New MU study strives to detect risk of psychotic disorders like schizophrenia

The study uses MRI scans to help detect and prevent psychosis from seriously developing in patients, which could help lower societal and public health costs.

Losing the ability to trust reality can significantly alter a person’s ability to function, but a new MU study that focuses on early detection for psychotic disorders can become a saving grace.

John Kerns, professor of psychology in the MU College of Arts and Science, recently published a study that indicates an increase of dopamine in the striatum of the brain is associated with psychotic disorders like schizophrenia. This association makes it possible to detect these psychotic disorders before they seriously develop.

Kerns’ study focuses on the association between psychosis and increased levels of dopamine in the striatum. The striatum is what processes positive versus negative feedback when a person is learning something new. Researchers suggest that when this area is dysfunctional, it interferes with a person’s ability to learn what is and is not real.

Having a sensory experience of something that is not truly there, being delusional and disconnecting with reality are all symptoms of psychosis or psychotic disorders.

Kerns' experiment tested two groups of people: one with psychosis symptoms and one without. He created a game where people would be presented with two pictures and based on how they responded, they could earn or lose points.

In this game, the subjects had to figure out which picture would earn them points and which picture would make them lose points. In a sense, they were trying to figure out which picture was considered “bad” and which picture was considered “good.”

Once the subject figured out which was which, Kerns would then switch it.

“What they thought was good turned bad and what they thought was bad turned good,” Kerns said.

People would get unexpected rewards or punishments when they responded a second time and had to re-learn which picture was good and which picture was bad.

Kerns and his team studied the striatum with MRI scans whenever what the person had previously learned changed. This data allowed Kerns to compare the two groups and see if there was a difference in the striatum or somewhere else in the brain.

“It really makes it hard for [people with psychosis] to interact with reality,” Joel Shenker, behavioral neurologist at MU Health Care, said.

When people can no longer function in society, they can no longer participate in society, resulting in public health and societal costs.

“Schizophrenia is associated with impairments in the ability to perform activities of daily living like financial management, transportation, cooking, cleaning, shopping and self-care activities,” Arpit Aggarwal, psychiatrist at MU Health Care, said.

When someone is diagnosed, society loses a contributing member and gains someone who has no choice other than to rely on the system.

According to a study in 2013 by Martin Cloutier et al., the U.S. economic burden of schizophrenia was estimated at $155.7 billion for 2013 in excess costs of healthcare, homeless shelters, loss of productivity and more.

If Kerns’ study is successful, the societal and public health costs could significantly drop. If psychosis can be detected early on, it could give the patient time to seek proper treatment like psychotherapy and medication to prevent the disorder from developing.

“[The MRI scan] could allow for a test that someone could maybe take, a non-invasive test someone could repeatedly do every so often to know the risk has not come back or it has come back and if there's a need for intervention again,” Kerns said.

However, there is concern from other doctors that the study could be relying too heavily on biomarkers, which are measurable indicators of a disease’s cause, without also paying attention to whether or not the actual disease and its symptoms are present. In this study, the biomarker is the functional MRI scans showing increased activity of dopamine systems.

Shenker said that some biomarkers alone are not enough to diagnose a patient.

“Hallucinations can occur in a patient with or without schizophrenia … We’re all at risk for different diseases,” Shenker said.

Nonetheless, the study is not over.

“So far things have been really consistent and we’ll have to see if that continues,” Kerns said. “The things that will make it more confident will be more replications and bigger sample size.”

The study, “Striatum-related functional activation during reward versus punishment based learning in psychosis risk,” can be found in Neuropsychopharmacology, an international scientific journal. The other authors of the study are two former graduate students at MU: Nicole Karcher and Jessica Hua.

Edited by Laura Evans | levans@themaneater.com

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