Abstract
This informative and concise guide is a very useful addition to the many recent publications on the topic of first episode psychosis. The book is written in a succinct and authoritative style by a group who have well-established credentials in the research and treatment of first episode psychosis patients at the South London and NHS Maudsley Trust and the Institute of Psychiatry. The strength of the book lies in its coverage of pharmacotherapy. Indeed, a better title for the book might have been The Medical Treatment of First Episode Psychosis. The book provides an up-to-date and extremely useful review of antipsychotic and antimanic treatments, with detailed comparisons of the various atypical antipsychotic medications and mood stabilisers. Treatment resistance and relapse is well summarised and the advice given may be just as pertinent to the pharmacotherapy of subsequent episodes of illness.
An additional chapter in this book provides a brief, practical and evidence-based overview of psychological interventions in first episode psychosis. This chapter supplements the preceding chapters on biological treatments. However, I would strongly recommend other sources for a more comprehensive review of such therapies in this phase of illness.
Despite its strengths, the book has a number of shortcomings. The chapter on clinical assessment of first episode psychosis is quite limited in scope and little attention is given to a description of what actually constitutes an emerging psychotic symptom or syndrome. Furthermore, the account of the formulation of such presentations is even more limited, and really fails to adequately address the complexity of the issue. However, this is well compensated for by a subsequent chapter, which provides a good overview of the genetic and developmental risk factors and triggers for psychosis and includes a brief description of the prodromal phase of emerging psychosis. In the remaining chapters on treatments there is, unfortunately, no mention of the role of electroconvulsive therapy, and there is disappointingly little advice given for the management of difficult presentations, such as those complicated by aggression, catatonia or comorbid disorders, for example substance dependence. Again, I would recommend other recent publications as a better source for this information.
A few useful references are made to the manner in which one might structure services to best meet the needs of first episode psychosis patients. This advice appears consistent with recommendations from other first episode services. However, it would have been particularly interesting if the authors had given a more elaborate account of their views regarding this in the book.
This book would be of most value to medical staff, in both psychiatry and general practice. It is sound in its practice and evidence-based in its advice. What it lacks in some areas is compensated for by its highly useful review of the principles of pharmacotherapy in first episode psychosis. Even though it concentrates on biological interventions, it is also likely to be of interest and benefit to non-medical mental health clinicians involved in the shared management of these patients. I recommend it as a very informative and practical guide to the treatment of first episode psychosis.