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Objective: To consider (i) whether schizophrenia is of recent (post 1,800 AD) origin, or has existed and was documented by the ancients; (ii) any consistency between modern evidence-based treatments, e.g., medications (clozapine in modern times) and supportive psychotherapy, and ancient treatments; and (iii) whether epigenetics offers the promise of better personal identification of mental illness in future, leading to better-tailored treatments. Method: The authors analyze Greek and Latin medical sources including English, French and German translations, concerning mental illness in classical times, in the light of modern definitions and understandings of schizophrenia. We discuss treatments recommended by classical writers. We consider the possibility of better identification and treatment of schizophrenia in future medicine using epidemiology. Results: Beginning with Asclepiades of Bithynia before 40 BC and subsequently, Aulus Cornelius Celsus (c. 25 BC–c. 50 AD), Soranus of Ephesus (c. 98–c. 138 AD) and Aretaeus of Cappadocia (c. 54–c. 79 AD) a range of mental illnesses consistent with types of schizophrenias are analyzed. Descriptions are more forthcoming after major Roman urbanisation from 27 BC onwards. It is possible that the form and prevalence of schizophrenias altered with urbanisation. Aretaeus worked in Rome and wrote: “The modes of mania are infinite in species, but one alone in genus. For it is altogether a chronic derangement of the mind, without fever.” Conclusion: We conclude that severe mental illness consistent with schizophrenia probably existed in ancient Greece and Rome, with urbanisation of the Roman Empire. The best modern treatments include all-encompassing support (e.g., medication such as clozapine, brief hospitalization, and supportive psychotherapy), recall aspects of treatments provided by some early Greek doctors. We note advances in treatment of cancer through epigenetics and suggest that epigenetics offers the promise of better personal identification of mental illness including schizophrenia, leading to better-tailored treatments. [ABSTRACT FROM AUTHOR]

We conducted a randomized phase III trial to compare the efficacy and safety of two purine analogs, cladribine and fludarabine, with high-dose chlorambucil, in patients with previously untreated chronic lymphocytic leukemia (CLL). Between 1997 and 2004, 223 patients with CLL were randomly assigned to cladribine, fludarabine or chlorambucil, for six cycles of therapy with frequent health-related quality of life assessments. There was no statistical difference for the primary endpoint of overall response with cladribine (70%), fludarabine (67%) and chlorambucil (59%), or complete remission (12%, 7% and 8%), respectively. However, the median progression-free survival (25, 10, 9 months) and median time to second treatment (40, 22, 21 months) were superior with cladribine. There was no significant difference in overall survival (96, 82 and 91 months), nor in toxicity or HRQoL assessments. Monotherapy with cladribine gives superior PFS and longer response duration than fludarabine and chlorambucil as first-line treatment of CLL. [ABSTRACT FROM AUTHOR]