G. Perini, L.C. Bergamo - Vol. 10, June 2004, Issue 2
Testo Immagini Bibliografia Summary Indice
Nuovi orientamenti per il trattamento delle
fasi acute della schizofrenia
New perspectives in the treatment of acute phases of schizophrenia
Schizophrenia comprises a group of severe mental conditions with 1% lifetime prevalence, onset in late adolescence-early adulthood, positive, negative, cognitive and affective symptoms, variable course, generally chronic and recurrent with residual symptoms and incomplete functional recovery. The disease is one of the first 10 causes of disability in the 15-44 age range, according to WHO classification. If timely treated, its course can be modified, remission obtained and chronic evolution prevented. Recent pathogenetic hypothesis regard schizophrenia as a genetically mediated neurodevelopmental disorder, characterised by structural and functional alterations of specific cerebral areas and such as the Dorsolateral Prefrontal Cortex (DFPLC) and meso-limbic-cortico-striatal circuits. The model proposed by Liberman (2001) is reviewed: four different stages of the disease (premorbid, prodromic, progressive, residual) have been identified, according to different clinical features, pathophysiological process and, possibly, different treatment strategies. This stages identification is crucial for prevention and treatment. Early identification and treatment of the psychosis at the very early onset of the disease prevent chronicity and subsequent negative evolution. Appropriate clinical treatment guidelines are discussed for the acute phase of the disease. The introduction of atypical antipsychotic as first line drug for schizophrenia has been one of the major advances in management of the diseases in recent year. Such an approach should aim at improving response to therapy, minimizing side effect and increasing compliance with treatment plan. In the long term, the application of well-design guidelines to the treatment of schizophrenia should ameliorate the course and prognosis of the diseases.