What is it about?
Antipsychotic medication is effective for treating the delusions and hallucinations of schizophrenia. However, many people with schizophrenia still find it difficult to engage fully in social or occupational activities. This shows that delusions and hallucinations are not the core problem for long-term function in everyday life. A wealth of evidence suggests that the core problem is the disorganisation or impoverishment of mental activity. These symptoms are sometimes described as ‘negative symptoms’. Disorganisation or impoverishment of mental activity produces wide-ranging but subtle disruptions to thinking, feeling and behaviour. Brain imaging studies suggest that the cause is impaired coordination of activity in the brain. The integration of activity in different brain circuits appears to be impaired.
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Why is it important?
The focus on treating delusions and hallucinations in schizophrenia has distracted from strategies to improve the coordination of activity in the brain circuits that support every-day activities. To improve outcomes in schizophrenia, we need to focus on the core problem. There is growing evidence that the structure and function of the brain can be changed in beneficial ways, even in adult life, by exercising the relevant brain circuits. We now have the ability to identify the relevant brain circuits. This will help us devise more effective strategies to strengthen these circuits.
Perspectives
Many decades of working with people suffering from schizophrenia has taught me that helping people engage in everyday activities produces worthwhile improvement in function and well-being. Recent developments in brain science have improved our understanding of the ways that we might enhance the coordination of activity in the brain circuits that support every-day activities. The time is ripe for developing more effective treatments.
Peter Liddle
University of Nottingham
Read the Original
This page is a summary of: The Core Deficit of Classical Schizophrenia: Implications for Predicting the Functional Outcome of Psychotic Illness and Developing Effective Treatments, The Canadian Journal of Psychiatry, August 2019, SAGE Publications,
DOI: 10.1177/0706743719870515.
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