Ariens Prize Talk, October 2014: Altering the course of Schizophrenia: challenges and opportunities
Schizophrenia is a devastating and usually life-long disorder which generally strikes young adults around the age of 25. It is characterised by delusions, hallucinations, cognitive dysfunction, loss of motivation, social isolation and a profound disruption of real-world function and quality of life. Though antipsychotics help many patients, remission is partial and not all respond, they have the burden of side-effects, and it is very rare that patients can lead normal lives. Progress in the treatment of schizophrenia has been frustratingly slow over the past decades, and there remains an urgent for its better control. Recently, our understanding of the genetic, epigenetic and environmental causes of schizophrenia has considerably improved, and their relationship to aberrant patterns of neurodevelopment has become clearer. There have also been many advances in our ability to identify adolescents and young adults at a high risk of becoming schizophrenic. This raises the radically new possibility of moving beyond symptomatic treatment and modifying the course to - and of - this debilitating disorder. The most promising window for intervention would be in young people just before - or after - conversion. This possibility is supported by recent studies both in clinically high-risk subjects and in rodent models: collectively, they suggest that pharmacotherapy and/or cognitive-psychosocial strategies can delay or moderate the emergence of schizophrenia. Of particular interest are “hybrid” strategies that alleviate symptoms in subjects at risk and, partly as a consequence, reduce the risk of transition to schizophrenia - or other psychiatric disorders. Much work remains to be undertaken. Nonetheless, this is an opportune moment for a broad-based consideration of the challenges and opportunities inherent in efforts to alter the course of schizophrenia. This which would represent a paradigm shift in treatment, and in the lives of those suffering from, or at risk of, this debilitating disorder.