The neurobiology of transition to psychosis: clearing the cache

The neurobiology of transition to psychosis: clearing the cache


J Psychiatry Neurosci 2017;42(5):294-299

Lena Palaniyappan, MBBS, PhD; Tushar Das, PhD; Kara Dempster, MD

See the research paper by Dukart and colleagues


The prepsychotic phase of schizophrenia is not only important for indicated prevention strategies, but also crucial for developing mechanistic models of the emergence of frank psychosis (transition). This commentary highlights the work of Dukart and colleagues, published in this issue of the Journal of Psychiatry and Neurosicence, who sought to identify MRI-based anatomic endophenotypes of psychosis in a well-characterized sample of patients with at-risk mental state (ARMS) and first-episode psychosis (FEP). Conceptual and translational challenges in clarifying the neurobiology of transitional prepsychotic states are discussed. A role of intracortical myelin in the neurobiology of transition is proposed. Transition may not be an outcome of “progressive structural deficits”; it may occur due to inadequate compensatory responses in the predisposed. The need to revise our current “deficit-oriented” models of neurobiology of psychosis in the wake of burgeoning evidence indicating a dynamic process of cortical reorganization is emphasized.

Affiliations: From the Robarts Research Institute & The Brain and Mind Institute, Western University, London, Ont., Canada (Palaniyappan, Das); the Department of Psychiatry, Western University, London, Ont., Canada (Palaniyappan, Das, Dempster); and the Lawson Health Research Institute, London, Ont., Canada (Palaniyappan, Das).

Financial support: This work was supported by the Canadian Institutes of Health Research [377213/ 201610PJT]; Bucke Family Fund and Opportunities Fund, Academic Medical Organization of South Western Ontario.

Competing interests: L. Palaniyappan has received speaker fees from Otsuka and educational grant support from Janssen. The other authors report no competing interests.

Contributors: All authors contributed substantially to the conception, writing and revision of this article and approved the final version for publication.

DOI: 10.1503/jpn.170137

Correspondence to: L. Palaniyappan, Prevention & Early Intervention Program for Psychoses (PEPP), A2-636, LHSC-VH, 800 Commissioners Road, London, Ont., Canada N6A 5W9;