Catad_tema Schizophrenia - articles

Schizophrenia: morphological changes in the brain

One of the areas of schizophrenia research is the analysis of morphological changes in the brain, since it is obvious that in this disease, along with the processes of synaptic transmission and receptor activity, the structure of nerve cells, fibers and some parts of the brain also undergoes changes. The search for anatomical changes in the brain is one of the components of etiological research.
The most commonly reported increase in the lateral ventricles of the brain; some researchers also point to an increase in the third and fourth ventricles, a decrease in the volume of the temporal lobes and an increase in the size of the pituitary gland. There are several theories about the role of organic changes in the development of the disease. It is believed that they take place already at the onset of the development of the disease and in this case are considered factors that increase the risk of developing schizophrenia. This theory is supported by recent results of brain ultrasound (enlargement of the lateral ventricles) of fetuses at high risk of developing schizophrenia (Gilmore et al., 2000).
According to another theory, anatomical changes play a role in the predominantly exogenous form of schizophrenia or arise for any non-specific reasons (for example, complications in childbirth). It is assumed that the reason for the increase in the size of the pituitary gland (which is observed at the onset of the disease, at the time of the first psychotic episode) is the increased activity of the hypothalamic-pituitary-adrenal system (HPA). Under the influence of corticoliberin or stress factors, the HGS is activated, which leads to an increase in the number and size of corticotropic cells, and hence the size of the pituitary gland (Ryan et al., 2003, 2004; Carmine M Pariante). Other studies show that in patients with schizophrenia, the regulation of myelination of nerve fibers in the frontal lobe is impaired. If the amount of myelin normally increases up to a certain age (about 40 years), then in schizophrenia its amount practically does not change with age. This is believed to lead to a decrease in the brain's ability to coordinate the activities of neural systems responsible for many functions. Clinically, these changes are manifested by various symptoms of schizophrenia, including disorders of cognitive processes. In a number of studies during autopsy, a decrease in the number of neuroglial elements in the cortex of the frontal lobes (mainly due to oligodendrocytes) and a decrease in the degree of expression of genes involved in the formation of myelin were noted. It is assumed that a decrease in the number of oligodendrocytes and myelin in the cortical layers leads to degeneration of the neuropil, resulting in an increase in the density of neurons. The myelin sheath of the nerve fibers of the cortex inhibits the decrease in the volume of the frontal lobes associated with the fixation of certain processes observed in schizophrenia; thus, a decrease in the amount of myelin in the cortical zones may be one of the reasons for the discharge of the neuropil in the frontal cortex. Methods for assessing morphological changes 1. The most sensitive method for detecting myelin is MRI of the brain in several projections using the "inversion-recovery" mode.
2. NMR spectroscopy on 1H hydrogen nuclei allows to determine the content of N acetylaspartate (NAA) - a marker of neurons, the level of which can be used to judge the number and density of cells.
3. NMR spectroscopy using the 31 P isotope is used to determine the content of phosphodiester residues (lipid metabolism products) and phosphomonoesters (markers of cell membrane synthesis). These biochemical markers can be used to indirectly assess the number of neurons and glial cells, their integrity and the extent of damage. Influence of typical and atypical antipsychotics on the myelination process Before 30 years, the content of myelin in patients with schizophrenia is higher than in healthy people, and after 30 years - significantly lower. This is consistent with observations of the high efficiency of treatment in the early stages of the disease and an increase in the degree of resistance to therapy and the progression of functional disorders in schizophrenic patients with age. Many studies have noted a significant effect of antipsychotics on the volume of white matter in the brain in patients with schizophrenia, but these data are conflicting. Researchers have reported both an increase (Molina et al., 2005) and a decrease (McCormick et al., 2005) in cerebral cortex white matter volume with prolonged use of atypical antipsychotics. Similar results have been observed with long-term therapy with typical antipsychotics (McCormick et al. 2005; Lieberman et al. 2005). Atypical antipsychotics (unlike typical drugs) have been shown to stimulate the formation of new neuroglial elements in the cortex of the frontal lobes of primates and rodents (Kodama et al., 2004; Selemon et al., 1999; Wang et al., 2004a). It is possible that these drugs are able to reduce the degree of deficiency of oligodendrocytes and / or myelin in the cerebral cortex. A recent study in a group of men with schizophrenia compared therapy with an atypical antipsychotic (risperidone) and a typical antipsychotic (fluphenosine decanoate (PD)). The study showed that in patients with schizophrenia, the structure of the frontal lobes differs from that in healthy people. White matter volume in the risperidone group was significantly higher than in the FD group, with an increase in white matter volume in the risperidone group and a decrease in the FD group compared to the control group. The volume of gray matter in both groups of patients was significantly lower compared to healthy people and in the risperidone group was less than in the PD group (George Bartzokis et al., 2007). In at least some cases of increased white matter volume in the risperidone group, a shift in the border between gray matter and white matter towards the cortex was noted (George Bartzokis et al., 2007). A decrease in neuronal density was also observed in the risperidone group. It is possible that increased myelination during risperidone therapy contributed to a decrease in the rate of fixation-related decrease in the volume of the frontal lobes. However, these studies do not allow determining whether the greater volume of white matter in the risperidone group is due to the retention of myelin, the volume of which was initially higher, or it is the result of the treatment itself. It is possible that such differences are related to patient demographic characteristics (gender, age) and study design (George Bartzokis et al., 2007). The molecular mechanism of the observed effect of atypical antipsychotics is not clear. It may be associated with the effect of these drugs on lipid metabolism (Ferno et al., 2005), facilitating dopaminergic transmission in the prefrontal cortex, since the stimulation of dopamine receptors can play the role of a protective factor against oligodendrocytes and promote the formation of new cells. Recent prospective studies have shown that, with less effective treatment and a more severe course of the disease, there is a tendency for the progression of structural changes in the brain, the main of which are an increase in the size of the ventricles and a decrease in the amount of gray matter. In addition, a relationship was noted between anatomical changes and non-adherence to the antipsychotic therapy regimen. These data indicate the possibility of antipsychotics to reduce the rate of progression of morphological changes in some patients. Thus, the study of morphological changes in the brain of patients with schizophrenia is one of the promising directions in the study of this disease. The results of these studies will help to better understand the reasons for its development, to study the features of the course and mechanism of action of the drugs used, including antipsychotics.

Information is current as of 17.09.2010

EEG, or encephalography, allows you to identify the smallest changes in the activity of the cerebral cortex. This method helps to assess such features of the brain as the ability to memorize and process information. Data analysis is based on the characteristics of changes in the synchronization of a number of brain rhythms. EEG in schizophrenia is used rather as an auxiliary method, since a similar specificity of changes in the functionality of the brain is observed in some other diseases, including organic lesions of the central nervous system.

In case of illness, patients see non-existent images and events of various forms

Despite its long history of study, schizophrenia still remains the main mystery of modern psychiatry. The fact is that the manifestations and course of the disease are well studied, but the reasons for its development still raise a number of questions. In addition, medicine today has nothing to oppose to this disease, so schizophrenia remains an incurable disease, although its symptoms can be successfully stopped with medication.

A few facts about psychopathology:

• first appears at the age of 22-35;
• in women it is more mild, in men it often manifests itself in adolescence;
• there are several severe forms of the disease, some of them are characterized by permanent progression;
• differs in paroxysmal course;
• without treatment leads to a split personality.

The symptoms of the disease are very diverse and are divided into two large groups - productive and negative. Productive symptoms are signs of exacerbation of the disease, which include hallucinations, delirium, paranoid syndrome, catatonic manifestations. Hallucinations are audible, visual, less often tactile and olfactory. In the vast majority of cases, the patient is confronted with voices in his head that make him do something against his will. Delusional disorder in schizophrenia manifests itself as an acute psychosis with obsessive thoughts and ideas. The patient may feel that he is being pursued by enemies, or he needs to stand at the head of the army. Since delirium is accompanied by hallucinations, a person is completely confident in the reality of everything that happens and can react aggressively to attempts by outsiders to interfere with his actions, no matter how crazy they really are.

The paranoid syndrome manifests itself in the fear of persecution, and the patient is sure that the whole world is against him. In general, paranoid symptoms can manifest in various forms, from mild anxiety and anxiety to an obsessive belief that the patient is in dire danger.

Catatonic manifestations are a stupor, during which the patient freezes in any, even the most uncomfortable, posture, not responding to stimuli and not engaging in conversations. Such behavior is preceded by mania - general emotional excitability, inappropriate behavior, anxiety, repeated meaningless movements or phrases.

Despite the acute manifestations, the productive symptomatology is rather successfully stopped by special drugs.

Negative symptomatology is understood as signs of a change in a person's personality. These include a flattened affect, social maladjustment, a tendency to vagrancy and gathering, inadequate hobbies, general depression and suicidal thoughts. These symptoms indicate a decrease in cerebral cortex activity and can lead to cognitive impairment and dementia. Negative symptoms are much more dangerous than specific manifestations of schizophrenia, since they are more difficult to treat and can lead to dangerous consequences, for example, suicide.

In general, the disease usually develops gradually, proceeds in the form of exacerbations, between which there is a period of relative clarity of mind. In some cases, continuous medication can help completely eliminate symptoms and achieve sustained remission. In psychiatric practice, there are many cases when the disease had only one episode, and after prolonged drug therapy, the patient no longer showed signs of schizophrenia until the end of his life.

Electroencephalography allows you to obtain the necessary information about changes in brain activity

It has been proven that in patients with schizophrenia, an increased production of dopamine is observed, which leads to a disruption in the activity of various areas of the brain. So, EEG in schizophrenia shows a noticeable increase in the intensity of work in the brain stem structures and a change in the activity of neurons in the cortex. At the same time, such signs are not enough to clarify the diagnosis (form and specificity of the course of the disease), therefore EEG is used as an auxiliary diagnostic method, mainly to exclude other pathologies, for example, epilepsy or organic brain lesions.

To obtain an accurate picture, it is necessary to study the activity of the brain during an exacerbation of the disease, when productive symptoms appear, but this is often impossible due to the aggressiveness of the patient and for a number of other reasons. At the same time, during the periods of "enlightenment", the bioelectric activity of the brain of a schizophrenic patient practically does not differ from the specificity of the work of the brain of an absolutely healthy person.

Changes in brain bioelectrical activity

Electroencephalography in schizophrenia with productive symptoms reveals the following bioelectrical disorders in the brain:

• decreased alpha index;
• excessively high synchronization of different rhythms in the temporal and frontal lobes of the cortex, mainly in the paranoid form of pathology;
• decreased beta-index of the right hemisphere with severe negative symptoms, increased in the left hemisphere with severe productive symptoms;
• increased activity of the right hemisphere with manic-delusional symptoms, a shift towards the left hemisphere - with severe depressive symptoms.

Interestingly, the activity of the brain in patients with severe forms of schizophrenia resembles the clinical picture characteristic of those taking severe psychostimulants and amphetamine.

In addition, with such a diagnosis, a weakening of the bioelectrical activity of the frontal lobe is often observed.

Changes in gamma rhythm and interhemispheric relationships

The gamma rhythm is the highest-frequency rhythm of brain activity, therefore it is the leading one in determining functional disorders. This indicator reflects the activity of some neural connections that determine the course of cognitive processes and the response to the action of neurotransmitters.

In psychosis against a background of schizophrenia, the following changes are observed:

• an increase in the power of the rhythm in the prefrontal cortex;
• weakening of the relationship between the hemispheres;
• change in the activity of the hemispheres.

So, the EEG of the brain in schizophrenia shows a shift in activity towards one hemisphere, and for men, pathological activity of the right hemisphere is characteristic, and for women - of the left. This largely explains the specificity of the manifestation of the disease in men and women.

Electrooculography and electrodermal activity

The procedure helps to diagnose the development of psychopathology

Electrooculography (EOG) in schizophrenia shows a violation of the movement of the eyeballs - they become intermittent, "jerky", while in a healthy person they move smoothly, along a sinusoid.

The study of electrodermal activity determines the change in the emotional state in response to skin irritation. In schizophrenia, there is a decrease in the nerve conduction of the epidermis.

Interestingly, this change in normal response is considered by some to be the first manifestation of a disease that can be diagnosed in early childhood.

Facial muscle conductivity

In schizophrenia, there is a paucity of facial expressions and low emotionality. However, electromyography (a study of the conduction of facial muscles) reveals increased muscle activity in response to emotionally provoking factors, while outwardly the patient's face remains impassive and indifferent.

Decoding the results

Having figured out whether EEG and other neurophysiological examinations can reveal the diagnosis of schizophrenia, it becomes clear that mental tests and observation of the patient's behavior remain the main diagnostic criteria. Deciphering the EEG results in schizophrenia allows you to get a more complete picture, but the method still remains auxiliary, and not the main one in the diagnosis of this disease.

At the same time, neurophysiological research sometimes suggests the possible development of the disease in a person in the future by the nature of the current changes in the bioelectrical activity of the brain.

The book by American authors outlines modern ideas about the work of the brain. The questions of the structure and functioning of the nervous system are considered; homeostasis problem; emotions, memory, thinking; specialization of the hemispheres and "I" of a person; biological bases of psychosis; age-related changes in brain activity.

For biology students, medical and psychology students, high school students and anyone interested in the science of the brain and behavior.

Another group of data obtained as a result of postmortem research also confirms the idea that with some disturbances in dopaminergic synapses, the function of the latter is excessively enhanced (see Fig. 181). Autopsy data show that patients with schizophrenia have slightly increased amounts of dopamine in the areas of the brain rich in this substance. In the same zones, changes were noted, indicating that along with an increase in the content of dopamine, the sensitivity to this substance also increased inadequately. These changes may in part be caused by the chronic use of antipsychotics, however, taking into account this circumstance, the noted shifts seem impressive. Changes in the dopamine system are much more noticeable in patients who died at a young age. In general, antidopamine neuroleptic drugs give the best effect in the treatment of younger people with type I schizophrenia.

However, like all partially acceptable hypotheses, this one has its weaknesses. Changes in the dopamine system, regularly noted in some studies, have not been found in a number of other similar studies. In addition, dopamine serves to transmit information in many parts of the brain, so it is difficult to explain why the primary changes leading to disorders of perception, thinking and emotions do not manifest themselves in more pronounced sensory and motor disorders. Although antipsychotic drugs cause improvement in the patient's condition, which is directly proportional to their antidopamine effect, other, "atypical" drugs that have nothing to do with dopamine, also give good results. Finally, in many cases of type II schizophrenia, all current medications are not particularly effective. Behavioral disorders in schizophrenia appear to be influenced by many brain systems, and it remains to be seen whether the dopamine neurotransmitter system is actually the main culprit.

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Approximately once a year, and sometimes a little more often, another fighter against psychiatry appears on the network. In general, they are very stereotypical people with a standard set of claims and a complete unwillingness to read any information, and even more so to look for it, if it does not confirm the fact that psychiatry is a pseudoscience, created for the personal enrichment of psychiatrists, pharmaceutical companies and the fight against dissidents. One of the main trump cards of fighters is the fact that people with schizophrenia turn into "vegetables" and psychiatrists with haloperidol are exclusively to blame for this. Repeatedly my colleagues, both at home and in my magazine, said that the process of turning into a vegetable is inherent in the disease itself. For the same reason, schizophrenia is better treated than admiring the wonderful and unique world of the sick person.

The idea that schizophrenia is associated with changes in the brain is not new at all. It was written about it back in the 19th century. However, at that time the main research tool was postmortem autopsies, and for quite a long time nothing special and distinctive from all other "cerebral" diseases was found in the brains of patients. But with the advent of tomography into medical practice, it was nevertheless confirmed that brain changes take place in this disorder.

It has been found that people with schizophrenia lose the volume of the cerebral cortex. The process of crust loss begins sometimes even before the onset of clinical symptoms. It is present even when the person is not receiving treatment for schizophrenia (antipsychotics). For five years of illness, the patient can lose up to 25% of the volume of the cortex in some areas of the brain. The process usually begins in the parietal lobe and spreads further along the brain. The faster the volume of the cortex decreases, the faster the emotional-volitional defect sets in. Everything becomes indifferent to a person and there is no desire for anything - the very thing that is called a "vegetable".

I have a little bad news. We are constantly losing nerve cells. This is actually a natural process and it goes quite slowly, but in patients with schizophrenia, this process is accelerated. So, for example, normally adolescents lose 1% of the cortex per year, and with schizophrenia 5%, adult men lose 0.9% of the cortex per year, sick 3%. In general, in adolescence, the malignant form of schizophrenia is very common, where in a year you can lose everything that you can, and even after the first attack, this process is visible to the naked eye.

Here is a picture for those interested, showing how the brain loses the cortex during 5 years of illness.

In addition to a decrease in the volume of the cortex, an increase in the lateral ventricles of the brain was also found. They are enlarged not because there is a lot of water, but because the brain structures that lie in the walls are reduced in size. And this is observed from birth.

Here are pictures of twins - the first has schizophrenia (the "hole" in the middle of the brain in the image is the dilated lateral ventricles), the second has no disease.

People with schizophrenia have had cognitive (cognitive) problems even before the onset of the disease and even before medication is used, including information processing and language memory. All these symptoms deepened as the disease progressed. among other things, they have a reduced (also even before the disease) function of the frontal cortex, which is responsible for criticism (that is, the correct perception of oneself, one's actions, comparing them with the norms of society) planning and forecasting activities.

Why this happens to the brain, in fact, no one knows for certain. There are 3 theories that have a fairly strong foundation.

1. Impaired development of the brain. It is assumed that already in utero, something goes wrong. For example, patients with schizophrenia have some problems with substances that are very important for the development of the brain - with the same reilin, which is supposed to regulate the process of cell movement during the development of the brain. As a result, the cells do not reach the places where they should be, they form incorrect and rare connections with each other. There are many more described mechanisms of the same plan, which say that a certain congenital defect causes a disease.

2. Neurodegeneration - increased destruction of cells. Here are considered cases when certain reasons, including various metabolic disorders, cause their premature death.

3. Immune theory. The newest and most promising. It is believed that this disease is the result of inflammation in the brain. why they arise now is reliably difficult to say - maybe this is the body that suits itself (autoimmune disease) or it is the result of some kind of infection (for example, there are facts that the mother's flu during pregnancy increases the risk of developing the disease). However, patients with schizophrenia have various inflammatory substances in the brain that can be very aggressive towards the surrounding cells. About similar mechanisms, but with depression
No one claims that antipsychotics for schizophrenia are a panacea. To some extent, now the situation with them is obvious that we will not be able to squeeze out of them as much benefit as we have now. It is possible to increase the safety profile of a drug, but antipsychotics do not radically solve the issue. We need some new ideas and discoveries in the field of schizophrenia, a new breakthrough in understanding the disease. The latest immune theory sounds very promising. However, for now, antipsychotics are all we have. These drugs allow patients to live in society for a long time, and not stay within the walls of a psychiatric hospital. Let me remind you that less than 100 years ago, mental illness was a sentence and treatment was limited only to keeping patients in hospitals. Now only a small proportion of patients are in hospitals and it is thanks to antipsychotics that this is possible. In fact, in practice, and any psychiatrist will tell you this, it is the lack of treatment that leads to a faster transformation into a vegetable. Brain damage ... it is destroyed by disease without antipsychotics and in some people it happens very quickly.

Schizophrenia is a mental illness associated with the breakdown of emotional reactions and thinking processes. Symptoms of this disease include delirium, hallucinations, disorganized thinking, as a result of social dysfunction.

Is schizophrenia visible on MRI?

According to the latest data, the reasons for the development of this pathology are two factors, one of which is a predisposition:

1. anomalies of the vascular bed of the brain: anterior and posterior trifurcation of the internal carotid artery, anomaly of the connective artery of the brain
2. abnormalities of gray and white matter of the brain. Most often, the pathology consists in local atrophy (part of the brain).
3. pathology of venous sinuses.
4. pathological activity in the frontal and temporal lobes of the brain.

The second factor is certainly important, so to speak, the triggering factor for the development of schizophrenia - it is mental trauma, no matter at what age it first occurred, but children's age is more prone to mental trauma.

MRI as a method that is sensitive to the factors of development of schizophrenia of the first group.

Anomalies of the vascular bed of the brain are perfectly detected by such a technique of MRI - angiography. Vascular anomaly occurs in one third of patients with schizophrenia. As a result of such a pathology as trifurcation (tripling of the internal carotid artery, and normally doubling) of the right or left internal carotid artery, ischemia of a certain part of the brain occurs, which is a powerful predisposing factor.

Below are examples of neuroimaging of patients with schizophrenia using MRI technologies.

A patient with schizophrenia. Performed MRI - angiography in the patient revealed trifurcation of the cerebral vessels. One of the most common brain abnormalities, a complication of which is schizophrenia.

This fMRI (functional MRI) image compares normal brain activity and a patient with schizophrenia who also has artery trifurcation.

MRI for schizophrenia

Back in 2001, a group of researchers from the University of California, based on evidence-based medicine, MRI reliably identified signs in patients with schizophrenia, using only the classic T1 and T2 sequences.

These signs include

1. violations of the structure of the white matter of the brain. Pathology was more common in the temporal lobes in patients who were diagnosed with schizophrenia for the first time, and pathological foci were also detected in the frontal lobes, but this localization is more typical for old patients who undergo repeated MRI scans.
2. The volume of the cerebral ventricle is greater in schizophrenic patients.

If the second sign of schizophrenia is just a reliable sign that the radiologist should always bear in mind, then the second sign prompted scientists to put forward a hypothesis about the work of the brain in schizophrenia. After the appearance of such a method as fMRI (functional MRI), this hypothesis was confirmed. Indeed, specialists in diagnostics in the study of a patient with early schizophrenia (figure below) reveal an increase in the signal in the frontal lobe, and with a late one in the temporal lobe (figure below).

A patient with late schizophrenia has an undulating course. Performed fMRI according to which increased activity in the temporal lobe.

Patient with early schizophrenia

MRI - increased activity of the frontal and occipital lobes.

Brain MRI in schizophrenia

In this classic MRI, the patient with schizophrenia and the norm are shown on the left at the same level of the head. The difference is obvious: the arrow indicates the expansion of the lateral ventricles, a typical MRI feature in patients with schizophrenia, which we wrote about earlier.

Many psychiatrists do not fully understand the principle of the MRI method, its capabilities in particular fMRI and such a method as DTI, therefore, they often neglect it. The last two methods of MRI can reveal the changes that occur in the cells of the brain at the cellular level. Classic MRI protocols are good for visualizing such pathological changes in schizophrenia: as changes in the substance of the brain, determination of the size of the ventricle, to exclude diseases that can simulate schizophrenia. In a person, for example, consciousness and psyche changed dramatically, psychiatrists clinically diagnose schizophrenia, and the patient turned out to have Alzheimer's disease, which was not difficult to identify with an MRI scan. Another case that ruled out the diagnosis was that the person had auditory hallucinations with suspected schizophrenia. After the performed MRI, a schwannoma of the sound-conducting nerve was revealed, which is a tumor. Therefore, from the point of view of evidence-based medicine, additional diagnostics is a necessary aspect of a correct diagnosis.

This photograph shows a patient with Alzheimer's disease. Initially there was a suspicion of schizophrenia. On MRI: a decrease in the volume of the brain, on the T2 sequence, a hyperintense area is visualized, indicating to us chronic ischemic changes in the brain.

MRI shows schizophrenia

Scientists have proven that MRI is effective in diagnosing schizophrenia for a long time. Researchers at the Friedrich Alexander University of Erlangen (Germany) in 2008 proved that MRI is able to differentiate (distinguish) diseases similar in symptomatology to schizophrenia. Based on this study, reliable signs of schizophrenia on MRI are also described:

1. Vascular changes - congenital anomalies of arteries, venous sinuses, anerism of cerebral vessels. Due to the redistribution of blood flow in the brain, others are better supplied with blood, therefore, this sign on MRI is also one of the triggering factors in the development of schizophrenia.
2. Signs of hydrocephalus - expansion of the lateral ventricles, an increase in the size of the third ventricle, expansion of the subarachnoid space. Expansion of the horns of the lateral ventricles
3. The defeat of the white matter of the brain. Most often it is atrophy of the white matter of the brain.
4. Chronic cerebral ischemia, which often occurs as a result of vascular changes in the brain.
5. Brain abnormality (developmental abnormality). The anomaly is localized in the brain stem, cerebellum, pituitary gland, which leads to functional impairment of these parts of the brain. Rathke's pocket cyst, Verge's cyst.

This information helps the radiologist in his work, so you can say for sure one of these signs the radiologist will pay attention to and draw the correct conclusions about the diagnosis.

A patient with schizophrenia has a frequent concomitant disease (comorbid disease) Rathke's cyst of the pocket.

Does MRI show schizophrenia

In schizophrenia, there is a redistribution of blood flow in the brain, which is not always noticeable when scanning in classic MRI sequences. If you use fMRI (functional MRI), the diagnosis of pathological foci in the brain becomes easier. Schizophrenia does not always immediately show signs of atrophy, vascular abnormalities, and so on on an MRI image. fMRI allows one to suspect schizophrenia in a normal person without pathological symptoms in the form of hallucinations and disturbances of consciousness. In schizophrenia, certain areas of the brain are more susceptible to arousal. This is proven by the way abnormal areas of the brain release more dopamine. Some scientists suggest that this is a congenital pathology, which eventually makes itself felt after exposure to mental trauma.

This still clinically healthy young man underwent an MRI examination

Addressed with headaches. Many noted that he was with a twist, but they could not say anything bad about him. In this patient, classical MRI did not reveal significant changes in the brain. On fMRI, pathological activity in the frontal lobe is evidence of early schizophrenia.

The young man did not believe this diagnosis 8 years later he turned again, but with more severe symptoms. On MRI in classical protocols, there were already changes in the form of atrophy of the white matter of the brain. This patient may be a bad example for patients, but early treatment for this patient could improve his quality of life.

Schizophrenia on MRI of the brain

MRI should be performed not only for patients with suspected schizophrenia for early diagnosis of changes, but also for patients with a long history of this disease for possible correction of treatment. A common sign on MRI in patients is atrophy of the brain matter. Some researchers believe that this process is not only associated with the spread of pathology, but also with the intake of drugs, so the treating psychiatrist should also be interested in this. Brain atrophy is easily visualized, as is ventricular enlargement, so it does not require complex MRI protocols that can assess nerve cell interactions (fMRI or DTI MRI). Progressive cerebral atrophy significantly impairs the patient's quality of life, therefore MRI control is desirable every 6 months.

Absolute (monozygous) twins are shown. On the right is a patient with schizophrenia, and on the left is the norm. MRI was performed at the same level of the brain. The patient has a pronounced increased signal from the medulla, expansion of the ventricles, atrophy of the medulla.

The patient has psychosis - schizophrenia, a manic course. MRI of the brain. Revealed arachnoid cysts of the brain.