Trying to get a jump on schizophrenia

Brain images denoting risk could key early treatment

Health & Fitness

January 12, 2003|By William Hathaway | William Hathaway,Special to the Sun

Dr. Godfrey Pearlson and his colleagues at the Institute of Living in Hartford, Conn., hope one day they will be able to look at the image of a living brain and know whether it will be tormented by the delusions of schizophrenia.

"It's possible that the brains of schizophrenics are damaged before their illness becomes evident," said Pearlson, who was recruited from Johns Hopkins University to head the new $20 million Olin Neuropsychiatry Research Center at the institute. "We want to find people before they experience symptoms of psychosis."

Pearlson, a professor of psychiatry at Yale University School of Medicine, soon expects to receive a new functional magnetic resonance imaging, or fMRI, machine capable of capturing in great detail images of the brain at work.

Researchers at the institute and at Yale Medical School will use the fMRI to identify -- and, they hope, offer earlier treatment for -- people deemed at high risk of developing schizophrenia, a disease characterized by incoherent thinking, disordered memory and delusions. One of the goals of the research is to tease out differences in the brains of the healthy and of those who become ill.

Advances in imaging technology already have started to correct some misconceptions about the baffling disease, which afflicts one of every 100 people.

Many scientists such as Pearlson conclude that schizophrenia is probably similar to diabetes, in that it is a disease in which patients inherit varying degrees of genetic susceptibility that is triggered by environmental causes.

Genes are known to play a role in whether an individual will become schizophrenic. An identical twin of a schizophrenic has a 50 percent risk of developing the disease, meaning other factors, such as infection early in brain development, must be involved.

Before imaging technologies became widely available, scientists had to rely on autopsies of schizophrenics to determine the extent of brain damage caused by the disease. But what happens to the brain just before onset of the disease and in the years that follow remains a matter of debate.

Imaging studies conducted in the mid-1970s showed people who developed schizophrenia had enlarged ventricles and that the size of those fluid-filled cavities in the brain did not appear to get larger over time. That led many scientists to conclude brain abnormalities in schizophrenics were formed by birth and the disease was triggered in teen-age years or early adulthood by hormonal or unknown environmental causes.

"Ten years ago, we were talking about static brain damage that happened in the uterus," Pearlson said. "But the picture now is more complicated."

Observational studies have shown that schizophrenics exhibit some early warning signs, such as emotional blunting, withdrawal, vagueness in thinking or changes in self-perception.

The problem is that those symptoms also are associated with a variety of other problems, and in the case of teen-agers, often deemed a part of normal development.

Psychiatrists can now predict about 20 percent to 50 percent of people who will develop severe psychosis but "that means in 50 percent to 80 percent of cases" they can't, said Dr. Thomas McGlashan, professor of psychiatry at Yale who has studied early development of schizophrenia.

McGlashan and Pearlson have united to create a library of images of Connecticut residents' brains -- both healthy and deemed at risk of succumbing to schizophrenia -- to see if they can improve those odds.

A study published recently in the journal Lancet suggests that in people deemed to be at risk of developing schizophrenia, there are subtle differences between the brains of those who go on to develop the disease and those who do not. The researchers from the University of Melbourne in Australia found that people who went on to develop the disease had slightly less brain tissue in the frontal cortex, medial temporal lobe and cingulate gyrus, all areas of the brain implicated in schizophrenia.

McGlashan also is studying whether early intervention with drugs can limit the loss of brain tissue and improve outcomes in people at high risk of schizophrenia.

"Whether or not there is an immediate treatment advantage of treating people at risk, we are understanding the disease better," McGlashan said.

William Hathaway is a reporter for the Hartford Courant, a Tribune Publishing newspaper.

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