Essentials of Schizophrenia

edited by Jeffrey A. Lieberman, MD; T. Scott Stroup, MD; and Diana O. Perkins, MD, MPH. American Psychiatric Publishing Inc, Washington, DC, 2012, 268 pages, $71.00 (paper).

With the publication of Essentials of Schizophrenia, the authors have provided trainees in psychiatry with a wide-ranging and encompassing overview of schizophrenia that affords them a strong clinical introduction to the illness. Consisting of 10 chapters written by 26 experts in the field, the text is highly readable and follows the goal laid out in the preface, in which the editors assert that while much-needed research continues to increase understanding of the origins and treatments of schizophrenia, “there is much to be done to improve the lives and outcomes of patients with mental illness by applying existing knowledge and making evidence-based treatments available” (p xv).

In accomplishing this goal, the authors successfully avoid an approach that focuses only on the medical model of disease and treatment. While a chapter on psychopathology provides a detailed review of the array of symptoms present in schizophrenia, equally broad chapters present the neurocognitive and social impairments that lead to the functional impairments that plague individuals with schizophrenia and their families. A consistency of both style and information in the chapters supports the effort to provide clinical relevance to the basic knowledge about schizophrenia.

As will benefit students and residents, the text clearly addresses and defines concepts that are frequently employed in clinical discussions. Concepts including “expressed emotion,” “Schneiderian symptoms,” and “negative symptoms” are explicitly defined. The same holds true for a discussion of psychopathology that defines various types of delusions and hallucinations, as well as positive and negative symptoms, in an organized and clear manner that will allow the trainee to better understand the at times arcane language of psychiatric diagnosis and description.

In keeping with the editors’ goal of applying existing knowledge to clinical care, the authors make good use of consensus guidelines such as the Patient Outcomes Research Team (PORT) recommendations and recent research including the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study. The authors challenge frequently employed clinical approaches, including the use of multiple antipsychotics, and consistently argue for an evidence-based approach to treatment.

A surprising and strong chapter focuses on a long-neglected aspect of care for individuals with schizophrenia. Much attention is paid to management of acute exacerbations of the illness, and to the recognition and treatment of first-episode psychosis, but the editors of this book have also included a chapter on the treatment of chronic schizophrenia. The authors provide useful information about the role of ongoing treatment and the principles of long-term care, even highlighting the role of good documentation in the continued care of an individual with schizophrenia. While metabolic dysregulation and other common medical comorbidities are covered, osteoporosis and hyponatremia, less well-recognized issues, are also discussed.

With any text that attempts to provide a concise review of the essentials, some areas will be neglected. For example, the chapter on epidemiology and natural history would have benefited from a more thorough review of risk factors, including genetic ones. Given that the primary audience of the book may well be students and residents, the chapter on first-episode psychosis would have benefited from a discussion of the medical workup of first-episode psychosis, which would provide some clarity to what is currently an inconsistent approach to medical evaluation of a psychiatric illness. In addition, more discussion of diagnostic issues in the first episode would benefit the psychiatry resident who is facing the perplexing diagnostic dilemma presented by a patient with the emergence of psychotic symptoms.

Other neglected areas include the role of advocacy groups such as National Alliance on Mental Illness (NAMI), the role of peer support and advocacy, and the rise of mental health courts in response to the system-wide issues of individuals with serious mental illnesses who move into the correctional world. A resources appendix that includes web addresses and organizations such as NAMI would benefit patients and their families.

For residents and students for whom Essentials of Schizophrenia may provide their first, and certainly most thorough, introduction to schizophrenia and its treatment, a brief historical review of schizophrenia would help to place in perspective the bewildering systems of care that a patient must negotiate in trying to obtain integrated care.

I highly recommend the inclusion of Essentials of Schizophrenia in the reading list for psychiatry residents, medical and nursing students, and other trainees who may be early in their career. For clinicians already active in the field, the text will serve as a refresher that may challenge some of their current treatment approaches to an illness that remains both baffling and frustrating to treat.

Jeffrey Stovall, MD

[email protected]

Author affiliations: Vanderbilt University School of Medicine, Nashville, Tennessee.

Potential conflicts of interest: None reported.

J Clin Psychiatry 2015;76(8):e1039

dx.doi.org/10.4088/JCP.15bk09801

© Copyright 2015 Physicians Postgraduate Press, Inc.