On Brain Disease

“Monday Musings” for Monday September 7, 2015

Volume V. Number 38/246


Science Series: No. 88


Schizophrenia, A Brain Disease

By Assad Meymandi, MD, PhD, ScD (Hon), DLAPA*

In the limited life span of Neolithic man, roughly ten thousand years, we have experienced stunning advances in knowledge, humanities, civil and individual rights; and with the birth of our beloved America, a perfection and maturation of the rule of law. These are all good news, indeed Gospels. But what stands out, if one would do a meta-analysis of all factors advancing the cause of life and advocating the dignity of humankind, is the field of science and its contribution to improving the quality of life.

Let’s take the case of understanding and treatment of schizophrenia, a dreaded brain disease. Yes, I said brain disease. We have come far from the days of demonic etiology of schizophrenia, the days of snake pits, and inhumane treatment of patients with schizophrenia (note: I did not call these patients schizophrenics. They are individual suffering from schizophrenia). The life giving transformation of care by pioneer institutions, such as England’s Bethlehem Hospital and our own Dorothea Dix Hospital, followed by the emergence of community psychiatry are eloquent testimonies of the evolution of care of severely ill psychiatric patients.

What is currently filling our psychiatric literature and journals is most promising. We are in the throes of making new scientific discoveries based on biologic markers, neurochemistry, and advances in images. Instruments such as high resolution Magnetic Resonance Imaging (MRI), Functional MRI (fMRI), Positron Emission tomography (PET) scans are discovering new frontiers in understanding schizophrenia. We are learning that this dreaded disease that causes hallucination, delusion, and paranoia, is a diseased or disarrayed neuronal web in the central nervous system, especially the brain.

Research scientists in neurobiology continue their pursuit of finding an effective pharmacological agent to help treat schizophrenia. We have learned about the cholinergic neurotransmitters, the muscarinic and nicotinic neuro-receptors and dopamine1 and dopamine 2 agonists and antagonists.

A new group of drugs under investigation, cholinergic agonists, mediated by two families of receptors, nicotinic and muscarinic receptors are offering promise. The nicotinic receptors are ligand-gated ion channels formed by pentameric (5) combinations of different a and b subunits, as well as homomeric (consisting of one repeated unit) receptors. Activation of the nicotinic receptors leads to a rapid increase in sodium and/or calcium conductance that increase neuron activity and neurotransmitter release. This explains why persons afflicted with schizophrenia have such a hunger for cigarettes.

Saint Paul, a fascinating brain, and an elegant stylistic writer (see Paul’s letters in The Bible) summed up the future of mankind in offering hope, charity and love. What science does for us is a combination of all three. It takes a tremendous amount of motivation and discipline (charity), tenacity and optimism (hope) and dedication and altruism (love) to pursue science.


*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association; Life Member, American Medical Association; Life Member, Southern Medical Association; and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012).

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