A review of the neuropathology of schizophrenia

1. Research on the structural basis for schizophrenia was considered a graveyard for neuropathologists, largely because its aetiology has remained obscure. However, there have been several recent major reviews and studies in leading journals on the neuropathology of schizophrenia highlighting the alterations found in the brains of schizophrenic patients. 2. It is clear from the evidence that schizophrenia can no longer be considered a purely functional psychosis with no structural basis. Multiple and possibly widespread neural systems are likely to participate, because diffuse ventricular enlargement and decreased cortical volume are common in schizophrenia. Interestingly, these features do not herald neuronal loss, findings similar to those obtained in alcoholic and aged populations. Impairment in judgement is common to all these subject groups. 3. The frontal and temporal lobes and their thalamic relays appear particularly affected in schizophrenia and there is some evidence for significant asymmetries. These regions are also consistently affected in patients with neurodegenerative cognitive impairment, although patients with schizophrenia can be distinguished by a lack of classical tissue pathology. 4. The cellular phenotypes that must be structurally compromised have yet to be definitively identified and the relationship between any neurochemical and structural abnormality remains unclear. The subtlety of these changes and their diffuse nature have evoked a consistent chorus that schizophrenia is a neurodevelopmental abnormality; however, this is hard to prove at a structural level using cross-sectional post-mortem analyses.