2011 issue 3

Back

Volume 20, issue 3

World Psychiatry Forum

Pathophysiology of schizophrenia: do we have any solid evidence of interest to clinicians?

Stephen M. Lawrie1, Bayanne Olabi1, Jeremy Hall1, Andrew M. McIntosh1
1. Division of Psychiatry, School of Molecular and Clinical Medicine, Royal Edinburgh Hospital, Morningside, Edinburgh EH10 5 HF, UK
Postępy Psychiatrii i Neurologii 2011; 20(3): 159–174
Keywords: schizophrenia, etiology, pathophysiology, diagnosis, early diagnosis, treatment response, predictive power, likelihood ratio

Abstract

A diagnosis of schizophrenia, as in most of psychiatric practice, is made largely by eliciting symptoms with reference to subjective, albeit operationalized, criteria. This diagnosis then provides some rationale for management. Objective diagnostic and therapeutic tests are much more desirable, provided they are reliably measured and inter preted. Defi nite advances have been made in our understanding of schizophrenia in recent decades, but there has been little consideration of how this information could be used in clinical practice. We review here the potential utility of the strongest and best replicated risk factors for and manifestations of schizophrenia within clinical, epidemiological, cognitive, blood biomarker and neuroimaging domains. We place particular emphasis on the sensitivity, specifi city and predictive power of pathophysiological indices for making a diagnosis, establishing an early diagnosis or predicting treatment response in schizophrenia. We conclude that a number of measures currently available have the potential to increase the rigour of clinical assessments in schizophrenia. We propose that the time has come to more fully evaluate these and other well replicated abnormalities as objective potential diagnostic and prognostic guides, and to steer future clinical, therapeutic and nosological research in this direction.