Abstract
This short book provides an excellent introductory overview of treatments for schizophrenia. Its contributors represent several disciplines including psychiatry, pharmacy, psychology and nursing which should help to enhance its appeal to multidisciplinary mental health teams. Most chapters offer clear summaries of the current state of knowledge in each area of therapeutics, together with sound recommendations for treatment implementation in simple, jargon-free language suitable for informing families, carers and patients as well as health professionals.
Particularly useful and up-to-date information is provided in the areas of drug treatment, psychotherapeutic approaches for persistent psychotic symptoms and the management of negative symptoms, cognitive impairment, comorbid anxiety and depression, and substance abuse. The excellent chapter on treatment adherence offers clear practical guidance that could readily be incorporated into most clinicians' range of therapeutic skills. There are very helpful summary tables, boxes and figures throughout the book that could serve as useful teaching aids in tutorials for students and health service staff.
The book could have benefited from a chapter on the engagement of the patient in a therapeutic alliance. This is an especially important matter in the treatment of schizophrenia that is often overlooked or taken for granted, yet is fundamental in achieving successful outcomes from a broad range of biomedical and psychosocial treatments. The use of the term ‘acute arousal’ in the chapter on management of agitation and violence is somewhat idiosyncratic. Although alternatives such as ‘acute disturbance’, ‘behavioural emergency’ or ‘challenging behaviour’ are not satisfactory either, the term ‘arousal’ is subject to diverse connotations and continuing debate about its definition and meaning that make its use in the present context problematic. No definition is given by the authors of this chapter, but what is meant is violent behaviour, its prevention and management. That said, however, the content of the chapter on this issue is clear, informative, practical and soundly based, leaving only matters of minor detail with which to quibble.
The contribution on family interventions was rather disappointing in that, while it gave a good overview of the literature on their efficacy, it provided little by way of practical guidance for the novice clinician who needs to incorporate family intervention skills into their routine clinical practice. Similarly, the chapter on substance abuse could have included some more detail on methods of psychosocial treatments for this problem. Although it could be argued that providing greater levels of detail concerning the practicalities of conducting such psychosocial treatments goes beyond the scope of the book as an introduction to the field, the level of detail provided in the drug treatment chapter would belie this argument.
It is well known that the rate with which evidencebased psychosocial treatments are taken up into routine practice in public mental health services is very poor. If this book is read conscientiously by mental health staff, it may help to advance the adoption of these treatments in clinical practice. If similarly read by families, carers and patients, then they can begin to challenge any discrepancies between what they actually receive at the hands of mental health services and the material in this well-written, concise book.