Book Review
Schizophrenia
The Epidemiology of Schizophrenia. Robin M Murray, Peter B Jones, Ezra Susser, Jim van Os, Mary Cannon, editors. Cambridge (UK): Cambridge University Press; 2003. 454 p. US$80.00.
Reviewer
rating*: Excellent
Review by: Mary V Seeman, MD
Toronto, Ontario
This well-edited book is divided into sections that include social epidemiology, developmental epidemiology, genetic epidemiology, special epidemiological issues, and emerging issues. A thorough examination of the epidemiologic differences between developing and developed countries is an example of subject matter from the first section. Here, the authors conclude that, when schizophrenia is defined narrowly, there is no difference in incidence among sites across the world. Conversely, when broadly defined, schizophrenia incidence is higher in developing countries. This may or may not partly account for the more favourable course and outcome of the disorder in developing countries. The authors of this section speculate that this more favourable course and outcome may also be due to the subsistence economies of developing countries, wherein reintegration into work is easier after an episode of illness. There is also greater community cohesion, less segregation of those with mental illness, and more family involvement. Mortality rates, however, are higher in developing countries.
An outstanding chapter in the second section is that by Dr Heinz Häfner, entitled “Prodrome, Onset and Early Course of Schizophrenia.” This chapter offers a thorough historical review of attempts to define prodrome and onset. Another chapter in this section contrasts schizophrenia first expressed at the 2 extremes of life: childhood and old age. This chapter examines prevalence, sex difference, phenomenology, risk factors, and brain abnormalities in the 2 groups—an innovative and welcome new perspective on the impact of development and cognitive–sensory deterioration.
The genetic epidemiology section is most informative, especially regarding issues of gene–environment correlation and interaction. The chapter by Dr Heinz Häfner, Dr Jim van Os and Dr Pak C Sham discusses genetic influence on exposure to various environments and differentiates gene–environment synergism, additive influences of genes and environment, and multiplicative influences. The authors conclude by suggesting interesting new approaches to genetic inquiry.
Special issues include mortality and physical illness in schizophrenia, along with suicide, substance abuse, and violence. The last 2 chapters deal with service planning and prevention, stressing systematic use of what we know about this illness put to the service of primary and secondary prevention and rational planning of community services.
The book’s purpose is to make us think about schizophrenia from slightly different points of view than are elaborated in most textbooks. Each chapter reviews what is known. New knowledge is not introduced, but the syntheses offered are fresh and up-to-date. The authors are all well informed; all write well, and the editors have done a good job of making the book coherent. The book is attractive, free of error, and reads well. I am certain that readers interested in schizophrenia, both clinicians and researchers alike, will come away with a renewed interest in this elusive illness.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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