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Book Review   |    
Marie Hobart
Psychiatric Services 2010; doi:
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edited by Jonathan M. Meyer, M.D., and Henry A. Nasrallah, M.D.; Arlington, Virginia, American Psychiatric Publishing, Inc., 2009, 471 pages, $67

Dr. Hobart is chief medical officer of Community Healthlink, Inc., Worcester, Massachusetts.

All of us who work with individuals with severe and persistent mental illness must attend to general medical health risks, especially those that are exacerbated by our psychiatric treatments. The latest edition of Medical Illness and Schizophrenia is a concise and useful guide for this endeavor. It is packed with up-to-date and highly relevant information from an array of international experts covering a broad spectrum of topics.

The book is based on the premise that general medical care for this population must be integrated into psychiatric care. The authors look at both historical and contemporary data regarding the high rate of comorbid medical conditions and the early mortality rate for persons with schizophrenia. An entire chapter is devoted to the background and outcomes of the CATIE study (Clinical Antipsychotic Trials of Intervention Effectiveness), which sets the stage for an in-depth look at metabolic syndrome, obesity, glucose intolerance and diabetes, lipid abnormalities, and cardiovascular disease. Alhough these chapters focus on persons with schizophrenia, they are broadly applicable to anyone taking antipsychotic medication. Each chapter presents a comprehensive summary of the clinical and epidemiologic aspects of the medical condition, as well as an excellent review of pertinent basic science. In particular, the chapter on lipid metabolism is one of the most understandable and practical reviews I have read. Useful guidance is provided to help distinguish between direct adverse effects of medication, downstream health consequences of their metabolic side effects, and expected medical sequelae of schizophrenia. The chapter on behavioral treatment for weight management reinforces the need to make this issue a routine component of our clinical work.

Almost every individual with schizophrenia will also suffer from a co-occurring addiction and its health consequences. The authors review nicotine dependence, as well as marijuana, alcohol, cocaine, and opiate use. The neurocognitive, affective, and social benefits that attract individuals to these substances are discussed. The subsequent devastating health outcomes are a major factor in early morbidity and mortality. Treatment strategies are briefly addressed, but for more details the reader must look elsewhere.

The infectious diseases discussed are HIV and hepatitis C. Transmission, neuropsychiatric consequences, and overall health consequences are reviewed for each of these viral infections, as well as associated prevention and treatment strategies.

Sexual dysfunction commands a complete chapter. This area is consistently overlooked by practitioners, yet has huge implications for quality of life and medication adherence. It has major implications for clinical management from both psychosocial and biological perspectives. The authors focus on the sexual side effects of psychiatric medications and how these may interact with underlying health conditions. The book concludes with chapters on special populations, including children and adolescents, the elderly, and women of reproductive age.

Thematically consistent content helps to create a sense of continuity throughout the work. Each chapter concludes with bullet points that summarize the essential information, which is especially helpful for the busy clinician. I would highly recommend this book to all physicians, nurses, and trainees who treat patients with schizophrenia, either in the psychiatric or the primary care setting. In addition to its value as a continuing education resource, this volume is a great quick reference when dealing with the myriad medical problems our patients face every day.

The reviewer reports no competing interests.




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