What is schizophrenia and when will they learn to diagnose it objectively Biophysicist Ushakov talked about the search for methods for the objective diagnosis of schizophrenia 09/05/2023, 08:11

– Vadim, is it really not clear today the reason for the development of schizophrenia, it is not clear why hallucinations and delusions appear in patients, and there is also no objective assessment of their condition? It turns out that doctors can differ drastically in their diagnosis?

– Unfortunately yes. The diagnosis of “schizophrenia” is largely a subjective assessment of the doctor. This is the problem of all psychiatry: there are no objective assessments.

When you come with other diseases, a diagnosis is made, ultrasound, MRI, blood tests, other biological fluids are taken, and a decision is made considering all your complaints and these tests. So what can we measure in psychiatry?

– You can only poll…

Yes, that’s what doctors are doing right now. They ask questions, conduct psychological tests – patients answer them, and points are awarded depending on the severity of this or that symptomatology.

We understand that there is a “great mathematician” sitting in front of us, who is a “great writer”, someone is a “filmmaker”. Some people are afraid of surveillance. All these can be different forms of delusions and psychiatrists classify it very well. Patients describe what worries them, what sounds are said and what orders or phrases these words are pronounced with, what hallucinations they have. But how to see this, for example, on an MRI or EEG, on a MEG – that’s really a question.

Have you decided to join this difficult challenge?

Yes, we want to create an objective assessment of the diagnosis of schizophrenia and also to see how the functioning of a hallucinating sick brain differs from a healthy brain.

“But to understand why the brain of a schizophrenic is special, it is necessary to understand how the brain works in general. Any guesses?

– There is an understanding that the brain works according to the principle of wealth. Rich club means rich in connection.

This is most reminiscent of the work of the ministries. Each ministry is rich in links in its subordinate sector. A branch is a region of neurons. In order to reach an agreement among themselves, the council of ministers must meet as soon as possible. And they will decide everything quickly among themselves, so that each minister does not have to bargain with employees of another sector (individual neurons). And if you think about it generally, our world is controlled by the connection-rich.

So does the brain. So what is schizophrenia? This is the situation where the “ministries” cannot agree. You cannot get certain parts of the brain to work together. They don’t want to obey. They have their own lives. Not every neuron “clan” can come to terms with another “clan” and consciousness fragmentation occurs.

How can this be seen with MRI?

“Our thinking is that schizophrenics have an altered brain structure. We won’t be able to grow new neurons anymore, so it’s hard to rebuild all of this damaged structure. But maybe you can work to make sure there’s no disruption.

The unusual structure can be seen with anatomical MRI scans. With the help of morphometry methods, it is possible to measure the volumes, areas, thicknesses of certain structures of the brain.

In the same MRI, you can also measure a method called tractography (a technique that allows you to visualize the pathways of the brain – white matter tracts). Diffusions reflect the direction of the axonal pathways through which cells connect. So we can see the large, so-called “telegraph lines” of the brain. In other words, we see how one part of the brain is connected to another with the help of lines and how strong this connection is.

– Do you see a different structure and direction of the “telegraph lines” in the brain structures on MRI in patients with schizophrenia?

– Yes. In addition, in such patients, wealth is lost because the brain cannot agree with itself. But for now, we only see violations. The next step is to understand how certain disorders relate to symptoms (hallucinations, delusions). Now we continued our investigation with the polygraph link.

– A lie detector?

– Yes. The polygraph reflects traces of the memory that is important to you – some event or incoming information that is important to you. We have the ability to use an MRI-compatible polygraph, a photoplethysmogram to record upper and lower respiration – this is the volume of blood in the vessels, the pulse. Also, we can also record how the cardiogram changes, the galvanic skin reaction, that is, when a person is worried, their hands sweat. We have an array of these methods.

– What questions do you ask or what stimuli do you present to people with schizophrenia to relate their symptoms to their brain structure?

“First of all, we present the patient’s own name. We know that a healthy person has a strong reaction to his name. And we look at the polygraph, what changes in indicators reflect the importance of the alert. We then need to use functional MRI (fMRI) to visualize the brain’s neural networks associated with delusions and hallucinations.

– How do you do this?

We present the patient with his own delusional plan. Every schizophrenic patient has a disease of his own. And this plot lives on in his neural networks. It turns out that his brain is able to process this information, accept it as it is, and put some “reality tags” on it.

If we give information in the opposite direction with the same words or expressions, the neural networks that theoretically manage to produce this information will become active. We will see them.

According to the polygraph, we will understand that these words are very important to a person. Let’s say we offer: “The KGB is following me.” And the next time: “The doctors are watching me.” According to his plan, if these are the KGB and not the doctor, then using the polygraph we will see the contrast between these two sentences and using the fMRI method we visualize the brain structures that are activated at the same time.

When will you start this work?

– We already did. But there are different ways to extract information from the received data and we are using them now.

What conclusion can be drawn from this study?

“We now know which brain structures are associated with the manifestation of hallucinations and delusions.

How many of these structures are there?

– Different. Here it is necessary to approach individually. Consider five to 10 large-scale brain networks.

Are they scattered around the brain?

– Of course it’s messy.

– And in people with delusions and hallucinations are distributed in a completely different way?

– There are common fault areas and there are those that do not belong to the general.

In the first approach, as they say, we calculated with a warm hand which regions worked where and saw the interconnected morphometric, tractographic and functional neural network changes. Now we will understand this in detail.

– Will an objective assessment of schizophrenia ever be possible?

– I’m almost sure there will be such an assessment. To achieve this, we began to conduct extensive examinations of these patients. And we create such a database. And we begin to analyze how different data relate to each other.

– What is this data?

– We study genes, immunology, neurophysiology, i.e. everything related to clinical manifestations of various symptoms, in collaboration with other institutes. We study brain lipidomes (composition and classes of lipids that make up cell membranes, axonal processes, etc.). However, if our cellular composition changes, lipidomas must also change. And if lipidomas change, this will also be reflected in myelination. Myelination is the formation of lipid myelin sheaths around nerve fibers to provide the transmission speed of nerve impulses (information) in the brain.

In the past two to three years, scientists have found an MRI method that allows myelination to be measured non-invasively (without penetrating the body). So, using these methods you can see not only structural changes (for example, how pathways change), but also how the brain is packaged with myelin sheaths. Combined with morphometry, tractography and fMRI data, this has good potential to predict which specific areas of the brain are affected in schizophrenia. The picture is slowly emerging.

In addition, with the participation of the Alekseevskaya hospital, a fairly large library of isolated brain samples from patients with schizophrenia was accumulated. We can now perform what is called transcriptomic analysis to identify changes in the molecular networks of cells and understand how this relates to other objective indicators.

– So the schizophrenia analysis will still be created?

– Yes it will happen. I’m sure it will.

— When will it appear?

— In the next 10 years, I think. We are working. If we create something, you will know it for sure.

Schizophrenia remains one of humanity’s most mysterious diseases. So far, the causes of its development have not been found, there is no objective diagnosis, it is completely incurable. One of the leading researchers at Moscow State University’s Institute for Advanced Brain Research says whether an analysis for schizophrenia will emerge and how it will help develop the polygraph. MV Lomonosov, Senior Researcher, Scientific and Clinical Research Center for Neuropsychiatry, Hospital. Alekseeva Vadim Ushakov.



Source: Gazeta

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