MRI's allow for better diagnosis of schizophrenia

From the Chicago Tribune:

Thanks to a study conducted by Dr. John Csernansky and his colleagues at Northwestern University's Feinberg School of Medicine, doctors can better diagnose schizophrenia, a devastating and potentially disabling mental illness.

"Diagnosing schizophrenia is more of an art than a science," said Csernansky, who heads Northwestern's psychiatry and behavioral sciences department, "but by using a computer to chart subtle changes in the brain from [magnetic resonance imaging], we can create brain maps. We still don't know why the disease is degenerative, but we can now see patterns. Even in the absence of obvious deterioration of behavior, we can see biological progression of the disease."

Long shrouded in myths, stigmas and discrimination, schizophrenia strikes 1 percent of the adult population, according to the National Alliance on Mental Illness. The Chicago Department of Health estimates that 21,000 people in Chicago have the disease.

Doctors cannot cure it but can treat its symptoms. Victims have difficulty distinguishing fantasy from reality, managing their emotions and relating to others. It typically emerges during late teens for men and early 20s for women. Because of the age of onset, said Csernansky, "Often, symptoms are [wrongly] attributed to adolescent turmoil or drug misuse."

Although doctors do not know what causes schizophrenia, it is more common among those with the disease in the family. "Typically, though, it's that Aunt Edna or Uncle Ed that no one knows much about, not the parents," said Csernansky. Although use of street drugs, early exposure to toxins and poor nutrition do not cause schizophrenia, he said, they can increase the risk.

Many patients go undiagnosed and/or untreated, such as Don Rodig, who died four years ago at age 50 after a tumultuous few years with the disease, said his mother, Gertie Rodig of Arlington Heights. "He tried to commit suicide four times and had a mental breakdown," Rodig said, "but when we took him to the hospital, he would check himself out."

Though he had symptoms such as hearing voices and believing the FBI was watching him, Rodig said her son never received medication.

The 350 participants in the study, which was launched in 1997 and is funded by the National Institute of Mental Health include people with schizophrenia and some without mental illness because, Csernansky said, "even normal patients' brains change." Doctors scan the participants' brains every two years.

"In the past, schizophrenia was blamed on long-term institutionalization or lifestyle factors," said Csernansky. "While those factors can cause some deterioration of the brain's gray matter, we know they do not cause schizophrenia."

The study has also helped put to rest the myth that poor parenting causes the disease, he added.

Treatment of schizophrenia includes antipsychotic medications and psychotherapy. By comparing the disease progression with treatment, Csernansky said, the study will help show how medications affect or do not affect the schizophrenic brain.

"In the past, we've had to look at cadavers' brains and compare them to those of normal people," said Dr. Douglas Meinecke, program officer for the clinical neuroscience branch of the National Institute of Mental Health. "We know that with schizophrenia, the brain is broken, but the differences are so complex. [Csernansky] has perfected the use of computers to analyze the MRI data and find these differences. This is a step toward diagnosis for a disorder that cannot be diagnosed with something as simple as blood or urine."

"It's too late for my son," said Rodig, "but I hope to goodness this study will help people with schizophrenia. They want to be productive, want to work and want to have homes.

"We've come a long way when it comes to understanding mental illness, and we have a lot to learn."