Though humbled by brain complexity, we still make progress - Interview with Prof Celso Arango

What have been the effects of recent advances in schizophrenia?

We’re too critical when we consider our own field. In the opening session, the new President of the EPA, Sylvana Galderisi, mentioned the sense that our field is less advanced. But, on the evidence of what we have achieved, that is not the case.

We have drugs to treat FEP and prevent relapse that have effect sizes that match those outside mental health. And we have psychosocial interventions with numbers-needed-to-treat that are no higher than interventions in other areas.

We are humbled by the complexity of the brain

Perhaps the problem relates to the complexity of the organ we’re dealing with. Faced with the brain, we feel humble. And it is true that compared with the structures of a joint, or a single cell, it is complex. And we are dealing with highly complex interactions between genes and environment, and between early environmental experiences and later environmental experiences, such that someone with a particular genetic background may develop schizophrenia, or depression, or anxiety -- or have no mental health problem at all.

Even in a single “entity” such as schizophrenia, we are facing a number of pathophysiologies that have a common symptomatology. Each will require different treatments.