Progressive cortical reorganisation: A framework for investigating structural changes in schizophrenia

One of the few well-replicated features of schizophrenia is the demonstration of neuroanatomical abnormalities affecting cortical and subcortical grey matter (GM). Evidence to date suggests that the greatest reduction in GM occurs in the immediate post-onset phase. The predominant view to date is that the accelerated grey matter (GM) loss represents an adverse process (degenerative or developmental deficit) contributing to the unfavourable course of schizophrenia. This prevailing emphasis on decompensation often overlooks the fact that human brain has an inherent capacity to remodel itself in response to insults that affect its function. In the wake of emerging insights into both micro- and macro-scale brain connectivity, a substantial amount of the longitudinal structural changes seen in patients with schizophrenia could result from a distributed, nevertheless inefficient, cortical reorganization response. Quantifying cortical reorganization in the early stages of illness can enable prospective grading of the underlying pathophysiological process in schizophrenia.