Schizophrenia is underlined by subtle changes in multiple regions in the brain. Professor David Lewis discusses some of these changes.

A major question in the study of schizophrenia is, what actually is wrong in the brain? For many years that was an open question as to even if there was something wrong. It is now clear that there are subtle changes in the brain, and these changes may affect multiple regions of the brain and it is still an ongoing issue to firmly identify what are the characteristic features. So, we still can’t, at autopsy, look at a brain specimen and make the diagnosis of schizophrenia. However, evidence is accumulating to indicate that, at a morphological level, certain cells in the brain may be smaller – they may have less in the way of the small protrusions off of their dendrites that are call spines. Other neurons seem to show altered expression or the amount of certain gene products. So, there may not be a classic neuropathology of schizophrenia in the sense of an identified lesion that is characteristic of the illness in the way that neurofibrillary tangles and neuritic plaques are characteristic of the neuropathology of Alzheimer’s disease. But the absence of that does not mean there aren’t a number of changes in the brain that are, in fact, the basis of the illness and we anticipate that with time, the specific characteristics of those changes will become more apparent.

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