This book, the second volume in the World Psychiatric Association's series ‘Evidence and Experience in Psychiatry’, was a pleasure to review. One can dip in and out of it at random to find an important aspect of schizophrenia summarised in a few paragraphs. It is a collection of six review articles, followed by expert commentaries, thus combining research evidence with clinical experience. The reviews cover diagnosis, pharmacological and psychotherapeutic treatments, prevention of disability and stigma, schizophrenia spectrum disorders and the cost of treating schizophrenia. Each concludes by summarising consistent evidence, incomplete evidence and areas open to research. The commentaries vary in quality, scope and length. Some emphasise particular aspects of the review, others elaborate on areas not covered, while a few explore or espouse the individual interests of the commentator.
The reviews are all well written, balanced and up-to-date. Given their ambitious scope, it is not surprising that individual areas get sketchy attention. The first article and commentaries express the well-rehearsed limitations of the diagnostic term without stating what should replace it. While atypical antipsychotics are only briefly covered in the review of pharmacological treatments, several commentators mention their superiority, highlighting the current lack of consensus. In an otherwise excellent review of psychotherapeutic treatments focusing on four well-researched modalities, the authors omit the area of interaction between psychological treatments and medication. Several commentaries note the exclusion of dynamic treatments from the review. The chapter on stigma and disability is the longest, most discursive and least focused. Schizophrenia spectrum disorders, not an area of great academic interest, is reviewed commendably. Cloninger's criticism of spectrum concepts makes superb reading, as he compares the shifting diagnostic boundaries between ICD and DSM to “moving around the chairs on the top deck of an ocean liner which is sinking because of a gaping hole in the bow”. The final article is an excellent introduction to health economics and methods of economic evaluation. It also summarises the current evidence for the greater cost-effectiveness of the atypicals.
The book is for whetting appetites rather than providing a substantial meal. Most people will find something of their particular interest, but no one is likely to find an exhaustive appraisal of an area. It is designed for an international readership, and some commentaries, such as those on continental concepts of schizophrenia, or experience of stigma in the less industrialised world, are rarely found together in one volume. However, the price is disproportionately steep, given that the book is likely to have a short shelf-life. Postgraduate libraries with money to spare may consider it a worthy addition. For those seeking an in-depth exploration of aspects of schizophrenia, the breadth of this volume will be scant compensation.
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