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Feature Article

Schizophrenia: towards better understanding and better outcomes

Vaughan J Carr

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Abstract

The longer the duration of untreated psychosis, the worse the clinical outcome. The clinical emphasis is therefore on early detection and prompt referral of patients with psychoses, including those with schizophrenia.

Key Points

  • Although strongly heritable, the genetic basis of schizophrenia is unknown and likely to be complex. Research is turning to the study of interactions among genes and between genes and environmental factors.
  • Cognitive impairment is a core feature of schizophrenia and is present before onset of illness, stable over time and a good predictor of long term function.
  • Early detection and treatment of schizophrenia is important in reducing the duration of untreated psychosis and promoting better outcomes.
  • Detection of psychotic symptoms requires asking questions about the experiencing of delusions and hallucinations.
  • Overcoming barriers to engagement in therapy is critical in achieving a good treatment outcome. Clinicians should take the initiative in this process to establish a strong therapeutic relationship.
  • Assertive monitoring of the patient’s physical health is necessary for detection of metabolic, cardiovascular and other abnormalities that are common in schizophrenia due to combinations of medication effects and unhealthy lifestyles.

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