Reviewer: Michael Schrift, DO (University of Washington School of Medicine)
Description: The fundamental premise of this book, with which I agree, is that schizophrenia is a complex condition, typically involving abnormal brain function, with exacerbations under stress, and manifesting multiple cognitive impairments in multiple domains, including deficits in social cognition which also further exacerbates the patients' problems. Just like individuals with overt brain diseases such as stroke benefit from speech, language, physical, and cognitive therapies, so would patients with schizophrenia. This new book reviews the psychological interventions that have some evidence of effectiveness in restoring cognitive and social functioning. Written and edited by nationally recognized clinician-researchers of psychosocial treatments in schizophrenia, this book is a welcome contribution to the field.
Purpose: The purpose of this book "is to provide an overview of current conceptualizations of, and treatments for, schizophrenia. The focus of the book is on psychological treatments for the disorder as these interventions are relatively ignored in graduate and medical training about schizophrenia, even though the evidence for their effectiveness is comparable to that of pharmacologic treatment, with the combination of the two typically producing the best treatment outcomes."
Audience: The intended audience includes psychologists, psychiatrists, and psychology graduate students.
Features: The first of the book's eight sections reviews such topics as the concept of schizophrenia, definitions, the medical model, course and prognosis, outcome, and diagnostic procedures and documentation. The second section covers the theories and models of schizophrenia including the neurobiology, environmental, and cognitive factors. Section 3 covers symptom, functional, and cognitive assessments as well inpatient and outpatient planning. The fourth section focuses on treatment issues and summarizes the psychological interventions used with schizophrenic patients. The remaining sections include a case vignette, recommended further readings, and a list of resources.
Assessment: Psychological treatments are greatly under considered and underutilized in schizophrenia. The authors are sort of guilty of their own criticism, however. They discuss their concept of schizophrenia — that it is a syndrome, not a disease, with varied degrees of severity, psychopathology, and levels of functioning — but refer to schizophrenia as if it is one disease. Unfortunately, the wide disparity of functioning in patients who are "diagnosed" with schizophrenia confounds any treatment outcome study. Is it the therapy that was effective in improving outcome, or was it the type of patient chosen or volunteered to be in therapy that was the essential ingredient in the outcome? This problem of validity of schizophrenia as one disease, unfortunately, continues to plague psychiatry. If we studied dementia or mental retardation the same way we do schizophrenia, we would never learn of Fragile X, PKU, or prion disease!
