to the Diagnostic and statistical manual of mental disorders (DSM-IV), schizophrenia stands for a persistent, often chronic and usually serious mental disorder influencing various behavioral, thinking, and emotional aspects of an individual. The symptoms for this disorder vary a lot, and may include delusions, hallucinations, disorganized speech and behavior etc (APA, 2000).
Although these and other symptoms of schizophrenia have been described long ago, the term and the precise concept of the disorder have not been defined in the literature until the end of the 19th century. Schizophrenia’s first name, created around the last decade of the 19th century by Emil Kraepelin, a German psychiatrist, was “Dementia Praecox”. Later, Eugen Bleuler, a Swiss psychiatrist, called it “the splitted mind” in Greek, therefore inventing the generally accepted term for the disorder. Schizophrenia is a comparatively unexplored mental disorder even in the 21st century: the scholars still argue on the possible causes and treatments for it, and continue their studies in different spheres of scientific research to determine and prove them.
The article by Lynn E. DeLisi “The Concept of Progressive Brain Change in Schizophrenia: Implications for Understanding Schizophrenia” published in the Schizophrenia Bulletin in 2008, explores the history of studies and discoveries upon the subject, offering some really interesting scientific cases for the determination of the roots of the problem and their impact on the development of the disorder.
The main idea of the article is to determine whether the concept of progressive brain change is really an issue in this mental disorder and whether it causes or results from its progress. The author investigates the ideas behind the illness from its early records. Notably, DeLisi states that Emil Kraepelin’s concept of Dementia Praecox has been based on the idea that it is a progressive brain disease. His later studies showed scientific evidence to the idea: a brain ventricular enlargement in chronic schizophrenia has been determined as a result of a few large pneumoencephalographic studies of the early 1900s. However, according to Lynn E. DeLisi (2008, 312), the concept has been long forgotten, because the belief that schizophrenia to had no “organic” cause. The psychological environment of the person with this mental disorder has been the one to blame for over seventy years to come. And even despite the findings that the inherited component increased the risk for the disorder to occur, schizophrenia has been treated with long-term psychoanalysis and family therapy.
Considerable evolution of the scientific methods of studying the disorder and the introduction of the computerized tomography that proved the significantly increased ventricular size in people with chronic schizophrenia caused the return to the early concept of the biological nature of this mental illness. This happened in the 1970s, and ever since, the scientists continue the research, trying to determine, prove and explain the causes and impacts of the progressive brain change in schizophrenia. In case the disorder is proved to be inheritable, it would be important to determine the gene or the genetic pathways that caused it, and this might offer a solution in treating this severe mental illness. The article by Lynn E. DeLisi offers a review of the current findings and summarizes the scientific evidence on the progressive brain change. It is interesting that with the further evolution of the imaging technology led to more precise studies on schizophrenia. The magnetic resonance imaging, which replaced the computerized tomography, offered the possibility to measure the volumes of anatomical structures and determine gray and white matter abnormalities. According to the numerous studies, a significant progress in defining the deviations of the structural size of the brain has been reached in the last decades. The varieties of the changes found include lateral ventricular enlargement, nonlocalized bilateral gray matter reductions, reduced white matter integrity, regional volume reductions, loss of normal asymmetries, and miscellaneous developmental abnormalities etc (DeLisi, 2008, 313). The points of view on these findings vary, as well as the results in patients who undergo different stages of the disorder or suffer from the chronic schizophrenia. DeLisi (2008, 315-316) suggests that the results of the studies reporting on anatomical changes in people with a first episode of schizophrenia, at a prodromal stage, or chronic patients, most of which consistently show progressive brain change. However, there has still been no significant evidence to be able to define which parts of the brain are impacted most and how as well as whether the structures affected are the same, and the entire process is the same in all individuals suffering from schizophrenia.
The author also questions several other possible reasons for the progression to occur: medication and metabolic change. However, according to the existing data, these reasons definitely need further investigation and scientific evidence.
In any case, according to Lynn E. DeLisi (2008, 318), the brain structural change can be detected prior to the onset of the disease and before the consumption of the medications by the individual.
Moreover, during a prodromal stage in the adolescence or early adulthood of the individual the disturbances in brain structure can already be detected. The author sums up the results of the existing studies and concludes that “active progression may occur prior to the onset of clinical symptoms; ventricular change occurs later and is a consequence of cortical change; and the progression is generally widespread” (DeLisi 2008, 318). Whether the structural changes begin much earlier, even before birth of an individual and to what extent the genetic factors influence the process, is still unknown. The author suggests that future research on the issue should focus on several aspects, including the studies of high-risk people longitudinally, the entire brain of the same person (in terms of how it is changing and how this is related to clinical outcome) and the impact of the functional and neurochemical impacts.
The results shown in the article under examination, as well as its conclusions prove that schizophrenia still requires careful investigation of both the causes and the impacts. Only further scientific research may help the medicine find the answers essential for curing the disorder.
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American Psychiatric Association (2000). Schizophrenia. Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, DC: American Psychiatric Publishing, Inc. Retrieved on Dec.16, 2009 from http://www.behavenet.com/capsules/disorders/schiz.htm
DeLisi, L.E. (2008). The Concept of Progressive Brain Change in Schizophrenia: Implications for Understanding Schizophrenia. Schizophrenia Bulletin, 34(2), 312-321.