Schizophrenia further developments

Chronic cocaine use can cause a syndrome of insomnia, hallucinations, delusions, and apathy. This syndrome develops around the time when the euphoria turns to a paranoid psychosis, which resembles paranoid schizophrenia. Further, after cessation of cocaine use, the hallucinations may stop, but the delusions can persist. Still, the incidence of a persistent cocaine-induced psychosis appears to be rare. One study found only 4 out of 298 chronic cocaine users receiving a diagnosis of psychotic disorder (Rounsaville et al. 1991). This incidence is approximately the... 

Another serious side effect of clozapine is a risk of seizures. This mainly occurs at higher doses of the drug, and having a seizure is not necessarily a sufficient reason to stop clozapine permanently. If the clozapine has been especially helpful, an anticonvulsant can be added to protect against further seizures. Valproate (Depakote) may be best in this regard because it not only provides protection from seizures but also may help to relieve some of the symptoms of schizophrenia. Recently, it has become clear that two atypical antipsychotic drugs, clozapine and olanzapine, are associated with an increased risk for the development of type II diabetes. 

Cognitive psychotherapeutic techniques have further been developed since their introduction by Beck et al. (1979), who demonstrated their effectiveness in the treatment of depression. Several studies have extended Beck s cognitive therapy to adulthood schizophrenia with encouraging clinical results. The efficacy of cognitive-behavioral approaches could be demonstrated in several key areas in schizophrenia, especially therapy-resistant hallucinations and delusions. Several approaches have also addressed therapeutic efforts in the treatment of associated symptoms such as anxiety and depression. In addition, cognitive-behavioral techniques have been shown to be effective in treatment of chronic schizophrenia, resulting in reduction of distress and disruption due to hallucinations and delusions. In some studies anxiety and depression associated with schizophrenia could also be reduced to some extent. The value of these techniques in children and adolescents has yet to be demonstrated. 

Neurochemists continue to improve the methods they use to measure and analyze chemicals of the brain. They have also developed techniques to study how neurons transmit messages across synapses to other neurons, and how these messages affect the recipients. Synaptic transmission is critical in brain function, and neurotransmitter imbalances have been associated with disorders such as depression and schizophrenia as well as drug abuse. Although the cause or causes of these conditions are not necessarily as simple as too much or too little of a certain neurotransmitter, chemicals such as dopamine and serotonin are undoubtedly involved. Neurotransmitters have been excellent starting points for further, ongoing studies into these issues. 

Clozapine, risperidone, olanzapine, quetiapine, and ziprasidone have all been approved for the treatment of schizophrenia. Data from long-term open evaluations of clozapine demonstrate that improvement is maintained over time, even when the dose is reduced. Further, patients did not develop tolerance to its antipsychotic effect. Naturalistic reports indicate that an adequate trial for acute response in some patients may be at least 6 months. Further, a small number (8 of 14) of previously refractory patients were successfully maintained on clozapine for up to 2 years ( 215). 

Nicotinic receptor agonists have been developed in an attempt to further characterize central nervous system cholinergic function and as potential candidates for the treatment of schizophrenia. 

The multifaceted approach needed for further research development is clearly accomplished in the present volume thanks to its Editors - multidisciplinary researchers themselves. Each chapter in itself - even though it represents an approach to specific aspects of schizophrenia distinctly different from the others -still reflects this need for a complex approach. Each deals with molecular mechanisms, but of different genes, expressing different proteins each deals with structures, which derive larger structures such as the... 

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