Recent advances in understanding schizophrenia.
Recent advances in understanding schizophrenia.
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DOI：
10.12703/p6-57
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Keshavan M
中科院分区：
文献类型：
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作者：
Haller CS;Padmanabhan JL;Lizano P;Torous J;Keshavan M
精神分裂症是一种高度致残的疾病，其原因仍有待更好地了解，治疗方法也有待改进。然而，最近在诊断、病因学和治疗方面取得了一些进展。尽管诊断的可靠性随着操作标准的提高而提高，包括精神障碍诊断和统计手册（DSM）第五版，但由于与其他精神障碍的实质性重叠，疾病边界的有效性仍然不清楚。最近强调维度方法和翻译生物行为研究领域的标准可能最终有助于走向基于神经科学的精神分裂症的定义。精神分裂症的病因现在被认为是多因素的，多个小效应和较少的大效应易感基因与几个环境因素相互作用。这些因素可能导致发育介导的神经可塑性改变，表现为神经递质和回路功能障碍的级联反应以及青春期早期发病的连接受损。这样的病因病理学的理解，激发了新的药理学和心理治疗的目标重新搜索。解决疾病的核心特征，如认知缺陷和阴性症状，并制定假设驱动的早期干预和预防战略是该领域的高度优先目标。精神分裂症是一种严重的慢性精神障碍，是所有医学中最致残的疾病之一。据美国国家精神卫生研究所（NIMH）估计，美国18岁以上的人中有240万人患有精神分裂症。这种疾病通常在青春期开始，并破坏学校，家庭和工作的形成目标，导致相当大的痛苦和残疾，并将预期寿命缩短约20年。治疗结果各不相同，有些人成功地得到治疗并重新融入社会（即重返工作岗位）。然而，尽管该领域的许多专家做出了努力，但精神分裂症仍然是一种慢性复发和缓解性疾病，与社会和职业功能的严重损害以及寿命缩短有关。综合治疗需要采取多模式方法，包括精神药理学、心理社会干预以及住房和经济维持援助。迄今为止的研究表明，遗传，神经，行为和环境因素的网络负责其发展和过程。本文旨在总结和解释精神分裂症研究的最新进展，提出这些最新发现如何可能导致更好地理解和可能进一步发展有效的治疗方法，并强调在我们对诊断，病因学和治疗的理解中发生的范式转变。
Schizophrenia is a highly disabling disorder whose causes remain to be better understood, and treatments have to be improved. However, several recent advances have been made in diagnosis, etiopathology, and treatment. Whereas reliability of diagnosis has improved with operational criteria, including Diagnostic and Statistical Manual of Mental Disorders, (DSM) Fifth Edition, validity of the disease boundaries remains unclear because of substantive overlaps with other psychotic disorders. Recent emphasis on dimensional approaches and translational bio-behavioral research domain criteria may eventually help move toward a neuroscience-based definition of schizophrenia. The etiology of schizophrenia is now thought to be multifactorial, with multiple small-effect and fewer large-effect susceptibility genes interacting with several environmental factors. These factors may lead to developmentally mediated alterations in neuroplasticity, manifesting in a cascade of neurotransmitter and circuit dysfunctions and impaired connectivity with an onset around early adolescence. Such etiopathological understanding has motivated a renewed search for novel pharmacological as well as psychotherapeutic targets. Addressing the core features of the illness, such as cognitive deficits and negative symptoms, and developing hypothesis-driven early interventions and preventive strategies are high-priority goals for the field. Schizophrenia is a severe, chronic mental disorder and is among the most disabling disorders in all of medicine. It is estimated by the National Institute of Mental Health (NIMH) that 2.4 million people over the age of 18 in the US suffer from schizophrenia. This illness typically begins in adolescence and derails the formative goals of school, family, and work, leading to considerable suffering and disability and reduced life expectancy by about 20 years. Treatment outcomes are variable, and some people are successfully treated and reintegrated (i.e. go back to work). Despite the effort of many experts in the field, however, schizophrenia remains a chronic relapsing and remitting disorder associated with significant impairments in social and vocational functioning and a shortened lifespan. Comprehensive treatment entails a multi-modal approach, including psychopharmacology, psychosocial interventions, and assistance with housing and financial sustenance. Research to date suggests a network of genetic, neural, behavioral, and environmental factors to be responsible for its development and course. This article aims to summarize and explain recent advancements in research on schizophrenia, to suggest how these recent discoveries may lead to a better understanding and possible further development of effective therapies, and to highlight the paradigm shifts that have taken place in our understanding of the diagnosis, etiopathology, and treatment.