Researchers: schizophrenia is neurodevelopmental disorder

Research is beginning to back up the idea that schizophrenia is a neurodevelopmental disorder.

So says Joshua Roffman, M.D., assistant professor of psychiatry at Harvard Medical School and director of Brain Genomics at Massachusetts General Hospital. “As we become more attuned with what is happening clinically with these individuals and also as we’ve had more tools from a neuroscience standpoint in terms of brain imaging, that has helped clarify the picture,” he says.

Roffman says that most investigators now think of schizophrenia as being of “a two-hit condition.” The first part occurs early in brain development, while the second happens when the illness is diagnosed, usually around the late 20s or early 30s.

He says researchers like Raquel Gur, M.D., Ph.D., – University of Pennsylvania neuropsychiatrist who has been studying 9,500 Philadelphia children and their families – have shown that more subtle parts of the illness, called prodromal symptoms, can be detected in some people before they are diagnosed with schizophrenia.

“These can occur in early or late childhood or in adolescence in the years that are leading up to when someone ultimately is diagnosed with having schizophrenia,” says Roffman. “Those prodromal symptoms are very consistent with the idea of schizophrenia as a disease of altered brain development.”

Roffman has been conducting brain imaging and genetic studies of individuals in late adolescence at high risk for schizophrenia who haven’t developed the condition. That could be, for example, someone who has a first-degree relative who has been diagnosed with the illness such as an older sibling.

“Do the brains of these individuals look more like their siblings, who actually have had the diagnosis of schizophrenia or do they look like healthy individuals who don’t have a family history of schizophrenia or are they somewhere in between the two?” Roffman asks. “The most common finding is indeed they are somewhere in between the two.”

William Carpenter, M.D., professor of psychiatry and pharmacology at University of Maryland School of Medicine, says there has been a shift in the way researchers are looking at schizophrenia. “What’s happening is we are learning how to detect it earlier,” he says.

In the past, Carpenter says, early struggles in the life of people who were later diagnosed with schizophrenia “were viewed as prognostic features that would tell you how severe it would be if it actually happened. We are now shifting our view that these early manifestations are actually manifestations of the schizophrenia itself.”

That’s important because it could mean early detection which could change the life course of someone on this track. “Identifying cases early increases the likelihood that a person can progress in their own life more successfully, maybe for a long time,” says Carpenter.

Other research has shown Cognitive Behavioral Therapy to be a beneficial treatment for schizophrenia, especially when combined with medication. There are also studies looking at the use of fish oil or Omega-3s, anti-inflammatory and antibiotic medications for treating the disease, Roffman says.

He has been studying the role of early exposure to folic acid in adolescents. “We are looking at kids who were born around the time when the U.S. government started to mandate folic acid fortification of grain products, which happened in the late 1990s,” he says. “As we follow these kids, who as a group now approaching the age of highest risk for schizophrenia and many other major mental illnesses, can we see things in their brains using MRI scans that suggest exposure to higher levels of folic acid while they were in utero might have been protective?”

Roffman is working on a related study with the Gur team in Philadelphia.

“The great hope is that by looking at these younger individuals we not only would be on a path to better treatments, but hopefully even the possibility of prevention,” he says. “Given how devastating the illness is, the possibility of preventing it would really be something for us to gain.”