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October 1993

Schizophrenia as a Brain Disease

Arch Neurol. 1993;50(10):1097. doi:10.1001/archneur.1993.00540100082022

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At the turn of the century, Kraepelin considered schizophrenia to be a degenerative disease of the brain. Bleuler and Freud, among others, changed this thinking, schizophrenia becoming variously a psychological, a psychiatric, or even a political diagnosis, ie, the "slow schizophrenia" of the Soviets, giving the government an excuse to lock up dissidents for years in psychiatric institutions.

Controversies about schizophrenia no longer are about its organic or psychogenic nature, but about the type of brain disease that it represents.

Seeman marshals evidence implicating the dopaminergic system in schizophrenia and demonstrating a left-sided brain predominance of the disorder. Williamson points out that dopamine abnormalities are only part of the story, since large Swedish and California pedigrees failed to show a linkage between the D2 dopamine receptor gene region and the presence of schizophrenia. He favors a glutamatergic system explanation of schizophrenia buttressed by his own recent observations on first-episode,

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