Schizophrenia: Fire in the Brain

Studies of the Effect of Drugs on the Brain Schizophrenia: Fire in the Brain and, for some, additional damage is ex r penenced. Despite this effect, there has Edward H. Taylor been no evidence that neuroleptic induced problems change the primary David Cohen's disagreement with the studies have shown that ventricular brain areas thought to be responsible for biological basis of schizophrenia ["Bioenlargement is not caused or changed schizophrenia. Simply linking TD with logical Basis of Schizophrenia: The Eviby extended neuroleptic treatment, neuroleptic drugs does not discredit dence Reconsidered," Social Work, 34 electroconvulsive treatment, long-term years of neurological findings and (May 1989), pp. 255-257] can be suminstitutionalization, age, or duration of schizophrenia research. Cohen offered marized into the following six broad illness (Shelton & Weinberger, 1986). A no research to identify where or how concepts: (1) no single abnormality is follow-up study of 18 individuals with neuroleptic-induced artifacts challenge associated only with schizophrenia; (2) chronic schizophrenia found no change the neuroscientific underpinnings of computerized axial tomography (CAT) in ventricle size after an additional 8 schizophrenia. No documentation was scans have limited importance; (3) findyears of drug treatment (Illowsky, provided to suggest a relationship be ings are based on small samples; (4) Juliano, Bigelow, & Weinberger, 1988). tween neuroleptic drug treatment and schizophrenia is difficult to diagnose; (5) National Institute of Mental Health decreased brain size; enlarged ventricles; neuroleptic drugs change brain func(NIMH) studies document that observfrontal lobe dysfunction; overproduction tions, produce damage, and cause mulable psychotic symptoms become more of dopamine and brain receptors; abnor tiple side effects such as tardive intense during drug-free periods and mal cerebral fluid; or changes in frontal, dyskinesia (TD); and (6) the biological decrease when neuroleptic drugs are adhippocampal, or dentate gyrus cells, argument is not new. ministered (Kirch, Bigelow, et al., 1988; Cohen supported his view by a collec Kirch, Jaskiw, Linnoila, Weinberger, & tion of assumptions put forth by a limited Wyatt, 1988). The only intervention number of individuals. Furthermore, known to reduce psychotic symptoms of these assumptions, when read closely, schizophrenia has been neuroleptic are generalizations, opinions, or inter Cohen is correct to assume that drugs (Torrey, 1988b). pretations. For example, Cohen used five neuroleptic drugs complicate analysis of If schizophrenia is not a medical illneuroscience references. Four of the five brain data and behavioral observations, ness, then why does it respond to citations are not findings but opinions However, the notion that neurological medications but not to independent made after reviews of selected research studies cannot be trusted if these social treatments? Case management, literature (Heinrichs and Buchanan medications have been taken is incorsocial skills training, and other therapies [Cohen, p. 255]; Marsden, Mindham, and rect. Most drugs create some type of increase functioning when accompanied Mackay [p. 256]; Cohen and Cohen [p. neurochemical interaction. As an examby neuroleptic treatment and fail if 255]; and Crane [p. 256]); the remaining pie, animal experiments show that drugs are not administered (Torrey, article addresses the length of time that nicotine creates functional changes in 1988b; Taylor, 1987).The side effects neuroleptic drugs remain active in the several parts of the brain (Kirch, that can occur from current medications brain (Campbell and Baldessarini Gerhardt, Shelton, Freedman, & Wyatt, testify to a need for new and improved [p. 256]). In addition, the opinions were 1987). Therefore, reporting general drugs rather than rejection of the not based on reviews of research de assumptions that neuroleptic drugs afbiological basis. Three important issues signed to discover whether biological in fect the brain sounds impressive but ofmust be considered in reviewing dicators of schizophrenia actually were fers little information. schizophrenia and neurological findings: neuroleptic artifacts. Instead, the opin Neuroleptic-free populations, although (1) Were primary symptoms present ions are simply assumptions formed difficult to locate, have been researched, before drug therapy? (2) Do neuroleptic from numerous studies with various along with many individuals withdrawn medications provide measurable benehypotheses and purposes, whose find from medications. Postmortem brain fits that are not outweighed by drugings illustrate how drugs interact in studies that explore schizophrenia induced side effects? and (3) Is there a numerous brain areas and complicate historically have reported abnormal direct relationship between drugs and neuroscience research. This argument is neurological structures. These projects specific brain damage? acceptable until the generalization is ap have included individuals who died beNeurological symptoms clearly exist plied to specific brain functions and fore neuroleptic drugs were discovered at the onset (before medicating) of structures. To change global concepts to and other individuals who, for various schizophrenia (Wyatt, Alexander, Egan, explicit variables requires controlled reasons, received no medications (Kirch & Kirch, 1988). Once medications are instudies with clear methods, focused & Weinberger, 1986). Numerous troduced, the brain's chemistry changes, hypotheses, and operational definitions.