Lieberman Jeffrey A, Perkins Diana O, Jarskog L Fredrik
Columbia University College of Physicians and Surgeons, New York, NY, USA.
CNS Spectr. 2007 Mar;12(3 Suppl 4):1-13; quiz 14. doi: 10.1017/s1092852900025906.
Schizophrenia is a neurodevelopmental disorder associated with persistent symptomatology, severe functional disability, and residual morbidity characteristic of neurodegenerative brain diseases. The illness begins with genetic susceptibility and generally expresses itself after puberty through subtle changes that begin during the prodromal stage. Symptoms get progressively worse and tend to become more resistant to treatment with each relapse. Evidence for a neuroprotective effect of some forms of early treatment is beginning to emerge. While the underlying mechanisms remain uncertain, atypical antipsychotics may counteract some of the progressive deteriorative effects by enhancing synaptic plasticity and cellular resilience. However, identifying and treating patients in the earliest disease states presents methodological challenges as there is no consensus on the best methods of intervention and differences in at-risk children are not readily detectable or substantial enough to predict which ones will develop schizophrenia. In this expert roundtable supplement, Jeffrey A. Lieberman, MD, reviews the historical context of progressive deterioration in schizophrenia. Next, Diana O. Perkins, MD, MPH, reviews some of the challenges to early identification of illness as well as the impact of early versus delayed treatment. Finally, L. Fredrik Jarskog, MD, focuses on the neurobiology of functional progression in schizophrenia as well as pharmacology and the potential for neuroprotection.
精神分裂症是一种神经发育障碍，与持续的症状、严重的功能残疾以及神经退行性脑疾病特有的残留发病率相关。该疾病始于遗传易感性，通常在青春期后通过前驱期开始的细微变化表现出来。症状会逐渐恶化，并且每次复发后往往对治疗更具抗性。一些早期治疗形式具有神经保护作用的证据开始显现。虽然潜在机制仍不确定，但非典型抗精神病药物可能通过增强突触可塑性和细胞恢复力来抵消一些渐进性恶化作用。然而，在疾病的最早阶段识别和治疗患者存在方法学挑战，因为对于最佳干预方法尚无共识，而且处于风险中的儿童之间的差异不易察觉或不够显著，无法预测哪些儿童会发展为精神分裂症。在本专家圆桌会议增刊中，医学博士杰弗里·A·利伯曼回顾了精神分裂症进行性恶化的历史背景。接下来，医学博士、公共卫生硕士戴安娜·O·珀金斯回顾了早期识别疾病的一些挑战以及早期治疗与延迟治疗的影响。最后，医学博士L·弗雷德里克·雅斯科格专注于精神分裂症功能进展的神经生物学以及药理学和神经保护的潜力。
