Monday, January 16, 2017

Is schizophrenia associated with brain volume changes independently of medication?

Further to my previous post, I have been looking at the 2010 study by Jo Moncrieff & Jonathan Leo on the effects of antipsychotic drugs on brain volume. I had not looked at this study before my previous post and perhaps I was being unfair concluding there needed to be more systematic review of brain scan studies of patients with psychosis or schizophrenia prior to them receiving antipsychotic drugs, because Jo and Jonathan have already done it. In her book, The Bitterest Pills, Jo mentioned this joint paper, which was published by Robin Murray, as editor of Psychological Medicine, "despite opposition from most of the five referees" (p.157).

The authors managed to find 21 "drug-naive" studies published between 1995 and April 2009 of patients who had had no more than 4 weeks of antipsychotic treatment. They conclude:-
Most studies of drug-naive patients examined here did not report or detect differences in total brain volume, global grey-matter volume or CSF volumes between patients and controls, including three studies of untreated patients with long-term illness. These results are particularly remarkable, given the difficulty of selecting a comparable control group in these studies. The results suggest that the brain changes found in some first-episode studies may also be attributable to drug treatment, especially because some studies suggest that structural changes may occur after only short periods of treatment.
They reinforced this conclusion in response to correspondence:-
As we showed in our systematic review, a large majority of studies with drug-naive patients with psychosis or schizophrenia have not found any differences in global brain or grey-matter volumes, or in total CSF or ventricular volumes between patients and controls (Moncrieff & Leo, 2010). Although some of these studies reported differences in the volumes of specific structures, such as the thalamus and the caudate nuclei, others found no differences and multiple testing suggests some of the results may be false positives.
I'm left wondering exactly what the evidence is for Robin Murray's view, mentioned in my previous post, that "subtle brain changes [are] present at onset of schizophrenia".

3 comments:

Matt Stevenson said...

Duncan,
I wonder why these researchers (the biological psychiatrists of the past) don't consider that adverse experiences (stress, isolation, poverty, possible trauma) might over time cause the brain to change size and shape? Then it wouldn't be a disease but a natural response to experience. This would apply not only to "schizophrenia", but in lesser degrees to what are called "borderline", "bipolar" and so on.

cobweb said...

The problem of MIS- diagnosis does not just lie with psychiatrists. The majority of people are treated, often without any input by a psychiatrist by GPs. Not that it makes much difference as drugs are almost always prescribed. It was outrageous to hear how individuals on a phone in to R5 this week showed a clear theme.ie GPs are still telling people that depression is a chemical imbalance n the brain. They are manipulated into taking the drugs by the time old analogy with diabetes - that a deficiency of metabolism means life time taking of drugs. A professor came on and declared th\t - to be fair - there may be exceptions - but individuals including himself need to take anti- depressants for at least three months to make a difference and some need to take them for 2 - 3 years - and maybe for life. He was clearly breaching even guidelines on prescribing. But another theme was that the relationship with a 'kind/caring' GP led to adherence to this advice.
Not one of them had been given a test to discover the supposed deficiency of chemicals in their brain -obviously as there is no test, None of the callers said they were receiving any follow up to test for harmful effects of the drugs.

Mark p.s.2 said...

What of the brain scans of successful schizophrenia persons? John Forbes Nash Jr , Rufus May, Daniel B. Fisher. Cherry picking? No, the disease doesn't exist. No blood test, no DNA test etc.