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Schizophrenia
Dr. Shitij
Kapur, Head
 The Schizophrenia Research Program is dedicated
to a greater understanding of the "mechanisms of response"
in persons with schizophrenia. We aim to determine how and why people
get better and how they can best maintain their recovery. We ask this
question across the spectrum of schizophrenia -- from first-episode
to chronic phases of the illness, across lines of gender, ethnicity
and biological types. Our research effort combines contributions from
all professional disciplines with the latest neuroimaging, neuropsychological
and psychosocial techniques. Understanding the mechanism of schizophrenia
gives us new approaches to treatment: reduced doses of antipsychotics,
better algorithms for choosing antipsychotics, better augmentation therapies
for patients for whom single-treatments don't work, better group therapies
and more effective educational strategies for families and patients.
Five-Year MRI Study Concludes
We recently concluded our five-year longitudinal
study of comparative mri changes in brain structure between people with
schizophrenia and normal controls. The results revealed no significant
brain structure changes between the groups over the study period. From
this, we concluded that functional and cognitive decline in schizophrenia
is not related to progressive changes in brain processes.
VCFS as a Clue to Schizophrenia
Velo-cardio-facial syndrome is a mental illness,
with a known genetic defect, that presents with schizophrenia-like picture.
We continue our projects examining the genetic basis of the illness
and establishing how these genetic changes express themselves in psychosis.
We have recently initiated a large-scale screening study to detect the
incidence of this genetic defect within the Schizophrenia Program client
population at CAMH.
Early Intervention in Schizophrenia
A single episode of psychosis can have a significant
impact on a person's life. We are continuing our work to prevent psychotic
episodes in people showing early signs of the illness, through low dose
drug treatment and supportive therapy.
Psychosocial Interventions to Enhance Outcome
Ongoing studies examine if brief, targeted education
for patients and families improves quality of life and treatment adherence
and, in turn, if this influences outcome. We continue to develop intervention
protocols to enhance motivation. Our ongoing study, comparing psychoeducation
and activity-oriented groups, continues.
Resource Use and Satisfaction among First Episode
Populations
The First Episode Psychosis Program has joined
with three other Ontario first episode programs to track use of available
resources over a one-year period. The project will compare user rates
and client satisfaction surveys between the centres. The interpretation
of the data collected in this project will enable these centres to improve
services and create effective new services.
How Often Do We Need to Give Antipsychotics?
Daily medication is a common part of psychiatric
illness treatment. However, our brain imaging studies have shown that
the effects of antipsychotics last much longer in the brain than in
the blood. We have been continuing our pilot study looking into the
optimal dosing frequency of antipsychotic medications. Subjects continue
to receive their medications every other day for three months, then
every three days for three months. At the same time, schizophrenia researchers
at the pet Centre are trying to determine the best dosing interval for
the new injectable "depot" atypical antipsychotics.
Augmentation Strategies to Clozapine
While clozapine may provide substantially improved
treatment of resistant symptoms of schizophrenia, some people feel there
is further room for improvement in their treatment. We have begun two
new studies using medication augmentation to a clozapine treatment plan.
The results of these studies may uncover more effective treatment strategies
using available medications.
Magnetic Stimulation to Study Brain Defects in
Schizophrenia
We have used magnetic stimulation techniques
to explore how the connectivity of the different brain regions may be
impaired in schizophrenia. The results show that brain regions in patients
with schizophrenia show impairments in inhibiting each other, especially
when patients are acutely ill. Based on our findings from these studies,
we are now beginning to explore if magnetic stimulation may have a role
in treating symptoms of illness.
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