Schizophrenia: Evolution and Synthesis

Schizophrenia: Evolution and Synthesis is the proceedings of the 2012 Ernst Strüngmann Forum in Frankfurt am Main. The papers capture the collegial atmosphere of a symposium with spirited exchanges among the contributors. The articles cross-reference one another liberally, and pivotal summary chapters provide a longitudinal review of the topics.

Taken as a whole, the volume lays out an argument that schizophrenia is a syndrome, “not a disease; at best a category like dementia, epilepsy or cancer.” Schizophrenia, the overview explains, begins in utero and is a lifelong physiologic and cognitive disorder; prodromal conditions occur in childhood, and schizophrenia declares itself in adolescence or early adulthood with the characteristic psychosis. Treatment must be tailored to its different phases. It is not a static condition; rather, its nature evolves over the lifetime and has a different character in the prodromal stage, in the first psychotic events, and then in the chronic disease of older adults. Viewed over this course of the lifetime, schizophrenia is primarily a neurocognitive disorder of which the positive symptoms of psychosis are only the most dramatic aspect. Its prodromal symptoms share phenomena of other developmental disorders, such as verbal and nonverbal learning disorders, conduct disorder, antisocial personality disorder, and autism spectrum disorder.

The other contributions in the volume provide the detail, with each section providing a different perspective under the general categories of heterogeneity, risk and resilience, models, and development and treatment. I found the section on models most interesting; it discusses animal models, studies of individual cells, and studies of tissue samples from patients with schizophrenia, and it presents mathematical constructs that describe computational studies of the dynamic systems that characterize the disorder.

The volume is well edited and easy to read. The introductory chapter by the editors lays out the overall plan and is worth rereading after finishing the book. Clinicians would enjoy this symposium if only to be reminded that there is more to schizophrenia than criterion A of DSM-5.