Young people who experience a first episode of psychosis often receive a diagnosis of schizophrenia.
Historically there has been the view that schizophrenia is a progressive, deteriorating condition and many clinicians were taught that point of view in their training.
When the field of Early Psychosis began to develop in the 1990s, a major theme was to discard the pessimistic attitude that clinicians held toward the possibility of significant recovery in psychotic disorders and replace it with a more balanced positive approach. The specialized Early Psychosis services that are now widely available are based on this attitude of realistic optimism.
As well, people with lived experience of psychosis, and their families, have increasingly insisted and demonstrated that recovery in schizophrenia is a realistic and attainable goal.
Yet studies of brain structure and function continue to produce data suggesting that there may be progressive changes associated with a diagnosis of schizophrenia.
In an article published in the Schizophrenia Bulletin journal in November 2012, Dr. Robert Zipursky (pictured) a leader in psychosis reseach in Canada, along with eminent colleagues in the UK, reviews the current evidence related to the question of whether or not a diagnosis of Schizophrenia indicates the person has a progress brain disease.
The article reviews all the recent evidence from brain scans, as well as other sources of data, and concludes that “schizophrenia is not a malignant disease that inevitably deteriorates over time, but one from which most people can achieve a significant degree of recovery”.
The authors strongly urge clinicians to provide young people and their families with this up-to-date information so that the old myths regarding negative outcomes for people receiving a diagnosis of schizophrenia can be laid to rest.
For a free copy of the full article click here.
An editorial published in the January 2010 edition of the American Journal of Psychiatry:By John H. Gilmore, M.D.
Understanding what causes schizophrenia is becoming harder and harder. We know that schizophrenia has genetic causes, since the most significant risk factor is having a first-degree relative with schizophrenia. However, most people with schizophrenia do not have an affected relative, and while the overall genetic contribution to schizophrenia may be large, the contribution of specific genes is very small. Candidate gene studies and more recent genome-wide association studies have had inconsistent results and indicate, at best, individual genes increase risk by less than 2 times—from an average population rate of 1 in 100 to 1.5 in 100. Pre- and perinatal complications and environmental exposures appear to have somewhat stronger effects than individual genes, as prenatal exposure to infection or hypoxia increases risk of schizophrenia from 1 in 100 to 2–4 in 100 (1). Schizophrenia is likely the result of an interaction between genetic risk and environmental exposures, and recent studies have attempted to describe that interaction.
To read five five vignettes based on actual experiences (somewhat altered to protect confidentiality), and posted by David Whitehorn (pictured) on his weblog Coming Back to Reality, click here.
