Schizophrenia
SCZ
Research on psychotic symptoms, changes in cognition and social functioning, and genetic associations.
Research question
How well do repeated measures of cognition and everyday functioning in early psychosis cohorts predict the long-term course?
Findings
Functioning across several domains
NICE guidance on psychosis and schizophrenia considers mental health history, cognitive and social development, educational and occupational functioning, and quality of life when assessing psychotic symptoms.
International genome-wide study
An international genome-wide study with up to 76,755 schizophrenia cases and 243,649 controls found associations with common variants at 287 genomic loci.
Quality of life after first-episode psychosis
RAISE-ETP enrolled 404 people with first-episode psychosis and randomized 34 US community mental health clinics. Over two years, participants at clinics offering coordinated team-based care showed larger gains in quality of life and participation in school or work than those at usual-care clinics.
Mean cortical thickness and surface area
In a cross-sectional ENIGMA analysis of 39 samples, 4,474 people with schizophrenia had thinner cortex and smaller cortical surface area on average than 5,098 controls. Differences were largest in frontal and temporal regions.
Treatment continuation in CATIE
In the CATIE randomized trial at 57 US sites, 1,061 of the 1,432 participants who took at least one dose (74%) stopped their assigned study medication before 18 months. The measure included several reasons, such as insufficient benefit, side effects, and patient choice.
Cognitive and functional outcomes in cognitive remediation trials
A meta-analysis of 130 randomized trials involving 8,851 people with schizophrenia spectrum disorders found post-intervention standardized effects favoring cognitive remediation of d=0.29 for global cognition and d=0.22 for overall functioning. The estimates pool trials with different control conditions and measures.
Psychiatric readmissions in Finnish national registers
A Finnish register study followed 62,250 people with prior inpatient care for schizophrenia for up to 20 years. During follow-up, 59% were readmitted for psychiatric care. The within-person adjusted hazard ratio during clozapine use versus periods without antipsychotic use was 0.51 (95% CI 0.49–0.53). Time-varying factors such as clinical status can still confound this comparison.
Limitations
An associated genomic locus may contain several candidate variants or genes. Follow-up work is needed to identify which variants and mechanisms play a role.
Original sources
Psychosis and schizophrenia in adults: prevention and management (CG178)
National Institute for Health and Care Excellence
Mapping genomic loci implicates genes and synaptic biology in schizophrenia
Vassily Trubetskoy et al.
Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program
John M. Kane et al.
Cortical Brain Abnormalities in 4474 Individuals With Schizophrenia and 5098 Control Subjects via the Enhancing Neuro Imaging Genetics Through Meta Analysis (ENIGMA) Consortium
Theo G. M. van Erp et al.
Effectiveness of antipsychotic drugs in patients with chronic schizophrenia
Jeffrey A. Lieberman et al.
Effectiveness, Core Elements, and Moderators of Response of Cognitive Remediation for Schizophrenia: A Systematic Review and Meta-analysis of Randomized Clinical Trials
Antonio Vita et al.
Comparative Effectiveness of Antipsychotic Drugs for Rehospitalization in Schizophrenia—A Nationwide Study With 20-Year Follow-up
Heidi Taipale et al.