If you attend an annual meeting of the American Psychiatric Association (APA), you are faced every day with a bewildering array of symposia, plenary sessions, work-shops, posters and so on. More often than not you make the wrong choice and that evening at some social function you are told about the session you ‘really should have attended’. The APA must be aware of this because it now produces the ‘Progress in Psychiatry Series’ which publishes ‘the best of the symposia’. This book is number 56 - clearly the APA is on to a good thing (Royal College please note).

Although it is not clear in the introduction, I presume this symposium was organised by Dr Ezra Susser of Columbia University in New York. There are only nine chapters, but six come from his department. The book is really an extension of his already published work, which argues forcefully for the role of prenatal factors in the aetiology of schizophrenia.

Nowakowski from New Jersey sets the scene with a useful description of normal prenatal brain development (but why is this Chapter 3?). Waddington et al from Ireland review especially their own work that suggests a ‘cascade process’ in which intrauterine events are associated in childhood with neuromotor and psychological abnormalities and in adulthood with the appearance of psychosis. But the core of the book is a description and expansion of Susser et al's finding that in the Dutch famine at the end of the Second World War, those who were exposed as foetuses in the first trimester of pregnancy to the height of the famine, had a greater than expected chance of developing schizophrenia in adult life. Susser believes that prenatal nutrition may be an important risk factor in schizophrenia; his current work is taking this further by looking at specific micronutrients.

This is an intriguing finding. However, to the best of my knowledge it has not been replicated. There must be many other specific situations in which pregnant mothers are exposed to famine. Also, what about chronic severe malnutrition in a country such as India? If Susser is right, then why is the incidence of schizophrenia not demonstrably higher in that country; or is it that such children die before reaching adulthood?

What I am really trying to say, I suspect, is that in this book there is no chapter providing a counterbalance to the undoubted enthusiasm of Susser's group. If Professor Tim Crow had been invited to speak at the symposium, there might have been a real debate.

For me, interested in clinical research in schizophrenia, this book will provide a useful source of references; I suspect it is not for the general psychiatrist.