Abstract
A patient with a treatment-resistant schizophrenic disorder and a degree in Classics had wanted to return to do some further study, and commenced correspondence high school work, which we were sure was well within his ability. He failed the paper and developed delusions that the teacher had set him up. When we could persuade him to undergo neuropsychological testing, not routine in our service at the time, we found that his functional IQ was well below 100. We viewed his ‘inability to learn’ about his illness differently. Our psychoeducation had been delivered crudely without an understanding of his cognitive difficulties.
Had we grasped the messages in this volume edited by Pantelis, Nelson and Barnes, we might have had a greater awareness of this possibility. The awareness of cognitive impairment in schizophrenia is as old as the term ‘dementia praecox’, but the integration of the implication of the now large body of knowledge into our daily treatment of people with schizophrenia has lagged behind, as the above case illustrates.
This book seeks to rectify that gap by providing a comprehensive and critical overview of this subject to a range of students of the subject: psychologists, researchers and psychiatrists alike. The authors of each chapter are all active researchers in the field, many of international standing.
The book is divided into three major sections. After an historic and methodological overview, it details the specific cognitive deficits (including those of memory, attentional, intellectual functions), associated neuropsychological and neurological abnormalities, and how these relate to models of schizophrenia. There are further chapters relating to movement disorders in schizophrenia, both those occurring in treatment-naive patients and of medication side effects.
Most of the chapters are of a technical nature and can be very informative. The chapter on IQ, and the relationship between the neuropsychological abnormalities and clinical features is particularly interesting clinically, as are the explanatory models for tardive dyskinesia. They summarise the findings and take the reader through the methodological difficulties that have bedevilled this area of research: the use of poorly standardised tests, the problem of activity of positive symptoms producing attentional and cognitive abnormalities and the effects of medication
The only disappointing chapter is the final one on the impact on psychosocial treatment of the neuropsychological findings. Instead of attempting to integrate the neuropsychological evidence with what is known (e.g. cognitive—behavioural treatment), one small scale trial is presented. How should we routinely apply this knowledge clinically? What are in the author's view, the necessary tests undertaken for any patient with schizophrenia? How might we tailor treatment regimes to the areas of deficit identified? Given the erudition of the previous work, more specific answers to these questions, even if speculative, would have been of value. Perhaps these are hopes that the research in this field cannot yet be expected to fulfil, but given the progress in understanding documented here, that time may not be long off. In all, the book is recommended as a detailed account of an increasingly important field, for the interested psychiatrist and trainee.