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The Effects of Brain Abnormalities within Schizophrenic Individuals

Schizophrenia:

*most devastating of all mental illnesses.

*starts during adolescence or early adulthood, but endures for life.

*over 2 million people in the U.S. are struck by this disease.

Meaning:

(Bear, Connors, Paradiso, 1996).

Type I: Characterized by psychotic espisodes that usually includes delusions (such as "I am a royal king"). Hallucinations such as hearing voices, disordered paranoid thoughts.

Type II:characterized by loss of appropriate emotional response ("flat effect" or inappropriate laughter or crying), abnormal postures (catatonia), and lack of spontaneous speech.

Definitions:

Gray Matter (GM): consists of neuronal cell bodies, synaptic dendritic and axonal extentions, supported by framework glia.

N-Acetylaspartate (NAA): an amino acid thought to be present in neurons, dendritic and axonal extentions, but not in glia.

Gray Matter Heterotopia (GMH): collection of normal neurons in abnormal locations secondary to arrest of radical migration of neurons.

Brain Abnormalities: structural abnormalities found within the brain causing schizophrenic symptoms

overall studies displayed abnormalities in temporal lobes (especially deficits in cortical gray matter and enlarged third and lateral ventricles. (Lim, Tew, Kushner, Chow, Matsumoto, DeLisi, 1996)
cortical gray matter deficit widespread in schizophrenic patients, but it is worse in prefrontal and temporal lobes than other regions. (Lim, Adalsteinsson, Spielman, Sullivan, Rosenbloom, Pfefferbaum, 1998)
there are cortical tissue volume deficits discriminating gray matter along with cognitive and motor deficits equal in immensity across several functional regions. (Nopoulos, Swayze, Flaum, Andreasen, 1998)
presence of cortical gray matter in first episode suggests brain abnormality occurs early in illness. (Sullivan, Lim, Mathalon, Beal, Harris, Hoff, Faustman, Pfefferbaum, 1998)
concentration of NAA greater in gray matter than in white matter (even though schizophrenic patients had less volume of cortical gray matter than controls) ( Lim, et. al.,1998)
GMH and schizophrenia are very similar, but GMH is not a direct cause of schizophrenia. GMH maybe associated with illnesses and lots of other neuropsychiatric illnessess (i.e. autism)

Studies: often used MRI scans, to have detailed assessment of tissue changes within brain structures.

Lim and associates (1998) used proton magnetic resonance spectroscopy images of NAA to understand contribution of neuronal and glial changes.
The meta-analysis study by Laurie and Abukmeil (1998) found 40 relevant MRI volumetric studies of a total of 1314 patients (931 males and 383 females) which suggested several different structures in cerebral areas.
A few studies used American Veterans with schizophrenia as participants comparing brain abnormalities with state hospital patients or healthy men. (Sullivan et. al., 1998, & Sullivan, Shear, Lim, Zipursky, & Pfefferbaum, 1996)

Suggested Reasons for Brain Dysmorphology: There are several suggestions as to why there are recurrent brain strucutures (especially, gray matter deficits) present in schizophrenic patients.

Gray matter volume deficits and enlarges 3rd and lateral ventricles affecting cerebral cortex as a whole may be due to neurodevelopment displacement of neurons in white matter of schizophrenic patients. This may also be the reason for white matter surplus.
Enlarged ventricals and reduced mass of cortical gray matter is an early neurodevelopment structure lesionprogressing with normal age-related changes.
However; just as GMH is suggested to develop from genetic suspetibility with environmental damage (such as toxic, infectious, or tereatogenic) during 2nd trimeseter of gestation, schizphrenia may have a similar genisis.

Discussion: Schizophrenia has a many contributing biological factors to the great amount of disability involved. Many therapists have tried to identified this disease as an environmental outcome of stress. Yet, the abnormal brain strucutres found among many studies imply that schizophrenia is indeed a result of biological determinants. This gives researchers that ability to determine more appropriate treatments for such a devistating disease.
Unfortunately, very little studies have been aplied to women with schizophrenia. It is important to find relationships with the disease and gender-related brain strucutes, to obtain the optimal pharmecutic therapy. Note that in the meta-analysis study of 40 relevant studies, there were a total of 1314 patients. Only 383 were women of these patients! It is essential to have more studies done on schizophrenic patients who are females.

                                                                            References
    Lauriello, J., Hoff, A., Wieneke, M. H., Blankfeld, H., Faustman, W. O., Rosenbloom, M., DeMent, S., Sullivan, E. V., Lim, K. O., & Pfefferbaum, A. (1997). Similar extent of brain dysmorphology in severly ill women and men in schizophrenia. American Journal of Psychiatry, 154, 819-824.
    Lawrie, S. M., & Abukmeil, S. (1998). Brain abnormality in schizophrenia. British Journal of Psychiatry, 172, 110-120.
    Lim, K. O., Adalstiensson, E., Spielman, D., Sullivan, E. V., Rosenbloom, M., & Pfefferbaum, A. (1998). Proton magnetic resonance of cortical gray matter and white matter in schizophrenia. Archives in General Psychiatry, 55, 346-352.
    Lim, K. O., Suliivan, E. V., Zipusrky, R. B., & Pfefferbaum, A. (1996). Cortical gray matter volume deficits in schizophrenia: a replication. Scizophrenia Research, 20, 157-164.
    Lim, K. O., Tew, W., Kushner, M., Chow, K., Matsumoto, B., & De Lisi, L. E. (1996). Cortical gray amtter volume deficit in patients with first-episode schizophrenia. American Journal of Psychiatry,153, 1548-1553.
    Nopoulos, P., Swayze, V., Flaum, M., Andreasen, N. C. (1998). Incidence of ectopic gray matter in patients with scizophrenia and healthy control subjects studied with MRI. Journal of Neuropsychiatry, 10, 351-353.
    Sullivan, E. V., Lim, K. O., Manthalon, D., Marsh, L., Beal, D. M., Harris, D., Hoff, A. L., Faustman W. O., & Pfefferbaum, A. (1998). A profile of cortical gray matter volume deficits characteristic of schizophrenia. Cerebral Cortex, 8, 117-124.
    Sullivan, E. V., Shear, P. K., Lim, K. O., Zipusrky, R. B., & Pfefferbaum, A. (1996). Cognitive and motor impairments are related to gray matter volume deficits in schizophrenia. Biological Psychiatry, 39, 234-240.

Thank You for Visiting Paty Pelayo's Homepage!
(Special thanks to Stephanie Gomez for her consideration & help.)

My Favorite Links

NeuroImaging Laboratory
BrainWeb: Online Interface to a 3D MRI Simulated Brain Database
Doctor's Guide to Schizophrenia Information & Resources (Lots of important links)
Progressive Brain Changes Detected in Childhood Onset Schizophrenia
The Schizophrenia Homepage (Several links provided)

Email: paty_76@hotmail.com