The subtitle of this book sums up the situation well. Immense progress has been made in delineating an association between schizophrenia and a multitude of neuropathological anomalies, yet much of the evidence is inconclusive and the essential abnormality remains unknown. The excellent review of structural brain imaging studies by Hopkins & Lewis in Chapter 1 concludes that the median decrease in brain size in schizophrenia is 3%. Despite the fact that a decrease of brain tissue volume is reliably found in groups of patients, gross brain structure in most patients is within the normal range. A variety of microscopic anomalies have been reported, but too few of the observations have been replicated. The balance of evidence does not demonstrate a widespread loss of neurons, although there is tantalising evidence for loss of particular groups of neurons, such as interneurons from the anterior cingulate cortex. There are also many reports of abnormalities of the microstructural components that support neurotransmission (axons, synapses and synaptic proteins) but different investigators report different anomalies at different cerebral locations.

In the foreword, Janice Stevens expresses the hope that the studies described in the book might be a springboard for segregating patients into pathologically distinct cohorts. I remain sceptical that this will prove a fruitful path. The magnitude of virtually all reported anomalies in schizophrenia reported in this book, whether it be size of brain ventricles, density of neurons in the cingulate cortex or concentration of synaptic proteins, is distributed unimodally. This observation supports the alternative view that a variety of different pathoplastic factors generate multiple dimensions of variation in brain structure and function in schizophrenia. But this formulation leaves us with the task of identifying the core abnormality that defines the illness. Although the contributors to this book are appropriately cautious in drawing conclusions, the evidence they present indicates that the strongest candidate for the essential abnormality is a defect that disrupts the development of normal connections between neurons.

Overall, the book presents a comprehensive review of the data from many sources, with excellent tables that summarise much of the literature in important areas. This is a book that schizophrenia researchers should have on their bookshelves. Students or clinicians seeking an authoritative review of the current state of knowledge regarding the neuropathology of the condition will also benefit from reading it.