New imaging research suggests that screening for early brain changes may predict schizophrenia

October 31, 2000

Can 'preventive psychiatry' be a reality? We don't know but now we know how to find out...

A new brain imaging study from the Institute of Psychiatry shows substantial brain changes in schizophrenia are present at the earliest stages of the illness, implying that these changes precede the appearance of psychotic symptoms. The findings, published in the American Journal of Psychiatry in November, may also suggest a role for brain imaging in pinpointing warning signs of the illness, and even preventing its development.

The study, led by Dr Tonmoy Sharma, involved 68 participants, including 37 people experiencing their first episode of psychosis and a group of healthy volunteers. Magnetic resonance imaging (MRI) scans identified differences in the structure of key regions, such as the temporal lobe, between the healthy volunteers and those experiencing psychosis.

While previous research has already shown that there are differences in the brains of people with schizophrenia and healthy volunteers, often these studies have involved people who have had schizophrenia for many years. Because of this, it is difficult to identify whether brain changes are due to the ageing process,a result of their illness or the side effects of their medication.

In this study, all the participants had experienced psychosis for only three months or less, and some had never taken antipsychotic drugs before. Still, the MRI scans showed quite distinct brain changes in key regions, suggesting that by the time someone starts to show signs of psychotic behaviour, their brains are already structurally different.

Preventing schizophrenia?

It is now recognised that people with schizophrenia have a better chance of recovery if their psychosis is treated at the earliest possible stage. In acknowledgement of this, the NHS Plan outlined in July this year prioritised treatment for early psychosis.

But the findings from this study indicates that brain changes are evident whilst the illness is in its earliest stages. Researchers, therefore, are now starting to focus on an even earlier stage called the 'prodrome phase', before psychosis becomes apparent in an attempt to prevent schizophrenia. However, signs of the prodrome are difficult to distinguish from the beginning of other psychiatric illnesses, or just normal adolescence.

According to Dr Sharma, a systematic way of recognising early signs of schizophrenia is now needed: "In schizophrenia, we have had a romantic notion of intervening before the condition has developed but so far, our instruments for diagnosis have not been good enough to allow us to do so".

He feels that in the future, brain imaging may provide a way of identifying early signs of schizophrenia and ultimately may fundamentally alter the approach to the condition. "From this study, we can see that characteristic brain differences are present at a very early stage and also shows the promise that brain imaging may become a powerful predictor of future illness.

"In cancer, we've seen that screening people at risk can have a great effect on treatment success. With a suitable schizophrenia screening method, for the first time, preventive psychiatry becomes a realistic possibility."
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Reference: D Fannon, X Chitnis, V Doku, et al. Features of Structural Brain Abnormality Detected in First-Episode Psychosis. American Journal of Psychiatry 2000; 157 (11) Notes to editors

· The Institute of Psychiatry is based at the Maudsley Hospital and is part of King's College London.
· For images of brain activity, background to the study, case studies, information on schizophrenia and all other enquiries, please contact Tracey Maher at the Institute of Psychiatry (phone: +44 20 7848 0910; email: t.maher@iop.kcl.ac.uk)

Institute of Psychiatry

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