Our understanding of the causation of schizophrenia has increased in the past several decades. Schizophrenia is a disease of the brain that is expressed clinically as a disease of the mind. Both its symptoms and signs and its associated cognitive abnormalities are too diverse to permit its localization in a single region of the brain. The working hypothesis shared by most investigators is that schizophrenia is a disease of neural connectivity caused by multiple factors that affect brain development. (3,4,5)

Our current model of the causation of schizophrenia is very similar to that used to unders

The most typical age for the onset of schizophrenia is during the late teens and early 20s, a time when brain maturation is reaching completion (6); this suggests that the pathogenesis of the disease must involve a neurodevelopmental process related to the final stages of "brain sculpturing," such as pruning or activity-dependent changes (psychological experiences that affect brain plasticity). (4)

The causation of schizophrenia is clearly a complicated matter. As our understanding of it progresses, however, our hope for improving the lives of patients with the disease increases. If we are able to identify the critical periods in brain development during which causative factors work their mischief, and if we can delineate the molecular and cellular processes that impair brain development and neural connectivity, then we can begin to identify preventive techniques that could be implemented before injury occurs. We can also potentially improve the treatment of schizophrenia, which currently focuses on reversing abnormal neural communication by blocking dopamine or serotonin receptors. Although newer treatments such as the recently developed atypical neuroleptic drugs have already substantially improved the outcome of schizophrenia, they remain blunt instruments that have relatively generalized effects on neurotransmitter systems. As we identify more precisely the cascade of events leading to schizophrenia -- neurodevelopmental abnormalities that lead to neural misconnections that lead, in turn, to impaired cognitive processing -- we will also identify better and more specific targets for future treatment.

tand cancer. That is, schizophrenia probably occurs as a consequence of multiple "hits," which include some combination of inherited genetic factors and external, nongenetic factors that affect the regulation and expression of genes governing brain function or that injure the brain directly. Some people may have a ge

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