Journal
INTERNATIONAL REVIEW OF PSYCHIATRY
Volume 19, Issue 4, Pages 347-359Publisher
TAYLOR & FRANCIS LTD
DOI: 10.1080/09540260701486563
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Funding
- NIMH NIH HHS [R03 MH077146-01A1, MH 60023, MH 56489, MH 077146, P50 MH 66392-01, R01 MH060023, P50 MH066392, R03 MH077146] Funding Source: Medline
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In spite of significant advances in treatment of patients with schizophrenia and continued efforts towards their deinstitutionalization, a considerable group of patients remain chronically hospitalized or otherwise dependent on others for basic necessities of life. It has been proposed that these patients belong to a distinct etiopathological subgroup, termed Kraepelinian, whose course of illness may be progressive and resistant to treatment. Indeed, longitudinal studies appear to show that elderly Kraepelinian patients follow a course of rapid cognitive and functional deterioration, commensurate with a dementing process, and that their poor functional status is closely correlated with the cognitive deterioration. Recent neuroimaging studies described a pattern of posteriorization of grey and white matter deficits with poor outcome in schizophrenia, and produced a constellation of findings implicating primary processing of visual and auditory information as central to the impaired functional status in this patient group. These studies are summarized in detail in this review and future directions for neuroimaging assessment of very poor outcome patients with schizophrenia are suggested.
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