Abstract
This book is quite a journey. As it happens, I read it while travelling back to Australia from the International Congress on Schizophrenia Research in the US. I looked at the foreword (by Michael Rutter) and the preface while crossing the Savannah River talking to Barbara Fish, whose seminal work into ‘pandysmaturation’ antedated by some decades much of the more recent excitement regarding the neurodevelopmental aspects of schizophrenia. It was pleasing to find that a number of the contributors to this volume have acknowledged her work.
The trip from Savannah to Atlanta was consumed by the section on ‘basic aspects’ that includes overviews of the genetics of brain development as well as a number of chapters looking at developmental aspects of the brain in children and adolescents. This useful section puts new developmental theories of schizophrenia in the context of normal brain development and also addresses how a variety of insults can impact on the developing brain with various outcomes dependant upon the type and timing of those insults. The long-term consequences of such insults are addressed in a chapter on long-term functional outcome in children of very preterm birth.
The leg of my journey to New York City had mewading through the section on ‘aetiological factors’. This section is somewhat patchy, with a tendency for some of the authors to concentrate very much on their own particular hobby horse and to quote themselves often. Having said this, there are useful chapters regarding how similar pathophysiologies might operate across a number of different diagnostic groupings, the role of epigenetics in the aetiology of schizophrenia and also the potential for linkages of structural brain imaging with genetic studies in determining an ‘alternative phenotype’ for schizophrenia. Refreshingly, in a book which is largely ‘biological’, a number of chapters in this section also deal with so called ‘environmental’ factors; these include nutritional aspects, social factors and substance misuse.
The toughest part ofmy journey, from New York to Los Angeles, coincided with perhaps the toughest component of the book in terms of density of fact and ease of reading. There are expert and detailed consideration of dopaminergic system dysregulation, limbic lobe mis-wiring, and thalamocortical circuits and their roles in schizophrenia. On a slightly lighter note and perhaps more readily accessible to the general reader are an excellent review of premorbid structural abnormalities in schizophrenia and a balanced reflection on neurodegenerative models of schizophrenia.
Appositely, on the flight into Melbourne my attention turned to early identification and the potential for early intervention in schizophrenia, work which has been pioneered by the Early Psychosis Prevention and Intervention Centre group in Parkville. In many ways this section also served to summarize and cogently integrate many of the preceding chapters and ties together a number of themes which are addressed therein. Thus, a fairly satisfactory conclusion to a book which is ambitious in its scope, somewhat patchy in its execution, but very relevant to the field of schizophrenia research.