EDITORIAL
Schizophrenia Research Where Are We? Bernard A. Fischer, MD
T
his issue of the Journal of Nervous and Mental Disease is dedicated to several intriguing articles related to schizophrenia and psychosis. In very general terms, they concern medications, psychosocial interventions, an examination of relatives’ distress levels, and various investigations into the thoughts and characteristics of people with schizophrenia. Leatherman and colleagues report a reanalysis of data from a randomized trial of long-acting injectable (LAI) risperidone versus oral risperidone. This reanalysis examines whether there is differential benefit of LAI in any of 12 different subgroups. In a separate reanalysis article, Rosenheck et al. use a noninferiority analysis of clinical antipsychotic trials of intervention effectiveness data to determine whether perphenazine is noninferior to olanzapine, risperidone, and quetiapine. Keller and colleagues offer a report on the examination of community adherence to recommended treatment and safety monitoring guidelines Chan et al. then explore whether illness knowledge and insight are related to medication adherence in outpatients with early schizophrenia illness. Turkington and colleagues report patient results from a preliminary look at teaching case managers cognitive behavioral techniques. The impact of illness psychoeducation on delusions and hallucinations is presented by Shiraishi et al. Barrowclough et al. have examined influences on levels of distress in relatives of people experiencing the recent onset of psychosis. Vohs and Lysaker discuss their findings on the link between metacognition and intrinsic motivation in chronic schizophrenia, whereas Bo et al. report on the connection between mentalizing and psychopathy/aggression in this population. Lavelle and colleagues present their review of patient nonverbal communications in relation to symptoms and success of social interactions. Boyette et al. have examined quality of life in relation to symptoms, personality, and aspects of attachment. Finally, Docherty et al. report their interesting findings on the symptom relationships with ambivalence in people with schizophrenia compared with bipolar disorder. Given the range of these topics submitted by researchers from around the globe, I was initially unsure of how to focus this editorial. Aside from a similar participant population, is there another unifying concept to these reports? I think the answer might be noVand I think that might be a good thing. There was a time when one person could know almost everything of importance in the natural world. People such as Francis Bacon, John Locke, Isaac NewtonVeach was an expert on science, theology, and philosophy. Later, there were similar experts with knowledge of all of medicine, then experts in the brain, then in psychiatry. As our knowledge has advanced, it has become increasingly necessary for subspecialization. We have long since reached the point where psychiatric research has become ‘‘subspecialized.’’ For the past 75 years or more, researchers have spent careers specifically investigating schizophrenia or bipolar disorder or depression. As recently as 30 years ago, the eminent schizophrenia researcher knew practically everything then known about the disorder. However, schizophrenia research itself has now become subspecialized. There are schizophrenia research groups with specific interests in pharmacology, neuroimaging, psychosocial interventions, genetics, epidemiology, neurocognitionVthe list goes on and on. What does this mean for schizophrenia research? Realistically, it means that it has become impossible for an individual researcher to be an expert in the entirety of schizophrenia research. How could this be a good thing? It means that schizophrenia research becomes increasingly expensive as entire research teams are required to complete studies and as new methods and technologies are used. It can also mean that researchers can become shortsighted and focus solely on their own research niche, losing sight of the bigger picture in the field. Despite these problems, I would argue that this subspecialization of schizophrenia research is good. Schizophrenia is a syndrome that affects the
Mental Illness Research, Education, and Clinical Center (MIRECC), Capital Health Care Network (VISN 5), Department of Veterans Affairs, Baltimore, MD; and Maryland Psychiatric Research Center (MPRC), University of Maryland School of Medicine, Baltimore. The author declares no conflict of interest. Send reprint requests to Bernard A. Fischer, MD, Maryland Psychiatric Research Center, P.O. Box 21247 Baltimore, MD 21228. E-mail: [email protected]. Copyright * 2014 by Lippincott Williams & Wilkins ISSN: 0022-3018/14/20201Y0004 DOI: 10.1097/NMD.0000000000000066
4
www.jonmd.com
The Journal of Nervous and Mental Disease
& Volume 202, Number 1, January 2014
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
The Journal of Nervous and Mental Disease
& Volume 202, Number 1, January 2014
brainVthe most complex system known to humankind. It impacts the individual, the family, and society. It can change the brain’s connections and chemistry as well as disrupt one’s physical health. Its costs are almost incalculable in terms of resources, impaired relationships, and painVboth from the illness itself and the stigma attached to it. The fact that the field of schizophrenia research has become so subspecialized that it is impossible for one individual to follow every branch of investigation is good. What this means is that we have scientists around the world using their specialized skill sets to understand the illness better, to develop better treatments, and to lessen the burdens of schizophrenia on patients and families. What
* 2014 Lippincott Williams & Wilkins
Editorial
this means is that every conceivable technique and advancement in science will eventually be brought to bear on this illness. What this means is that no matter how much we struggle, how many false leads we pursue, and how much we still do not know, we are pushing forward. Having too much knowledge for any one person to master is good. Of course, to make use of the knowledge gained by these subspecialized research groups, it is necessary for researchers in other areas and clinicians to periodically sample what is happening in the field. In this spirit, I commend to you the articles in this special issue. Varied to be sure, but all focused on pushing schizophrenia research forward. And that is a good thing.
www.jonmd.com
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
5
Schizophrenia Research Where Are We? Bernard A. Fischer, MD
T
his issue of the Journal of Nervous and Mental Disease is dedicated to several intriguing articles related to schizophrenia and psychosis. In very general terms, they concern medications, psychosocial interventions, an examination of relatives’ distress levels, and various investigations into the thoughts and characteristics of people with schizophrenia. Leatherman and colleagues report a reanalysis of data from a randomized trial of long-acting injectable (LAI) risperidone versus oral risperidone. This reanalysis examines whether there is differential benefit of LAI in any of 12 different subgroups. In a separate reanalysis article, Rosenheck et al. use a noninferiority analysis of clinical antipsychotic trials of intervention effectiveness data to determine whether perphenazine is noninferior to olanzapine, risperidone, and quetiapine. Keller and colleagues offer a report on the examination of community adherence to recommended treatment and safety monitoring guidelines Chan et al. then explore whether illness knowledge and insight are related to medication adherence in outpatients with early schizophrenia illness. Turkington and colleagues report patient results from a preliminary look at teaching case managers cognitive behavioral techniques. The impact of illness psychoeducation on delusions and hallucinations is presented by Shiraishi et al. Barrowclough et al. have examined influences on levels of distress in relatives of people experiencing the recent onset of psychosis. Vohs and Lysaker discuss their findings on the link between metacognition and intrinsic motivation in chronic schizophrenia, whereas Bo et al. report on the connection between mentalizing and psychopathy/aggression in this population. Lavelle and colleagues present their review of patient nonverbal communications in relation to symptoms and success of social interactions. Boyette et al. have examined quality of life in relation to symptoms, personality, and aspects of attachment. Finally, Docherty et al. report their interesting findings on the symptom relationships with ambivalence in people with schizophrenia compared with bipolar disorder. Given the range of these topics submitted by researchers from around the globe, I was initially unsure of how to focus this editorial. Aside from a similar participant population, is there another unifying concept to these reports? I think the answer might be noVand I think that might be a good thing. There was a time when one person could know almost everything of importance in the natural world. People such as Francis Bacon, John Locke, Isaac NewtonVeach was an expert on science, theology, and philosophy. Later, there were similar experts with knowledge of all of medicine, then experts in the brain, then in psychiatry. As our knowledge has advanced, it has become increasingly necessary for subspecialization. We have long since reached the point where psychiatric research has become ‘‘subspecialized.’’ For the past 75 years or more, researchers have spent careers specifically investigating schizophrenia or bipolar disorder or depression. As recently as 30 years ago, the eminent schizophrenia researcher knew practically everything then known about the disorder. However, schizophrenia research itself has now become subspecialized. There are schizophrenia research groups with specific interests in pharmacology, neuroimaging, psychosocial interventions, genetics, epidemiology, neurocognitionVthe list goes on and on. What does this mean for schizophrenia research? Realistically, it means that it has become impossible for an individual researcher to be an expert in the entirety of schizophrenia research. How could this be a good thing? It means that schizophrenia research becomes increasingly expensive as entire research teams are required to complete studies and as new methods and technologies are used. It can also mean that researchers can become shortsighted and focus solely on their own research niche, losing sight of the bigger picture in the field. Despite these problems, I would argue that this subspecialization of schizophrenia research is good. Schizophrenia is a syndrome that affects the
Mental Illness Research, Education, and Clinical Center (MIRECC), Capital Health Care Network (VISN 5), Department of Veterans Affairs, Baltimore, MD; and Maryland Psychiatric Research Center (MPRC), University of Maryland School of Medicine, Baltimore. The author declares no conflict of interest. Send reprint requests to Bernard A. Fischer, MD, Maryland Psychiatric Research Center, P.O. Box 21247 Baltimore, MD 21228. E-mail: [email protected]. Copyright * 2014 by Lippincott Williams & Wilkins ISSN: 0022-3018/14/20201Y0004 DOI: 10.1097/NMD.0000000000000066
4
www.jonmd.com
The Journal of Nervous and Mental Disease
& Volume 202, Number 1, January 2014
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
The Journal of Nervous and Mental Disease
& Volume 202, Number 1, January 2014
brainVthe most complex system known to humankind. It impacts the individual, the family, and society. It can change the brain’s connections and chemistry as well as disrupt one’s physical health. Its costs are almost incalculable in terms of resources, impaired relationships, and painVboth from the illness itself and the stigma attached to it. The fact that the field of schizophrenia research has become so subspecialized that it is impossible for one individual to follow every branch of investigation is good. What this means is that we have scientists around the world using their specialized skill sets to understand the illness better, to develop better treatments, and to lessen the burdens of schizophrenia on patients and families. What
* 2014 Lippincott Williams & Wilkins
Editorial
this means is that every conceivable technique and advancement in science will eventually be brought to bear on this illness. What this means is that no matter how much we struggle, how many false leads we pursue, and how much we still do not know, we are pushing forward. Having too much knowledge for any one person to master is good. Of course, to make use of the knowledge gained by these subspecialized research groups, it is necessary for researchers in other areas and clinicians to periodically sample what is happening in the field. In this spirit, I commend to you the articles in this special issue. Varied to be sure, but all focused on pushing schizophrenia research forward. And that is a good thing.
www.jonmd.com
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
5
