Abstract
The title of this book warrants comment. I incorrectly assumed it meant a review of the constellation of disorders that is now captured under this term. The authors, respected experts in their field, acknowledge that the term’s meaning is variable, evident, for example, between the scientific literature and DSM-5. However, this is not a text focused on a dissection of this topic. I believe its use in the title is to highlight the variability that exists across the spectrum, an important starting point for a book intent on providing a broad overview of the topic in a very concise format (94 pages).
The book is divided into 4 sections (Description, Theories and Models of Schizophrenia Spectrum, Diagnosis and Treatment Indications, and Treatment). Given the scope of these topics, one can appreciate how brief the overviews must be. In the preface, the authors note the book’s intent is to provide a comprehensive update that spans both theory and practice. This is the second edition, the first published in 2006, and a synopsis of changes in the field since sets the stage. Both volumes are part of a series published under the framework of Advances in Psychotherapy, Evidence Based Practice, developed and edited with the support of the Society of Clinical Psychology (American Psychological Association Division 12). In the preface, the authors note the focus is on psychological treatments, while the publisher identifies the series as ‘how-to’ references on particular disorders.
Albeit brief, the book does try to capture current thinking that spans conceptualization, diagnosis, etiology, and treatment. That it succeeds is reflected in topics that have been highlighted, an example being the discussion of the field’s shift from a neuroprogressive model to one that underscores neurodevelopmental issues. Sections are short and references are up to date; in addition, summary points are provided in the margins throughout. Efforts have also been made to incorporate historical aspects that shaped directions in thinking and policy development, making the read even more interesting.
In this context, the occasionally strained relationship between psychological and ‘medical’ treatment (e.g., pharmacotherapy) arises different times throughout. At the outset, the point is made that this text addresses psychological interventions ‘usually neglected in graduate and medical training about schizophrenia, even though the evidence for their effectiveness is comparable to that of pharmacologic treatment…’. It is also noted at different times that combining the two lines of intervention makes for the best treatment outcomes. This said, a discussion later in the text regarding treatment in the absence of medications reminds us that debate on what constitutes ‘best’ treatment continues (a position that also highlights the notion that a ‘one size fits all’ approach may not be appropriate).
Because so much material is covered in such a limited space, there is a compelling need for the writing to be organized, clear, and succinct. The authors are very successful in this regard, again assisted by the use of multiple headings, subheadings, and highlighted points in the margins. However, something has to give in the face of such demands and, not surprisingly, the discussion cannot adequately capture the depth and complexity of the many topics covered.
This, of course, speaks to the intended audience. The authors express hope that this text will serve a wide readership, from students to ‘advanced clinicians and researchers looking for a compact review of current conceptualizations and clinical tools.’ This may be true for psychological treatments—the book’s focus—but this cannot be said for the ‘medical’ end of things. A discussion on topics, such as neurophysiology and antipsychotic medications, is lacking and, perhaps because of that, even misleading. For example, metabolic issues are attributed to antipsychotic medications, which is only part of the story, as the illness itself has been implicated. Similarly, the described association between first-generation antipsychotics and tardive dyskinesia may mistakenly lead the reader to conclude that this same adverse event is no longer a risk with the newer drugs, which is not the case.
Notwithstanding these issues, the book does a good job in what it has chosen to put its emphasis on—psychological treatments. Gains in this direction have been made but there is more to do. This text, nicely laid out and reasonably priced, succinctly but effectively keeps us abreast of this topic and more recent advances.