A brain scan method showing a chemical abnormality in a critical part of the brain could herald an early method of diagnosis for schizophrenia thanks to the work of a collaborative team at the new Centre for Psychosis, Institute of Psychiatry at King's College London, and University College London, Institute of Nuclear Medicine.
Schizophrenia is one of the most serious mental disorders, involving disrupted thinking and behaviour and can be devastating for the sufferer and their carers alike. It is as common as diabetes in the UK affecting one per cent of the population and it can often strike young people at the height of an individual's potential, for example during A-levels, or when embarking on a career or at university. In some cases lifelong and expensive treatment is required.
"What this intriguing finding means is that for the first time we may have a non-invasive method for scanning chemicals in the brains of living patients which may lead to new treatment and diagnostic approaches in the disorder. This is work in progress and we desperately need more funding to develop and extend this very exciting development," said Professor Pilowsky.
Structural brain scans have already revealed that schizophrenic patients as a group often have smaller brains, with subtle evidence of shrinkage in particular areas associated with emotions, thinking and memory and scientists have long thought from studying patients brains at post mortem that a chemical abnormality in the NMDA system might exist . This new chemistry deficit in the temporal cortex found in living patients now confirms this. Pilowsky and her colleagues revealed this defect after a long period of investigation. This included development of the SPET scan itself, and application of the technique to scanning of schizophrenic patients, who were not being treated with anti psychotic medication. Scans of a small group of these patients were compared to healthy individuals using the most up-to-date analytic methods.
In the brain, nerve cells 'talk' to each other using special chemical messengers (called neurotransmitters). When a cell releases one of these chemical messengers it fits into its unique receptor to transmit a message. NMDA, and its messenger chemical glutamate that are essential for cell-to-cell communication within the brain. A deficiency in this system could literally result in 'loose' wiring, with fragile connections between areas of the brain that need to communicate. Schizophrenia researchers have suspected that this may be happening in the disorder, but early studies were affected by medications patients had been taking before their death, and by the event itself. SPET and PET scanning allow imaging of brain and body chemicals in humans in life.
Professor Lyn Pilowsky, supported by the Medical Research Council, has been developing this scan (called SPET) for the last five years. Her collaborators include Professor Peter Ell and his team at the Institute of Nuclear Medicine at UCL, Dr Rodrigo Bressan and Dr James Stone, King's College London, Professor John Krystal, Yale University, USA, and Professor David Wyper's team, Glasgow University. The results of this study were published in the Journal of Molecular Psychiatry, February 06.
The paper, 'First in vivo evidence of an NMDA receptor deficit in medication-free schizophrenic patients' appeared in Molecular Psychiatry, February 2006.
Professor Pilowsky is the first author of this paper and is the Professor of Neurochemical Imaging, Institute of Psychiatry, King's College London. During the course of this research Professor Pilowsky was a UK Medical Research Council Senior Clinical Research Fellow (1999-2004). Other colleagues in this collaboration included: Dr Rachel Mulligan, Austin Hosp.Melbourne, Victoria, Australia; Dr Erik Arstad, Hammersmith IMANET, Imperial College London; Physicists/Mathematical Modellers and Dr Kjell Erlandsson, Columbia University, New York. Professor Robin Murray, Institute of Psychiatry, King's College London.
The case and control subjects used in the study were from in and around London. It is particularly helpful that this research was done in collaboration with colleagues, patients and their families from the South London and Maudsley NHS Trust, and the wider London area.
The Institute of Psychiatry is part of King's College London which now hosts four prestigious Medical Research Council research centres, more than any other university in the country. King's College London is the fourth oldest university in England with more than 13,800 undergraduate students and nearly 5,700 postgraduates in nine schools of study based at five London campuses. It is a member of the Russell Group: a coalition of the UK's major research-based universities. The College has had 24 of its subject-areas awarded the highest rating of 5* and 5 for research quality, demonstrating excellence at an international level, and it has recently received an excellent result in its audit by the Quality Assurance Agency.
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