HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH Psychiatric Bulletin Advances in Psychiatric Treatment All RCPsych Journals		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

Electronic Letters to:

EDITORIALS: Mark Weiser, Jim van Os, and Michael Davidson Time for a shift in focus in schizophrenia: from narrow phenotypes to broad endophenotypes The British Journal of Psychiatry 2005; 187: 203-205 [Abstract] [Full text] [PDF]

eLetters: Submit a response to this article

Electronic letters published:

Location isnt everything!

Hugh Jones   (29 September 2005)

Location isnt everything! 29 September 2005
Hugh Jones, Consultant Psychiatrist Lordship lane CMHT, London Send letter to journal: Re: Location isnt everything! hugh.jones{at}slam.nhs.uk Hugh Jones	Calls for a new research agenda in schizophrenia are perhaps inevitable. Despite all the interesting work over the past 15 years our understanding of schizophrenia remains importantly incomplete. Focussing on more basic mental components such as cognition or emotion is in keeping with the focus within cognitive psychology on individual symptoms e.g. delusions, hallucinations. Although these approaches look for abnormality in different places, they pretty much agree on what sort of abnormality they are looking for. The aim is to measure something in healthy individuals (e.g. odd beliefs, dopamine,or cognition) that is either increased or decreased in schizophrenic patients. This quantitative view of abnormality would imply that schizophrenia is best thought of as a multidimensional illness, in contrast to an older categorical view of the illness. As it happens epidemiological studies that demonstrate psychotic like symptoms within the normal population suggest this multidimensional view may be correct. However the reverse may not be true. Psychotic like symptoms in the normal population may reflect a continuum between say normal beliefs and delusions. They could also reflect the continuous variation of abnormal delusional beliefs in the general population, preserving a qualitative difference between delusions and normal beliefs. Similarly the nature of abnormal dopamine function in schizophrenia is unknown. However the superior efficacy of the low potency dopamine antagonist clozapine argues against any simplistic quantitative model that equates psychosis with dopamine overactivity. Their proposal does seem to give undue prominence to the location of any abnormality at the expense of what type of abnormality one is looking for. That such a strategy is likely to prove inadequate may be observed from acquaintance with the functional imaging literature in schizophrenia