The 2015 International Congress on Schizophrenia Research

Never discourage anyone who continually makes progress, no matter how slow.

-Plato

Recently, I attended the 15th International Congress on Schizophrenia Research (ICOSR). This biennial meeting brings together scientists from across the globe who exchange data, techniques, and ideas on the broad range of disciplines involved with discovery in schizophrenia. Approximately 1000 delegates attended, and there were about 300 oral presentations and over 500 poster presentations.

[[{"type":"media","view_mode":"media_crop","fid":"24695","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_5918296671530","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4029","media_crop_rotate":"0","media_crop_scale_h":"100","media_crop_scale_w":"108","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":" ","typeof":"foaf:Image"}}]]ICOSR Founding Directors, Dr S. Charles Schulz (University of Minnesota) and Dr Carol A. Tamminga (University of Texas Southwestern Medical School), turned planning of the 2017 meeting over to a 7-person Executive Committee. I want to personally thank Drs Schulz and Tamminga for their outstanding commitment and dedication to this conference, which they have directed since 1987.

I first attended the ICOSR in 2007 as a general psychiatry resident, thanks to the generous support of my mentors, and was honored to receive a Young Investigator award at the 2009 meeting. These two formative experiences certainly inspired and encouraged me in the pursuit of a career in schizophrenia research. The conference gathering every 2 years is a major opportunity to reach peers and take stock of where the field is heading. Schizophrenia researchers’ talent, dedication, and willingness to share knowledge are equally as impressive.

One sobering “take-home message,” however, was the absence of a major breakthrough in the pharmacological treatment of schizophrenia. I was struck by the symposium “Rising From the Ashes: How Do We Move Ahead on Novel Antipsychotic Drug Development?”¹ The presenters critically reviewed recent so-called failed efforts to develop novel therapies for schizophrenia, including metabotropic glutamate receptor agonists, phosphodiesterase 10 inhibitors, glycine reuptake inhibitors, oxytocin, and intranasal insulin, and how we as a field might chart a path forward. That said, compelling information on the need for medications to decrease relapse as well as novel ways to monitor and reduce medication nonadherence-the major reason for relapse-were also presented.

We can learn just as much, if not more, from the failures as we do from the successes. As Aesop’s fable “The Tortoise and the Hare” reminds us, “slow and steady wins the race.” We are continuing to make incremental progress in many areas, including early detection, prevention, and intervention; risk factor epidemiology; genetics; endophenotypes; neuroinflammation; pharmacological and nonpharmacological treatments, including an increasing use of technology; and recognition and management of medical, psychiatric, and substance use comorbidities.

We are in the midst of a paradigm shift in the field, and new diagnostics and treatments that yield clinically significant improvement for the heterogeneous set of disorders known as schizophrenia are being developed. This includes targets that are “upstream” of dopamine dysfunction, such as abnormalities in the hippocampus and prefrontal cortex, as well as the loss of parvalbumin GABAergic interneurons. Biomarkers of disease risk, treatment response, and response prediction are being identified using imaging, genetics, and blood. Treatment strategies that are based on the stage of illness are being considered. Also for consideration are specific agents that may be more effective for certain subsets of patients (eg, adjunctive anti-inflammatory agents for patients with evidence of inflammation). Because exposure to dopamine D2 antagonists may irreversibly alter neuronal physiology, patients taking these agents may have decreased response to other agents.

Because I am a movie buff, let me offer an analogy between the ICOSR meeting and the Rocky films. Throughout the films, the heavyweight boxing champ Rocky must face his various fears and channel “the eye of the tiger.” In the same way, we need to set our sights on a goal and work for it with complete, unrelenting determination. When I think of 1000 bright, motivated schizophrenia researchers at the same venue, united in the common cause of improving quality of life for our patients with this devastating illness, I am inspired.

It is also great to see past recipients of the Young Investigator award grow over time in their research careers. Drs Schultz and Tamminga are leaving a legacy of energy and enthusiasm-our field’s own “eye of the tiger”-that we must continually harness as we strive toward game-changing findings regarding disease pathophysiology, diagnosis, and treatment. We need and have to do better for our patients, and I remain hopeful that we can and will succeed. More dedicated information about the ICOSR is available at http://www.schizophreniacongress.org.

Disclosures:

1. Grace AA, Rasmussen K, Schmidt CJ, et al. Rising from the ashes: how do we move ahead on novel antipsychotic drug development?” Presented at: 15th International Congress on Schizophrenia Research; March 30, 2015; Colorado Springs, CO.