Book Reviews

Review of Schizophrenia Today, edited by D Kemali, G Bartholini and D Richter (pp xv + 282). Oxford &c.: Pergamon Press 1976

Proceedings of the Royal Society of Medicine, Vol. 70, September 1977, p. 663

The papers presented here are the proceedings of a conference held in 1975, in which an attempt was made to cover the main fields in which research on schizophrenia is currently being carried out.

   The most significant advance along clinical lines has been the internationally organized work on clarification of the criteria for the diagnosis, by which a high degree of conformity of practice has been reached. This has helped to stimulate a mass of work on the biological side (genetics, biochemistry, pharmacology) which is now beginning to tell a coherent and exciting story.

   'Schizophrenia' can be taken as a descriptive term, just as 'epilepsy' is, for a syndrome which can be the end result of many factors, endogenously from genetical causes, exogenously from drugs or brain lesions. At a deeper level it now seems certain that it is a disorder of central transmitter mechanisms, probably limited to the mesolimbic system, and probably based on an imbalance between dopaminergic and cholinergic neuronal activities. Clinically and psychologically there is a hypervigilant state, shown also in the EEG in low voltage desynchronized fast patterns and lack of alpha.

   The state is not entirely unamenable to influence by such psychotherapies as alpha training, meditation and yoga; but it is more directly and effectively controlled by antipsychotic drugs which blockade dopaminergic synapses. This is a long way in advance of where we were even ten years ago.