Preface

When the word "schizophrenia" is mentioned, the public tends to retreat in silent horror. To the lay person, schizophrenia conjures up a spectrum of emotions ranging from fear that a patient will become violent during hallucinatory psychosis, to dismissal that this is a made-up disorder based on a range of normal human emotions that has turned extreme. For some lay audiences, schizophrenia can mean that extreme anxiety has turned into paranoia or that certain traumatic experiences have catapulted a person into a momentary disconnect from reality, and hence they are exhibiting a "psychotic" episode.

In his article in *Psychiatric Times* (November 10, 2021) Dr. Mark Ruffalo, a psychoanalytic psychotherapist at the University of Central Florida College of Medicine and Tufts University School of Medicine, Boston, Massachusetts, explained that schizophrenia is more than an extreme manifestation of what is commonly in the repertoire of human psychology. In his words, there is a misunderstanding that "schizophrenia exists …… as an extreme variation of normality". It was Paul Blueler (1857‒1939) who first introduced the term "schizophrenia" to describe the disorder previously known as Dementia Praecox. According to Dr. Ruffalo, "it is now generally accepted that what we called schizophrenia is likely a grouping of different disease processes, perhaps upward of 200". The dramatic symptoms experienced by patients, their persistence, the degree of impairment, the severity and resistance to being "convinced out of their irrationality" has no parallel in normal mental functioning. Pathological states are a departure from physiological functioning governed by different biological rules or mechanisms of action.

People suffering from the symptoms of schizophrenia often face stigma from society. No research advances can claim success if the knowledge they uncover fails to reach the public and improve their perception of the disorder and its outcomes. Patients suffering from the symptoms of schizophrenia are just like any other person. They deserve to be treated equally, fairly and be fully included in society, which needs to be kind to them and support them in their adversity. By extension, service efforts must incorporate diversity and equity.

Schizophrenia research, like that into any disease, must be committed to integrity and dedicated to partnership with people with the diagnosis, their loved ones, and their community. It goes without saying that research, dissemination, and evidence translation is an international projects that must be dedicated to transparency informed by the highest ethical values.

Educating the next generation of researchers, clinicians, and professionals is essential, as advances in understanding and treatment lie in continual improvement and education. This book collates the latest exciting findings by distinguished researchers, scholars, and professionals who study schizophrenia from various angles; yet their collective works converge into a single mission ‒ exchanging the latest advances in

research and facilitating the application of their findings to clinical practice and treatment. The chapters in this book are organized into various topic headings, taking the reader on a journey of understanding schizophrenia through its symptoms and diagnosis, epidemiology, mechanisms of action, brain imaging, psychopharmacology, psycho-behavioral intervention, social inclusion, community care, social action, diversity and inclusion, novel therapeutics and future directions. The rationale for the topics is summarized in brief paragraphs under their respective headings.

This book stands out from similar publications in that it aims to bring a person-andcommunity-centered approach to a disorder that inflicts a heavy burden not only personally but communally. Patients with schizophrenia and their family as well as members of society must be well informed about the illness so they can form their opinions based on scientific data. Ultimately, the latest research is bringing a message of comfort that improvement in diagnostics, management of clinical trajectories, and therapeutic interventions are not only hope but are coming closer to them as a reality.

To the researchers who have committed their professional lives to the identification, elaboration, discovery, and formulation of the areas of etiology or therapies for schizophrenia, this book brings a multi-disciplinary view so that each researcher can see that, as focused as their own research topic is, it adds to the essential knowledge that demands to be woven into the fabric of understanding of this perplexing human condition called schizophrenia. I hope that the researchers who have contributed to this book will take with them insights from their colleagues from different disciplines and feel, in the spirit of scientific comradeship, that collectively they are moving closer and closer to solving the puzzle of schizophrenia.

> **Jane Yip** Director, Indiana Brain Mapping, Carmel, Indiana, USA

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Section 1

Neurobiology
