I once heard a psychiatrist who likened the brain to the heart.  He said “The heart can generally survive one heart attack relatively well, maybe two.  You can rehabilitate and recover to live a fairly normal life.  But after a few heart attacks your heart will become so dehabilitated that no amount of rehab will allow you to recover.  Schizophrenia is just like a heart attack.  You can survive one or two bouts relatively well.  With the proper medication you will live a relatively normal and productive life.  However after multiple bouts no amount of medication and counseling will allow you to live a normal and productive life.

Catching schizophrenia before symptoms appear is challenging. A new brain scan study may have an answer.

That is why early diagnosis is key to the effective treatment of schizophrenia. In a recent study, scientists probed brain activity and their findings may help clinicians catch schizophrenia even before the first psychotic episode.

Schizophrenia is a mental health disorder characterized by disrupted perceptions and thoughts. Symptoms can include delusions, hallucinations, and impaired cognitive abilities.  In the United States, schizophrenia affects an estimated 0.25–0.64 percent of the population. Often appearing in an individual’s late teens or early 20s, schizophrenia is highly disruptive, challenging to treat, and long-lasting. 

Treatment is much more effective if doctors can diagnose the condition early. Currently, however, specialists cannot diagnose schizophrenia until an individual has had their first psychotic episode. At this point, an individual’s behavior can change dramatically, and they “may lose touch with some aspects of reality.”

Recently, a team of researchers decided to look in detail at patterns of brain activity. They hoped to identify a pattern in how parts of the brain communicate that might predict the onset of schizophrenia.  The study of brain activity that might predict the onset of schizophrenia used the combined skills of researchers from a number of institutions – the Massachusetts Institute of Technology in Cambridge, the Beth Israel Deaconess Medical Center in Boston, MA, the Brigham and Women’s Hospital, also in Boston, and the Shanghai Mental Health Center in China.  They published their combined findings this week in the journal Molecular Psychiatry.

The first signs

Before someone experiences their first psychotic episode, there can be subtle changes in the way they think. For instance, they might switch topics abruptly when talking, or answer questions with seemingly irrelevant answers.  However, only about 1 in 4 people who display these symptoms go on to develop schizophrenia. The researchers wanted to find a way to predict who will go on to develop the condition with more accuracy.

Because the Shanghai Mental Health Center receives such a high volume of patients, it made the perfect base for the study. In total, the researchers identified 158 people aged 13–34 years old who displayed the early symptoms that often predict schizophrenia. They also analyzed 93 control participants who did not display this telltale behavior.  Using MRI scans, the study focused on resting state networks; these are interactions between regions of the brain that occur while a person is at rest and not engaged in any thinking (cognitive) tasks.  Each participant had an MRI scan and then received a follow-up scan 1 year later. At the 1-year point, 23 of the 158 high-risk individuals had received a schizophrenia diagnosis.  By examining the 23 and comparing them with the other participants, the research team was able to identify patterns that only occurred in these individuals.

The superior temporal gyrus

One brain region that caught the investigators’ eye was the superior temporal gyrus. This region of the brain contains a key area for processing sounds – the auditory cortex. Usually, it connects to areas involved in movement (motor control) and hearing, vision, taste, smell, and touch (sensory perception).  In the participants who had psychotic episodes, the superior temporal gyrus connected differently, having closer communication with another brain region – the limbic regions, which are important for emotion processing.  The study’s authors believe this might help explain why auditory hallucinations — hearing voices, for instance — are common in people with schizophrenia.

The also believe that this type of gyrus – limbic communication might be considered a risk factor for schizophrenia. If we use these types of brain measurements, then maybe we can predict a little bit better who will end up developing psychosis, and that may also help tailor interventions.”  The scientists hope that, if we can detect these subtle changes in communication between brain regions at an earlier age, it might help us predict who is most at risk.

The researchers are already carrying out similar studies, looking at a younger set of individuals and carrying out further analyses on the brain scans they did, searching for additional communications which might be considered risk factors.  Although this work is in its infancy, the benefits could be significant for those at high risk of developing schizophrenia.