How Schizophrenia Affects the Brain


It’s hard to fully understand a mental disease like schizophrenia without peering into the human brain. Now, a study by University of Iowa psychiatry professor Nancy Andreasen uses brain scans to document how schizophrenia impacts brain tissue as well as the effects of anti-psychotic drugs on those who have relapses.

Andreasen’s study (cited below), published in the American Journal of Psychiatry, documented brain changes seen in MRI scans from more than 200 patients beginning with their first episode and continuing with scans at regular intervals for up to 15 years. The study is considered the largest longitudinal, brain-scan data set ever compiled, Andreasen says.

Schizophrenia affects roughly 3.5 million people, or about one percent of the U.S. population, according to the National Institutes of Health. Globally, some 24 million are affected, according to the World Health Organization.

Nancy Andreasen and her lab are using brain scans from magnetic resonance imaging to better understand how anti-psychotic drugs affect the brains of schizophrenia patients.

Nancy Andreasen and her lab are using brain scans from magnetic resonance imaging to better understand how anti-psychotic drugs affect the brains of schizophrenia patients.

The scans showed that people at their first episode had less brain tissue than healthy individuals. The findings suggest that those who have schizophrenia are being affected by something before they show outward signs of the disease.

Nancy Andreasen and her lab are using brain scans from magnetic resonance imaging to better understand how anti-psychotic drugs affect the brains of schizophrenia patients.

“There are several studies, mine included, that show people with schizophrenia have smaller-than-average cranial size,” explains Andreasen, whose appointment is in the Carver College of Medicine. “Since cranial development is completed within the first few years of life, there may be some aspect of earliest development—perhaps things such as pregnancy complications or exposure to viruses—that on average, affected people with schizophrenia.”

Andreasen’s team learned from the brain scans that those affected with schizophrenia suffered the most brain tissue loss in the two years after the first episode, but then the damage curiously plateaued—to the group’s surprise. The finding may help doctors identify the most effective time periods to prevent tissue loss and other negative effects of the illness, Andreasen says.

The researchers also analyzed the effect of medication on the brain tissue. Although results were not the same for every patient, the group found that in general, the higher the anti-psychotic medication doses, the greater the loss of brain tissue.

“This was a very upsetting finding,” Andreasen says. “We spent a couple of years analyzing the data more or less hoping we had made a mistake. But in the end, it was a solid finding that wasn’t going to go away, so we decided to go ahead and publish it. The impact is painful because psychiatrists, patients, and family members don’t know how to interpret this finding. ‘Should we stop using antipsychotic medication? Should we be using less?’”

The group also examined how relapses could affect brain tissue, including whether long periods of psychosis could be toxic to the brain. The results suggest that longer relapses were associated with brain tissue loss.

The insight could change how physicians use anti-psychotic drugs to treat schizophrenia, with the view that those with the disorder can lead productive lives with the right balance of care.

“We used to have hundreds of thousands of people chronically hospitalized. Now, most are living in the community, and this is thanks to the medications we have,” Andreasen notes. “But antipsychotic treatment has a negative impact on the brain, so … we must get the word out that they should be used with great care, because even though they have fewer side effects than some of the other medications we use, they are certainly not trouble free and can have lifelong consequences for the health and happiness of the people and families we serve.”

The study was published in June and was funded by Janssen Scientific Affairs, the National Institutes of Health (grant number:R01 MH097751)and the Brain & Behavior Research Foundation. Contributing authors, all from the UI, include associate psychiatry professor Beng-Choon Ho, visiting faculty Dawei Liu, resident AnviVora and senior research assistant Steven Ziebell.

Source: University of Iowa


Nancy C. Andreasen, Dawei Liu, Steven Ziebell, Anvi Vora, & Beng-Choon Ho (2013). Relapse Duration, Treatment Intensity, and Brain Tissue Loss in Schizophrenia: A Prospective Longitudinal MRI Study Am J Psychiatry (170), 609-615 DOI: 10.1176/appi.ajp.2013.12050674

  • Callahan

    I knew that Schizophrenia was caused by having high levels of the monoamines dopamine and serotonin, but I didn’t know that it also caused damage to the brain tissues. I also am surprised to find out that the medication also causes damage to the brain. Seeing as how severe schizophrenia’s effects are causing delusions, hallucinations, and effecting every aspect of one’s life if the person’s going to suffer damage any ways from the disease wouldn’t it be better to just use the medicine to block the monoamines so that way they can at least be able to have a functioning life? Also in regards to lowering the amount of medication if the person dose not have an effective dose then there really wouldn’t be any reason to give the medicine because not only would the person’s schizophrenia return, but also the medicine would also do physical harm to the person’s body.

    • Hi Callahan, thanks for reading. Meds used to blocked monoamines may increase social functioning and motor skills but would also likely increase severity of hallucinations and episodes of hostility in turn – possibly severe depression as well. In other words, you may “fix” some of the issues but new ones will arise in their place…whether this translates to a functioning life is debatable. But your hypothesis is a good one and something that has been discussed for some time. In terms of medication, you’ve hit the nail on the head and this is what the researchers of this paper are most concerned about I think.

  • Emma

    I am currently learning about schizophrenia in my psychology class, we read several articles and watched videos about people dealing with schizophrenia. However, what fascinated me the most in this article is that the medication given to patients diagnosed with schizophrenia is damaging their brain why would you give it to them? Isn’t it just like fighting fire with a fire and just making a bigger fire. Or is the outcome and the affect of the medicine do more good than harm the patient. Also if decreasing the amount given to them it would not help cure them it would just be like any other medication with no affect. I was also wondering as I was reading my psychology textbook Discovering Psychology 6th Edition in the prologue the where a story about a women who was suffering from schizophrenia and was having hallucinations about a fire happening in her room, as someone had walked by she was screaming for help and when the child getting her some help they told her shes just hallucinating but what if there really was a fire and nobody listened she would have died. I feel like people with schizophrenia are just like the little boy who cried wolf.

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