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Book Reviews   |    
The Epidemiology of Schizophrenia
Reviewed by Daniel W. Bradford, M.D.
Psychiatric Services 2004; doi: 10.1176/appi.ps.55.3.324
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edited by Robin M. Murray, Peter B. Jones, Ezra Susser,Jim van Os, and Mary Cannon; Cambridge, England, Cambridge University Press, 2003, 454 pages, $80

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Although The Epidemiology of Schizophrenia will leave you with as many questions as you had before you started reading it, your questions will have become better informed, mirroring the complexity of the epidemiologic issues themselves. The contributors to this volume do not pretend to have the answers, and this does not obscure the book's clear implications for future research, service delivery, and disease prevention.

The text begins with a discussion of social epidemiology and raises some remarkable points that bolster arguments for the role of "social and psychological aetilogical factors" in schizophrenia. A range of developmental etiology findings is then presented, in which the authors demonstrate the likelihood that prenatal and perinatal risk factors interact with genes to create compounded effects. This discussion transitions well into the next section, which is devoted to the "relatively new discipline" of genetic epidemiology, focusing on molecular genetics and the interaction of polygenic and environmental risk factors. Specific attention is then given to special issues from an epidemiologic point of view, including mortality, substance abuse, and violent behavior. The final section demonstrates how epidemiology can inform service delivery and prevention.

Throughout the book, the authors present implications for future research, some of which would significantly alter the way we have studied schizophrenia. For example, because of the difficulty in ascertaining exactly what risks are transmitted by genes, the authors suggest that future molecular genetic research should encompass a much broader phenotype. In fact, one chapter calls into question the traditional view of schizophrenia as a discrete entity rather than an extreme end of a continuum. Several chapters emphasize the need for interdisciplinary collaboration, including neuroimaging, molecular genetics, and nosology.

Although the chapters are authored by several different researchers, the editors have done a good job of pulling the seemingly disparate topics together into a cohesive discussion. Reading the book requires a modest background in research concepts and related language. The editors include a glossary of epidemiologic terms and assume no previous study of epidemiology. However, readers who are unfamiliar with the field will likely have difficulty with some of the concepts presented. For example, the discussion of classical genetic epidemiology is fairly dense and technical. On the other hand, many of the chapters are more accessible. In addition, the editors provide interesting and user-friendly introductory segments before each section.

By pulling together information from several fields, the text helps to set a precedent for strengthening research alliances. It is ironic that a disease that is often so isolating for the individuals affected will perhaps foster unprecedented collaboration among various disciplines.

Dr. Bradford is a Robert Wood Johnson clinical scholar at the University of North Carolina School of Medicine in Chapel Hill and a clinical instructor in the department of psychiatry of UNC Hospitals.




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