Psychiatric Annals

FROM THE GUEST EDITORS 

This Issue: Managing Comorbidities in Schizophrenia

Michael Y. Hwang, MD; Lewis A. Opler, MD, PhD; Charles H. Kellner, MD

Abstract

This issue of Psychiatric Annals represents an important compilation of the latest information on comorbidity in schizophrenia. As treatment of schizophrenia goes through a reappraisal phase with the widespread use of second-generation antipsychotics, the issue of comorbidity takes on added significance.

Psychiatrists strive to make patients' lives better overall and to recognize the need to treat “the whole patient” to maximize functionality and social re-integration. Thus, attending to treatment of the core symptoms of schizophrenia is only the first step. Managing associated symptoms and side effects of treatment must be addressed with equal vigor.

Of course, accurate diagnosis is the key to successful treatment, and this subject is authoritatively covered in the articles presented here.

We begin with an overview of “Dimensional Approaches to Understanding and Treating Psychosis,” provided by Drs. Robert F. Krueger and Angus W. MacDonald III. This is followed by two articles, “Management of Schizophrenia with Obsessive-Compulsive Disorder” by Drs. Hwang, Opler, and colleagues and “Managing Depression in Schizophrenia” by Dr. Samuel G. Siris, explaining that the comorbid depression and anxiety disorder in schizophrenia have emerged as important clinical and research issues in the past few years. This is partly due to modifications of criteria in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition,1 as well as the advent of new antipsychotic medications that target specific schizophrenic symptoms without the adverse effects of older medications that may mimic affective symptoms or cause cognition impairment.

The effects of traumatic events on patients with schizophrenia are discussed in “Comorbid Posttraumatic Stress Disorder and Schizophrenia” by Dr. Kristina Muenzenmaier and colleagues. Dealing with violent behavior, a subject of concern not only to patients, families, and caregivers but also one that continues to receive prominent media attention, is given comprehensive coverage in “Schizophrenia with Aggressive and Violent Behaviors” by Menahem Krakowski, MD, PhD.

In “Schizophrenia and Co-occurring General Medical Illness,” Drs. Delia Cimpean, William C. Torrey, and Alan I. Green highlight the crucial issues of dealing with comorbid medical and metabolic disorders including obesity, both idiopathic and iatrogenic as a consequence of the atypical antipsychotics.

The issue closes with a commentary from Dr. Sun Young Yum, a second-year psychiatric resident, who discusses “The Starved Brain: Eating Behaviors in Schizophrenia.”

We invite you to enjoy and learn from the excellent contributions on the subject of comorbidity in schizophrenia that comprise this issue of Psychiatric Annals.

Dr. Hwang is associate professor of psychiatry, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey (UMDNJ), Piscataway, NJ. He also is director of schizophrenia research and the residency program at the East Orange Campus of the New Jersey Veterans Affairs (VA) Health Care System, East Orange, NJ.

Dr. Hwang completed his psychiatric residency training at Albert Einstein Medical College, Bronx, NY, and has fellowship in psychiatric research at the Columbia University College of Physicians and Surgeons, New York, NY. Dr. Hwang's research interest is in neuropsychology and psychopharmacologic treatment in schizophrenia with comorbid conditions. He has received a fellowship grant sponsored by the American Psychiatric Association and National Institutes of Mental Health (NIMH) to study schizophrenia with obsessive-compulsive symptoms. He has received investigator initiated grants from pharmaceutical industries and is a principal investigator of VA Mental Illness Research, Education, and Clinical Centers grant at the New Jersey VA Health Care System.

Dr. Hwang has authored more than 100 journal articles and book chapters, primarily in schizophrenia with comorbid disorders. He is co-editor of an APA monograph on management of schizophrenia with comorbid conditions. Dr. Hwang is also on the review boards of several journals and has given numerous presentations.

Dr.…

This issue of Psychiatric Annals represents an important compilation of the latest information on comorbidity in schizophrenia. As treatment of schizophrenia goes through a reappraisal phase with the widespread use of second-generation antipsychotics, the issue of comorbidity takes on added significance.

Psychiatrists strive to make patients' lives better overall and to recognize the need to treat “the whole patient” to maximize functionality and social re-integration. Thus, attending to treatment of the core symptoms of schizophrenia is only the first step. Managing associated symptoms and side effects of treatment must be addressed with equal vigor.

Of course, accurate diagnosis is the key to successful treatment, and this subject is authoritatively covered in the articles presented here.

In This Issue

We begin with an overview of “Dimensional Approaches to Understanding and Treating Psychosis,” provided by Drs. Robert F. Krueger and Angus W. MacDonald III. This is followed by two articles, “Management of Schizophrenia with Obsessive-Compulsive Disorder” by Drs. Hwang, Opler, and colleagues and “Managing Depression in Schizophrenia” by Dr. Samuel G. Siris, explaining that the comorbid depression and anxiety disorder in schizophrenia have emerged as important clinical and research issues in the past few years. This is partly due to modifications of criteria in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition,1 as well as the advent of new antipsychotic medications that target specific schizophrenic symptoms without the adverse effects of older medications that may mimic affective symptoms or cause cognition impairment.

The effects of traumatic events on patients with schizophrenia are discussed in “Comorbid Posttraumatic Stress Disorder and Schizophrenia” by Dr. Kristina Muenzenmaier and colleagues. Dealing with violent behavior, a subject of concern not only to patients, families, and caregivers but also one that continues to receive prominent media attention, is given comprehensive coverage in “Schizophrenia with Aggressive and Violent Behaviors” by Menahem Krakowski, MD, PhD.

In “Schizophrenia and Co-occurring General Medical Illness,” Drs. Delia Cimpean, William C. Torrey, and Alan I. Green highlight the crucial issues of dealing with comorbid medical and metabolic disorders including obesity, both idiopathic and iatrogenic as a consequence of the atypical antipsychotics.

The issue closes with a commentary from Dr. Sun Young Yum, a second-year psychiatric resident, who discusses “The Starved Brain: Eating Behaviors in Schizophrenia.”

We invite you to enjoy and learn from the excellent contributions on the subject of comorbidity in schizophrenia that comprise this issue of Psychiatric Annals.

Reference

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Publishing; 1994.

About the Guest Editors

Dr. Hwang is associate professor of psychiatry, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey (UMDNJ), Piscataway, NJ. He also is director of schizophrenia research and the residency program at the East Orange Campus of the New Jersey Veterans Affairs (VA) Health Care System, East Orange, NJ.

Dr. Hwang completed his psychiatric residency training at Albert Einstein Medical College, Bronx, NY, and has fellowship in psychiatric research at the Columbia University College of Physicians and Surgeons, New York, NY. Dr. Hwang's research interest is in neuropsychology and psychopharmacologic treatment in schizophrenia with comorbid conditions. He has received a fellowship grant sponsored by the American Psychiatric Association and National Institutes of Mental Health (NIMH) to study schizophrenia with obsessive-compulsive symptoms. He has received investigator initiated grants from pharmaceutical industries and is a principal investigator of VA Mental Illness Research, Education, and Clinical Centers grant at the New Jersey VA Health Care System.

Dr. Hwang has authored more than 100 journal articles and book chapters, primarily in schizophrenia with comorbid disorders. He is co-editor of an APA monograph on management of schizophrenia with comorbid conditions. Dr. Hwang is also on the review boards of several journals and has given numerous presentations.

Dr. Kellner is professor and chair, Department of Psychiatry, New Jersey Medical School of UMDNJ in Newark, NJ. He is currently the overall principal investigator of an NIMH-funded multi-site study comparing maintenance electroconvulsive therapy (ECT) with pharmacotherapy. Dr. Kellner received his medical degree from Cornell University, Ithaca, NY, and completed a psychiatry residency at Cedars-Sinai Medical Center, Los Angeles, CA. He then completed a 3-year fellowship in biological psychiatry at the NIMH. From 1984 to 2002, he was on the faculty of the Medical University of South Carolina in Charleston, SC. He was the editor-in-chief of The Journal of ECT for 10 years and has authored numerous publications on ECT.

Dr. Opler is clinical professor of psychiatry, New York University School of Medicine, lecturer in psychiatry, College of Physicians and Surgeons of Columbia University, and director, Research Division, New York State Office of Mental Health. Dr. Opler was among the first clinical investigators to demonstrate that negative symptoms in schizophrenia respond to novel treatment approaches. In carrying out this research, Dr. Opler helped develop the Positive and Negative Syndrome Scale (PANSS). In addition to his work on the assessment and treatment of symptoms in schizophrenia and other psychotic disorders, Dr. Opler carried out psychosocial research on the etiology and prevention of homelessness in people with serious mental illness. An outspoken advocate for the mentally ill, Dr. Opler has received several awards from national mental health organizations.

Authors

10.3928/00485713-20050101-02

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