March 02, 2006

Understanding the Glass Ceiling for Outcome in Schizophrenia

Another good editorial article - somewhat technical in nature (because its written primarily for psychiatrists) but very educational for people who want to stay up on the latest research. The full story is linked to at the bottom.

Understanding the Glass Ceiling for Functional Outcome in Schizophrenia

Despite the widespread availability of medications that suppress psychosis and prevent relapse, most patients with schizophrenia function poorly in the community and few lead fully independent lives. This has led researchers to identify factors other than psychosis that are associated with poor functional outcome. Perhaps not surprisingly, impaired cognition has emerged as a highly reliable predictor of poor functional outcome in schizophrenia. Performance on a range of cognitive tasks has been shown to be associated with poor social and occupational functioning (1). Addressing this and other treatment-refractory aspects of schizophrenia, such as negative symptoms, as well as reconfiguring our system of care to emphasize early intervention and access to rehabilitation services are essential steps if we are to move beyond symptom control and relapse prevention and toward improved functional outcome in this illness.

The insight that impaired cognition underlies much of the functional disability in schizophrenia is well timed in view of the explosion of new knowledge over the past decade regarding how the brain supports cognitive and emotional processing and how this is modulated neuropharmacologically and by experience. To capitalize on this new knowledge and translate it into therapies, a number of steps must be taken (2). First, the specific cognitive mechanisms that fail in schizophrenia need to be identified, together with the process by which these deficits lead to functional disability. Second, the neural systems underlying impaired cognition in schizophrenia need to be identified. Knowledge from animal models and basic human pharmacological and imaging studies can then provide targets for modulating impaired cognitive networks and inform the development of both pharmacological and psychosocial therapies.

Four articles in this issue of the Journal take important steps toward this goal. ...

Research that increases our understanding of the mechanisms underlying poor functional outcome in schizophrenia is necessary to guide treatment development to help patients get beyond their "glass ceiling." The combination of behavioral, electrophysiological, and structural and functional brain imaging approaches used in these four papers exemplifies the progress that is now being made in this direction.

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