The British Journal of Psychiatry (2001) 178: 387
© 2001 The Royal College of Psychiatrists
Schizophrenia
Swaran P. Singh, Consultant Psychiatrist
Psychiatric Outpatients' Department, University Hospital, Nottingham NG7
2UH
EDITED BY SIDNEY CROWN and ALAN LEE
Edited by Mario Maj & Norman Sartorius. Chichester: John Wiley &
Sons. 1999. 492 pp. £60.00 (hb). ISBN 0 471 999067
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.
