Neurobiology and Psychiatry

Neurobiology and Psychiatry: Volume 2

Robert Kerwin

Cambridge: Cambridge University Press, 223 pp., 1993.

How often have you talked to a patient with schizophrenia and wondered what is going wrong in this person’s brain to cause such extraordinary symptoms? This second volume from Cambridge Medical Reviews traces how far we have come in our understanding of schizophrenia and other neuropsychiatric disorders such as manic depressive illness, mental retardation and Alzheimer’s disease.

As with most areas of science, knowledge is based on technology. Some of the technologies are familiar to all, but the majority are likely to be new to most readers. However, even the familiar approaches are given a new twist. The best example of this is a chapter on neuroendocrinology by Beam and Raven which examines the effects of hormones on neurotransmitters and brain development. Another excellent chapter by Falkai and Bogerts discusses the post mortem neuropathology of schizophrenia. Their carefully crafted review slowly accumulates evidence for the hypothesis that the major locus of pathology in schizophrenia has to be in the temporal lobe and that this damage likely occurs during early brain development.

Chapters devoted to newer technologies are not nearly so straightforward. To make it easier for the general reader, the editor has attempted to provide some background information. This is particularly helpful in the case of molecular genetic studies. Gill and Walsh provide a very useful discussion of such things as candidate gene analysis compared to linkage analysis, which makes it much easier to understand more complex chapters such as the one by Honer and Kennedy. These Canadian investigators have taken a novel approach to the molecular genetics of schizophrenia by using antibodies as clues. Keshavan and Pettegrew also provide a superb review of magnetic resonance spectroscopy which provides the reader with a clear understanding of how brain chemistry can be examined in living patients with this technique.

It is interesting how often new knowledge in neurophysiology can be applied to many neuropsychiatric disorders. It is now known that nerve growth factors (NGF) play a critical role in the development and maintenance of the neuron. This fact has stimulated researchers to examine the role of NGF in Alzheimer’s disease, mental handicap and even the psychoses. Likewise, it has been recognized that neuronal growth and migration are controlled to some degree by membrane proteins called integrins. Genetic abnormalities in these proteins may cause developmental abnormalities which could result in mental handicap or psychosis. Most clinicians will probably find these discussions a little difficult to follow. However, it seems likely that neurophysiology is going to become increasingly important in psychiatry in the coming years. These preliminary investigators should provide a good introduction to the work to follow.

In spite of the sophistication of this volume, one still might ask whether we really know more about what is wrong with the brains of these patients. I believe that the honest answer is that we still don’t know much about causality. However, we seem to have rediscovered our organ – the brain. With the rapid acquisition of knowledge about how the brain works, the future can only appear bright.