TCPR: Dr. Ongur, I know you’ve been interested in creative ways of helping patients with psychosis function well in the community. Are we not doing very well as a field in improving the functioning of our schizophrenic patients?
Dr. Ongur: We actually do very well when using antipsychotics to treat positive symptoms, whether those are symptoms of schizophrenia or manic episodes. We can take patients who are psychotic, put them on an antipsychotic, and over the ensuing weeks most of the positive symptoms will come under control. If they are hearing voices, we can quiet the voices, and we can improve their delusional thinking so that they can do reality testing. And for patients who are manic, we can treat grandiosity and excessive activity.
TCPR: And isn’t that enough to improve patients’ functioning in the community?
Dr. Ongur: There are a couple of lines of research showing that treating the positive symptoms is not sufficient. The first line of research has focused on the relationship between positive symptoms and functioning in the community, broadly defined as living on your own, holding down a job, and having meaningful relationships. As it turns out, the positive and manic symptoms are not directly related to these abilities. In other words, some patients are free of these positive symptoms and yet not able to live independently, and then other patients have significant positive symptoms and can function very well. What does seem to predict functioning, however, is cognitive functioning and negative symptoms.
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