Embracing the Complexity of Heterogeneity in Schizophrenia: A New Perspective From Latent Clinical-Anatomical Dimensions

Support continues to grow for the idea that schizophrenia, as we know it, is not a discrete illness but rather a generalized symptom of brain dysfunction. Distinct groups of individuals, sharing some common symptoms, may be affected by different underlying pathophysiology. This idea is driven by a number of factors, including clinical observations suggesting a wide variation in patient phenomenology, course, demographics, and prognosis (eg, deficit syndrome1). Further support comes from a series of new studies that have adopted unsupervised machine learning approaches and generated compelling evidence to suggest biological and clinically relevant discrete biotypes2 as well as clinical high-risk (CHR) subtypes.3 Of course, as noted above, there are common symptom phenotypes across schizophrenia, irrespective of any subgroups, and there is a reasonable argument to be made that these are central to diagnostic systems and in communicating the clinical experience. A range of brain abnormalities is also widely observed in psychosis, and the extent to which these map on to specific symptoms or functions, or give rise to broader constellations of clinical features, remains an open question. Clouding this picture, findings may also relate to compensatory mechanisms or to any number of confounds that separate schizophrenia from neurotypical controls. It is presently unclear whether particular brain abnormalities contribute to particular subtypes, or reflect or contribute to dimensions ...
Source: Schizophrenia Bulletin - Category: Psychiatry Source Type: research