The origin of schizophrenia: genetic thesis, epigenetic antithesis, and resolving synthesis

Traditionally, it has been thought that schizophrenia results from the interaction of predisposing genes and hazardous environmental factors. In this article, the paradigm of "genes plus environment" is challenged, and a new interpretation is presented, in which the emphasis on DNA sequence variation is shared with epigenetic misregulation as a critical etiopathogenic factor. Partial epigenetic stability (metastability) of gene regulation is consistent with various nonmendelian irregularities of schizophrenia, such as the presence of clinically indistinguishable sporadic and familial cases, discordance of monozygotic twins, coincidence of peaks of susceptibility with major endocrine rearrangements, and fluctuating course of disease severity, among others. It is also suggested that stochastic epigenetic events might account for a substantial portion of phenotypic variance, which traditionally has been ascribed to environmental effects. This theoretic essay is constructed according to the principle of Hegelian dialectic reasoning (thesis-antithesis-synthesis), which serves the goal of showing that the best outcome of molecular genetic studies in schizophrenia (and perhaps other complex diseases) can be expected when components that effect chromatin structure and gene regulation are taken into account and investigated comprehensively.