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The Early Stages of Schizophrenia

Edited by Robert B. Zipursky, M.D., and S. Charles Schulz, M.D.

  • ISBN 978-0-88048-840-2
  • Item #8840

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In sharp contrast to the prevailing belief during the past century that schizophrenia inevitably results in a progressive deteriorating clinical course, research since the early 1980s shows that early intervention can significantly improve the long-term outcome of this complex illness. With very early treatment, many affected individuals can achieve an excellent recovery.

This research has set off an explosion of interest in—and optimism about—early intervention in what was once thought to be an intractable illness. The work of 19 top experts in the field of schizophrenia research is available in this single, powerful volume that introduces the concept of early intervention and describes the clinical approaches most likely to facilitate the fullest degree of recovery. Contributors review the clinical and epidemiological evidence that supports the importance of comprehensive and optimal treatment during the early stages of schizophrenia—treatment that must encompass emotional, family, and vocational as well as pharmacological needs of affected individuals.

This rich overview is organized into three major parts:

  • Early Intervention, Epidemiology, and Natural History of Schizophrenia, which presents an overview of important concepts in early intervention and reviews our current understanding of the outcome from a first episode of schizophrenia, including which features predict the onset of first-episode psychosis
  • Management of the Early Stages of Schizophrenia, which reviews the critical management issues in providing specialized and optimal care to this complex patient group and their families, including meeting the patient's emotional needs
  • Neurobiological Investigations of the Early Stages of Schizophrenia, which describes important specialized topics that contribute to our understanding of the first episode of schizophrenia, including schizophrenia in childhood and adolescence and cognitive dysfunction in the early stages of schizophrenia

This ground-breaking volume provides reason for new optimism about the treatment and outcome of schizophrenia. With its dramatically different perspective on the potential long-term outcome of a still-baffling illness, this volume is a must-read for mental health practitioners and educators, psychiatry residents, and family members of affected individuals.


  • Contributors
  • Introduction
  • PART I: Early Intervention, Epidemiology, and Natural History of Schizophrenia
  • Chapter 1. Closing In: What Features Predict the Onset of First-Episode Psychosis Within an Ultra-High-Risk Group?
  • Chapter 2. Epidemiology of First-Episode Schizophrenia: The Suffolk County Mental Health Project
  • Chapter 3. Investigating the Early Stages of Schizophrenia: The Hillside Prospective Study of First-Episode Schizophrenia
  • PART II: Management of the Early Stages of Schizophrenia
  • Chapter 4. Optimal Pharmacologic Management of the First Episode of Schizophrenia
  • Chapter 5. Meeting the Patient's Emotional Needs
  • Chapter 6. Family Intervention in the Early Stages of Schizophrenia
  • PART III: Neurobiological Investigations of the Early Stages of Schizophrenia
  • Chapter 7. Childhood-Onset Schizophrenia: Research Update
  • Chapter 8. Schizophrenia During Adolescence
  • Chapter 9. Cognitive Impairment in Early-Stage Schizophrenia
  • Afterword
  • Index


    Evelyn J. Bromet, Ph.D.
    April A. Collins, M.S.W.
    Marilyn A. Davies, Ph.D.
    Shmuel Fennig, M.D.
    Robert L. Findling, M.D.
    Lee Friedman, Ph.D.
    John T. Kenny, Ph.D.
    Sanjiv Kumra, M.D.
    Jeffrey A. Lieberman, M.D.
    Elizabeth McCay, R.N., Ph.D.
    Patrick D. McGorry, M.D., Ph.D.
    Ramin Mojtabai, M.D., Ph.D.
    Robert Nicolson, M.D.
    Lisa J. Phillips, B.Sc., M.Psych.
    Judith L. Rapoport, M.D.
    Kathryn Ryan, R.N., M.Sc.(N.)
    S. Charles Schultz, M.D.
    Alison R. Yung, M.B., M.P.M.
    Robert B. Zipursky, M.D.

About the Authors

Robert B. Zipursky, M.D., is the Tapscott Chair in Schizophrenia Studies at the University of Toronto and the Clinical Director of the Schizophrenia and Continuing Care Program at the Centre for Addiction and Mental Health in Toronto, Canada. A graduate of Cornell University and the McMaster University School of Medicine, Dr. Zipursky completed his residency training in psychiatry at the University of Pittsburgh and a postdoctoral research fellowship at Stanford University. Dr. Zipursky's major research interest has been in applying brain imaging techniques to the study of schizophrenia.

S. Charles Schulz, M.D., is Professor and Head of the Department of Psychiatry at the University of Minnesota Medical School in Minneapolis. Dr. Schulz graduated from the University of Southern California before matriculating to the University of California Los Angeles for his medical degree. After completing residency training at UCLA, Dr. Schulz moved to Bethesda, Maryland, where he served as a Clinical Associate at the National Institute of Mental Health. Over the past 20 years, Dr. Schulz has been involved in studying the use of brain imaging and neuropsychology research techniques to treat adolescents suffering from psychosis.

The Early Stages of Schizophrenia is an inspiring book for mental health professionals who work with people who have schizophrenia. . . . As its editors intended, this volume gives hope.—Kelly M. Askins, M.D., Psychiatric Services, 2/1/2003

All-in-all, The Early Stages of Schizophrenia is well worth reading by all of us in the various mental health disciplines, whether in hospitals, clinics, or community programs. . . . I intend to keep the book in my library and consult it frequently.—Jack R. Anderson, M.D., Metapsychology Online Book Reviews, 2/1/2003

Schizophrenia remains one of the most challenging illnesses in all of medicine. This book provides a valuable clinical and research perspective on the early stages of schizophrenia, including its presentation and diagnosis, as well as treatment and research implications. It provides a wealth of information that should be of interest to a wide audience.—John M. Kane, M.D., Vice President for Behavioral Health Services, Chairman, Department of Psychiatry, Hillside Hospital, Glen Oaks, New York

Recent studies of the early stages of schizophrenia offer tantalizing clues to pathophysiology, brain plasticity, prevention, drug treatment, and coping strategies for this disorder. Drs. Zipursky and Schulz have compiled pivotal contributions to this burgeoning field, including their own, and translated them into practical treatments offering new hope that the course of schizophrenia can be changed. It is a timely and representative sampling of the exciting current progress with schizophrenia.—Thomas H. McGlashan, M.D., Professor of Psychiatry, Yale University School of Medicine, New Haven, Connecticut

The greater safety and better efficacy on negative, cognitive, and affective symptoms of schizophrenia produced by some atypical antipsychotics offer the hope that the early treatment of this disease at or before the first full episode can stop schizophrenic deterioration before it starts. This book tells us the state of the art of how to prevent schizophrenic deterioration, both by pharmacological and by psychosocial treatment. The later is important because it may prevent the breaking of family ties and resume the normal course of vocational development to the patient.—John M. Davis, M.D., The Psychiatric Institute, University of Illinois, Chicago

Drs. Zipursky and Schulz have seized the publishing high ground with this concise, lucid, and authoritative summary of a very important emerging area of schizophrenia research and treatment. Recent developments in characterizing genetic and environmental factors associated with the risk for early-onset psychosis and the importance of early treatment have made it increasingly critical that we understand the biology and treatment of the first episode. This volume brings together investigators and clinicians at the cutting edge of this aspect of the schizophrenia syndrome. The chapters are scholarly and comprehensive. This book is an important addition to the library of clinicians and researchers interested in the evolution of the schizophrenia syndrome.—Daniel R. Weinberger, M.D., Chief, Clinical Brain Disorders Branch, Division of Intramural Research Programs, National Institute of Mental Health, Bethesda, Maryland

This should be a useful compilation of mostly published material and clinical experience in the area of early schizophrenia. The chapters on prediction of psychosis in individuals at high risk, childhood-onset schizophrenia, and pharmacological management should prove to be particularly useful to both adult and child/adolescent psychiatric clinicians. The book should reinforce the hope engendered by the recent increase in early stages of psychosis in general and schizophrenia in particular.—Ashok Malla, MBBS;FRCPC;MRCPsych;DPM, Professor, Depts Psychiatry, Family Med, & Epidemiology, Director, Prevention & Early Intervention Psychoses Univ Western Ontario & London Health Sciences Centre

The choice of authors for this book is astute. . . . The reading is easy, informative, and captivating. . . . This book is reader-friendly, has an abundance of practical information, and introduces the developing events of the next decade.—Y. D. Lapierre, M.D., Annales RCPSC, 2/1/2003

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