Abstract
This book takes the unusual tack of narrowing its scope to schizophrenia, and aims to provide ‘all that one would need to know to treat people with schizophrenia at all stages of an illness and all clinical circumstances’.
Textbooks derive much of their impact and durability from the authority of their authors. Here, both editors are eminent and well-known contributors to the literature on schizophrenia and both are also editors of general psychiatry texts. The authors of the individual chapters are properly described as ‘authorities who come from both sides of the Atlantic and occasionally elsewhere’. However, only Pat McGorry seems to qualify for the final part of that description.
This book provides a reflection on the current concerns and achievements of the mainstream clinical community. It is interesting, therefore, to find chapters covering topics such as ‘Clinical Interaction with Patients and Families’ which draws on the authors’ work in cognitive behavioural therapy and psychoeducation, ‘Case Management of Patients with Schizophrenia’ which provides a brief but useful review of the elements of case management along with a sceptical review of the place of assertive community treatment, and ‘Medical Management of Persons with Schizophrenia’ which discusses a few health problems commonly encountered.
While timeliness of a book such as this is always an issue, the discussions are up to date. Most chapters reference material from the year 2000. For example, the recent developments resulting from the cardiac complications of thioridazine are usefully discussed.
Where clinical practice guidelines and similar developments provide advice about highly specific clinical decisions, this book's strength is in providing the background information that supports clinical practice. Most chapters are concise and clinically focussed. Inevitably, there are a few quibbles with emphasis. Advice on establishing a maintenance dose of antipsychotic drugs, a clinical question facing every patient being treated for an acute psychosis, is dealt with summarily ‘… use the same dose of antipsychotic medication that was efficacious during acute treatment’. Meanwhile, a list of adjunctive treatments is discussed at length without useful conclusions. Strangely, this passage is duplicated word for word later in the book.
A few chapters provide slightly challenging views on their topics. Munk-Jorgensen's chapter on suicidal behaviour makes a strong case for the high risk of suicide especially in the year after an initial diagnosis of schizophrenia. While I appreciate the sentiment behind preventive strategies such as ‘do not ever discharge a schizophrenic patient on a Friday, when all decentralised services are closed, but wait until Monday morning’, I doubt that this is really an answer. McKenna makes a refreshing call to look again at the nature of disability in patients with chronic schizophrenia without being limited by concepts such as negative symptoms, positive symptoms and deterioration. Stroup and Morrisey's chapter on ‘Systems of care for schizophrenia in different countries’ describes care in three developing countries and three developed countries. In the process, they argue that people with schizophrenia are especially vulnerable to developments of market-based health care and shrinking social welfare budgets.
Overall, this book has something to offer anyone caring for people with schizophrenia as a starting point for answering clinical questions. Unfortunately, it does not contain enough information to be considered as a reference book nor enough detail to direct clinical practice. Trainees writing cases or preparing for other parts of the examination may appreciate the concise, clinically focussed discussions.