Schizophrenia: Concepts and Clinical Management

As psychiatry becomes more evidence-based, and as we think about specific treatments for different disorders, it is important to have a readable book that covers a broad range of topics in schizophrenia—from diagnosis to pathophysiology to treatment to special problems. Dr. Johnstone is an accomplished clinician and highly recognized investigator who has the experience and credentials to bring such a book together with her colleagues from the University of Edinburgh. In addition, because of its digestible length and well-written style, this is an excellent book for residents to expand their knowledge about this important specific disorder. Because it is readable and covers many aspects of schizophrenia, it could serve as the basis for a seminar on schizophrenia for advanced trainees. In addition, most clinicians will find this book valuable for a relevant update on schizophrenia. As a history major during my undergraduate training, I was particularly impressed by the scholarly, historical approach and the depth of perspective of many of the chapters. Each contributor to this multiple-author volume has his or her own style and approach. Some of the chapters are especially strong and held my interest and are highlighted below.

Dr. Johnstone’s introductory chapter and her chapter on “Diagnostic Issues: Concepts of the Disorder” are broad and well synthesized. Taken together, these two chapters provide a view of schizophrenia in the twentieth century and the attempts of clinicians and researchers alike to grapple with this enigmatic illness. Dr. Johnstone’s well-referenced work brings an uncommon depth to the work of Kraepelin and Bleuler that is not often found in books by American authors. By understanding the way these two great people approached schizophrenia and the relationship of their work to current concepts, the reader approaches the subsequent chapters with a broad background.

The chapters by Dr. Lawrie provide excellent teaching value as he reviews the areas of brain imaging and neuropsychological studies of schizophrenia. All too often, papers and chapters launch into the results of such studies while leaving many readers behind on just how the tests are performed and what is their unique value. The neuropsychology chapter is very useful for acquainting clinicians and students alike with the cognitive difficulties exhibited by many patients with schizophrenia and how they are assessed.

Dr. Lang provides an especially strong chapter, “Service Provision: The Clinical Perspective.” By carefully describing the many attempts that society and psychiatry have made to help patients with schizophrenia, she helps us understand the rationale for many approaches and puts our current attempts in a more accurate perspective. Further, this chapter provides the basis for an excellent group of chapters on psychosocial problems and treatments.

Two chapters, “Special Problem Areas” and “Legal and Ethical Issues,” provide a background not frequently included in American books on schizophrenia. The real-life issues described and discussed—including suicide and legal aspects of the violent patient—provide not only important information but also a perspective from outside the United States that could allow for more creative approaches.

Are there any weaknesses in this volume? Some parts of the book are somewhat outdated and superficial, especially when compared with the depth and scholarship of many of the other chapters. In the area of psychopharmacology, the reader will need to supplement the chapters written here with other review articles.

In conclusion, this is a very useful and readable book that can bring anyone up-to-date about schizophrenia. For the reader in the United States, the book provides an interesting and well-referenced perspective that goes beyond our sometimes overly technical approach.