This impressive text comprehensively describes current knowledge in schizophrenia epidemiology. The contributors include many of the main international researchers in this field.
The challenge schizophrenia presents to epidemiologists and its attractiveness as a field of inquiry are captured in the foreword: Schizophrenia may be the leading unsolved disease afflicting humans. The reasons our understanding of schizophrenia falls behind that of many other disorders are made clear as one reads on. Its incidence is relatively low (although its chronicity means the disease burden is great), case definitions vary, there is no simple diagnostic test, monitoring trends in incidence is challenging. Many epidemiological observations remain unexplainedwhat underlies the season of birth effect? Does incidence of the disorder vary internationally? Why is its course apparently more benign in developing nations? Why are African Caribbean migrants at increased risk?
At over 400 pages in length this is more a book for dipping into than reading from cover to cover in one sitting. To make it more accessible the text is organized into five broad themessocial, developmental and genetic epidemiology, special issues (suicide/other causes of death/association with drug misuse), and emerging issues. There is good cross-referencing between chapters and each section begins with an overview of the area covered. Many contributions contain useful summaries bringing the reader up to date with findings from research in the topic area.
Highlights for me were the chapters on temporal trends (Bresnahan et al.), prenatal and perinatal risk factors (Cannon et al.), childhood development (Cannon et al.), molecular genetics (Zammit et al.), and service implications (Thornicroft et al.). There are comprehensive reviews of the main cohort studies contributing knowledge in the field. Current models of chronic disease aetiologyfetal programming and life course epidemiology are acknowledged although some of the authors' notions of the concept of life course epidemiology are at odds with mine. The link between epidemiological findings and clinical care/ service planning, so often not made clear in epidemiological investigations, are nicely teased out in one of the final chapters.
For epidemiologists coming new to schizophrenia and without a grounding in psychiatry, the book would benefit from an introductory chapter/primer on how schizophrenia is defined and operationalized in different studies. For example, what is the distinction between schizophrenia, schizoaffective disorder, schizotypy, schizophreniform disorder, psychosis, and affective psychosis? Some of these issues are covered in van Os and & Verdoux's provocative chapter outlining new thinking concerning the continuum of psychotic symptoms in the population but this would have been useful at an earlier point in the text.
Reading this book has confirmed to me the very real challenges of conducting research in this area. The range of approaches used to overcome these challenges is impressive but I am struck by the range of unanswered, but answerable research questions and look forward to seeing these addressed over the next decade.