reader must accept the author's interpretation and therefore has only limited possibilities for assessing the validity of the studies mentioned. For instance, the research design, the basis of the study, the number of subjects, and the size of an effect are often not mentioned. However, in a chapter written by Dazzan, Kravariti, Fearon, and Murray, fundamental epidemiologic concepts are brought into the discussion. This chapter summarizes, with the use of a meta-analytic approach, the evidence given in many previous chapters, which provides the reader with a good overview. The authors systematically examine the evidence of predictive power (i.e., the size of the effect, sensitivity, and positive predictive value) of familial risk and obstetrical complications, early developmental factors, neuropsychological and educational factors, and social and environmental factors. From this chapter, it becomes evident that familial risk is the most important single factor in the development of schizophrenia and that high positive predictive values of other risk factors can be obtained only in high-risk populations. This book can be recommended to all researchers with an interest in the prevention of schizophrenia.
Merete Nordentoft, M.D., Ph.D.
Bispebjerg Hospital
DK-2400 Copenhagen NV, Denmark
merete.nordentoft@dadlnet.dk(Edited by William S. Ston)
(Figure)
An Artist's Interpretation of a Person with Schizophrenia.
By permission of Adrian Cousins/Wellcome Photo Library.
Several chapters describe the schizophrenia-liability syndrome schizotaxia, which is defined as a syndrome with neuropsychological and psychophysiological deficits and "negative symptoms" (e.g., apathy, abulia, and blunted affect) that, on the whole, characterize biologic relatives of patients with schizophrenia. As long as the genetic pathways to the illness are not fully elucidated, these findings will be diluted with data from unaffected relatives. The research on adult relatives (often siblings) of patients with schizophrenia is an evolving area that can provide interesting contributions to the understanding of the core features of the illness. There seems to be convincing evidence that adult relatives of patients with schizophrenia differ from people who are not related to patients with schizophrenia with regard to neuropsychological and psychophysical functions and perhaps also structural, functional, and chemical abnormalities of the brain. Research in this area ought to be not only summarized but also subjected to meta-analysis. There are some caveats in this kind of research, which are given little attention in the book: factors such as common rearing of siblings, common prenatal and perinatal exposure to neurotoxic agents, and the effect of being raised in a family in which schizophrenia is developing in a family member need to be taken into account when studies are conducted. The consequences of the research in this area are as yet uncertain, and more research is necessary before a targeted preventive strategy can be developed.
To identify early predictors of schizophrenia is a difficult task, and an ideal design for doing so does not exist. Various strategies have been developed (e.g., adoption studies, twin studies, longitudinal studies of high-risk patients, birth-cohort studies, and case–control studies), and in each study design, methodologic considerations are crucial — for instance, when there is uncertainty about the direction of the associations. In one chapter, Marenco and Weinberger mention that when obstetrical complications are found to be predictors of later schizophrenia, it should be kept in mind that women with schizophrenia have less healthy lifestyles than other women during pregnancy and have more obstetrical complications. Thus, part of the observed association between obstetrical complications and later schizophrenia could be genetically mediated if a family history of schizophrenia were taken into consideration. This type of consideration is important and would have been a useful addition to the chapters that discuss risk factors for schizophrenia.
The chapters are narrative reviews, and the authors provide information about the most recent findings in a range of fields, with extensive citations of almost 200 references in some chapters. Often, the reader must accept the author's interpretation and therefore has only limited possibilities for assessing the validity of the studies mentioned. For instance, the research design, the basis of the study, the number of subjects, and the size of an effect are often not mentioned. However, in a chapter written by Dazzan, Kravariti, Fearon, and Murray, fundamental epidemiologic concepts are brought into the discussion. This chapter summarizes, with the use of a meta-analytic approach, the evidence given in many previous chapters, which provides the reader with a good overview. The authors systematically examine the evidence of predictive power (i.e., the size of the effect, sensitivity, and positive predictive value) of familial risk and obstetrical complications, early developmental factors, neuropsychological and educational factors, and social and environmental factors. From this chapter, it becomes evident that familial risk is the most important single factor in the development of schizophrenia and that high positive predictive values of other risk factors can be obtained only in high-risk populations. This book can be recommended to all researchers with an interest in the prevention of schizophrenia.
Merete Nordentoft, M.D., Ph.D.
Bispebjerg Hospital
DK-2400 Copenhagen NV, Denmark
merete.nordentoft@dadlnet.dk(Edited by William S. Ston)