The Neuropathology of Schizophrenia: Progress and Interpretation

Abstract

Harrison P.J., Roberts G.W. (Eds) The Neuropathology of Schizophrenia: Progress and InterpretationOxford University Press, Oxford, 2000, 386 pages. Price: £65. ISBN 0 19 262907 7 In their introduction the editors describe the neuropathology of schizophrenia as the Holy Grail of biological psychiatry. This book chronicles recent progress in search of this elusive goal. To search at all asks questions of the relationship between mind, brain and illness. The editors' contention that the answer lies somewhere between the nihilism of the mind–brain dualists and the structure=function dictum of the empiricists is unexpectedly apposite, given that the single structure consistently found to be altered in schizophrenia is the ventricles – the space between structures. The editors, Paul Harrison and Gareth Roberts, well known figures in British schizophrenia research, have brought together several notable investigators in this multi-author text, including: Daniel Weinberger, David Lewis, Albert Galaburda and Nancy Andreasen. The book comprises 15 chapters spanning neuropathology, brain imaging, and neurodevelopment. The reader should have some prior familiarity with the subject. This is not an introductory text so much as a survey of the current issues in schizophrenia research. This is reflected in the somewhat disorientating structure of the book. For example, a good introduction to the general organization of cortical circuitry does not appear until chapter 10, well after the chapter on cortical pathology in schizophrenia. Nonetheless, there is method here. If read from cover to cover, the book progresses from the wealth of (often contradictory) findings thrown up by structural imaging and histology in the early chapters, to more cautious concluding chapters, which take a more sceptical view and emphasize the number of methodological issues which must be taken into account to investigate the neuropathology of schizophrenia effectively. As several new methods of functional brain imaging, immunohistochemistry and molecular biology have developed in the last 20 years it is beyond the scope of this book to provide a thorough background to each. The authors of each chapter only provide a cursory review of past work to introduce their particular subject area. However, a large number of tables summarizing previous studies are found throughout, providing a clear point of departure for the reader to pursue further the background literature. Disappointingly for a pathology text, there are few illustrations (including only one colour figure), yet this is almost certainly due to the camera shy nature of schizophrenia which does not exhibit the kind of qualitative abnormalities that neuropathology traditionally seeks to demonstrate. The book covers most of the current issues in schizophrenia research, including: a chapter on asymmetry, two chapters on neurodevelopment, a chapter on animal models and a chapter offering insight from the neuropathology of other diseases and lesions. With two chapters on neuroimaging and four on histology and gliosis, the balance of the book is weighted in the direction of histological research. Here the pathology of the hippocampus, cortex and synaptic pathology take precedence with little mention of subcortical structures not currently in vogue in schizophrenia research. The subtlety of changes found is a recurring theme and they are interpreted here in the light of the dominant developmental theories. Clinicians and researchers familiar with the field will benefit most from this work. Those new to this area of neuropathology will still find this book useful as an accompaniment to a comprehensive introductory text. It is an intelligent and readable reference that provides a balanced overview of the most recent issues guiding schizophrenia research.