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Edited by Peter McGuffin Michael J Owen, and Irving J Gottesman. Published by Oxford University Press, Oxford, 2002, pp 472, £65.00. ISBN 0-19-263148-9
At all turns we can less and less speak of medicine without qualifying it with the term molecular. Our genetic underpinnings and their consequences have assumed their rightful place as extremely important factors in the pathophysiology of most disease—in fact it sometimes seems nearly all disease. In (arguably) the current bible of molecular medicine,1 Barton Childs argues, to my mind convincingly, that the future general textbook of medicine will move even further away from the traditions of Osler and firmly towards Garrod. Disease becomes incongruence between variable homeostatic mechanisms and the internal and external environments. At the centre is biochemical individuality and its molecular counterpart mutation. Proteins (and the genes that drive their production) are ubiquitous parts of our homeostatic mechanisms at all levels, the molecular and subsequent biochemical variation determines how we interact with environmental experiences, including social, and how these feedback on the system.
That psychiatric illness is not exempt from such genetic considerations has been clear for some time. What this new volume edited by Peter McGuffin and his colleagues shows, however, is how widely permeating this has become. There are chapters here that range from personality and cognition (an excellent one from Plomin, Happe, and Caspi) through to personality disorders, anxiety, and eating disorders, through to the more mainline genetics of schizophrenia and affective psychoses. In general they are well written and surprisingly up to date. As a source book of references alone this is worth having and those to very recent publications including 2002 are numerous. The traditional tripos of family, twin, and adoption studies is covered for most disorders before moving into linkage, association, and, where relevant, other molecular analyses such as cytogenetics. The chapter on dementia naturally moves further into the field of molecular pathology and biology, and covers the transmissible encephalopathies and CJD. Contentious areas are not omitted and the chapter on ethical issues is thoughtful and avoids the tokenism (or complete omission) that was the hallmark of some previous works.
Are there any drawbacks? There are always some to be found and as usual these may simply reflect bias on the part of the reviewer. The chapter on mental retardation is exceptionally short given its huge clinical importance (mental retardation and epilepsy together are the most common of all neurological conditions) and the recent explosion of interest in the genetic (and epigenetic) phenomena involved. However, this is a relatively small quibble; it is a well produced and worthwhile volume. On the reviewer’s copy the edges of many chapters are already very well thumbed and grubby, which is as good a recommendation as any.