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    The myth of schizophrenia as a progressive brain disease.

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    Author
    Zipursky, RB; Reilly, TJ; Murray, RM
    Date
    2013-11
    Source Title
    Schizophrenia Bulletin
    Publisher
    Oxford University Press (OUP)
    University of Melbourne Author/s
    Murray, Robin
    Affiliation
    Medical Education
    Metadata
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    Document Type
    Journal Article
    Citations
    Zipursky, R. B., Reilly, T. J. & Murray, R. M. (2013). The myth of schizophrenia as a progressive brain disease.. Schizophr Bull, 39 (6), pp.1363-1372. https://doi.org/10.1093/schbul/sbs135.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/255311
    DOI
    10.1093/schbul/sbs135
    Open Access at PMC
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3796078
    Abstract
    Schizophrenia has historically been considered to be a deteriorating disease, a view reinforced by recent MRI findings of progressive brain tissue loss over the early years of illness. On the other hand, the notion that recovery from schizophrenia is possible is increasingly embraced by consumer and family groups. This review critically examines the evidence from longitudinal studies of (1) clinical outcomes, (2) MRI brain volumes, and (3) cognitive functioning. First, the evidence shows that although approximately 25% of people with schizophrenia have a poor long-term outcome, few of these show the incremental loss of function that is characteristic of neurodegenerative illnesses. Second, MRI studies demonstrate subtle developmental abnormalities at first onset of psychosis and then further decreases in brain tissue volumes; however, these latter decreases are explicable by the effects of antipsychotic medication, substance abuse, and other secondary factors. Third, while patients do show cognitive deficits compared with controls, cognitive functioning does not appear to deteriorate over time. The majority of people with schizophrenia have the potential to achieve long-term remission and functional recovery. The fact that some experience deterioration in functioning over time may reflect poor access, or adherence, to treatment, the effects of concurrent conditions, and social and financial impoverishment. Mental health professionals need to join with patients and their families in understanding that schizophrenia is not a malignant disease that inevitably deteriorates over time but rather one from which most people can achieve a substantial degree of recovery.

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