Thomas McGlashan

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Dr. Thomas McGlashan (born 1942) is an American professor of psychiatry at Yale University, well known for his academic contributions to the study of schizophrenia and other mental illnesses.

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Professional career

He obtained his medical qualification from the University of Pennsylvania in 1967, and was a staff member in Chestnut Lodge, where according to the New York Times, May 23, 2006, McGlashan "strived for years to master psychoanalysis, only to reject it (for psychosis) after demonstrating, in a landmark 1984 study, that the treatment did not help much at all in people ... with schizophrenia.". [1] These long term follow up and reported outcomes for patients with schizophrenia are known as the Chestnut Lodge studies. [2]

In the 1990s he embarked upon work focused on interventions early in the course of schizophrenia, and became an early advocate and researcher in early detection and intervention for psychosis, [3] including being a key participant in the Norway early detection studies (TIPS) [4] and PRIME studies on early treatment of those at risk of schizophrenia [5] The study reported that the drug Olanzapine had a "trend significant" effect in preventing conversion to psychosis and that further, larger studies are warranted. [6]

Professor Thomas McGlashan is the current recipient of the Richard Wyatt Award, [7] of the International Early Psychosis Association, and of the Psychiatric Research Award of the American Psychiatric Association for his contributions to the field of early detection and intervention in psychosis.

Books

Co-authored:

Related Research Articles

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Antipsychotics, also known as neuroleptics, are a class of psychotropic medication primarily used to manage psychosis, principally in schizophrenia but also in a range of other psychotic disorders. They are also the mainstay together with mood stabilizers in the treatment of bipolar disorder.

Psychosis Abnormal condition of the mind

Psychosis is an abnormal condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior that is inappropriate for a given situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities. Psychosis can have serious adverse outcomes.

Schizophrenia Mental disorder characterized by psychosis

Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations, delusions, paranoia, and disorganized thinking. Other symptoms include social withdrawal, decreased emotional expression, and apathy. Symptoms typically develop gradually, begin during young adulthood, and in many cases never become resolved. There is no objective diagnostic test; diagnosis is based on observed behavior, a history that includes the person's reported experiences, and reports of others familiar with the person. To be diagnosed with schizophrenia, symptoms and functional impairment need to be present for six months (DSM-5) or one month (ICD-11). Many people with schizophrenia have other mental disorders, especially substance use disorders, depressive disorders, anxiety disorders, and obsessive–compulsive disorder.

Olanzapine Atypical antipsychotic medication

Olanzapine is an atypical antipsychotic primarily used to treat schizophrenia and bipolar disorder. For schizophrenia, it can be used for both new-onset disease and long-term maintenance. It is taken by mouth or by injection into a muscle.

Chestnut Lodge Former hospital in Maryland, United States

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Olanzapine/fluoxetine Antidepressant medication

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Risk factors of schizophrenia include many genetic and environmental phenomena. The prevailing model of schizophrenia is that of a special neurodevelopmental disorder with no precise boundary or single cause. Schizophrenia is thought to develop from very complex gene–environment interactions with vulnerability factors. The interactions of these risk factors are intricate, as numerous and diverse medical insults from conception to adulthood can be involved. The combination of genetic and environmental factors leads to deficits in the neural circuits that affect sensory input and cognitive functions.

The management of schizophrenia usually involves many aspects including psychological, pharmacological, social, educational, and employment-related interventions directed to recovery, and reducing the impact of schizophrenia on quality of life, social functioning, and longevity.

In medicine, a prodrome is an early sign or symptom that often indicates the onset of a disease before more diagnostically specific signs and symptoms develop. It is derived from the Greek word prodromos, meaning "running before". Prodromes may be non-specific symptoms or, in a few instances, may clearly indicate a particular disease, such as the prodromal migraine aura.

Early intervention in psychosis is a clinical approach to those experiencing symptoms of psychosis for the first time. It forms part of a new prevention paradigm for psychiatry and is leading to reform of mental health services, especially in the United Kingdom and Australia.

Wayne Fenton was an American psychiatrist, well known for his academic contributions to the study of schizophrenia including key contributions to the classification of subtypes.

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Patrick McGorry Australian psychiatrist

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In psychiatry, catastrophic schizophrenia or schizocaria is an obsolete term for a rare and acute form of schizophrenia leading directly to a severe and unremitting chronic psychosis and deterioration of the personality. Catastrophic schizophrenia was thought to be the most severe subtype of schizophrenia, as it had "an acute onset and rapid decline into a chronic state without remission". Catastrophic schizophrenia was also referred to as schizocaria, which was defined by Gerhard Mauz as a psychosis that caused the absolute destruction of the core of one's being. The term "catastrophic schizophrenia" has fallen out of use due to a number of reasons, including advances in psychiatric treatment, which led to a significant decline in patients that fit the diagnosis as their symptoms did not reach the severity of catastrophic schizophrenia, along with modern refinement of the definition and subtypes of schizophrenia. This term has not been included in any version of the DSM. In modern terms, catastrophic schizophrenia would likely be defined as 'acute-onset chronic schizophrenia with poor prognosis'.

At risk mental state is the clinical presentation of those considered at risk of developing psychosis or schizophrenia. Such states were formerly considered treated as prodromes, emerging symptoms of psychosis, but this view is no longer prevalent as a prodromal period can not be confirmed unless the emergence of the condition has occurred.

Basic symptoms of schizophrenia

Basic symptoms of schizophrenia are subjective symptoms, described as experienced from a person's perspective, which show evidence of underlying psychopathology. Basic symptoms have generally been applied to the assessment of people who may be at risk to develop psychosis. Though basic symptoms are often disturbing for the person, problems generally do not become evident to others until the person is no longer able to cope with their basic symptoms. Basic symptoms are more specific to identifying people who exhibit signs of prodromal psychosis (prodrome) and are more likely to develop schizophrenia over other disorders related to psychosis. Schizophrenia is a psychotic disorder, but is not synonymous with psychosis. In the prodrome to psychosis, uncharacteristic basic symptoms develop first, followed by more characteristic basic symptoms and brief and self-limited psychotic-like symptoms, and finally the onset of psychosis. People who were assessed to be high risk according to the basic symptoms criteria have a 48.5% likelihood of progressing to psychosis. In 2015, the European Psychiatric Association issued guidance recommending the use of a subscale of basic symptoms, called the Cognitive Disturbances scale (COGDIS), in the assessment of psychosis risk in help-seeking psychiatric patients; in a meta-analysis, COGDIS was shown to be as predictive of transition to psychosis as the Ultra High Risk (UHR) criteria up to 2 years after assessment, and significantly more predictive thereafter. The basic symptoms measured by COGDIS, as well as those measured by another subscale, the Cognitive-Perceptive basic symptoms scale (COPER), are predictive of transition to schizophrenia.

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Mauricio Tohen is a Mexican American research psychiatrist, Distinguished Professor, and Chairman of the Department of Psychiatry & Behavioral Sciences at the University of New Mexico. Tohen's research has focused on the epidemiology, outcome, and treatment of bipolar and psychotic disorders, and is especially known for innovating the design of clinical trials and the criteria to determine outcome in such diseases. Tohen has edited several books on his specialties. His social awareness has been noted in the promotion of programs to improve mental health care in areas such as substance abuse, bipolar disorder and schizophrenia.

Zucker Hillside Hospital Major teaching and psychiatric hospital

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References

  1. Carey, Benedict (2006-05-23). "A Career That Has Mirrored Psychiatry's Twisting Path". The New York Times. Retrieved 2008-01-18.
  2. McGlashan TH (June 1984). "The Chestnut Lodge follow-up study. I. Follow-up methodology and study sample". Arch. Gen. Psychiatry. 41 (6): 573–85. doi:10.1001/archpsyc.1984.01790170047006. PMID   6428370.
  3. McGlashan TH (1996). "Early detection and intervention in schizophrenia: editor's introduction". Schizophr Bull. 22 (2): 197–9. doi: 10.1093/schbul/22.2.197 . PMID   8782281.
  4. Johannessen JO, Larsen TK, Joa I, et al. (August 2005). "Pathways to care for first-episode psychosis in an early detection healthcare sector: part of the Scandinavian TIPS study". Br J Psychiatry Suppl. 48 (48): s24–8. doi: 10.1192/bjp.187.48.s24 . PMID   16055803.
  5. McGlashan TH, Zipursky RB, Perkins D, et al. (May 2003). "The PRIME North America randomized double-blind clinical trial of olanzapine versus placebo in patients at risk of being prodromally symptomatic for psychosis. I. Study rationale and design". Schizophr. Res. 61 (1): 7–18. doi:10.1016/S0920-9964(02)00439-5. PMID   12648731. S2CID   1118339.
  6. McGlashan TH, Zipursky RB, Perkins D, et al. (May 2006). "Randomized, double-blind trial of olanzapine versus placebo in patients prodromally symptomatic for psychosis". Am J Psychiatry. 163 (5): 790–9. doi:10.1176/appi.ajp.163.5.790. PMID   16648318.
  7. "The Richard J. Wyatt Award". Archived from the original on 2009-10-30. Retrieved 2010-06-23.