ABSTRACT
Schizophrenia is an illness with an unknown pathophysiology and aetiology and inadequate treatments. However, data have accumulated which are progressively contributing to a characterization of illness mechanisms. In this chapter, the ‘systems’ aspect of pathophysiology and therapeutics in schizophrenia will be emphasized. Schizophrenia is not merely an illness of a single brain region, and probably not of any one single neurotransmitter system. Rather, it appears that, during the manifestation of disease symptoms, an entire neural system (in the authors’ view, the limbic system) behaves abnormally when performing mental tasks, and abnormally influences related neocortical and subcortical brain areas. Dysfunction of the anterior cingulate cortex and the hippocampus occur most regularly in psychotic states of the illness, both at rest and with task stimulation (Figure 10.1). Moreover, in another study, when volunteers were engaged in a task, persons with schizophrenia who were performing similarly to the normal comparison group, also show regional cerebral blood flow (rCBF) defects in the anterior cingulate cortex (data not shown).
