Sliding into psychosis

This week’s edition of Nature is a special issue on schizophrenia and it includes an open-access feature article on the neuroscience of why the disorder only tends to appear in young-adulthood.

One of the themes to come out of the piece is how symptoms of schizophrenia, like delusions and hallucinations, lie on a continuum – the idea being that we all have reality distortions to varying degrees and that these distortions themselves may vary in intensity.

In about a third of people, these will intensify into florid psychosis and a diagnosis of schizophrenia, but for others, the experiences seem self-limiting.

One of the big questions in schizophrenia research is to understand what happens in the mind and brain during this transition and, of course, if possible, to prevent it by early treatment.

This has sparked a great deal of heated debate because up to two thirds of ‘at risk’ people will never develop schizophrenia anyway, and yet might be unnecessarily labeled and medicated.

It’s probably worth noting that the idea of a ‘continuum of psychotic symptoms’ is popular but also still not very well defined, as a locked editorial in the latest issue of Psychological Medicine makes clear.

It’s possible to see a sliding scale in the intensity of experiences, how often they occur, and the emotional impact they have, among many other things, but its not clear how you would go about disproving a continuum in many cases.

The Nature article is a remarkably broad look at the whirlwind of issues surrounding how schizophrenia develops and tackles the issue from the basic neuroscience to the ethics of early treatment.

There’s loads more great stuff on schizophrenia in the same issue, sadly most of it locked out of the internet, but if you want more neuroscience, there is another open-access article on the contentious issue of whether the brain’s glial cells communicate.
 

Link to article ‘Schizophrenia: The making of a troubled mind’.
Link to article ‘Neuroscience: Settling the great glia debate’.
Link to table of contents for this issue.