Current Issues in the Psychopharamacology of Schizophrenia

Editors: Breier A, Tran PV, Herrera JM, Tollefson GD, Bymaster FP.
Lippincott Williams & Wilkins Healthcare, Philadelphia, 2001.
US$42.95; pp579; ISBN 0-7817-2422-8

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This is an excellent book. It is a multi-editor (5 editors), multi-author (63 authors) American book. The outcome is a hard-covered, relatively thick book with 579 pages. Apart from the Introduction and the Index, there are 34 chapters. The contents are presented in 6 sections.

Section I is on Basic Pathophysiology, with 4 chapters on Neurotransmitters, Neuroanatomy, Neurodevelopment, and Neuropathology.

Section II is about Neurobehavioural Pharmacology, with 6 chapters on Dopamine, Pharmacogenetics, Animal Models, Neuroimaging, Neurophysiology and Psychophysiology, and Neurocognition.

Section III is on Second Generation Antipsychotics, with 5 chapters on Clozapine, Olanzapine, Risperidone, Quetiapine, and Sertindole.

Section IV is on Novel Therapeutic Strategies, with 5 chapters on Partial Dopamine Agonists, Serotonin, Glutamate, Muscarinic Agonists, and Neuropeptides.

Section V is on Clinical Issues, with 8 chapters on Childhood-onset Schizophrenia, Predictors of Schizophrenia, Positive/Negative Symptoms and Beyond, Geriatric Schizo- phrenia, Long-term Management, Suboptimal Treatment Response, Ethnic Issues, and Pharmacoeconomics.

Section VI is on Special Issues, with 6 chapters on Gender Issues, Comorbid Mood Disorders, Dementia in Schizophrenia, Movement Disorders, Psychopharmacology in Japan, and Social Reintegration.

The Benefits

Comprehensiveness is assured by the wide array of topics that have been chosen, from the basic sciences to clinical issues, from current new drugs to potential future drugs, from pharmacoeconomics to ethnic-cultural issues and f inally, ending the book with a chapter on integrating the pharmacological and the non-pharmacological approaches in the management of schizophrenia. The result is a book that appears almost like an encyclopaedia.

All the chapters are evidence-based and fully referenced. I am amazed by the amount of recent research that has been done and which had escaped my notice before I read this book.

The book certainly conveys an impression that this is the state-of-the-art on this subject. Although a lot of facts remain uncertain, the reader is left with a feeling that all the pieces of this jigsaw puzzle will one day be in place.

Despite this, reading through this book need not be particu- larly laborious because each chapter always starts with some- thing basic before moving to the advanced information. Both novices and veterans will be able to understand and benefit, and find the book interesting to read.

Each chapter was written by experts in that field. Some of the more famous authors include Nancy Andreasen, John Kane, Jeffrey Lieberman, Carol Tamminga, and Daniel Weinberger.

One of the advantages of a multi-author book is that each chapter can stand alone as a reference to one specific topic if the reader does not have time to go through the whole book. On the other hand, good editorship is shown by the mean- ingful and coherent relationships between the 34 chapters. Despite the large number of authors, duplication of contents is surprisingly non-apparent. The style of presentation of each chapter is also remarkably consistent.

It is interesting to note 4 Chinese names (Drs Ho, Lin, Lin, and Pi) among the authors.

The Drawbacks

Perhaps the biggest disadvantage of this book is the strong pharmaceutical company influence amongst the editors and authors. At least 3 editors and 7 authors work at Eli Lilly and Co and it would be natural for the reader to look for evidence of bias as a result. Indeed, this book has put the ‘atypical’ antipsychotics in a much better light than the

‘conventional’ drugs and, among the ‘atypical’ drugs, olanzapine is given a better light than risperidone. I don’t mean that these statements are automatically untrue, but they would be more convincing if written in a book without such an involved influence. Likewise, ziprasidone and iloperidone are briefly referred to, with no specific chapters about them.

There are also a number of printing errors, including ‘Alzhcimer’ instead of ‘Alzheimer’, ‘f ight-or-fight’ instead of ‘fight-or flight’, ‘crased’ instead of ‘erased’ and, in one Table, ‘No Impairment’ should be a separate heading rather than embedded inside ‘Mild Impairments’. There is also some confusion in the use of italics among the headings and sub-headings and Table numbers are not always accurate. In addition, there is an error in the alphabetical order of the list of Contributing Authors.

Conclusion

Overall, this is an excellent book, and counts among one of the best books I have ever read. I have learned a lot from reading it, and would highly recommend it to anybody who wants to keep up to date with the psycho-pharmacology of schizophrenia.

Dr HK Cheung
Chief of Service
Castle Peak Hospital Hong Kong
China

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