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Nancy Andreasen
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By Ulrika
Kahl, Ph.D.
Introduction
HUBIN is this time proud to present the VIP
profile of one of the world's leading psychiatrists in the field
of schizophrenia. With an impressive list of publications behind
her, Professor Nancy Andreasen has for the past four decades helped
solving many of the questions around schizophrenia. She is also
one of the pioneers in the development and refinement of many of
the brain imaging methods that are used in psychiatric research
today, and which are important tools in the investigations aiming
at a clearer picture of what schizophrenia really is, and how it
could possibly be cured. Professor Andreasen is furthermore the
head of one of  HUBIN's
international affiliates at the University of Iowa - College of
Medicine in Iowa State, USA.
Schizophrenia
Schizophrenia is one of most puzzling diseases
known to man. Caused by several factors, of which many are still
not fully examined, this disastrous disease is characterized by
a multiplicity of symptoms that affect most aspects of human cognition,
emotion and behavior. Due to this variability, the diagnosis is
often complicated. Each patient displays his or her own individual
profile, which also varies over the course of the disease.
What we today call "schizophrenia"
was originally described nearly a hundred years ago by clinical
scientists. It was first referred to as "a serious cognitive
illness with an  early
onset", and eventually termed "schizophrenia" - where
"schizo" means "split" and "phrenia"
"mind".
Today - almost a century later - much is still unclear around schizophrenia.
This despite the fact that roughly one percent of the people that
are born in the world today will develop the disease at some point
in their lives. Many forms of schizophrenia can today be suppressed
with medications, and therapeutic treatment also helps. However,
although some patients do really well, most patients continue to
show some incapacity in terms of functioning socially and professionally.
A major problem is that, when in the case
of most other mental illnesses only one single functional brain
system can be pointed out as the one affected or impaired, schizophrenia
in contrast affects a broad range of conceptual and cognitive systems,
such as perception, language, memory, attention and several "executive
functions". Hence, there is still some confusion around the
definition of the disease.
Several models for the mechanisms of schizophrenia have been proposed.
Some claim it is a single disease, caused by a single mechanism.
Others suggest it is instead a combination of several disorders
with etiological and mechanistic heterogeneity. A third major explanatory
model divides the symptoms of schizophrenia into two broad classes
- positive and negative. The positive symptoms are those that are
exaggerations, or distortions of otherwise present symptoms, such
as hallucinations, delusions, disorganized speech or bizarre behavior.
The negative symptoms represent a loss or diminuition of functions
that are normally present and include alogia (loss of emotional
expression), affective blunting, anhedonia, avolition and attentional
impairment.
Nancy Andreasen
One of the psychiatrists who supported the
positive/negative symptom-based model of schizophrenia back in the
seventies was Professor Nancy Andreasen.
Nancy Andreasen, who was then a researcher and Assistant Professor
of Psychiatry at the University of Iowa, had earlier due to personal
circumstances become fascinated by the enigmatic field of psychiatry.
For Nancy Andreasen the road to psychiatry was longer than what
is ordinary. Before getting her medical degree as a psychiatrist
from the University of Iowa in 1970, she actually already had a
Ph.D. - in English!!!
After studies at the University of Nebraska,
and later Radcliffe College in Cambridge, Massachusetts, Nancy Andreasen
finally earned a Ph.D. from the University of Nebraska in 1963.
Then after years of teaching English in Nebraska, and becoming an
Assistant Professor in English  at
the University of Iowa, Iowa, Nancy Andreasen's life took an unusual
turn. During and after the pregnancy and birth of her first-born
daughter, Nancy Andreasen experienced some almost life-threatening
complications involving hypertension. Going through the difficult
time and hospitalization that followed, Nancy Andreasen started
to develop an interest in medicine. She began reading literature
about what she was actually going through personally. When she finally
came out of the shaking experience, not only did she feel relieved
over having survived, but she also somewhere deep down inside felt
a gratitude towards medical science, and what it had done for her.
She almost felt that she owed it to medicine to give something back,
and with the knowledge she had gathered during her time in the hospital,
Nancy felt ready to go back to school to head for another degree
- this time in medicine.
Many people may find the switch from language
to psychiatry quite radical. However, when you think about it, there
are quite a few similarities. At least in the case of schizophrenia,
where indeed some of the neural circuits known to be affected are
actually the ones that control our speech, and our auditory senses.
Schizophrenics commonly have auditory hallucinations. The speech
may be slow or reduced, and have illogical content. The molecular
mechanisms behind these phenomena are still not fully solved, but
they have over the years caught many scientists' attention and interest.
Research at The University of Iowa
The Department of Psychiatry at The University
of Iowa - which possesses the largest educational hospital in the
country - [quote] promotes interactive, high-quality research; provides
high-quality health care related to the prevention, detection, and
treatment of psychiatric disorders; educates psychiatry professionals
and the citizens of Iowa about care [end quote]. Professor Nancy
Andreasen is the Director of the Mental Health Clinical Research
Center, and holds The Andrew H. Woods Chair of Psychiatry at The
Department of Psychiatry at University of  Iowa
- College of Medicine. The main research interests and treatment
specialties of this in-patient unit are brain imaging, schizophrenia,
genetic and family studies, and creativity.
By using methods like magnetic resonance
(MR) and positron emission techniques (PET) scientists can today
track neural circuits in the brain to find out which of these are
for instance involved in cognition, and thereby get an idea of what
happens in schizophrenic patients' brains compared to control brains.
Together with the past and present co-workers in her lab, Professor
Nancy Andreasen has helped refining these methods, which now are
used around the world in clinical treatment and medical research.
One of the greatest advance steps of Andreasen's lab is the development
of the software BRAINS. BRAINS is a highly advanced image analysis
program, which allows studies and measurements of segments, regions,
layers and structure volumes of the brain. It can also be used to
calculate the levels of molecular markers, and the blood flow and
rate of metabolic processes in the brain.
In Professor Andreasen's lab, advanced methods
and tools like BRAINS have been used in studies of patients to  investigate
the mechanisms behind for example cognition, and language and plasticity
in schizophrenia. Current research aims at creating a three-dimensional
graphical map of the brain with its layers and segments. Many findings
have spawned out of the research. Areas not previously known to
be involved directly in cognition, such as the thalamus and the
cerebellum, have lately been shown to play significant roles in
schizophrenia. This is the first indication of schizophrenia also
being a sub-cortical rather than purely cortical illness, a finding
that surely opens up possibilities for new solutions in the schizophrenic
research field.
The clinical patient studies of the department
contain meticulous evaluation methods, where psychiatric specialists
personally perform interviews with the patients in order to come
to a conclusive diagnosis. The model described earlier, where the
symptoms of schizophrenia is categorized as either positive or negative,
has been extensively used over the years in order to interpret the
results of the clinical studies, and to work out the best treatment
method for each respective individual.
Other Activities
Apart from the position at The University
of Iowa, Nancy Andreasen also has important functions in many committees
and organizations. Over the years, her scientific work has resulted
in nearly 500 publications. In addition to  her
impressive list of scientific papers, she is also responsible for
a number of books about schizophrenia and mental illness. Most recently
the revised edition of "The Broken Brain" - which first
came out in 1984 - was released. "The Broken Brain" describes
the biological revolution in psychiatry, and is very interesting
reading even for those without a degree in the field. Nancy is also
- among other positions - the editor of one of America's most acclaimed
journals in psychiatry, "The American Journal of Psychiatry".
The Future
For the future, Nancy Andreasen has high
hopes for solving the mysteries around schizophrenia that have been
puzzling mankind ever since the first documented signs appeared
generations ago. With better organization, more advanced equipment
and research methods, and of course plain dedication, psychiatrists
will hopefully soon find answers to their questions, something that
would indeed make the lives easier for those millions of people
across the planet that directly or indirectly are affected by schizophrenia.
References
Recent papers by Nancy Andreasen, with links to PubMed abstracts.
Previous VIPs:
Göran Sedvall
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