In 2014, a break out news was published by Malaysia local reporters claimed that 1 out of 100 populations in Malaysia were diagnosed with Schizophrenia. This statistical report revealed the reality of mental health among Malaysians, whereby it is a concern for medical practitioners, especially psychiatrist to help those affected with early diagnosis and identification at early stages, so that the patients may have high chances to be treated through proper rehabilitation. Schizophrenia is a chronic mental disorder which characterized by bizarre features of behavioral whereby they submerged in their own thoughts, delusions, hallucinations, and disorganized speech. It is a common practice for patients to be diagnosed based on the observations, long run treatment, and Neuropsychology test evaluations. Due to the nature of psychiatry diagnosis procedure, the chance of misdiagnosis at an early stage of mental sickness is quite common as behavioral assessment is based on subjective evaluation by the psychiatrist due to absence or unknown etiology.
In recent years, neurosciences offering valuable capabilities in assisting the diagnostic measures of Schizophrenia and create a clear bridge of psychiatry and neuroscience in providing clear pathways between psychology and neurology through the research on neural activation of the brain by using multiple types of neuroimaging techniques such as functional Magnetic Resonance Imaging (fMRI), Electroencephalography (EEG), and Event Related Potential (ERP). Each of these neuroimaging techniques has their own specialty in investigating neural activity across the brain region, but all in all, they provide the same directions of studies which are the cognitive abilities based on localization and neural activation region. A previous study by Simon et.al were conducted on the memory skill of Schizophrenic subjects by observing different sources of visual input and they need to recall which directions of the visual input is coming from. The study revealed that there was reduced prefrontal regions activation among schizophrenic compared to the healthy subjects and there was an indication that the reduction was mediated by the roles of the thalamus, medial anterior prefrontal cortex, and cerebellum. Meanwhile, for EEG or ERP, they captured the fast temporal processing of cognition by time locked the neural response once cognition activated. Both of these tests are valuable in assessing how big is the cognitive response are and also how fast the response are, which all of these information are crucial in determining one’s cognition state’s in ability to give attention, comprehension, discrimination, memory and learning. Cognitive neuroscience is dominant in the objective evaluation because the neural response does not give false positive compared to subjective evaluation of patients. Due to that reason, cognitive studies offering high accuracy in clinical diagnosis. However, cognitive neuroscience may also have limitation in terms of normative data for certain test such as in ERP. In ERP test, there is no specific range of measurement that can exactly be followed, but surely the principle of obvious small reading or too large responses being interpreted as abnormalities. For this such reason, cognitive neurosciences on psychiatry studies is still being widely researched so that it can create specific normalize data for certain mental disorders which could assist in clinical diagnosis more accurately. Same goes to other neuroimaging techniques as fMRI whereby the source localization may variously activate in different patients due to individual’s variation. Despite the variations, it is being accepted by many neuropsychologist and neuroscientist that schizophrenic have a mental reduction in prefrontal and frontal area which confirming the low cognitive process abilities among schizophrenic.
Cognitive neurosciences not only limited to diagnosis stages, but also may provide cognitive therapy for certain patients who may not fully benefited by antipsychotic medications. Cognitive therapy is conducted by using noninvasive neurostimulation of repetitive transcranial magnetic stimulation (rTMS) on left temporoparietal region, whereby it is speculated to be able to reducing auditory verbal hallucinations. Even though the treatment was not significantly positive, it does indicate a moderate effect of improving auditory verbal hallucinations among schizophrenic.
As a summary, cognitive neurosciences offers scientific knowledge that able to help psychiatrist and clinicians with diagnosing schizophrenic patients more accurately. It is still an early step for cognitive neurosciences to be recognized as objective measurement as many limitations still on extensive research. However, knowing that cognitive studies can offer high accuracy of diagnosis in mental disorder such as schizophrenia may reduce the rate of misdiagnosis in mental disorder.
About the Writer:
My name is Siti Atiyah Ali and I am a doctorate student in the field of Cognitive Neurosciences from Universiti Sains Malaysia (USM). My current research project is being supervised by Dr Tahamina Begum, a senior lecturer at Department of Neurosciences, USM Kubang Kerian, Kelantan. This opinion paper was written based on our personal perspectives and opinions.
References:
- Yahaya H. http://www.astroawani.com/berita-malaysia/satu-daripada-100-rakyat-malaysia-hidap-skizofrenia-46532. 2014. Retrieved on 16thApril 2018
- Spitzer M. A cognitive neuroscience view of schizophrenic thought disorder.Schizophr Bull. 1997. 23(1):29-50.
- Reynolds, C. F., Lewis, D. A., Detre, T., Schatzberg, A. F., & Kupfer, D. J. The Future of Psychiatry as Clinical Neuroscience. Academic Medicine: Journal of the Association of American Medical Colleges, 2009. 84(4), 446–450. http://doi.org/10.1097/ACM.0b013e31819a8052
- S. Simons, S. W. Davis, S. J. Gilbert, C. D. Frith, and P. W. Burgess. Discriminating imagined from perceived information engages brain areas implicated in schizophrenia, NeuroImage, 2006. vol. 32, no. 2, pp. 696–703.
- Aleman A. Neurocognitive Basis of Schizophrenia: Information Processing Abnormalities and Clues for Treatment. Advances in Neuroscience, vol. 2014, Article ID 104920, 15 pages, 2014. doi:10.1155/2014/104920
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]