Eur J Neurol Book Review

A Neurodynamic Theory of Schizophrenia (and related disorders)
Robert Miller
Morrisville, NC, USA: Lulu Enterprises Inc., 2008; hardcover, 681 pp., ISBN 978-0-473-13653-6

The present book represents an "opus magnum" of Robert Miller, anatomist and neuroscientist at Otago University, Dunedin, New Zealand, presenting a broad overview of our present understanding of schizophrenia and related disorders, based on personal experience and a review of the pertinent literature up to June 2007. He critically discusses the current definitions and classifications of mental illnesses that from both the theoretical and practical point of view need to be discussed and challenged, since for most of these disorders, in particular schizophrenia and other mental diseases, there exist only loose definitions which have to be validated. As the author emphasizes in his Foreword, the title of this book is not to be seen as a rival to other approaches to understanding schizophrenia, such as the "neurodevelopmental theory", but critically reviews the various levels of explanatory arguments from molecular genetics to developmental processes and growth factors, morphology and pathophysiology of mental disorders. Much of the contents of this book is based on the curriculum vitae of the author who, in 1967 sufferend from a psychotic breakdown and, since then, was extremely interested in the manyfold problems of schizophrenia and related mental disorders. The book is divided into six parts with many chapters and subheadings. Part I - Philosophical background and synopsis of the whole theory, after a historical introduction including DSM classifications, models of illness, and explanation of the "neurodynamic concept" with its implications for taxonomy of these disorders, presents a synopsis of this theory with discussion of the different causes and hypotheses, eg., the dopamine theory, of mental diseases as well as related abnormalities in brain pathophysiology and morphology. Part II - Genetic and environmental causal factors for schizophrenia and related disorders - extensively reviews their inheritance and genetic risks, environmental and other non-genetic factors, all illustrated by data from the literature in tabulated form, evidence pointing to a developmental precursor of schizophrenia, its relations to complicated pregnancy of child birth ("perinatal distress"), head injury and other childhood insults, and other environmental factors (eg., immigration), familial psychosocial causative factors. Part III - Psychosis: the "outer layer of the onion" - discusses theories of psychosis in schizophrenia, development of the "dopamine hypothesis" in connection with basal ganglia functions, its relations to clinical symptoms, with a critique of the dopamine hypothesis, with presentation of alternative hyotheses for indirect action of dopamine D2-receptor-blocking antipsychotic agents, and the impact of other neurotransmitters, the main hypothesis proposed to account for the psychotic episodes in schizophrenia being a neurochemical one. Part IV - Trait abnormalities of schizophrenia: psychology and psychophysiology - refers to symptoms of schizophrenia and their correlative structure, wit emphasis on "thought disorder" as the most prominent symptom. He further reviews sensory perceptions in schizophrenia with discussisons of the interhemispheric and intermodal interactions and emphasis on changes of visual and auditory perception, but also refering to somesthetic, proprioceptive and vestibular perception, emphasizing that, although the evidence on abnormalities of interhemispheric transfer in schizophrenia is confusing, there is some evidence for a failure of intermodal integration of information in schizophrenia. The next chapter is dedicated to motor function in schizophrenia, including eye movements, with a discussion of their feedback and control, and their relationship to symptom groups. An extensive chapter is dedicated to cognitive phenomena in schizophrenia, its inhibition as well as short term and working memory and their impairment, and shift of attention as a paradigm with unresolved complexity, some of these abnormalities can be mimicked in normal subjects by the NMDA antagonist ketamine. Then, language and its organization in schizophrenia as well as current relevant theories, are discussed. Part V - Brain biology in schizophrenia -, after overview of clinical electrophysiology and cerebral activation, latency of evoked and event-related potentials, abnormalities of P 300 potentials and their clinical relevance, the author extensively describes the substrate of schizophrenia in brain morphology, changes in the volume of the brain, gray and white matter, and other cerebral areas, microscopic features in post-mortem brain, neuroimaging data, and morphologic changes at various stages of illness in relation to the pathologic process, correlations between symptoms and brain morphology as well as their genetic and environmental determinants and their relations with the severity of illness. Part VI - Conclusions - summarizes the previous chapters giving some explanations of the "neurodynamic theory" as the criterion for a scientifically valid concept of disease with regard to both functional development, psychosocial influence, psychopathology, and their implications for treatment and prevention of disability. A reference list of 129 pages, various appendices with many informative tables, an extensive subject and first authors index are given at the end of this remarkable book that tries to add new thoughts on the development, pathobiology and their relations with brain dysfunction and clinical symptomatology of schizophrenia and related disorders. A book based on extensive literature work, worth while to be read in its whole complexity, which may give some impact on future research in mental disorders. 
K.A.Jellinger, Vienna, Austria..