From maps to mechanisms through neuroimaging of schizophrenia

Schizophrenia today: three views of the future Three Perspectives in this issue cover different aspects of the current state of our knowledge about schizophrenia. Thomas Insel, director of the US National Institute of Mental Health in Bethesda, Maryland, outlines a new approach to schizophrenia that could in time lead to new treatments. He calls for schizophrenia to be emphasized as a neurodevelopmental disorder in which psychosis is a late — and potentially curable — stage. Andreas Meyer-Lindenberg, director of the Central Institute of Mental Health in Mannheim, Germany, explains how neuroimaging and other systems-level techniques can help develop future treatment. And Jim van Os, Gunter Kenis and Bart Rutten review our knowledge of the environmental factors that influence schizophrenia risk, and the major challenges that will be involved in teasing them out. Functional and structural brain imaging has identified neural and neurotransmitter systems involved in schizophrenia and their link to cognitive and behavioural disturbances such as psychosis. Mapping such abnormalities in patients, however, cannot fully capture the strong neurodevelopmental component of schizophrenia that pre-dates manifest illness. A recent strategy to address this issue has been to focus on mechanisms of disease risk. Imaging genetics techniques have made it possible to define neural systems that mediate heritable risk linked to candidate and genome-wide-supported common variants, and mechanisms for environmental risk and gene–environment interactions are emerging. Characterizing the neural risk architecture of schizophrenia provides a translational research strategy for future treatments.