Brain size and Schizophrenia
In the picture above, the different lobes of the brain are color coded. According to the studies found concerning brain volume and schizophrenia, there are two main areas affected. These areas are colored green and the blue lobe that borders on the green. This illustrates why it is so important for research to continue in order to help those afflicted with schizophrenia as it is a lifelong disorder.
A new multi-site brain imaging study shows sub-groups of people use their brains differently. When imitating emotional faces; it shows their ability to interact socially. Individuals with schizophrenia don’t necessarily have a different social brain function than people without mental illness. They do, however, fall into different types of sub-groups and may respond to different types of treatment. Most brain research in mental health field compares disease group to non-disease group labeled as either healthy or normal. That is how they search for biomarkers and this search has been elusive. At this time there is really no effective treatment to handle social impairments. This study was designed to figure out brain networks of social behavior as targets for treatment and research. People with these social impairments do not react as expected in emotional situations like fear, sadness, and happiness (CAMH, 2019).
What is it?
The DSM-5 or the Diagnostic and Statistical Manuel of Mental Disorders is used to diagnose mental disorders. It is maintained by the American Psychiatric Association and updated periodically; last done in 2013. Schizophrenia is described by the current DSM as having at least two of the following symptoms and one of the first three. The symptoms are delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, negative symptoms like diminished emotional expression or motivation. There is a scientific consensus that the illness is a brain-based highly heritable illness. Newer research has shown that schizophrenia is a neurodevelopmental disorder. The current thought about the patho-physiology of schizophrenia include dysregulation of dopamine glutamate and GABA neurotransmitter systems. Testing has found decreased grey matter volume, disturbances in brain and cognitive functioning. There is a delay, unfortunately from the time of onset of illness to time of being treated. It has been found that up to 11% of homeless have been diagnosed as having diagnosis of schizophrenia. Younger people (18-30 Yrs-13%, 31-40 yrs 21%) have shown higher rates; women more than men.
Even with all the research that has been done those afflicted with this disorder continue to face negative stereotypes and stigma. It is felt that an understanding of psychotic illnesses as neurological disorders could help the community at large in viewing illness as no different than any other medical illness (Stalter & Cho, 2018).
Physical changes with Schizophrenia?
Schizophrenia has a variable presentation, course, and outcome. Up to one half of patients can be held to have a good outcome but a meta-analysis of 50 follow-up studies found only 13.5% patient with schizophrenia recover in the long term. A study done to check the effectiveness of the meds showed minimal response in 51% treated with meds versus 30% in placebo group. There was noted a good response from 23% treated with meds versus 14% in placebo group. It was also noted that even in patients who had been stable for 3-6 years on meds relapse after medications are stopped. That is why duration of treatment needs to be individualized and determined by psychologist/psychiatrist not governmental bureaucracy. In addition, the past 20 yrs have found there is less total brain tissue in patients with schizophrenia when compared to ‘normal’ people. The areas this loss is noted are prefrontal, medial or superior temporal lobes.
Unfortunately, few studies have had the power to detect size of the effect. There are also studies that have shown the effects of other factors associated with schizophrenia on structure of the brain. They include pre-illness development influences or co-morbidity. One of these problems is drinking alcohol. It can lead to shrinkage of prefrontal cortex. It must be noted that there is a danger of stopping treatment. Discontinuing after remission increases the risk of relapse and this is the greatest predictor of relapse. This relapse can lead to worse cognitive function, risk of injury to oself-esteemitalization, decreased quality of life, self esteem and reduced ability to return to previous functioning and support. It can also make it difficult to become employed with frequent absences creating few opportunities (Lawrie, 2018).
Schizophrenia is one of the most serious and disabling psychiatric disorder with approximately 1% prevalence across the world. It is a complex syndrome with a combination of symptoms, which can be divided into positive, negative and cognitive categories. Widespread changes in grey matter volume and progressive grey matter volume reduction have been repeatedly reported in both first episode and chronic schizophrenic patients. This study found no significant differences in gender distribution, age, education and total grey matter volume between patients with schizophrenia and normal. After six weeks antipsychotic treatment a progression of grey matter volume was seen. This study also found the effect of treatment was worsened by family history with remission associated with a higher education level. Patients with schizophrenia typically also had a disorder of the self in the resting-state and task-related activities. The study concluded that grey matter baseline may help to predict positive remission as well as general psychopathological and negative symptoms might relate to processing and social cognition. Having family history, longer duration and lower education has been associated with bad prognosis.
There is still research that needs to be done to better understand the pathological mechanism in schizophrenia (Zhang et al, 2018).
Many studies have been done showing reduced whole brain and cortical grey matter volume when matched with control groups. This loss is progressive and points to high risk for psychosis. Elevated cytokines are also seen with reduced grey matter in frontal cortex. Microglia are non-neural cells forming part of the adventitial structure of the central nervous system. Migratory they act as phagocytes (a white blood cell that ‘eats’ debris and bacteria) to clear waste products of the nervous system. As such they play a major role in pruning synapses. Post mortem studies have also shown elevated inflammatory markers and elevated microglial cell density in brains of patients with schizophrenia primarily frontal and temporal lobes. This study found a total cortical grey matter volume significantly lower in schizophrenia patients when compared to healthy controls and also temporal cortical grey matter volume was found to be lower. These studies have shown many break throughs, however, further study is needed to determine the biological significance of elevated microglial activity in the context of brain volume changes in patients with schizophrenia (Selavaj et al, 2018).
Center for Addiction and Mental Health.(2019). Brains of people with schizophrenia-related disorders aren’t all the same. Science Daily.
Lawrie, S. (2018). Are structural brain changes in schizophrenia related to antipsychotic medication? A narrative review of the evidence from a clinical perspective. Therapeutic Advances in Psychopharmacology, 8(11).
Selavaj, S. et al. (2018). Brain TSPO imaging and grey matter volume in schizophrenia patients and in people at ultra high risk of psychosis: An [C]PBR28 study. Schizophrenia Research
Stalter, L. & Cho, R.C. (2018). Improving lives affected by schizophrenia-related brain disorders. SARDAA-Schizophrenia and Related Disorders Alliance of America.
Zhang, X. et al. (2018). Progressive grey matter volume changes in a patient with schizophrenia over six weeks of antipsychotic treatment and their relationship to clinical improvement. Neuroscience Bulletin, 34 (5).