Structural Brain Changes in Schizophrenia: The Issue of Subgroups

Abstract

Developments in modern neuroimaging techniques have significantly advanced our ability to examine brain structures in living subjects. As a result, replicable neuropathological changes have been demonstrated in the brains of schizophrenic patients. In schizophrenia research, though, the lack of qualitative findings and consistent clinicopathological correlations between neuroanatomical abnormalities and psychiatric symptoms leaves interpretations of the findings wide open to speculation. Some investigators (e.g., Kety 1980; Crow 1980; Jeste et al. 1982; Seidman 1983; Goetz and van Kammen 1986; Keefe et al. 1988) have argued that neuropathological changes are particular to certain clinical subgroups of patients with the syndrome of schizophrenia. The implication of this argument is that anatomical changes are markers of a distinct pathogenic and/or etiologic variety of the illness. This suggestion derives part of its appeal from the idea that schizophrenia is made up of many related diseases and is not a unitary entity. While this may turn out to be true, the neuroanatomical findings, as we will argue, do not appear to be discriminators of illness subtypes and suggest that there is a continuum of neuropathological change occurring in schizophrenia. Here, we will focus on the issue of subgroups in schizophrenia and how the current evidence from computed tomography (CT) and magnetic resonance imaging (MRI) supports the latter view.