Schizophrenia bulletin · 2026
From Protective Factors to Mechanisms: Charting the Neurobiology of Schizophrenia Resilience.
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Bittner Robert A, Barnes-Scheufler Catherine V, Reif Andreas, Qubad Mishal
Аннотация
BACKGROUND AND HYPOTHESIS: Elucidating the neurobiological and psychological mechanisms that promote resilience to the adverse effects of schizophrenia's genetic and environmental risk architecture may reveal new avenues for advancing treatment and prevention. Identification of genetic loci associated with schizophrenia resilience enables links between protective polygenic variation, non-genetic resilience factors, and intermediate phenotypes. This approach may help identify protective traits and delineate potentially evolutionarily shaped resilience mechanisms that attenuate schizophrenia pathophysiology across biological levels.
STUDY DESIGN: This narrative review integrates current concepts in psychiatric resilience research with findings from schizophrenia resilience genetics and evolutionary medicine. Within a decompositional, dimensional framework, we summarize evidence for trait-level resilience factors that may be linked to schizophrenia resilience variants and discuss candidate neurobiological mechanisms.
STUDY RESULTS: Schizophrenia's substantial fitness costs and evolutionary dynamics may have favored common genetic variants that buffer elevated polygenic liability and promote resilience to the disorder. Existing evidence implicates protective traits across obstetric, immunological, cognitive, and visual-system domains as candidate mediators of resilience to schizophrenia pathophysiology.
CONCLUSIONS: Current findings suggest that common genetic variants may confer resilience to schizophrenia by enhancing neural plasticity, fluid intelligence, and visual cognition. Immune-related and obstetric pathways remain promising candidates, although direct links to resilience variants have not been established. Such mechanisms may reflect evolutionarily shaped adaptations that attenuate risk-allele penetrance and could also modify clinical expression, course, and somatic comorbidity. Their characterization may provide initial insights into the neurobiology of schizophrenia resilience and identify targets for preventive and disease-modifying interventions.
STUDY DESIGN: This narrative review integrates current concepts in psychiatric resilience research with findings from schizophrenia resilience genetics and evolutionary medicine. Within a decompositional, dimensional framework, we summarize evidence for trait-level resilience factors that may be linked to schizophrenia resilience variants and discuss candidate neurobiological mechanisms.
STUDY RESULTS: Schizophrenia's substantial fitness costs and evolutionary dynamics may have favored common genetic variants that buffer elevated polygenic liability and promote resilience to the disorder. Existing evidence implicates protective traits across obstetric, immunological, cognitive, and visual-system domains as candidate mediators of resilience to schizophrenia pathophysiology.
CONCLUSIONS: Current findings suggest that common genetic variants may confer resilience to schizophrenia by enhancing neural plasticity, fluid intelligence, and visual cognition. Immune-related and obstetric pathways remain promising candidates, although direct links to resilience variants have not been established. Such mechanisms may reflect evolutionarily shaped adaptations that attenuate risk-allele penetrance and could also modify clinical expression, course, and somatic comorbidity. Their characterization may provide initial insights into the neurobiology of schizophrenia resilience and identify targets for preventive and disease-modifying interventions.