Unmasking schizophrenia

Abstract

Most schizophrenia researchers agree that multiple genetic and environmental factors contribute to this enigmatic disorder, but the exact nature of their interaction is much less clear. However, recent work by Deutsch et al.1. Deutsch C.K et al. Skewing of the brain midline in schizophrenia. NeuroReport. 2000; 11: 3985-3988 Crossref PubMed Scopus (21) Google Scholar on craniofacial dysmorphology (physical anomalies of the head and face) promises to uncover some of the embryological antecedents in schizophrenia by extrapolation from more established developmental trajectories. Although schizophrenia patients do not exhibit major craniofacial anomalies of the head and face, as do individuals with disorders such as Down Syndrome, minor physical anomalies of the head and face are over-represented in schizophrenia. In particular, recent studies have suggested that schizophrenia patients exhibit a greater number of minor physical anomalies than do non-schizophrenic individuals at the juncture of two craniofacial regions: the frontonasal prominence (e.g. forehead, orbital structure, and nose) and the maxillary prominence (e.g. cheek area and the upper jaw). ‘Fate-maps’, which detail how specific embryological regions mature into adult forms, reveal that this frontonasal–maxillary junction corresponds neuroanatomically to the diencephalic and mesencephalic border of the developing embryo. Because the adult brain and face derive from this common embryological primordium, Deutsch et al.1. Deutsch C.K et al. Skewing of the brain midline in schizophrenia. NeuroReport. 2000; 11: 3985-3988 Crossref PubMed Scopus (21) Google Scholar hypothesized that pathological processes in schizophrenia that produce craniofacial dysmorphology at the frontonasal–maxillary junction should also produce brain dysmorphology at the diencephalic and mesencephalic border. This, in turn, should result in midline anomalies in the mature brain.