Book Review

Schizophrenia

N Engl J Med 1996; 334:1142-1143April 25, 1996

Article

Schizophrenia
Edited by Steven R. Hirsch and Daniel R. Weinberger. 740 pp. Cambridge, Mass., Blackwell Science, 1995. $125. ISBN: 0-632-03276-6

Schizophrenia is widely regarded as the most disabling psychiatric disorder, but scientific knowledge about its pathogenesis and treatment has been acquired relatively recently. In the 1950s, half a century after Kraepelin and Bleuler defined the characteristics and course of schizophrenia, the serendipitous discovery of the antipsychotic effects of chlorpromazine ushered in the neuropharmacologic era. The 1970s brought a new understanding of the role of neurotransmitters and the epidemiology of the illness. In the 1980s, the development of brain-imaging techniques allowed investigators to probe abnormalities in the structure and function of the brain in schizophrenia and fueled the development of new models of the disorder. Techniques involving molecular biology and genetics are now adding further to the understanding of schizophrenia and related psychoses.

No wonder, then, that a flurry of books about schizophrenia have appeared over the past decade. Two scientific journals (Schizophrenia Bulletin and Schizophrenia Research) are fully dedicated to this disease. Schizophrenia represents the latest effort to summarize the rapidly expanding body of knowledge about this disease in one volume of reasonable size. The editors have assembled an impressive group of authors from Europe and the United States. This mix is a major strength of the book. The two editors, one British and the other American, are themselves prominent psychiatric researchers.

The usual topics are covered in reasonable depth in 33 chapters divided into four sections. There are 11 chapters on descriptive aspects, another 11 on biologic aspects, 6 on physical treatments, and 5 on psychosocial aspects. It is puzzling that the chapter on neurocognitive deficits is included in the section on descriptive aspects and that the one on epidemiology is placed in the section on biologic aspects. A reversal of this arrangement would make more sense. There are major overlaps among several chapters. But on the positive side, this book has chapters not found in most recent books on schizophrenia, such as one on the risk of violence and another on homelessness.

How up to date is Schizophrenia? A check of the percentage of references that were published in the five years before 1995, when the book was published, revealed the following: the percentage of newer citations ranged from a low of 5 to 6 percent in chapter 8 (on the course and outcome of the illness) and chapter 2 (descriptive psychopathology) to a high of 41 to 50 percent in chapter 18 (clinical pharmacology of antipsychotic drugs) and chapter 25 (atypical antipsychotic-drug therapy). This range may reflect the areas of research in schizophrenia that are growing the fastest. Twenty-two percent of all 4809 references were published in the past five years. The book has an impressive index of 52 pages divided into two parts: subjects and authors.

This well-edited book could serve as a textbook for a course or a reference for clinicians and researchers. It is a comprehensive update of knowledge about a brain disorder about which new information is being generated at a very fast pace.

Henry A. Nasrallah, M.D.
Ohio State University College of Medicine, Columbus, OH 43210