Schizophrenia
Philip G. Janicak Stephen R. Marder Rajiv Tandon Morris Goldman Editors Schizophrenia Recent Advances in Diagnosis and Treatment
Editors Philip G. Janicak Department of Psychiatry Rush University Chicago, IL, USA Rajiv Tandon College of Medicine University of Florida Gainesville, FL, USA Stephen R. Marder UCLA Semel Institute Los Angeles, CA, USA Morris Goldman Department of Psychiatry and Behavioral Sciences Northwestern University Chicago, IL, USA ISBN 978-1-4939-0655-0 ISBN 978-1-4939-0656-7 (ebook) DOI 10.1007/978-1-4939-0656-7 Springer New York Heidelberg Dordrecht London Library of Congress Control Number: 2014936416 Springer Science+Business Media New York 2014 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com)
For Rodney and Jude who taught me so much To Paula for her support and her patience For Gitanjali, Anisha, Neeraj, and Nammi for their love and support Phil Steve Rajiv For Hilarie, Frank DeHaan, and Paul Tolpin to whom I am forever grateful Morrie
Preface Over 60 years ago, chlorpromazine dramatically changed our understanding and treatment of patients suffering from schizophrenia. Clozapine reemerged over 20 years ago, representing both our most effective drug for refractory schizophrenia and most vexing in terms of its disadvantages. While some would argue that there has been little progress since, an enormous amount of research into the underlying pathoetiology of schizophrenia has been conducted. This body of knowledge sets the stage for future progress in: Parsing out the heterogeneity associated with the umbrella term schizophrenia, allowing for subgroups to emerge with major implications for more effective treatment approaches. Early identification of at-risk individuals who may be prophylactically treated to prevent or attenuate the disease process. Developing therapies which are more targeted and less deleterious in terms of unwanted effects. Translating symptom reduction into improved functionality and quality of life. At present, the most promising initiatives to facilitate these goals are in the areas of genetics, neuroimaging, and psychosocial rehabilitation approaches. This book is divided into four sections. Part I summarizes our present state of knowledge about the diagnosis and treatment of schizophrenia. Part II considers recent discoveries into its pathoetiology, including the status of biological markers, genetics, and neuroimaging as they relate to diagnosis and potential novel therapeutic approaches. Part III explores the optimization of our present therapeutic approaches, novel treatments, and management of the substantial risks associated with both the illness and its present therapies. Part IV discusses progress in the long- term management of schizophrenia, focusing on biological and psychotherapeutic strategies to improve functioning and facilitate recovery. Finally, Part V considers future directions and predictions of how diagnosis and treatment of schizophrenia will change. vii
viii Preface While the sense of being in a holding pattern is inevitable given the pace of progress in the clinical arena, there is also a growing recognition that the significant strides taken in basic research will usher in a second renaissance in the care of patients suffering from schizophrenia. Chicago, IL, USA Los Angeles, CA, USA Gainesville, FL, USA Chicago, IL, USA Philip G. Janicak, M.D. Stephen R. Marder, M.D. Rajiv Tandon, M.D. Morris Goldman, M.D.
Contents Part I Overview 1 Introduction... 3 Philip G. Janicak, Stephen R. Marder, Rajiv Tandon, and Morris Goldman 2 The Evolving Nosology of Schizophrenia: Relevance for Treatment... 13 Rajiv Tandon and Dawn Bruijnzeel Part II Recent Research into the Pathophysiology of Schizophrenia 3 Overview of Neurobiology... 27 Rajiv Tandon and Morris Goldman 4 Pathophysiology of Schizophrenia... 35 Jaya Padmanabhan and Matcheri S. Keshavan 5 Genetics of Schizophrenia... 59 Alan R. Sanders 6 Recent Advances in Neuroimaging Biomarkers of Schizophrenia... 71 Lei Wang and John G. Csernansky Part III Medical Management of Schizophrenia 7 Acute Management of Schizophrenia... 107 Philip G. Janicak 8 Therapeutic Neuromodulation for Treatment of Schizophrenia... 139 Jeffrey T. Rado and Edgar I. Hernandez ix
x Contents 9 Pharmacogenetics in the Treatment of Schizophrenia... 161 Bill W. Massey, Jiang Li, and Herbert Y. Meltzer 10 Management of Comorbid Medical Conditions in Schizophrenia... 175 Jeffrey T. Rado 11 Management of Water Imbalance in Schizophrenia... 205 Morris Goldman and Pichai Ittasakul 12 Management of Medication-Related Adverse Effects... 225 Wanlop Atsariyasing and Morris Goldman Part IV Management of Schizophrenia and Its Long-Term Complications 13 Long-Term Pharmacological Management of Schizophrenia... 265 Stephen R. Marder 14 Psychosocial Rehabilitation and Psychotherapy Approaches... 275 Robert S. Kern, William P. Horan, Shirley M. Glynn, L. Felice Reddy, Jason Holden, Eric Granholm, Luana R. Turner, Mary E. Sullivan, and William D. Spaulding Part V Future Directions and Implications 15 Conclusion... 315 Philip G. Janicak, Stephen R. Marder, Rajiv Tandon, and Morris Goldman Index... 321
Contributors Wanlop Atsariyasing, M.D. Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand Dawn Bruijnzeel, M.D. Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL, USA John G. Csernansky, M.D. Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Shirley M. Glynn, Ph.D. VA Greater Los Angeles Healthcare System, University of California - Los Angeles, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles, CA, USA Morris Goldman, M.D. Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA Eric Granholm, Ph.D. VA San Diego Healthcare System and University of California, San Diego, CA, USA Edgar I. Hernandez, M.D. Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA Jason Holden, Ph.D. Research Service, VA San Diego Healthcare System, San Diego, CA, USA William P. Horan, Ph.D. VA Greater Los Angeles Healthcare System, University of California - Los Angeles, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles, CA, USA Pichai Ittasakul, M.D. Department of Psychiatry, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Philip G. Janicak, M.D. Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA xi
xii Contributors Robert S. Kern, Ph.D. VA Greater Los Angeles Healthcare System, University of California - Los Angeles, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles, CA, USA Matcheri S. Keshavan, M.D. Department of Psychiatry, Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Harvard Medical School, Boston, MA, USA Jiang Li, Ph.D. Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA Stephen R. Marder, M.D. UCLA Semel Institute, Los Angeles, CA, USA Bill W. Massey, Ph.D. Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA Herbert Y. Meltzer, M.D. Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA Jaya Padmanabhan, M.D. Department of Psychiatry, Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, USA Jeffrey T. Rado, M.D., M.P.H. Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA L. Felice Reddy, Ph.D. VA Greater Los Angeles Healthcare System, USA Alan R. Sanders, M.D. Department of Psychiatry and Behavioral Sciences, NorthShore University HealthSystem, Evanston, IL, USA University of Chicago, Evanston, IL, USA William D. Spaulding, Ph.D. Department of Psychology, University of Nebraska - Lincoln, Lincoln, NE, USA Mary E. Sullivan, M.S.W. Department of Psychology, University of Nebraska - Lincoln, Lincoln, NE, USA Rajiv Tandon, M.D. College of Medicine, University of Florida, Gainesville, FL, USA Luana R. Turner, Psy.D. University of California - Los Angeles, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles, CA, USA Lei Wang, Ph.D. Department of Psychiatry and Behavioral Sciences and Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA