Alterations in Brain Matter Loss and Gain Identified in Schizophrenia Interview with:

Lena Palaniyappan Medical Director Prevention & Early Intervention Program for Psychoses (PEPP) London, Ontario

Dr. Lena Palaniyappan

Lena Palaniyappan
Medical Director
Prevention & Early Intervention Program for Psychoses (PEPP)
London, Ontario What is the background for this study? What are the main findings?

Response: It is now well established that patients with schizophrenia show reduced thickness of brain’s grey matter in Magnetic Resonance Imaging studies, indicating either a developmental or an acquired deficit in the amount of brain tissue. Such reductions are seen both in treated and untreated patients, suggesting that current treatments do not reverse the process of tissue loss, if at all this is occurring in patients. We wanted to study if subtle increase in brain tissue also accompanied this reduction. We observed that across the group of 98 medicated patients, reduced thickness was consistently accompanied by subtle, but nevertheless noticeable increases in thickness. Such increases were more pronounced in those with a longer duration of illness. What should readers take away from your report?

Response: The most important message is that in patients with schizophrenia, the brain changes are not simply a downhill one-way traffic lane. There are small but perhaps crucial ‘gain of structure’ that often goes unnoticed by the prevailing focus on ‘loss of structure’. This may be a reminder for us to acknowledge the compensatory mechanisms that are in action alongside pathological processes that contribute to symptoms of schizophrenia. What recommendations do you have for future research as a result of this study?

Response: It is not clear if the subtle increase is a compensatory effect or an additional pathological phenomenon. This needs to be clarified in future studies. Further, while clinicians do not often see a full reversal of the diagnostic features of schizophrenia in many patients, there exists a sizeable subgroup of patients who recover completely and never come back to see a psychiatrist. We really need to understand the brain mechanisms that underlie such resilience. This, in my opinion, is the most important piece of puzzle on which, unfortunately, not enough effort has been spent to date. Is there anything else you would like to add?

Response: This provides us hope to consider strategies that can harness brain’s plasticity in treating this illness. Nevertheless, I would like to remind your readers that caution must be practiced when interpreting a single cross-sectional study such as this. Thank you for your contribution to the community.


S. Guo, L. Palaniyappan, P. F. Liddle, J. Feng. Dynamic cerebral reorganization in the pathophysiology of schizophrenia: a MRI-derived cortical thickness study.Psychological Medicine, 2016; 1 DOI:10.1017/S0033291716000994

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Last Updated on May 30, 2016 by Marie Benz MD FAAD