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Kelvin Lim and Sanjiv Kumra

Kelvin Lim (R) and Sanjiv Kumra (R), both psychiatric researchers, are using magnetic-resonance-imaging techniques to describe the brain anatomy that distinguished psychotic illness.

An inside view

Imaging technology illuminates the anatomical aspects of adolescent mental illness--from schizophrenia to substance abuse.

By Jennifer La Forgia

From Dec. 22, 2006

The revealing power of magnetic resonance imaging (MRI) is helping psychiatric researchers demystify the potential causes of schizophrenia and is casting new light on troubling behaviors such as adolescent substance abuse.

Physicians once relied only on the layered shadows of X-rays to view the interior of the body and the brain, but today, MRI technology brings the body's inner structures into tight focus. With recent MRI advances, researchers can pinpoint areas of heightened brain activity and the subtleties of normal and abnormal brain communication pathways.

Some of this new knowledge arises from the University's Department of Psychiatry's special focus on schizophrenia.

The World Health Organization ranks schizophrenia among the 10 most debilitating human diseases. It affects a person's ability to think clearly, to tell the real from the unreal, to form close relationships and to function in society. The first outward signs of the illness usually emerge in the teen years and early twenties, but sometimes much earlier. Schizophrenia affects about 1 percent of the population.

Today, researchers in the Department of Psychiatry continue to piece together the signature differences in brain structure and function that distinguish schizophrenia.

With access to the University's Center for Magnetic Resonance Research, a state-of-the-art MRI facility dedicated solely to research, brain researchers such as psychiatrist Kelvin Lim are obtaining image-based evidence of the differences between normal brains and those of persons with schizophrenia.

Lim and fellow psychiatric researchers Tonya White and Sanjiv Kumra agree the differences that distinguish schizophrenia are present in the white matter of the brain.

One might say the white matter is like the super highway communication system of the brain. It is deep within the brain and is made up of neuronal pathways that connect all major brain regions. Its disruption has profound implications and may account for the diverse symptoms of schizophrenia. Normally, the neurons that make up these pathways are coated with myelin, a white substance that gives the white matter its name and makes it possible for neurons to send messages efficiently. Myelin is like the insulation around wiring and when it's not in good shape, messages are garbled.

"There is clear evidence of disruption in the organization of the brain's white matter in schizophrenia, and we can relate this level of disruption to how well people are thinking and their cognitive ability," says Lim

Brain scientists refer to white matter as being "organized" when the neuronal pathways are aligned in a mostly parallel fashion and "disorganized" when this parallel alignment is in disarray.

Lim says, "There is clear evidence of disruption in the organization of the brain's white matter in schizophrenia, and we can relate this level of disruption to how well people are thinking and their cognitive ability."

Tonya White, an assistant professor in child and adolescent psychiatry, is uncovering subtle brain differences between young people who develop normally versus those who develop schizophrenia or other psychotic illnesses.

White's early findings indicate that in people with schizophrenia the white matter pathways within the hippocampus (a brain structure critical to memory) are disrupted. In addition, her group showed that the fornix, another white matter pathway, is smaller in people with schizophrenia.

As key areas of difference are identified in young people with and without mental illness, more information will emerge on what can positively and negatively affect these areas.

Sanjiv Kumra, the head of the Division of Child & Adolescent Psychiatry, co-led a study that found adolescents who smoke a lot of marijuana shared similar white matter abnormalities as those observed in teenagers with schizophrenia. The study suggests that heavy marijuana use may hasten the onset of schizophrenia in those who are genetically predisposed to it.

Kumra notes that while MRI technology has helped show that environmental experiences (such as drug use) can affect the developing structure of the brain's white matter, new data suggests there may also be ways to improve brain structure. A recent Swedish study shows a positive correlation between practicing the piano and increased organization of white matter in the brain's motor regions.

Psychiatric researchers will continue to use MRI technology to unveil differences in the brains of people with mental illness and those without. And, although still in the future, this technology may one day be used to detect psychiatric problems early, when they are most responsive to treatment.

Republished from Pictures of Health, fall 2006, a publication by the Academic Health Center.