Schizophrenia--a brain disease? A critical review of structural and functional cerebral abnormality in the disorder

Br J Psychiatry. 1995 May;166(5):563-82. doi: 10.1192/bjp.166.5.563.

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: CT, 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.

Publication types

  • Review

MeSH terms

  • Brain / pathology
  • Brain / physiopathology
  • Brain Damage, Chronic / diagnosis
  • Brain Damage, Chronic / physiopathology*
  • Brain Damage, Chronic / psychology
  • Brain Mapping
  • Diagnostic Imaging
  • Humans
  • Neurocognitive Disorders / diagnosis
  • Neurocognitive Disorders / physiopathology*
  • Neurocognitive Disorders / psychology
  • Psychiatric Status Rating Scales
  • Reproducibility of Results
  • Schizophrenia / diagnosis
  • Schizophrenia / pathology
  • Schizophrenia / physiopathology*
  • Schizophrenic Psychology*