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The neuropathology of schizophrenia has been for a long time perhaps one of the most controversial fields of biomedical research. In the middle decades of the last century there was an increased interest in the neuropathology of psychosis based on the assumption that structural alterations in the brain would provide insight into the understanding of this complex and devastating disease. However, the results of these investigations have been contradictory and it has become a cliché to say that schizophrenia is the graveyard of neuropathologists. Indeed, the results of neuropathological investigations were confusing, and resulted from both clinical and pathological problems. The clinical definition of schizophrenia has been controversial and for a long time internationally accepted diagnostic criteria did not exist. Patients' cohorts were extremely variable and clinical histories far from complete. Most patients had treatment which again varied from centre to centre. The neuropathological methodology was also somewhat primitive and inappropriate to detect subtle changes. Moreover, the material examined varied considerably from centre to centre and sometimes the pathological changes described were the result of another disease process, including epilepsy or minor traumas. It was thus not surprising that these studies were contradictory.
With the advent of neuroimaging a new era has started. It was Johnstone and her colleagues who showed structural alterations (enlarged ventricles) in the brain of psychotic patients using at that time, the novel methodology of CT scanning. Not much later a report of Stevens observing astrocytosis in the brains of patients with schizophrenia, rekindled interest in the neuropathology of schizophrenia.
This book is a comprehensive review of cerebral changes associated with psychosis. The 15 chapters cover a wide range of structural, functional, macroscopical, histological, neurochemical, and pharmacological changes associated with the disease. In addition there are chapters on animal models and methodological issues, as well as on the consequences of treatment. The results of structural and functional imaging are reviewed, the second in relation to neural circuitries. There is an excellent chapter on cerebral asymmetry, a feature important in the understanding of the disease. Two chapters deal with development, one more specifically with cortical development, giving a concise review of the molecular basis for the organisation of the forebrain and pattern formation in relation to pathogenesis. Synaptic pathology and the organisation of cortical circuitries, for a long time inaccessible to conventional methodology, have become the subject of intense research, and recent developments have been suitably summarised in two separate chapters. The chapter on cortical pathology reviews a new generation of quantitative microscopical studies in relation to the GABA, glutamate, and dopamine systems. The problems of gliosis are revisited in a separate chapter with the conclusion that it is unlikely to be a core feature of the neuropathology of schizophrenia. A chapter examines schizophrenia from the perspective of other neurodegenerative diseases and lesions, including those which may cause schizophrenia-like symptoms—for example, metabolic diseases, epilepsy, and psychosis in neurodegenerative disorders. These provide useful information in the differential diagnosis of schizophrenia and other diseases of the nervous system with similar symptomatology.
This is a timely book, reviewing recent developments in our understanding of the disease mechanism in schizophrenia. The editors have brought together international experts in the field to produce a book with a true multidisciplinary approach. Their achievement should be congratulated. However, less praise should be lavished on the publishing house, which has failed to invest in high quality reproductions. There is a single coloured plate of neuroimaging of MRI and PET and the black and white reproductions of the same images have not been removed. None the less, this is a book which should be purchased by those who are interested in schizophrenia, both neuropathologists and psychiatrists.
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