Schizophrenia Research: Research Annual Report 2002

The Schizophrenia Research Program is dedicated to a greater understanding of the "mechanisms of response" in persons with schizophrenia. We aim to determine how and why people get better and how they can best maintain their recovery. We ask this question across the spectrum of schizophrenia -- from first-episode to chronic phases of the illness, across lines of gender, ethnicity and biological types. Our research effort combines contributions from all professional disciplines with the latest neuroimaging, neuropsychological and psychosocial techniques. Understanding the mechanism of schizophrenia gives us new approaches to treatment: reduced doses of antipsychotics, better algorithms for choosing antipsychotics, better augmentation therapies for patients for whom single-treatments don't work, better group therapies and more effective educational strategies for families and patients.

Five-Year MRI Study Concludes

We recently concluded our five-year longitudinal study of comparative mri changes in brain structure between people with schizophrenia and normal controls. The results revealed no significant brain structure changes between the groups over the study period. From this, we concluded that functional and cognitive decline in schizophrenia is not related to progressive changes in brain processes.

VCFS as a Clue to Schizophrenia

Velo-cardio-facial syndrome is a mental illness, with a known genetic defect, that presents with schizophrenia-like picture. We continue our projects examining the genetic basis of the illness and establishing how these genetic changes express themselves in psychosis. We have recently initiated a large-scale screening study to detect the incidence of this genetic defect within the Schizophrenia Program client population at CAMH.

Early Intervention in Schizophrenia

A single episode of psychosis can have a significant impact on a person's life. We are continuing our work to prevent psychotic episodes in people showing early signs of the illness, through low dose drug treatment and supportive therapy.

Psychosocial Interventions to Enhance Outcome

Ongoing studies examine if brief, targeted education for patients and families improves quality of life and treatment adherence and, in turn, if this influences outcome. We continue to develop intervention protocols to enhance motivation. Our ongoing study, comparing psychoeducation and activity-oriented groups, continues.

Resource Use and Satisfaction among First Episode Populations

The First Episode Psychosis Program has joined with three other Ontario first episode programs to track use of available resources over a one-year period. The project will compare user rates and client satisfaction surveys between the centres. The interpretation of the data collected in this project will enable these centres to improve services and create effective new services.

How Often Do We Need to Give Antipsychotics?

Daily medication is a common part of psychiatric illness treatment. However, our brain imaging studies have shown that the effects of antipsychotics last much longer in the brain than in the blood. We have been continuing our pilot study looking into the optimal dosing frequency of antipsychotic medications. Subjects continue to receive their medications every other day for three months, then every three days for three months. At the same time, schizophrenia researchers at the pet Centre are trying to determine the best dosing interval for the new injectable "depot" atypical antipsychotics.

Augmentation Strategies to Clozapine

While clozapine may provide substantially improved treatment of resistant symptoms of schizophrenia, some people feel there is further room for improvement in their treatment. We have begun two new studies using medication augmentation to a clozapine treatment plan. The results of these studies may uncover more effective treatment strategies using available medications.

Magnetic Stimulation to Study Brain Defects in Schizophrenia

We have used magnetic stimulation techniques to explore how the connectivity of the different brain regions may be impaired in schizophrenia. The results show that brain regions in patients with schizophrenia show impairments in inhibiting each other, especially when patients are acutely ill. Based on our findings from these studies, we are now beginning to explore if magnetic stimulation may have a role in treating symptoms of illness.