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Schizophrenia – a Brain Disease? a Critical Review of Structural and Functional Cerebral Abnormality in the Disorder

Published online by Cambridge University Press:  02 January 2018

S. E. Chua  and
P. J. McKenna
S. E. Chua
Affiliation:
Institute of Psychiatry, London
P. J. McKenna*
Affiliation:
Fulbourn Hospital, Cambridge
*
Dr McKenna, Fulbourn Hospital, Cambridge CB1 5EF
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Abstract

Background

With genetic and neurochemical findings pointing to a biological aetiology, considerable effort has been devoted to finding direct evidence of brain abnormality in schizophrenia.

Method

T, MRI, post-mortem and functional imaging studies are reviewed to assess which structural and/or functional brain abnormalities have been consistently demonstrated.

Results

The only well-established structural abnormality in schizophrenia is lateral ventricular enlargement; this is modest and there is a large overlap with the normal population. There is no consensus on the presence of any localised structural abnormality from MRI and post-mortem studies, but the most promising findings concern temporal lobe limbic structures. Hypofrontality is not a well-replicated finding in schizophrenia under resting conditions, but the evidence is stronger for a selective association with negative symptoms. A number of studies have found hypofrontality under conditions of neuropsychological task activation. However, findings in these studies are divided and a recent methodologically sophisticated study has failed to confirm it, although this study suggested a decoupling of prefrontal and temporal function.

Conclusion

Schizophrenia is characterised by minor structural abnormality which, in the case of lateral ventricular enlargement, may be better understood as a risk factor than a causative lesion. The functional imaging findings are not transparent but suggest that, as a disorder, schizophrenia shows complex alterations in regional patterns of activity rather than any simple deficit in prefrontal function.

Type
Review Article
Information
The British Journal of Psychiatry , Volume 166 , Issue 5 , May 1995 , pp. 563 - 582
Copyright
Copyright © Royal College of Psychiatrists, 1995 

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