Antecedents, Onset, and Early Course of Schizophrenia: Discussion

Abstract

This symposium and its proceedings have been assembled, now for the third time, because we are, as the title says, deeply committed to searching for the cause or causes of schizophrenia. Meanwhile, time is passing, progress has been slow, and we are now hoping that the new scientific technologies such as molecular genetics and brain imaging will provide answers. However, we still need to use clues from the past and what we presently know about the clinical characteristics of schizophrenia. The quality of the early signs of illness and age at onset of schizophrenia is the single most important aspect of the illness that could yield clues to its underlying biology. Based on present knowledge, the onset of schizophrenia appears to be a genetically programmed process, slowly developing until it reaches some threshold of clinical detection. Detecting the occurrence of its pathology, will then depend on the sophistication of our knowledge about its consequences and the ability to make use of new diagnostic tools. Diabetes mellitus is an analogous illness of a chronic nature. If one depended on the clinical presentation of a patient in a diabetic coma or crisis for diagnosis the age of onset might be stated as middle-aged adulthood. However, the process has been building up over several years microscopically in blood capillaries, and in the pancreas. Diagnosis might be made many years earlier through characteristic ocular signs, elevated post-prandial blood sugars, other physiological problems, and eventually genetic markers, only to be clinically considered a “disease” at a much later time.