The Myth of Schizophrenia as a Progressive Brain Disease

Abstract

Schizophrenia has historically been considered to be a deteriorating disease, a view reinforced by recent MRI findings of progressive brain tissue loss over the early years of illness. On the other hand, the notion that recovery from schizophrenia is possible is increasingly embraced by consumer and family groups. This review critically examines the evidence from longitudinal studies of (1) clinical outcomes, (2) MRI brain volumes, and (3) cognitive functioning. First, the evidence shows that although approximately 25% of people with schizophrenia have a poor long-term outcome, few of these show the incremental loss of function that is characteristic of neurodegenerative illnesses. Second, MRI studies demonstrate subtle developmental abnormalities at first onset of psychosis and then further decreases in brain tissue volumes; however, these latter decreases are explicable by the effects of antipsychotic medication, substance abuse, and other secondary factors. Third, while patients do show cognitive deficits compared with controls, cognitive functioning does not appear to deteriorate over time. The majority of people with schizophrenia have the potential to achieve long-term remission and functional recovery. The fact that some experience deterioration in functioning over time may reflect poor access, or adherence, to treatment, the effects of concurrent conditions, and social and financial impoverishment. Mental health professionals need to join with patients and their families in understanding that schizophrenia is not a malignant disease that inevitably deteriorates over time but rather one from which most people can achieve a substantial degree of recovery.

Progressive Brain Atrophy and Cortical Thinning in Schizophrenia after Commencing Clozapine Treatment

“…In addition, widespread cortical thinning of the cerebral cortex involving not just frontotemporal regions but also parietal and occipital regions has been demonstrated in individuals with schizophrenia compared with healthy controls (Nesvåg et al, 2008;Sprooten et al, 2013). It remains unclear whether these progressive changes are inherent to the pathophysiological disease processes underlying schizophrenia or whether they are related to or are accelerated by treatment with antipsychotic agents or other illness-related factors (Ho et al, 2011;Zipursky et al, 2013).…”

Sport: A Possible Road toward Social Inclusion and Quality of Life

“…It can reduce the hospitalizations, improve Social Functioning, achieve a good quality of life, promote social inclusion and functional recovery. Schizophrenia is not a malignant disease that inevitably deteriorates over time [43]: we must work to promote recovery in every single person.…”

A neurodevelopment and neuroplasticity-based framework for early intervention in psychotic disorders

“…However, a more important question is whether these changes are related to the progressive pathology of schizophrenia or reflections of other factors. Neuroplastic, developmental and medical (including iatrogenic) factors can play a role in these MRI findings (Zipursky et al 2013;Bora, 2015). One important confounder is antipsychotic use, as animal studies provided strong evidence suggesting that antipsychotics can decrease cortical volume (Konopaske et al 2008).…”