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Book Forum: Schizophrenia and Paranoid/Delusional Disorders   |    
Origins and Development of Schizophrenia: Advances in Experimental Psychopathology
MING T. TSUANG, M.D., PH.D., D.SC.; WILLIAM S. STONE, PH.D.
Am J Psychiatry 2000;157:1898-1898. doi:10.1176/appi.ajp.157.11.1898
View Author and Article Information
Brockton, Mass.

Edited by Mark F. Lenzenweger and Robert H. Dworkin. Washington, D.C., American Psychological Association, 1998, 557 pp., $49.95.

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Thanks to a combination of conceptual and technical advances, our understanding of the origins and development of schizophrenia is growing steadily. This volume reviews that progress in four interrelated areas. Part 1 mainly covers genetic and environmental bases of schizophrenia, with one chapter devoted to a neurobiological model based on information flow through the nucleus accumbens. Part 2 focuses on aspects of cognition. Chapters cover eye-tracking dysfunction; eye-movement dysfunction; the integration of lateralization, memory, and language; relationships between word generation and hallucinations in the context of abnormal frontotemporal neural interactions; and the use of process-oriented strategies from cognitive psychology to understand cognitive deficits in schizophrenia. Part 3 stresses vulnerability factors (e.g., in attention and perception), both in schizophrenic patients and in their relatives. Chapters on the role of affect in schizophrenia and on cognitive and clinical characteristics of patients with schizophrenia assessed early in their illness (as well as their nonpsychotic younger siblings) are also included. Part 4 focuses on the identification of factors to predict the onset of schizophrenia, the relapse of psychosis, and the relationship of schizotypal personality disorder to schizophrenia. A brief epilogue follows.

Overall, the book is very good. The topics are important, their organization is sensible, and the chapters are written clearly by productive researchers. Although some chapters are relatively brief, most are long enough to provide at least moderate levels of depth about their subjects. As in any complicated field, not all areas of research can be included, nor all conceptual models stressed. With that caveat, some important areas of research received less emphasis than might be expected. In both part 2 and part 3, for example, considerable emphasis was placed (correctly) on problems of attention or perception in schizophrenic illness. By contrast, much less emphasis was placed on long-term memory and executive functions, which are also well-documented areas of deficit. Moreover, other areas might have received additional emphasis. A lot of current thinking about the development of schizophrenia, for instance, involves neurodevelopmental models. This was certainly made explicit in the chapters by Cannon and by Walker et al. and was implicit in other chapters in part 1. It is a major theme with multiple alternative viewpoints that might have been considered in more detail. The same argument might be made about the degree of emphasis accorded to biological correlates of schizophrenia. In the epilogue, Richard R.J. Lewine stresses the "strong biological orientation" of the book. This may reflect one’s view of whether the glass is half full or half empty. Some types of biological factors are represented (e.g., in the etiological roles of genetic and environmental factors, in the neuronal model based on the nucleus accumbens, and in the neurodevelopmental theories that were stressed), but others are not. With the exception of a positron emission tomography study, there was little reference to the growing literature on structural and functional brain abnormalities in patients with schizophrenia and their biological relatives. Similarly, selected neurochemical abnormalities were discussed mainly in two out of 17 chapters.

In the prologue, the editors state that their "greatest hope for this volume is that some of its chapters will serve as a foundation for future research" in the same way that a small number of previous books have served to take stock of schizophrenia research and focus the field. At this point, it would be premature to conclude that the book will achieve such an ambitious goal. Nevertheless, most students of the origins of schizophrenia will find it to be a very informative readable guide to the current status of the field.

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