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Pharmacopsychiatry 2004; 37: 90-97
DOI: 10.1055/s-2004-832661
General Concepts
© Georg Thieme Verlag KG Stuttgart · New York

Course Typologies, Treatment Principles, and Research Concepts

W. Gaebel1
  • 1Department of Psychiatry and Psychotherapy, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Publication History

Publication Date:
16 November 2004 (online)

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In order to explore the mechanisms of illness course and outcome and to improve treatment in schizophrenia and affective disorders, a theoretical framework as provided by the biopsychosocial concept, e. g. the vulnerability-stress-coping model, has been applied. To develop a coherent and valid research strategy, however, respective model components have to be translated into neuroscience concepts and operationalized accordingly. Course characteristics (typologies, markers), course influences (determinants, triggers, modifiers) and course predictors are discussed from a theoretical perspective. Building on this discussion, an integrative concept of illness course and course mechanisms is proposed. Finally, further research recommendations are given. Future research should elaborate on the neurobiological characteristics of course and outcome in methodologically adequate prospective interventional long-term studies.

References

  • 1 American Psychiatric A ssociation. Practice guidelines for the treatment of patients with schizophrenia. Washington, DC; 1997
    Google Scholar
  • 2 Awad A G. Prediction research of neuroleptic treatment outcome in schizophrenia - state of the art. In Gaebel W, Awad AG, editors Prediction of neuroleptic treatment outcome in schizophrenia. Concepts and methods. Wien; Springer 1994: p 1-14
    Google Scholar
  • 3 Berrios G E. The history of descriptive psychopathology. In Mezzich JE, Jorge MR, Salloum IM, editors Psychiatric epidemiology. Assessment concepts and methods. Baltimore; Hopkins University Press 1994: p 47-68
    Google Scholar
  • 4 Bleuler E. Dementia praecox oder Gruppe der Schizophrenien. In Aschaffenburg G, editor Handbuch der Psychiatrie. Leipzig; Deuticke 1911
    Google Scholar
  • 5 Bleuler M. The schizophrenic disorders: long-term patient and family studies. Translated by Clemens SM New Haven, Conn; Yale University Press 1978
    Google Scholar
  • 6 Breier A, Schreiber J L, Dyer J, Pickar D. Course of illness and predictors of outcome in chronic schizophrenia: implications for pathophysiology.  Br J Psychiatry. 1992;  (Suppl 18) 38-43
    PubMedGoogle Scholar
  • 7 Detre T, McDonald M C. Managed care and the future of psychiatry.  Arch Gen Psychiatry. 1997;  54 201-204
    PubMedGoogle Scholar
  • 8 Engel G L. The clinical application of the biopsychosocial model.  Am J Psychiatry. 1980;  137 535-544
    PubMedGoogle Scholar
  • 9 Frank E, Prien R F, Jarrett R B, Keller M B, Kupfer D J, Lavori P W, Rush A J, Weissman M M. Conceptualization and rational for consensus definitions of terms in major depressive disorders. Remission, recovery, relapse, and recurrence.  Arch Gen Psychiatry. 1991;  48 851-855
    CrossrefPubMedGoogle Scholar
  • 10 Gaebel W. Prediction research of outcome in neuroleptic treatment - definitions and concepts. In Gaebel W, Awad AG, editors Prediction of neuroleptic treatment outcome in schizophrenia. Concepts and methods. Wien; Springer 1994: 15-26
    Google Scholar
  • 11 Gaebel W. Illness theory and identity of psychiatry.  Nervenarzt. 2001;  72 329 -330
    CrossrefPubMedGoogle Scholar
  • 12 Gaebel W, Awad A G. Prediction of neuroleptic treatment outcome in schizophrenia. Wien; Springer 1994
    Google Scholar
  • 13 Gaebel W, Frommann N. Long-term course in schizophrenia: concepts, methods and research strategies.  Acta Psychiatr Scand. 2000;  102 (Suppl 407) 49-53
    CrossrefPubMedGoogle Scholar
  • 14 Gaebel W, Jänner M, Frommann N, Pietzcker A, Kopcke W, Linden M, Müller P, Müller-Spahn F, Tegeler J. First vs multiple episode schizophrenia: two-year outcome of intermittent and maintenance medication strategies.  Schizophr Res. 2002;  53 145-159
    Google Scholar
  • 15 Gaebel W, Pietzker A, Ulrich G, Schley J, Müller-Oerlinghausen B. Predictors of neuroleptic treatment response in acute schizophrenia: results of a treatment study with perazine.  Pharmacopsychiatry. 1988;  21 384-386
    PubMedGoogle Scholar
  • 16 Goodman A. Organic unity theory: the mind-body problem revisited.  Am J Psychiatry. 1991;  148 553-563
    PubMedGoogle Scholar
  • 17 Gottesman I I, McGuffin P, Farmer A E. Clinical genetics as clues to the genetics of schizophrenia.  Schizophr Bull. 1987;  13 23-47
    PubMedGoogle Scholar
  • 18 Hegarty J D, Baldessarini R J, Tohen M, Waternaux C, Oepen G. One hundred years of schizophrenia: a meta-analysis of the outcome literature.  Am J Psychiatry. 1994;  151 1409-1416
    PubMedGoogle Scholar
  • 19 Herz M I, Lamberti J S. Prodromal symptoms and relapse prevention in schizophrenia.  Schizophr Bull. 1995;  21 541-551
    PubMedGoogle Scholar
  • 20 Hogarty G E, Goldberg S C, Collaborative Study G roup. Drug and sociotherapy in the aftercare of schizophrenic patients. One-year relapse rates.  Arch Gen Psychiatry. 1973;  28 54-64
    PubMedGoogle Scholar
  • 21 Huber G, Gross G, Schüttler R. A long-term follow-up study of schizophrenia: psychiatric course of illness and prognosis.  Acta Psychiatr Scand. 1975;  52 49-57
    PubMedGoogle Scholar
  • 22 Kendler K S. A Psychiatric dialogue on the mind-body problem.  Am J Psychiatry. 2001;  158 989-1000
    CrossrefPubMedGoogle Scholar
  • 23 Klein D. Harmful dysfunction, disorder, disease, illness and evolution.  J Abnormal Psychol. 1999;  108 421-429
    PubMedGoogle Scholar
  • 24 Kraemer H C, Kazdin A E, Offord D R, Kessler R C, Jensen P S, Kupfer D J. Coming to terms with the terms of risk.  Arch Gen Psychiatry. 1997;  54 337-343
    PubMedGoogle Scholar
  • 25 Larsen T K, Friis S, Haahr U, Joa I, Johannessen J O, Melle I, Opjordsmoen S, Simonsen E, Vaglum P. Early detection and intervention in first-episode schizophrenia: a critical review.  Acta Psychiatr Scand. 2001;  103 323-334
    CrossrefPubMedGoogle Scholar
  • 26 Lehman A F. Evaluating outcomes of treatments for persons with psychotic disorders.  J Clin Psychiatry. 1996;  57 (Suppl 11) 61-67
    PubMedGoogle Scholar
  • 27 Lewis A. The state of psychiatry. New York; The science house 1967
    Google Scholar
  • 28 Lieberman J A, Kane J M, Sarantakos S, Gadaleta D, Woerner M, Alvir M, Ramos-Lorenzi J. Prediction of relapse in schizophrenia.  Arch Gen Psychiatry. 1987;  44 597-603
    PubMedGoogle Scholar
  • 29 Lieberman J A, Sheitman B B, Kinon B J. Neurochemical sensitization in the pathophysiology of schizophrenia: deficits and dysfunction in neuronal regulation and plasticity.  Neuropsychopharmacol. 1997;  17 205-229
    CrossrefPubMedGoogle Scholar
  • 30 Lieberman J A, Perkins D, Belger A, Chakos M, Jarskog F, Boteva K, Gilmore J. The early stages of schizophrenia: Speculations on pathogenesis, pathophysiology, and therapeutic approaches.  Society of Biological Psychiatry. 2001;  50 884-897
    PubMedGoogle Scholar
  • 31 Lilienfeld S, Marino L. Mental disorder as a Roschian concept: a critique of Wakefield’s ”harmful dysfunction” analysis.  J Abnormal Psy . 1995;  104 411-420
    PubMedGoogle Scholar
  • 32 Linszen D, Dingemans P, Lenior M. Early intervention and a five year follow up in young adults with a short duration of untreated psychosis: ethical implications.  Schizophr Res. 2001;  51 55-61
    CrossrefPubMedGoogle Scholar
  • 33 Marengo J. Classifying the courses of schizophrenia.  Schizophr Bull. 1994;  20 519-536
    PubMedGoogle Scholar
  • 34 May P RA. Predicting individual responses to drug treatment in schizophrenia: A test dose model.  J Nerv Ment Dis. 1976;  162 177-183
    PubMedGoogle Scholar
  • 35 McGorry P D, Yung A R, Phillips L J, Yuen H P, Francey S, Cosgrave E M, Germano D, Bravin J, McDonald T, Blair A, Adlard S, Jackson H. Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms.  Arch Gen Psychiatry. 2002;  59 921-928
    Google Scholar
  • 36 Mrazek P J, Haggarty R J. Committee on prevention of mental disorders. Washington DC; National Academy Press 1994
    Google Scholar
  • 37 Nuechterlein K H. Vulnerability models for schizophrenia: State of the art. In Häfner HG, Janzarik W, editors Search for the causes of schizophrenia. Berlin; Springer 1987: pp 297-316
    Google Scholar
  • 38 Piaget J. The psychology of intelligence. In Piaget J, editor The psychology of intelligence. London; Routledge & Kegan Paul 1992
    Google Scholar
  • 39 Post R M. Transduction of psychosocial stress into the neurobiology of recurrent affective disorder.  Am J Psychiatry. 1992;  149 999-1010
    PubMedGoogle Scholar
  • 40 Riecher-Rossler A, Rossler W. The course of schizophrenic psychoses: what do we really know? A selective review from an epidemiological perspective.  Eur Arch Psychiatry Clin Neurosci. 1998;  248 189-202
    CrossrefPubMedGoogle Scholar
  • 41 Strauss J S. Mediating processes in schizophrenia. Towards a new dynamic psychiatry.  Br J Psychiatry. 1989;  155 22-28
    PubMedGoogle Scholar
  • 42 Van Os J, Marcelis M. The ecogenetics of schizophrenia: a review.  Schizophr Res. 1998;  32 127-135
    CrossrefPubMedGoogle Scholar
  • 43 Van Praag H. Over the mainstream: diagnostic requirements for biological psychiatric research.  Psychiatry Res. 1997;  72 201-212
    CrossrefPubMedGoogle Scholar
  • 44 Van Praag H. Nosologomania: a disorder of psychiatry.  World J Biol Psychiatry. 2000;  1 151-158
    PubMedGoogle Scholar
  • 45 Wakefield J. Evolutionary versus prototype analyses of the concept of disorder.  J Abnorm Psychol. 1999;  108 374-399
    CrossrefPubMedGoogle Scholar
  • 46 Warner R. The prevention of schizophrenia: what interventions are safe and effective?.  Schizophr Bull. 2001;  27 551-562
    PubMedGoogle Scholar
  • 47 Watt D C, Katz K, Shepherd M. The natural history of schizophrenia: a 5-year prospective follow-up of a representative sample of schizophrenics by means of a standardized clinical and social assessment.  Psychol Med. 1983;  13 663-670
    CrossrefPubMedGoogle Scholar
  • 48 Wölwer W, Buchkremer G R N, Häfner H G W, Klosterkötter J, Maier W, Möller H -J, Gaebel W. German Research Network on Schizophrenia.  Eur Arch Psychiatry Clin Neurosci. 2003;  253 321-329
    CrossrefPubMedGoogle Scholar
  • 49 Wyatt R J, Damiani L M, Henter I D. First-episode schizophrenia. Early intervention and medication discontinuation in the context of course and treatment.  Br J Psychiatry. 1998;  172 (Suppl) 77-83
    PubMedGoogle Scholar

Prof. Dr. Wolfgang Gaebel

Department of Psychiatry and Psychotherapy

Heinrich-Heine-University Düsseldorf

Bergische Landstrasse 2

40629 Düsseldorf

Germany

Phone: +49 211 922 2000

Fax: +49 211 922 2020

Email: Wolfgang.Gaebel@uni-duesseldorf.de

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