ABSTRACT
Schizophrenia is a brain disease with differing symptomatic presentations, outcomes, and complex genetic mechanisms. A selection of recent work integrating clinical observations, human brain imaging and genetics will be reviewed. While the mechanics of brain dysfunction in schizophrenia remains to be well understood, the emerging evidence suggests that a number of interacting genetic mechanisms in dopaminergic and glutamatergic systems affect fundamental disease-related cognitive brain processes and may do so early in disease neurodevelopment. The availability of new imaging and genetic technologies, and institutional support for research in the translational neurosciences, extends the hope that increased understanding of these brain processes could yield meaningful clinical applications.
In Singapore, the prevalence of mental health problems is suggested to be about 16.6%.1 Schizophrenia, the focus in this review, affects about 1% of the population worldwide. However, it appears that only some 10% of those with mental health problems here seek professional help.2 Cultural attitudes and stigma remain as barriers to care, often delaying treatment.3 Thus, outcomes may be improved, at least in the short term, with earlier treatment of diagnosable mental disorders. However, in addition to these major challenges, there are real biological limitations to treatment efficacies in terms of psychotic symptom management and patient acceptability in the long term, a clear message out of the recent large real-world clinical antipsychotic trials in schizophrenia.4,5
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