Psychosis In The Inner City

The "epigenetic puzzle" which is schizophrenia, forms the focus of this Monograph, but the authors do not sit comfortably with the notion that this is an entity. Rather, they approach the non-affective psychoses on a broad epidemiological base, ascertaining cases of so-called "functional" psychosis over a quarter of a century. They examine admission policies, showing that patients are admitted to hospital on the grounds of their particular presentation, rather than their diagnosis. They explore differences between males and females with psychotic disorders, and show that gender is a more powerful influence than diagnosis. They investigate trends over time, and find that demography is the major influence. Looking at criminality, they show that the factors predicting criminal behavior in individuals with psychotic illness are much the same in those without psychotic illness. And they trace the longitudinal course of illness, putting paid to the schizophrenia/manic depression dichotomy. Their powerful message isthat diagnostic criteria are spurious, complacent constructs, which lull us into a false sense of security, and which should be challenged. They suggest that it is epidemiology which can place the current vogue for diagnostic conformity in its correct perspective.
Epidemiology has a vital role to play by exploring the attributes of the clinical concept of schizophrenia and their correlates in relation to the population base from which cases are drawn. While many clinical and biological studies still operate with truncated distributions of such attributes because of unsystematic or opportunity sampling, an epidemiological sample is less likely to be affected by such bias andmore likely to be representative of the entire spectrum of manifestations of the notional disease. The study of epidemiologically defined samples of schizophrenia cases should therefore lead to more precise questions about syndrome boundaries, clinical heterogeneity, and associations with possible risk factors.
To mention some of the highlights of the monograph, the analyses of crime and schizophrenia, and of the comparative incidence of disorders in Afro-Caribbean and African immigrants, are methodologically ingenious and lead to well supported conclusions. The description of the clinical profile of late onset schizophrenia is a timely contribution to a topic which attracts less attention in the current literature than is warranted by its critical importance for any aetiological theories about the disorder.
This monograph is an excellent overview of the ideas and many of the findings generated by a highly productive group of researchers. It has a good chance to become one of the standard references on several of the key aspects of schizophrenia.