CINS is planned as a multidisciplinary research centre with a goal to ‘individualize’ the treatment of schizophrenia. It has started up January 1, 2009. At present, the choice of treatment in psychiatry, but, especially in schizophrenia is a matter of trial-and-error. There are no predictors, there are no markers, and little effort is made to match treatment to the patient’s pathology or pathophysiology. The primary aims of CINS are to develop tools to predict the effect of specific interventions in the individual patient with schizophrenia – and to provide a scientific basis for new treatment and preventive strategies directed at the pathogenetic and pathophysiological disturbances in the patient.

Schizophrenia is a severe brain disease with complex pathogenetic and pathophysiological mechanisms and inadequate treatments. A precondition for prevention as well as for development of more effective treatments is a better understanding of the complex neurobiological and environmental mechanisms involved in the development of the clinical symptoms. 

Such studies depend on interdisciplinary collaboration involving the use of psychometric, cognitive, psychophysiological, brain imaging, and genetic methods. Until now most clinical schizophrenia studies have focused on disturbances examined with either one or two of the above mentioned methods. One of the strengths of CINS is the unique opportunity of studying the effect of specific interventions on genetically determined intermediate phenotypes – or endophenotypes – within all the mentioned domains. We have illustrated this in fig. 1

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Fig. 1. Please, refer to the text for elaboration

Benefits for patients

Schizophrenia is a disorder that afflicts the young, often stays with them for life, and exerts tremendous suffering in both patients and relatives, and for the larger society, the costs exceed the costs for cardio-vascular diseases. There is a need for more effective treatments – and for knowledge that can help us to prevent the invalidating and deteriorating course in many patients. We expect three major outcomes of the studies in CINS:

First, we will generate a better understanding of the genesis of this illness (mapping Fig. 1) which will allow us to provide much better guidance and education about the true nature of schizophrenia to patients and families

Second, we expect to find specific markers and predictors that will help us match patients to specific treatments, this should help end the current practise of “trial-and-error’ treatment matching and lead us to towards rational individualized treatment

Finally, we hope that the pathophysiological deficits and endophenotypes identified in this project will provide a more rational target for drug delivery (rather than the current emphasis on surface symptoms) thus leading to novel treatments in the long run

CINS will:

1. Characterize endophenotypes for schizophrenia that can form a basis for interventions; and 2. Study the effect of specific pharmacological and non-pharmacological interventions on these endophenotypes - and on the course of the disease - in order to develop a scientific basis for treatments and preventive interventions targeting schizophrenic endophenotype. In order to do this we will:

1. Recruit, study, and follow antipsychotic-naïve first-episode patients with schizophrenia, their healthy relatives and matched controls.  Patients and controls are examined at base-line and after 6 weeks and 6, and 12 months of treatment, healthy siblings at base-line. Further follow-up studies are planned after 2, 5, and 10 years. Additional subjects will be recruited in Utrecht and London. Part of the data will analysed together as part of the PECANS (Pan European Collaboration Antipsychotic Naïve Schizophrenia) project
2. Study monozygotic (MZ) and dizygotic( DZ) twins discordant – or concordant – for schizophrenia or schizophreniform disorder  
3. Recruit, study, and follow prodromal “pt.” meeting the criteria for being at Ultra High Risk of developing a psychotic disorder within 12 months
4. Re-examine two previous cohorts of antipsychotic-naïve first-episode schizophrenic pt. and controls with focus on the relation of treatment, drug-abuse, and stress to functional as well as neurobiological outcome. Parts of these data will also be pooled with data from Utrecht and London
5. Study the effects in pt. and healthy controls of interventions with compounds modulating specific transmitttersystems believed to be involved in the pathophysiology of schizophrenia on psychophysiological and cognitive candidate endophenotypes. Since we also want to study the effect of age on the endophenotypes and on the effects of interventions, we plan to study children, as well as adolescents and young, middle-aged, and elderly adults