Vol 2 n° 4 - Schizophrenia: General Findings
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The  State-of-the-art  article  by  Carol  A.  Tamminga (page 339) reviews the current state of knowledge about the mechanisms and causes of schizophrenia. Although both of these domains remain unclear, several modern techniques and critical advances in the understanding of mammalian brain function hold promise for future devel- opments. The function of integrated neural systems in the central nervous system will undoubtedly be shown to be important to the pathophysiology of schizophrenia. In the Basic research article, Paul J. Harrison (page 349) summarizes the significant results of postmortem tissue studies in schizophrenia. This research looks at brain tis- sue from patients with schizophrenia and measures the changes in proteins, transmitters, and neuronal modu- lators.  Although  early  studies  were  limited  by  inade- quate techniques and poor knowledge of localization, current  research  uses  advanced  methodology  and focuses on regional pathology, especially limbic system abnormalities. Marc Laruelle and Anissa Abi-Dargham wrote the Phar- macological aspects article (page 359), which relates the development of a new imaging technique to measure dopamine concentrations in the synapse and its applica- tion in schizophrenia. The resulting data reveal that the active episodes of psychosis are associated with increased concentrations of dopamine in the synapse. This is the first evidence we have for hyperdopaminergic activity in schizophrenia, and it has come only as a result of this sophisticated new imaging technique. The dynamics of these increased dopamine concentrations are now being studied, and hypotheses are currently being proposed for a pathophysiology of schizophrenia involving dopamine. In one of the articles in the Clinical research section, T. Scott Stroup et al (page 373) review the comparative effi- cacy of antipsychotic drugs, with an emphasis on the new antipsychotic compounds. The new antipsychotic agents have a broader affinity profile than the typical compounds and have fewer motor side effects. Additional aspects of their comparative pharmacology remain to be document- ed, but preliminary evidence for differentiation is pre- sented. Overall psychosocial outcome for persons with schizophrenia is currently being emphasized. The second Clinical research article by Ming Tsuang et al (page 381) discusses our understanding of the diag- nostic entity of schizophrenia from a genetic perspective. This article argues that the diagnosis of schizophrenia is only the “tip of the iceberg” of a larger diagnostic class, which could be called schizophrenia spectrum disorders or schizotaxia.  The illnesses in this group appear to share the same set of etiologic factors, spectrum of symptoms, and pharmacology, and research is under way to define this further. Whereas schizophrenia alone has a world- wide prevalence of 1%, the new schizophrenia spectrum disorders proposed here have a worldwide prevalence of approximately 6%. The Poster article contributed by Ceslo Arango (page 392) addresses an issue of great importance and of increasing public attention in schizophrenia: violence. It reviews and quotes statistics on the incidence and prevalence of vio- lence, and discusses the predictors. The data reviewed by this investigator suggest that the clinical symptoms gen- erated by the illness are the best predictors of violence. Thus, optimizing treatment could be an antidote to some of the violence associated with the illness. Carol A. Tamminga, MD 3 3 7 I n   t h i s   i s s u e . . .