Schizophrenia Wars: A New Hope

The architecture of schizophrenia is in the midst of a renovation, with the details of its clinical course and underlying neurobiology rapidly evolving, with important treatment implications, according to the introduction to the special March/April issue of Harvard Review of Psychiatry.

“This special issue of the Harvard Review of Psychiatry brings together global experts in the epidemiology, neurobiology, and treatment of schizophrenia to reevaluate the natural history of the illness, and to elaborate priorities for new interventions,” writes guest editor Joshua L. Roffman, MD, Director of the Brain Genomics Laboratory at Massachusetts General Hospital and Assistant Professor of Psychiatry at Harvard Medical School.

The special issue included eight papers that discussed paramount areas in the progress toward an understanding of the development and course of schizophrenia. With decades passing since the last major treatment breakthrough for the condition, advances in this area are crucial. Papers in the special issue covered such advances as:

• How altered genetics and brain connectivity contribute to the biology of schizophrenia. Schizophrenia has long been thought of as a disease of “disconnectivity,” but this idea has only recently been validated by modern genetic and brain imaging techniques. It is hoped that new schizophrenia treatment approaches may arise from connectome-based studies.
• A rekindled focus on the schizophrenia prodrome that may provide opportunities for early detection and intervention. Such research may allow for identifications of young patients at clinical high risk, as well as the development of interventions for preventing or delaying schizophrenia development.
• The identification of risks faced by schizophrenia patients’ children. The risks include increased rates of psychotic disorders, depression, anxiety, and other mental health conditions. Research indicates that those who are at familial high risk may be identified early, helping predict later risk.

New approaches to understanding how schizophrenia develops over time were highlighted in other papers in the special issue. These included:

• Suggested approaches to studying the long-term course of schizophrenia, including a new analysis indicating that symptoms and impaired cognition may be more stable than previously thought.
• The potential for electroencephalography to show genetically mediated patterns of electrophysiological endophenotypes in patients with schizophrenia.
• Updated evidence suggesting that dysfunctional voice processing may explain the auditory and verbal hallucinations that occur in schizophrenia.

Updates on new treatment directions were also presented in the special issue. Among the promising therapies for patients early in the course of psychosis is cognitive remediation, which could be particularly helpful during the prodromal period. Emerging treatment and preventive approaches were highlighted in another paper. New evidence indicates the possible potential of repurposing treatments and supplements like B-vitamins and omega-3 fatty acids.

Roffman concluded, “The critical reappraisal of the natural history of schizophrenia, and the related insights around new intervention strategies...provide every reason to be optimistic.”