vittorio

for decades, psychiatry treated schizophrenia as a single disease with predictable neural patterns. but a new study, pulling MRI data from 6,000+ patients across 22 countries, just made that idea obsolete it’s not one illness. it’s a spectrum of biological chaos 2/

patients show massive variability in brain structure: cortical thickness, surface area, and subcortical volume fluctuate wildly. but one feature is interestingly uniform across all cases: the folding pattern of the right anterior cingulate cortex. what does this mean? 3/

folding patterns in this region solidify in early childhood. this suggests schizophrenia isn’t just a condition that emerges later, it’s baked into neural development from the start. the brain’s blueprint was altered before symptoms even began. 4/

this kills the old model of schizophrenia as a disease of chemical imbalance alone. it’s a neurodevelopmental condition with structural hardwiring issues. the variability explains why symptoms differ so much: paranoia, hallucinations, cognitive impairment. no two cases are the same. 5/

but here’s the good news: if the disorder is fundamentally structural, psychiatric drugs targeting chemicals are treating the wrong thing. the whole field needs a reset. 6/

another new meta-analysis (Mancini et al., 2025) confirms anticholinergic medications worsen cognitive decline in schizophrenia. psych drugs aren’t just failing, some are actively damaging cognition. this has massive implications. 7/

anticholinergic burden directly correlates with worsening memory, attention, and executive function. patients on high doses perform 2 standard deviations below the general population in cognitive tasks. we're drugging them into functional collapse. 8/

even worse: the study found tapering off anticholinergics actually improved cognition. this should be a breaking news. we have millions of patients on drugs that make them worse, not better. 9/

so where does this leave us? - schizophrenia is not one disorder, it’s a spectrum of structural abnormalities. - most treatments target symptoms, not causes (obviously). - some drugs may be accelerating cognitive decline instead of treating the disease. 10/

what’s next? neuroplasticity-based treatments. precision psychiatry. structural neuroengineering. psychiatry needs to stop throwing chemicals at a structural problem. the real cure for schizophrenia won’t be found in pills, it’ll be rewiring the brain itself. 11/

ai-driven brain mapping, gene therapy, and neurostimulation are the future of psychiatry. whoever cracks this first controls the next great leap in mental health. how long until we start seeing real rewiring tech hit the market? 12/

https://doi.org/10.1176/appi.a...