- Email: [email protected]
Treating schizophrenia
366
good quality practice questions. A comprehensive index is a useful and unexpected feature. The book could be strengthened by more careful editing, by
providing references, and by supplementation answer keys with explanatory comments.
of
DONALD J. SMELTZER Columbus, OH, U.S.A.
SCHIZO 00104
Schulz, S.C. and Tamminga (Eds.), Schizophrenia. Scient$c Progress, 418 pp. Oxford University Press, New York, 1989. $70.00 One of the exciting developments in the field of schizophrenia research is the burgeoning interest among scientific investigators in schizophrenia and related disorders. This interest is reflected by the quality and quantity of work in the field and by the ferment among scientists which takes place in the interchange conducted at scientific meetings. In recent years the field has grown to the point that major international meetings focus exclusively on schizophrenia. The International Congresses of Schizophrenia Research, held in 1987 and 1989, represent such comprehensive gatherings. The organizers of the first congress compiled 40 papers from the invited speakers and present them in this volume which may well represent only the first of an important series. The editors have drawn together a remarkable compendium of information on schizophrenia in this collection. Their familiarity with the field led to a better than average selection of presenters and authors on the broad range of topics relevant to schizophrenia ranging from classification and epidemiology to basic studies and animal models. Each section is set off by a brief introduction from the editors orienting the reader to the chapters found within. Each chapter contains a good re-
view of the research relevant to the specific study presented and then most offer new results for the readers’ consideration. Bibliographies are uniformly comprehensive and provide good foundations for further investigation. Most chapters raise questions needing additional study, such as that by E.F. Torrey. Illustrations and figures in the volume are generally helpful to the reader, although there is some variability in the reproduction of brain images from MRT and PET studies. A book of this nature always suffers somewhat from its diversity of focus but the included topics do serve to encompass most current schizophrenia research. It will serve best those who are working in academic centers and who are looking to stay abreast of the work going on by those using unfamiliar techniques. Clinicians involved in teaching and training will also find good material. Most of all, volumes such as this serve as markers of where the field has been and where it may be going. I would recommend it to anyone with an interest in the problem of schizophrenia. I also hope that future volumes will be published within a year of the congress, not two years later such as with this volume. The field is moving quite rapidly and some material may become outdated over a 2 year interval. JEFFREY A. C~FFMAN Columbus, OH, U.S.A.
SCHIZO 001I I
Mendel, W.M., Treating Schizophrenia, 230 pp. Jossey-Bass, San Francisco, CA, 1989. USD 24.95. Werner Mendel is known to many psychiatrists who care for the chronic mentally ill as a leading treatment innovator and theoretician. In this book, he svnthesizes his observations on what schizo-
phrenia is and how to treat it. It is a distillate of wisdom based on years of work in the trenches with several hundreds of patients. The first half of the book (‘The Disease’) is devoted to a review of the complicated lifelong nature of the illness, and the second, entitled ‘The Treatment’, is a discussion of specific challenges that occur in the course of caring for individuals
367
with schizophrenia. In the chapters on the disease, Dr. Mendel emphasizes the critical importance of grasping the fundamentals of natural history, especially for diagnosis, and argues persuasively that persistently mentally ill persons have quite specific longterm treatment needs. Dr. Mendel believes that although much progress has been made in psychopharmacologic management, patients with schizophrenia generally struggle with their symptoms and impairments throughout their lives; moreover, the ability to treat this complex illness requires considerable knowledge, expertise, and experience. Dr. Mendel attends to a number of topics in detail, including age of onset (his data suggest that the first episode is rarely diagnosed), the undulating pattern of the illness (rather than the relentless downhill course reported in early accounts), features that characterize remission, exacerbation, and crisis in the illness, how treatment affects the course. and factors that affect prognosis. He extends his comments on the nuclear defects that he feels characterize these patients, even in remission; specifically, disturbed capacities to manage anxiety. to handle interpersonal relationships, and to form sound judgements and decisions reflecting one’s own life experience (Dr. Mendel calls this a failure in historicity). He also considers the aging schizophrenic patient (remissions are longer, psychotic symtoms less frequent), and questions common wisdom about suicide, reproductivity, and longevity rates. Finally, he illustrates for the reader a detailed case, drawn compositely from his files. In the second part of the book, he provides a new translation of the classic case of Ellen West, treated by Ludwig Binswanger in the early part of this century, and proposes that the multiplicity of complaints and complex, lifelong impairment of this patient is a typical schizophrenic pattern. He
summarizes in some detail the application of supportive care techniques (his treatment of choice), which he has explored elsewhere, especially in Supportive Care: Theory and Technique (LOS Angeles, Mara Books, 1975). In other chapters, he considers the utility and purpose of hospitalization, the psychology of prescribing medication, and issues associated with outpatient and community-based care and residential programs. The book is well-organized and written in engaging and clear style. Apparently it is Dr. Mendel’s final opus and it succeeds admirably. The ring of truth sounded frequently in my reading, the kind of response one has to observations and insights delivered by someone highly familiar with real patients. As with any book on such a vast topic, there are likely to be gaps one would have hoped to have filled. For example, I would have liked a more detailed discussion of rehabilitation, cognitive changes, the relevance of positive and negative symptom patterns in treatment, and greater detail about acute and longterm interventions in psychopharmacology. No doubt some will also quarrel with specific points. Yet, Dr. Mendel gives us a framework of concepts and experiences that should stimulate thinking and counter the attitudes of those who look upon treatment of schizophrenia as a tiresome chore fraught with boredom and lacking in challenges. Few individuals working with schizophrenic patients have anywhere near this physician’s experience. And, there are surprisingly few monographs on the treatment of schizophrenia for those of us who work in this area. In summary, this is an essential reference. THEO C. MANSCHRECK
Concord, NH U.S.A.
SCHIZO 00126
Lieberman, R.P., DeRisi. W.J. and Mueser, K.T. Social Skills Training ,for Psychiatric Patients. 250 pp. Pergamon Press, New York, 1989. USD 24.50. Social Skills Training For Psychiatric Patients is a well-written, informative book that is likely to be
of value to anyone in the mental health field who works with the chronically ill psychiatric patient. The book reflects the obvious skill and experience of its authors. Dr. Lieberman, in particular, has conducted some of the pioneer work in psychiatric rehabilitation, traditionally a somewhat unglorified field of interest.
good quality practice questions. A comprehensive index is a useful and unexpected feature. The book could be strengthened by more careful editing, by
providing references, and by supplementation answer keys with explanatory comments.
of
DONALD J. SMELTZER Columbus, OH, U.S.A.
SCHIZO 00104
Schulz, S.C. and Tamminga (Eds.), Schizophrenia. Scient$c Progress, 418 pp. Oxford University Press, New York, 1989. $70.00 One of the exciting developments in the field of schizophrenia research is the burgeoning interest among scientific investigators in schizophrenia and related disorders. This interest is reflected by the quality and quantity of work in the field and by the ferment among scientists which takes place in the interchange conducted at scientific meetings. In recent years the field has grown to the point that major international meetings focus exclusively on schizophrenia. The International Congresses of Schizophrenia Research, held in 1987 and 1989, represent such comprehensive gatherings. The organizers of the first congress compiled 40 papers from the invited speakers and present them in this volume which may well represent only the first of an important series. The editors have drawn together a remarkable compendium of information on schizophrenia in this collection. Their familiarity with the field led to a better than average selection of presenters and authors on the broad range of topics relevant to schizophrenia ranging from classification and epidemiology to basic studies and animal models. Each section is set off by a brief introduction from the editors orienting the reader to the chapters found within. Each chapter contains a good re-
view of the research relevant to the specific study presented and then most offer new results for the readers’ consideration. Bibliographies are uniformly comprehensive and provide good foundations for further investigation. Most chapters raise questions needing additional study, such as that by E.F. Torrey. Illustrations and figures in the volume are generally helpful to the reader, although there is some variability in the reproduction of brain images from MRT and PET studies. A book of this nature always suffers somewhat from its diversity of focus but the included topics do serve to encompass most current schizophrenia research. It will serve best those who are working in academic centers and who are looking to stay abreast of the work going on by those using unfamiliar techniques. Clinicians involved in teaching and training will also find good material. Most of all, volumes such as this serve as markers of where the field has been and where it may be going. I would recommend it to anyone with an interest in the problem of schizophrenia. I also hope that future volumes will be published within a year of the congress, not two years later such as with this volume. The field is moving quite rapidly and some material may become outdated over a 2 year interval. JEFFREY A. C~FFMAN Columbus, OH, U.S.A.
SCHIZO 001I I
Mendel, W.M., Treating Schizophrenia, 230 pp. Jossey-Bass, San Francisco, CA, 1989. USD 24.95. Werner Mendel is known to many psychiatrists who care for the chronic mentally ill as a leading treatment innovator and theoretician. In this book, he svnthesizes his observations on what schizo-
phrenia is and how to treat it. It is a distillate of wisdom based on years of work in the trenches with several hundreds of patients. The first half of the book (‘The Disease’) is devoted to a review of the complicated lifelong nature of the illness, and the second, entitled ‘The Treatment’, is a discussion of specific challenges that occur in the course of caring for individuals
367
with schizophrenia. In the chapters on the disease, Dr. Mendel emphasizes the critical importance of grasping the fundamentals of natural history, especially for diagnosis, and argues persuasively that persistently mentally ill persons have quite specific longterm treatment needs. Dr. Mendel believes that although much progress has been made in psychopharmacologic management, patients with schizophrenia generally struggle with their symptoms and impairments throughout their lives; moreover, the ability to treat this complex illness requires considerable knowledge, expertise, and experience. Dr. Mendel attends to a number of topics in detail, including age of onset (his data suggest that the first episode is rarely diagnosed), the undulating pattern of the illness (rather than the relentless downhill course reported in early accounts), features that characterize remission, exacerbation, and crisis in the illness, how treatment affects the course. and factors that affect prognosis. He extends his comments on the nuclear defects that he feels characterize these patients, even in remission; specifically, disturbed capacities to manage anxiety. to handle interpersonal relationships, and to form sound judgements and decisions reflecting one’s own life experience (Dr. Mendel calls this a failure in historicity). He also considers the aging schizophrenic patient (remissions are longer, psychotic symtoms less frequent), and questions common wisdom about suicide, reproductivity, and longevity rates. Finally, he illustrates for the reader a detailed case, drawn compositely from his files. In the second part of the book, he provides a new translation of the classic case of Ellen West, treated by Ludwig Binswanger in the early part of this century, and proposes that the multiplicity of complaints and complex, lifelong impairment of this patient is a typical schizophrenic pattern. He
summarizes in some detail the application of supportive care techniques (his treatment of choice), which he has explored elsewhere, especially in Supportive Care: Theory and Technique (LOS Angeles, Mara Books, 1975). In other chapters, he considers the utility and purpose of hospitalization, the psychology of prescribing medication, and issues associated with outpatient and community-based care and residential programs. The book is well-organized and written in engaging and clear style. Apparently it is Dr. Mendel’s final opus and it succeeds admirably. The ring of truth sounded frequently in my reading, the kind of response one has to observations and insights delivered by someone highly familiar with real patients. As with any book on such a vast topic, there are likely to be gaps one would have hoped to have filled. For example, I would have liked a more detailed discussion of rehabilitation, cognitive changes, the relevance of positive and negative symptom patterns in treatment, and greater detail about acute and longterm interventions in psychopharmacology. No doubt some will also quarrel with specific points. Yet, Dr. Mendel gives us a framework of concepts and experiences that should stimulate thinking and counter the attitudes of those who look upon treatment of schizophrenia as a tiresome chore fraught with boredom and lacking in challenges. Few individuals working with schizophrenic patients have anywhere near this physician’s experience. And, there are surprisingly few monographs on the treatment of schizophrenia for those of us who work in this area. In summary, this is an essential reference. THEO C. MANSCHRECK
Concord, NH U.S.A.
SCHIZO 00126
Lieberman, R.P., DeRisi. W.J. and Mueser, K.T. Social Skills Training ,for Psychiatric Patients. 250 pp. Pergamon Press, New York, 1989. USD 24.50. Social Skills Training For Psychiatric Patients is a well-written, informative book that is likely to be
of value to anyone in the mental health field who works with the chronically ill psychiatric patient. The book reflects the obvious skill and experience of its authors. Dr. Lieberman, in particular, has conducted some of the pioneer work in psychiatric rehabilitation, traditionally a somewhat unglorified field of interest.