The Early Course of Schizophrenia

A small, dense book, The Early Course of Schizophrenia is generally well organized and useful. The editors collected a logical series of chapters from many leaders in the field that both describe and discuss mostly up-to-date research in early stages of schizophrenia. The chapters begin with the prenatal period, continue through the premorbid period, and finally discuss treatment of early schizophrenia. Controversial questions are introduced and discussed. When is the optimal time to begin treatment in the prodromal phase? Which medications are best in the prodromal phase and early symptomatic period? What nonpharmacologic treatments are helpful at this time? A discussion of cognitive-behavioral treatment of early schizophrenia, with a review of the literature comparing it to treatment with medication, was particularly good. As our medications continue to show problems with respect both to efficacy and to side effects, learned discourse on psychological treatments is most welcome.

Almost every chapter, although short, takes great pains to critically examine the research in its area, explains experimental design, and reviews research that is both supportive and contradictory of the central point. Although the authors have a point of view, they allow the reader to reach her or his own opinion of the literature presented.

The chapters summarize the world literature in early-episode research. Most chapters are excellent, and the only chapter that I considered to be redundant is "Prodromal Period: Pharmacological and Behavioural Interventions." Most of the information in this chapter is provided elsewhere in the same volume, and the discussion of antipsychotic medication is at a less sophisticated level than the discussions in the rest of the book.

The rest of the book is suitable for psychiatrists at all levels of training. However, particularly in regard to imaging studies and cognitive tests, the nonexpert reader will have to accept the findings as reported. Generally, the language and concepts are not overly specialized to prevent the psychiatrist in practice to appreciate the wisdom therein contained.

I would have liked to have seen biographies of the contributors, which are not listed anywhere. And although the book speaks for itself, there is no introduction.

Early schizophrenia is currently the focus of a lot of research and clinical interest, because, as this excellent book shows, there is much yet to understand about the import of the prodromal period: the predictive value of obstetric complications; early, prepsychotic behavioral and cognitive changes; and the effect of early medical and psychological intervention. Clearly, as more research in these areas is performed, psychiatrists will be in a better position to modify the often-tragic course of schizophrenia early, helping our patients to maintain or even improve their independent functioning, relationships, and work. As genetic, imaging, cognitive, and behavioral studies are perfected, is it too much to hope to intervene for a person deemed to be "ultra-high risk" before the illness develops and prevent it?

The Early Course of Schizophrenia is a worthwhile summary of the current research in all these areas, and I recommend it.