Larry J. Seidman: Is it Possible to Integrate Studies of Brain, Neurocognition and Self in Schizophrenia? A Possible Path Through the Brain's Default Network
An advance in understanding the psychopathology of schizophrenia and related psychoses, beginning largely in the 1970's, was to identify neuropsychological problems and subsequently, with the advent of brain imaging based on MRI, to delineate structural and functional brain bases of these cognitive dysfunctions. The results from use of these tools, has substantially changed the understanding of schizophrenia, which is now understood to typically have significant neuropsychological features that evolve from the "premorbid" through "prodromal" and frank psychotic phases. At the same time, neural circuitry supporting executive, language and memory functions was shown to be abnormal, and that these alterations are often present well before the psychotic phase begins. Thus, neuropsychological and neuroimaging tools confirmed that schizophrenia is a disorder involving dysfunction of the brain, and that this disorder is neurodevelopmental in origin, with the psychotic process a "late" phase. Of note, is that in order to demonstrate "objective" deficits, more complex, phenomenological concepts of the inner world like the "self" were largely ignored for the last 2 decades of the 20th century, and a somewhat simplistic psychopharmacologically oriented biology dominated the field. However, as a number of investigators have demonstrated, it is possible to measure aspects of the self from interviews and other psychological measures, and also to "visualize" the brain states of the self while using functional MRI. This has revitalized interest in capturing aspects of inner mental life such as with the "default mode" functioning (e.g., activity of brain circuits when people are "just" thinking and not doing a task), and perhaps initiating a more relevant and appropriate biology of schizophrenia, and for the field of psychiatry at large. In this talk, I will cover these issues and will also address research in clinical and genetic high risk populations, as well as aspects of specificity in comparisons between risk for bipolar psychoses compared to schizophrenia. I will also discuss how this approach can be linked to novel treatments based upon brain plasticity.