Do we have any solid evidence of clinical utility about the pathophysiology of schizophrenia?

A diagnosis of schizophrenia, as in most of psychiatric practice, is made largely by eliciting symptoms with reference to subjective, albeit operationalized, criteria. This diagnosis then provides some rationale for management. Objective diagnostic and therapeutic tests are much more desirable, provided they are reliably measured and interpreted. Definite advances have been made in our understanding of schizophrenia in recent decades, but there has been little consideration of how this information could be used in clinical practice. We review here the potential utility of the strongest and best replicated risk factors for and manifestations of schizophrenia within clinical, epidemiological, cognitive, blood biomarker and neuroimaging domains. We place particular emphasis on the sensitivity, specificity and predictive power of pathophysiological indices for making a diagnosis, establishing an early diagnosis or predicting treatment response in schizophrenia. We conclude that a number of measures currently available have the potential to increase the rigour of clinical assessments in schizophrenia. We propose that the time has come to more fully evaluate these and other well replicated abnormalities as objective potential diagnostic and prognostic guides, and to steer future clinical, therapeutic and nosological research in this direction.     

VISUAL HAZE DETECTION THRESHOLD ASSESSMENT BY ASCENDING METHOD OF LIMITS AND A TRANSFORMED STAIRCASE PROCEDURE IN APPLE JUICE SIMULATIONS UNDER " STORE LIKE" CONDITIONS

Visual haze detection thresholds were assessed in thirty panelists by two methods: the ascending method of limits and a transformed staircase procedure (UDTR, from Wetherill and Levitt 1965). The 3AFC test was used as the response procedure for both methods. Experimental samples consisted of an apple juice simulation (water with food coloring). Haze was added to the samples using formazin, and was calibrated to eleven levels ranging from 0.75–13.30NTU. Haze detection thresholds under store-like conditions (3.55 ± 0.57 [mean ± S.E.] and 3.16 ± 0.50 NTU by the two methods, respectively) were higher than those found previously under more controlled viewing conditions. No differences were found between methods, genders, or order of method presentation ( p > 0.05); a practice effect showed a slight improvement in detection thresholds between sessions ( p = 0.05). Nonparametric tests confirmed the similarities in the threshold estimates from the two methods. The two methods estimated visual haze detection thresholds equally well. However, the ascending method of limits may be preferred method due to the shorter time involved in administration.