Neuroimaging and Recovery in Schizophrenia
July 30, 2005

Schröder, Bottmer and Pantel (2002) reviewed at least 30 longitudinal neuroimaging studies on structural cerebral changes in schizophrenia involving CT and MRI scans. Besides the early identification of ventriculomegaly (i.e., enlarged ventricles, thought to reflect on atrophic processes of surrounding neural tissue) in schizophrenia in 1927 (pneumoencephalography) by Jacobi and Winkler, these researchers noted: "In addition, decreased volumes of the frontal and temporal lobes, the medial temporal substructures [e.g., hippocampus] and thalamic nuclei, and the cerebellum were also frequently described" (p.83).

Schröder and colleagues presented evidence suggesting that cortical volume changes are dynamic and reversible (which fits with my hypothesis that the neurobiology of the severe mental disorders is largely the neurobiology of stress/fear/anxiety). This runs counter to current neurodevelopmental and neurodegenerative models. These studies demonstrated significant reversibility of ventriculomegaly and reduced cortical volume in good-outcome patients. The current neuroreductive (neurodevelopmental and neurodegenerative) models would be hard pressed to explain these data.

Schröder et al (2002) concluded :"...the presently available neuroimaging studies do not convincingly support the hypothesis that schizophrenia is generally associated with a global cerebral tissue loss" (p.93).

I think that the changes in neural structure (e.g., atrophic processes in the hippocampus, prefrontal areas, etc.) and function (fMRI research) we sometimes see in schizophrenia research are dynamic, and not as static as previously thought. As our knowledge of the brain as a dynamic open system closely intertwined with experience (constructing and transforming as well as being transformed by the affective information processed) and memory (e.g., our growing knowledge of neuroplasticity, neurotrophic factors in cellular vulnerability, the role of mirror neurons, etc.) increases, we will be in a better position to appreciate how dynamic these disorders really are (despite the glacial pace of recovery in some patients). John Strauss pointed out that while our DSM categories are static entities, the human brain is a dynamic and complex system. Steven Hyman and Eric Nestler (1993), in their volume The Molecular Foundations of Psychiatry , noted:

"The human brain is remarkably plastic. It adapts to a wide variety of circumstances, forms memories of experiences, and learns...it can...produce disabling psychopathology...and it can recover" (p. 95).

Brian Koehler PhD
New York University
80 East 11th Street #339
New York NY 10003
212.533.5687
brian_koehler@psychoanalysis.net