by Steven M. Silverstein, William D. Spaulding, and Anthony A. Menditto; Cambridge, Massachusetts, Hogrefe and Huber Publishers, 2006, 84 pages, $24.95 softcover
Dr. Stovall is associate professor of psychiatry and family medicine and community health at the University of Massachusetts Medical School, Worcester.
I began to read this book with modest expectations. I anticipated another text that fragmented the discussion of the treatment of schizophrenia into different camps and philosophies that grow out of competing understandings of the etiology of the disorder. Schizophrenia, written by Drs. Silverstein, Spaulding, and Menditto, accomplishes much more than that.
The volume is part of a series in evidence-based practices in psychotherapy and is succinctly written to provide a workable treatment framework for practitioners. It will provide psychiatry residents and medical students with a clear introduction to psychosocial treatments of schizophrenia. The authors begin with the argument that schizophrenia develops with a combination of biological and environmental factors that interact to alter brain development. They review the role of antipsychotic medications in the management of symptoms of schizophrenia, and then they focus on the psychosocial and rehabilitation treatments that can alter the individual's long-term functioning and the course of the disorder.
Beginning with an introduction and summary of studies about the epidemiology and development of schizophrenia, the authors base their arguments of the concept of rehabilitation outlined by the supportiveness of the individual's environment, the individual's strengths and characteristics, and the community's requirements for adequate functioning. They propose psychosocial treatments that focus on the individual's degree of social disability; unique skills, strengths, and deficits; reactivity to environmental stress; and presence of abnormal cognitions. Using this foundation the authors provide a thorough and clearly written 26-page review of psychosocial treatments for schizophrenia.
Improvements in the text would have been possible. One case example is provided, but additional case studies might have allowed the reader to more clearly understand the areas of assessment and treatment planning. The authors provide only a brief discussion of the role of addiction in schizophrenia. Given the evidence-based models of treatment for patients with dual diagnoses, a broader discussion of this topic was warranted. The book also suffers from an overreliance on references and studies that are up to ten years old. More recent studies with similar findings on the impact of psychosocial treatments would have strengthened the book and helped convince more skeptical readers.
Finally, the discussion of well-defined models of service delivery, such as assertive case management, clubhouses, and supported housing, would have benefited from expansion and would have been consistent with the authors' overall discussion.
Overall, Schizophrenia strongly serves the purpose of broadening our understanding of effective treatment for schizophrenia and could easily serve as introductory reading in many training programs. The authors' argument that the most effective treatment is an integrated one that combines symptom-focused treatments with strength- and vulnerability-based rehabilitation efforts is a timely reminder to all of us involved in treating individuals with schizophrenia.