Schizophrenia revisited

Robin McCreadie is Director of Clinical Research and a consultant psychiatrist at Crichton Royal Hospital (Bankend Road, Dumfries DG1 4TG, UK. E-mail: robin.mccreadie{at}nhs.net). He has carried out research in schizophrenia for over 30 years.

It is now four years since I wrote an editorial in APT introducing a series of articles about schizophrenia (McCreadie, 2000). At that time subjects that we thought were topical were schizophrenia in adolescence (Hollis, 2000), the detection of early relapse (Birchwood et al, 2000), cognitive impairment (O’Carroll, 2000), depression in schizophrenia (Mulholland & Cooper, 2000), the role of the community psychiatric nurse (Gournay, 2000), the person with schizophrenia in conditions of high security (Thomson, 2000), smoking habits (Kelly & McCreadie, 2000) and assessment of drug-related movement disorders (Gervin & Barnes, 2000). Many of these articles remain topical and are worth a return visit. Although little on schizophrenia has appeared in APT since, there have been a number of important developments. A new APT series ‘Schizophrenia revisited’, which begins in this issue with Stuart Leask’s article on environmental influences, will address some of these.

Aetiological factors

The search for aetiological factors in schizophrenia continues. Both environmental and genetic factors excite much interest, but many studies are not replicated. In recent years, however, a number of environmental factors do appear to be of relevance: season of birth, geography of birth, urbanisation, immigration and substance use, as well as maternal factors such as prenatal influenza, famine and other stresses, and obstetric complications. The evidence for these putative factors is critically assessed by Stuart Leask in the current issue (Leask, 2004).

The NICE clinical guideline

The National Institute for Clinical Excellence clinical guideline for schizophrenia was launched in December 2002 (National Institute for Clinical Excellence, 2002). Although it received a generally warm welcome, it contained little on how it should be implemented. As Paul Rowlands will point out in the next issue of APT (Rowlands, 2004, in press), distribution of a guideline is not implementation: more needs to be done. Successful implementation will require collaborative working between managers, clinicians and service users. The guideline is extremely ambitious and it must be recognised that in some areas resource deficiencies might present insurmountable obstacles.

Applications of neuroimaging

There has been an explosion of interest in the research community regarding neuroimaging in schizophrenia and other psychiatric disorders; indeed, there are journals totally devoted to this topic. However, much of the research remains just that: research. What, if any, are the implications of the findings for clinicians? Should we be scanning patients with first-episode schizophrenia? And if so, why? These and other issues will be explored.

Cognitive impairment

As I have already mentioned, in the 2000 series of articles cognitive impairment was discussed. We make no apology for returning to this topic. It is now recognised that cognitive impairment is a core feature of schizophrenic illness, and much of the inability of an individual with schizophrenia to cope successfully in the community is due to such deficits. Cognitive deficits can be detected early in the illness; the role of cognitive remediation in first-episode schizophrenia will be reviewed.

Early intervention

First-episode schizophrenia is also addressed in an article on early intervention. There is still vigorous debate about the value of such intervention, but whatever its merits it is likely to be practised for some considerable time. ‘Early intervention’ means different things to different people, and there are at least three currently accepted definitions and three different models of care. An article on this topic will emphasise that there is more to early intervention than simply intervening early: it also requires the intervention to be effective.

Lifestyle issues

At any given time the vast majority of people with schizophrenia are not in hospital, but are living in the community. Their illness forms just one part of their lives. However, many of their lifestyle ‘choices’ predispose them to poor physical health and comorbid medical disease. Many people with schizophrenia die prematurely. Opportunities to modify lifestyle and risk factors such as weight gain and obesity will be described.

Finally, it is well known that sexual dysfunction is common in both men and women with schizophrenia. The illness itself and antipsychotic and other medications are contributing factors. The evidence regarding the sexual function and behaviour of people with schizophrenia will be presented, and the implications for clinical practice described.

References

Birchwood, M., Spencer, E. & McGovern, D. (2000) Schizophrenia: early warning signs. Advances in Psychiatric Treatment, 6, 93–101.[Free Full Text]

Gervin, M. & Barnes, T. R. E. (2000) Assessment of drug-related movement disorders in schizophrenia. Advances in Psychiatric Treatment, 6, 332–343.[Free Full Text]

Gournay, K. (2000) Role of the community psychiatric nurse in the management of schizophrenia. Advances in Psychiatric Treatment, 6, 243–249.[Free Full Text]

Hollis, C. (2000) Adolescent schizophrenia. Advances in Psychiatric Treatment, 6, 83–92.[Free Full Text]

Kelly, C. & McCreadie, R. G. (2000) Cigarette smoking and schizophrenia. Advances in Psychiatric Treatment, 6, 327–331.[Free Full Text]

Leask, S. J. (2004) Environmental influences in schizophrenia: the known and the unknown. Advances in Psychaitric Treatment, 10, 323–330.

McCreadie, R. (2000) Schizophrenia: what’s new? Advances in Psychiatric Treatment, 6, 81–82.[Free Full Text]

Mulholland, C. & Cooper, S. (2000) The symptom of depression in schizophrenia and its management. Advances in Psychiatric Treatment, 6, 169–177.[Free Full Text]

National Institute for Clinical Excellence (2002) Schizophrenia: Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care – Clinical Guideline 1. London: NICE.

O’Carroll, R. (2000) Cognitive impairment in schizophrenia. Advances in Psychiatric Treatment, 6, 161–168.[Free Full Text]

Rowlands, P. (2004) The NICE schizophrenia guidelines: the challenge of implementation. Advances in Psychiatric Treatment, 10, in press.

Thomson, L. D. G. (2000) Management of schizophrenia in conditions of high security. Advances in Psychiatric Treatment, 6, 252–260.[Free Full Text]

This article has been cited by other articles:

				J. Woolley and P. McGuire Neuroimaging in schizophrenia: what does it tell the clinician? Advan. Psychiatr. Treat., May 1, 2005; 11(3): 195 - 202. [Abstract] [Full Text] [PDF]

				R. W. Kerwin and A. Bolonna Management of clozapine-resistant schizophrenia Advan. Psychiatr. Treat., March 1, 2005; 11(2): 101 - 106. [Abstract] [Full Text] [PDF]

				M. Connolly and C. Kelly Lifestyle and physical health in schizophrenia Advan. Psychiatr. Treat., March 1, 2005; 11(2): 125 - 132. [Abstract] [Full Text] [PDF]

				Y. V. Gopal and H. Variend First-episode schizophrenia: review of cognitive deficits and cognitive remediation Advan. Psychiatr. Treat., January 1, 2005; 11(1): 38 - 44. [Abstract] [Full Text] [PDF]

				S. P. Singh and H. L. Fisher Early intervention in psychosis: obstacles and opportunities Advan. Psychiatr. Treat., January 1, 2005; 11(1): 71 - 78. [Abstract] [Full Text] [PDF]

				P. Rowlands The NICE schizophrenia guidelines: the challenge of implementation Advan. Psychiatr. Treat., November 1, 2004; 10(6): 403 - 412. [Abstract] [Full Text] [PDF]

				S. J. Leask Environmental influences in schizophrenia: the known and the unknown Advan. Psychiatr. Treat., September 1, 2004; 10(5): 323 - 330. [Abstract] [Full Text] [PDF]

This Article Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by McCreadie, R. G. Search for Related Content PubMed Articles by McCreadie, R. G.