Mapping the Brain to Detect Early Mental Disorders

Researcher John Csernansky, MD, chair of psychiatry and behavioral sciences at the Northwestern University Feinberg School of Medicine, and of psychiatry at the Stone Institute of Psychiatry, Northwestern Memorial Hospital, is working to produce a “map of the unique dips, swells and crevasses of the brains of individuals that he hopes will provide the first scientific tool for early and more definite diagnosis of mental disorders such as schizophrenia.” The hope is be able to diagnose such mental disorders at their earlier stages, when they are most treatable, a task that currently remains elusive.

Measuring these features of brain structure will allow Csernansky and colleagues to reveal how they function, thus revealing “how the brains of humans with and without major mental disorders differ from each other and the time frame over which those differences develop.”

Csernansky said that the current method of diagnosing psychiatric illness—by asking a patient about his or her symptoms and history—is “akin to diagnosing a heart attack by asking people when their pain came and where it was located. We would like to have the same kinds of tools that every other field of medicine has.”

It is for this reason that Csernansky is heading an NIMH study to measure the differences in brain structure between people with schizophrenia and people whose brains are “normal” in order to more quickly identify the disease in its earliest stages and determine if drugs used to treat it actually stop its advance.

As opposed to the current method in which treatments are evaluated to see if a patient’s symptoms have improved over a few months, Csernansky wants to know “whether a few years later are you more able to work, are you better able to return to school? If you take these medicines for years at a time, is your life better than if you had not taken them? We want to understand the effects of the medicines we give on the biological progression of the disease. We think that's what ultimately determines how well someone does…

“Like every other illness, psychiatric illnesses don’t blossom in their full form overnight. They come on gradually. You don’t need a biomarker to tell you that you have breast cancer, if you can feel a tumor that is the size of a golf ball. But who wants to discover an illness that advanced? A biomarker of the schizophrenic brain structure would help us define it, especially in cases where the symptoms are mild or fleeting.”

Csernansky is advancing the use of MRI brain maps to measure brain differences by teaching computers to do work that until now had been done by technicians using a light pen to trace and manually measure brain structure boundaries. Using the computers will allow the procedure to be faster and more accurate.

“Understanding what changes in brain structure occur very early in the course of schizophrenia and how medication may or may not affect these structures as time goes by will help us reduce the uncertainty of psychiatric diagnosis and improve the selection of treatments,” concluded Csernansky.