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UI study finds evidence of link between children and adults forms of schizophrenia

IOWA CITY, Iowa -- People with schizophrenia, once thought to be the victims of poor parenting, are now recognized as victims of an error in brain development. A new University of Iowa study is helping provide evidence that schizophrenia may in fact be a developmental disorder, present in children though the symptoms don't usually manifest themselves until adulthood.

The study, conducted by Peg Nopoulos, UI assistant professor of psychiatry, provides evidence that supports this theory and will help physicians better understand the development of schizophrenia.

Her findings are published in the August issue of the American Journal of Psychiatry.

Schizophrenia is usually diagnosed in adults between the ages of 18 and 20, but it is occasionally evident in children under the age of 12. The childhood-onset form of the disorder is similar to the adult-onset form in many ways, but it is more severe. Adults and children with schizophrenia share similar cognitive, motor and behavioral disorders, and the use of magnetic resonance imaging (MRI) indicates there are abnormalities in certain areas of the brain in both child and adult schizophrenics.

These findings suggest that schizophrenia may be a developmental disorder in which brain anomalies are present at birth, but the symptoms of schizophrenia generally aren't severe enough for diagnosis until a person reaches young adulthood.

Nopoulos and her colleagues investigated this hypothesis by using MRI to study the brains of 24 patients with childhood-onset schizophrenia. Their examination focused on a brain region called the cavum septi pellucidi (CSP). An enlarged CSP is associated with some forms of mental retardation, and is found in 12 percent of adult-onset schizophrenics. The biological significance of an enlarged CSP is that it can serve as a marker for anomalies in brain development.

"When I see an enlarged CSP, it raises a red flag. It is an indicator of brain maldevelopment and may be associated with a cognitive deficit," Nopoulos said.

The CSP is a small cavity of fluid in a layer of tissue that separates the lateral ventricles, two bodies of fluid inside the brain. Early in embryonic development it starts out as a single layer, but splits into two layers soon afterward. Just before birth, the two layers fuse back into one. In some people with schizophrenia the tissue does not fully fuse, and their CSP is larger than normal.

All patients with schizophrenia have cognitive deficits, such as problems with learning, memory, organization and other intellectual skills, Nopoulos said, and CSP development may be related to cognitive deficits in schizophrenics.

"Patients with schizophrenia who have an enlarged CSP are more cognitively impaired than people with schizophrenia whose CSP is of normal size," Nopoulos said.

Nopoulos found that the CSP was enlarged in about 12 percent of the people with childhood-onset schizophrenia, about the same number found in people with adult-onset schizophrenia. However, the size of the CSP found in the childhood-onset sample was much larger indicating a more severe anomaly. The finding suggests that childhood- and adult-onset schizophrenia are the same disease on a continuum of severity.

"These findings help us understand the developmental process involved in schizophrenia and confirms that the brain changes that we see are a part of the disorder," Nopoulos said.