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Schizophrenia is not something I really wanted to focus on much in this blog. Certainly, family dysfunction (and a variety of other stresses including someone just leaving home for the first time to go to college or join the military - an extremely common scenario) may trigger or exacerbate a first psychotic episode in a vulnerable patient, leading to the hallmark delusions and hallucinations.
However, the vast majority of neuroscientists, physicians, and psychologists no longer believe schizophrenia to be primarily a "functional" (psychological or behavioral) disorder.
As I have mentioned several times, given the current state of our knowledge about neural networks in the brain (100 billion nerve cells with over a thousand separate connections each), the idea that schizophrenia is a brain disease is extremely difficult to "prove" beyond a shadow of a doubt, as some mental illness deniers insist we must.
It would be hard to believe that the brain is the only organ in the body that is immune from any chronic developmental disease that would cause microscopic deterioration to its parts - in this case its neural network connections.
The fact that our current treatments for psychosis suck big time, while an important issue in itself, is not really relevant to the argument about the nature of the illness.
Still, because some of my readers keep bringing schizophrenia up, I would like to describe a new study that I think should finally lay at least one argument to rest. The study is brilliantly designed and the results very clear.
In my post Antipsychotics Are for Psychosis, Not Insomnia, I discussed an earlier study that looked at the role of antipsychotic medications in the development of severe brain shrinkage (cerebral atrophy) that is seen in many severe cases of chronic schizophrenia. That study concluded that both the underlying disease and the medication both contributed to this phenomenon. The study was not conclusive, however, because there was no actual control group.
At last, we now have the very first prospective study about this issue by Andrew M. McIntosh, David C. Owens, William J. Moorhead, Heather C. Whalley, Andrew C. Stanfield, Jeremy Hall, Eve C. Johnstone, and Stephen M. Lawrie. It has been published on line in the journal Biological Psychiatry.
A prospective study is one that follows over time a group of similar individuals (cohort) who differ with respect to certain factors under study, in order to determine how these factors affect rates of a certain outcome. In this case, 162 individuals at high genetic risk of schizophrenia and 36 healthy control subjects were followed over 10 years.
The high risk subjects had at least two first- or second degree relatives affected with schizophrenia. None of the subjects in the study had any psychotic symptoms or other evidence of schizophrenia at the beginning of the study.
Participants received detailed clinical and up to five MRI scan assessements at 2-year intervals. The results? 17 of the 146 high-risk subjects who were scanned developed schizophrenia over the 8 years of the study. People at high genetic risk of schizophrenia had significantly greater reductions over time than the control group for whole brain volume and left and right prefrontal and temporal lobes.
Greater prefrontal reductions were shown in high-risk subjects who subsequently became unwell compared with those who did not. These changes were significantly associated with increasing severity of psychotic symptoms.
In other words, cerebral atrophy was developing in these patients before they had been treated with any antipsychotic medication. In fact, it started to develop before they even had any symptoms! So the atrophy is clearly present in the absense of any treatment at all.
Oh, and guess what? The study was not funded by the drug companies, nor do any of the authors declare any drug company connections.
So, if you are the unfortunate parent of a person with schizophrenia who is dead set on blaming yourself for the condition of your child, I would ask two questions. These are rhetorical questions, since I have no way of evaluating the accuracy of your anwers:
First, were you an abusive or neglectful parent or the spouse of an abusive or neglectful parent? If not, what on earth are you feeling so guilty about?
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