Schizophrenia and Manic-Depressive Disorder Are Diseases of the Brain
By E. Fuller Torrey, M.D.
It has been suspected for over a century that schizophrenia and manic-depressive
disorder (bipolar disorder) are diseases of the brain. In 1837, Dr. W.A.F. Browne,
the best-known English psychiatrist of his generation, wrote:
Insanity, then, is inordinate or irregular, or impaired action of the mind, of the
instincts, sentiments, intellectual, or perceptive powers, depending upon and produced by
an organic change in the brain.
In that same year, Dr. Amariah Brigham, one of the founders of American psychiatry,
also wrote that insanity "is now considered a physical disorder, a disease of the
brain."
It would be 150 years, however, before these statements could be proven. Since the
early 1980s, with the availability of brain imaging techniques and other developments in
neuroscience, the evidence has become overwhelming that schizophrenia and
manic-depressive disorder are diseases of the brain, just as multiple sclerosis,
Parkinsons disease, and Alzheimers disease are diseases of the brain. The
brains of individuals with these diseases are measurably different from individuals who do
not have these diseases, both structurally and functionally. A brief summary of
some of the evidence that proves this point follows:
- Individuals with schizophrenia and manic-depressive disorder, including those who
have never been treated, have enlarged ventricles in the brain,
as demonstrated in over 100 studies to date.
Van Horn JD, McManus IC. Ventricular
enlargement in schizophrenia. A meta-analysis of studies of the ventricle: brain ratio
(VBR). British Journal of Psychiatry 160:687697, 1992.
Soares JC, Mann JJ. The anatomy of mood disorders: review of structural neuroimaging
studies. Biological Psychiatry 41:86106, 1997.
Elkis H, Friedman L, Wise A, et al. Meta-analyses of studies of ventricular
enlargement and cortical sulcal prominence in mood disorders. Comparisons with
controls or patients with schizophrenia. Archives of General Psychiatry 52:735746,
1995.
- Individuals with schizophrenia, including those who
have never been treated, have a reduced volume of gray matter in the brain,
especially in the temporal and frontal lobes.
Lawrie SM, Abukmeil SS: Brain abnormality in
schizophrenia: a systematic and quantitative review of volumetric magnetic resonance
imaging studies. British Journal of Psychiatry 172:110120, 1998.
- Individuals with manic-depressive disorder have an enlarged amygdala and
increased numbers of white matter hyperintensities.
Strakowski SM, DelBello MP, Sax KW, et al.
Brain magnetic resonance imaging of structural abnormalities in bipolar disorder.
Archives of General Psychiatry 56:254260, 1999.
Dupont RM, Jernigan TL, Heindel W, et al. Magnetic resonance imaging and mood
disorders: localization of white matter and other subcortical abnormalities. Archives
of General Psychiatry 52:747755, 1995.
Videbech P. MRI findings in patients with affective disorder: a meta-analysis. Acta
Psychiatrica Scandinavica 96:157168, 1997.
- Individuals with schizophrenia and manic-depressive
disorder, including those who have never been treated, have more neurological
abnormalities, as shown in over 25 studies.
Schroder J, et al. Neurological soft signs in
schizophrenia. Schizophrenia Research 6:2530, 1992.
Torrey EF, et al. Schizophrenia and Manic-Depressive Disorder. New York:
Basic Books, 1994, pp. 127 ff. and pp. 176177.
- Individuals with schizophrenia and manic-depressive disorder, including those who have
never been treated, have more neuropsychological abnormalities that impair their
cognitive function, including such things as information processing and verbal memory.
Goldberg TE, Gold JM. Neurocognitive functioning
in patients with schizophrenia: an overview. In: Psychopharmacology: The Fourth
Generation of Progress, Bloom FE and Kupfer DJ (eds). New York: Raven Press, 1995, pp.
12451257.
Hoff AL, Shukla S, Aronson T, et al. Failure to differentiate bipolar disorder from
schizophrenia on measures of neuropsychological function. Schizophrenia Research
3:253260, 1990.
Morice R. Cognitive inflexibility and pre-frontal dysfunction in schizophrenia and mania. British
Journal of Psychiatry 157:5054, 1990.
- Individuals with schizophrenia, including those who have never been treated, show decreased
function of the prefrontal area, an area of the brain that we use for planning and
thinking about ourselves.
Berman KF,
Weinberger DR. Functional localization in the brain in schizophrenia. In: Review
of Psychiatry, vol. 10, Tasman A and Goldfinger S (eds). Washington DC: American
Psychiatric Press, 1991, pp. 2459.
Andreasen NC, et al. Hypofrontality in
neuroleptic-naive patients and in patients with chronic schizophrenia. Archives of
General Psychiatry 49:943958, 1992.
- Approximately 50 percent
of individuals with schizophrenia and manic-depressive disorder, including those who have
never been treated, have impaired awareness of their own illness. This has been
shown in at least 50 different studies. Such individuals do not realize that they
are sick, and they will, therefore, usually not accept treatment voluntarily.
Studies suggest that this impaired awareness is probably related to the
decreased function of the prefrontal area. These individuals are thus similar to some
patients who have had a stroke and, because of brain damage, are unaware of their
disability and deny it. The lack of awareness of illness in individuals with
schizophrenia and manic-depressive disorder is the most common reason that they do not
take their medication.
Amador
XF, David AS. Insight and Psychosis. New York: Oxford, 1998.
Ghaemi SN. Insight and psychiatric disorders: a review of the literature, with a focus on
its clinical relevance for bipolar disorder. Psychiatric Annals 27:782790,
1997. Peralta V, Cuesta MJ. Lack of insight in mood disorders. Journal of Affective
Disorders 49:5558, 1998.

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