In our Forum discussion "journal club" series, the editors of Schizophrenia Bulletin provide access to the full text of a recent article. A short introduction by a journal editor gets us started, and then it's up to our readers to share their ideas and insights, questions, and reactions to the selected paper. So read on"
Lawrie SM, McIntosh AM, Hall J, Owens DG, Johnstone EC. Brain structure and function changes during the development of schizophrenia: the evidence from studies of subjects at increased genetic risk. Schizophr Bull. 2008 Mar 1;34(2):330-40. Abstract
Wood SJ, Pantelis C, Velakoulis D, Y"cel M, Fornito A, McGorry PD. Progressive changes in the development toward schizophrenia: studies in subjects at increased symptomatic risk. Schizophr Bull. 2008 Mar 1;34(2):322-9. Abstract
One view of the course of schizophrenia is that of progressive deterioration often ending in a defect end-state. This view has been refuted by long-term course studies reporting many and varied course types (see theme in Schizophrenia Bulletin:14, 1988) and finding a substantial number of patients with good outcome (for example, see recent report of the WHO outcome studies [Hopper et al., 2007]). The neurodevelopmental view of schizophrenia suggests that primary pathophysiology is present early without progression in later stages of illness. Observations of a number of cohorts are compatible with the view that progression, if it occurs, is in the early years of illness. In fact, clinical and functional improvement is often observed in late-life schizophrenia. Several conceptual issues have made observations to date non-decisive on the issue of disease progression. First is the syndrome status of schizophrenia, with no reason to expect different component illnesses to follow the same course. A view of typical course is meaningless if various diseases within the syndrome have inherently different patterns. A second consideration involves the domains of pathology associated with schizophrenia. In many cases impaired cognition appears years before reality distortion or disorganization symptoms and remains static throughout the course of illness. In the same cases, the later-appearing psychosis may be episodic or continuous with decreasing intensity late in life. Avolitional pathology may begin early and be trait-like, or may develop after psychosis and mark a deteriorating aspect of the illness. The question of progression becomes a question of progression of which psychopathological aspect.