Letter to the Editor: The half-alive concept of schizophrenia is still better than the spectrum of everything

Functional brain networks in clinical high-risk for bipolar disorder and psychosis

Abnormal connectivity in the brain has been linked to the pathophysiology of severe mental illnesses, including bipolar disorder and schizophrenia. The current study aimed to investigate large-scale functional networks and global network metrics in clinical high-risk for bipolardisorder (CHR-BD, n = 25), clinical high-risk for psychosis (CHR-P, n = 30), and healthy controls (HCs, n = 19). Help-seeking youth at CHR-BD and CHR-P were recruited from the early intervention program at Dokuz Eylul University, Izmir, Turkey. Resting-state functional magnetic resonance imaging scans were obtained from youth at CHR-BD, CHR-P, and HCs. Graph theoretical analysis and network-based statistics were employed to construct and examine the topological features of the whole-brain metrics and large-scale functional networks. Connectivity was increased (i) between the visual and default mode, (ii) between the visual and salience, (iii) between the visual and cingulo-opercular networks, and decreased (i) within the default mode and (ii) between the default mode and fronto-parietal networks in the CHR-P compared to HCs. Decreased global efficiency was found in CHR-P compared to CHR-BD. Functional networks were not different between CHR-BD and HCs. Global efficiency was negatively correlated with subthreshold positive symptoms and thought disorder in the high-risk groups. The current results suggest disrupted networks in CHR-P compared to HCs and CHR-BD. Moreover, transdiagnostic psychosis features are linked to functional brain networks in the at-risk groups. However, given the small, medicated sample, results are exploratory and hypothesis-generating.

Schizophrenia-schizoaffective-bipolar spectra: an epistemological perspective

For decades clinicians and researchers have been thinking and writing about the spectrum of schizophrenia disorders. Indeed both Kraepelin and Bleuler believed in schizophrenia as a spectrum, both in a clinical (individual) and hereditary (family) continuum, from just some exquisite personality traits to unquestionable chronic and debilitating psychosis. Other authors would put the schizophrenia spectrum disorders on different levels of continuum: developmental, psychofunctional, existential, and genetic. Here, we would like to present an historical chronology for the schizophrenia-schizoaffective-bipolar spectra plus a tridimensional model for these spectra: the first axis for categories (affective versus nonaffective psychoses), the second axis for dimensions (personality versus full blown psychosis), and a third axis for biomarkers (remission versus relapse). We believe that without the schizophrenia-schizoaffective-bipolar spectra concept in our minds all our efforts will keep failing one the hardest quest: searching for biomarkers in schizophrenia and related disorders.