Reviews

Essentials of Schizophrenia

Although this book is offered as an overview of the clinical essentials of the diagnostic category of schizophrenia, the title is misleading as the ‘essentials’ detailed are largely restricted to those that are biomedical. The individual chapters, written by prominent clinicians and researchers in the field, present a summary of its epidemiology, symptom profile, associated impairments and optimal treatment strategies. The first two chapters provide relevant background relating to epidemiology, symptoms and outcome, but I think they could have included discussion of the validity of the diagnosis and reference to stress diathesis/continuum models which acknowledge that we are all vulnerable to developing psychosis

Although this book is offered as an overview of the clinical essentials of the diagnostic category of schizophrenia, the title is misleading as the ‘essentials’ detailed are largely restricted to those that are biomedical. The individual chapters, written by prominent clinicians and researchers in the field, present a summary of its epidemiology, symptom profile, associated impairments and optimal treatment strategies. The first two chapters provide relevant background relating to epidemiology, symptoms and outcome, but I think they could have included discussion of the validity of the diagnosis and reference to stress diathesis/continuum models which acknowledge that we are all vulnerable to developing psychosis.

Chapters three to five examine the prodrome/first episode and the impairments (neuro-cognitive, social and functional) that are frequently associated with psychosis. Chapters six and seven detail comorbid problems, including substance misuse and physical health problems. The inclusion of the latter is a clear strength of the volume, given consistent (and alarming) findings about the reduced-life expectancy and increased risk of physical health problems in this population.

The final chapters turn to optimal treatment including pharmacological and psychosocial interventions. The latter chapter features individual and family-based approaches that have been found to be associated with clinical gains when offered as an adjunct to pharmacological treatments. There is little detail of what the specific approaches might look like in practice and the evidence reviewed in support of their inclusion is often dated. For example, the trials of cognitive behaviour therapy discussed are some of the earliest studies. At the same time, the thorny issue of dissemination of these empirically validated treatments is neglected.

In conclusion, the book offers a ‘snap-shot’ of biomedical perspectives of psychosis, so it may be a useful addition to library stock. I would not recommend it for individual purchase. In my view, it is too restrictive in its focus and does not address the many questions that remain about the diagnosis, search for optimal acceptable treatments and societal stigmatising responses.

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