ABSTRACT
The concept of schizophrenia originated from clinical description (Kraepelin, 1899 (reprinted in 1999); Bleuler, 1911; Schneider, 1980), and was linked to the neurobiology of the dopamine system via the discovery of therapeutic agents (Carlsson, 1988, 2000, 2001a, b). For several decades, this state of affairs left psychiatry in a highly unsatisfactory situation regarding one of its most prominent disorders. On the one hand, the disorder is characterized by profound changes in the way a person relates to the environment and experiences self, other people and the world (American Psychiatric Association, 1994). On the other hand, it is treated with substances that act upon a pathway within the brain whose function was hardly known for decades, except for its role in motor and neuroendocrine functions, which are related to the side effects, but not to the therapeutic effects of the drugs. In this chapter, some recent discoveries regarding the function of the prefrontal cortex and the mesocortical and mesolimbic dopaminergic pathways will be described, and the findings will be related to the psychopathology of schizophrenia. Models of neuronal functioning at the systems level have reached a degree of sophistication such that, for the first time, they have clinical implications with respect to pharmacological and non-pharmacological intervention strategies, and the long-term management of this disorder.
