Book reviews

Books by IEPA members, and of interest to IEPA members, are reviewed here.

If you would like to have a book reviewed, or you would like to submit a review, email the IEPA Secretariat for details: secretariat@iepa.org.au.

The Recognition and Management of Early Psychosis: A Preventive Approach

Jackson and McGorry. The Recognition and Management Early Psychosis: A Preventive Approach, Second Edition, 2009.

This is a totally new edition of the original “state of the field” text written in 2009. The content is almost completely changed and the sixty contributors feature a wider range of names. The text is both broad and deep in scope. It begins with introducing the rationale for early psychosis intervention and basic concepts of prevention and staging models. Several chapters focus on current research on the biology, identification, and early response to the “at-risk mental state”. This is followed by discussions of measurement and impact of duration of untreated psychosis, mental health literacy and pathway to care efforts. The following chapters deal with interventions during the first episode and the few years after, referred to as the “critical period”. Particular attention is given to intervention in bipolar disorder, substance misuse, suicide prevention and emotional and personality dysfunction. Finally there are overviews of family intervention, enhancing work functioning, relapse prevention and treatment resistance, followed by descriptions of a group of service models from around the world.

This book will be very useful for organizations and individuals seeking a compendium of the literature summarizing relevant concepts and research results. While the book does have specific recommendations for clinical programs, most of the book is designed to lay out current scientific knowledge, with less emphasis on practice recommendations. It will come as no surprise to most readers that the research overview raises as many questions as it answers. It is an important text for clinicians and researchers alike. The breadth and recency of the research covered in this text demonstrates the momentum which has built during the last ten years, and lays a solid foundation for the next decade of research and continuing service development.

Tamara G. Sale, M.A., Mid-Valley Behavioral Care Network, Early Assessment and Support Team (EAST Program), Salem Oregon

Working with People at High Risk of Developing Psychosis

Addington et al

Working with People at High Risk of Developing Psychosis is an edited volume written by a range of prominent clinician researchers in the field of the pre-psychotic phase of first episode psychosis. A large number of ‘prodrome’ clinics are in various stages of operation around the globe and this book would be useful for clinicians, researchers and administrators involved in those clinics. The chapters included focus on assessment and engagement; working with individuals, groups and families. It is becoming increasing obvious to us that beyond the socio political aspect of getting such projects up and running (and financial sustained beyond that phase) the quality assurance tasks in terms of clinical practice is mighty. Handbooks such as this, concerning a unifying topic and containing information across a range of themes are essential for the busy mental health worker who usually has to’ hit the ground while running’. The early psychosis field needs to produce a range of such books, from different viewpoints, and on a regular basis. Service development aspects of the ultra high risk field will require increasing attention and reflection as progress is made.

Jane Edwards, PhD Deputy Clinical Director ORYGEN Youth Health

“Working with People at High Risk of Developing Psychosis – a treatment handbook” provides an excellent overview of current knowledge in treatment options for young people who are at risk of developing psychosis. Drawing on their knowledge of current research in the area, the authors outline the rationale for psychological interventions for young people who are ‘at risk’ of a psychotic disorder and also likely to be experiencing a range of other symptomatology. Given the complexity of this client group, there is a strong emphasis on diagnostic variability, poor help-seeking and developmental issues; along with practical information on issues of engagement, assessment and formulation. Chapters then follow which focus on psychological interventions for stress, emotional distress, substance misuse, attenuated psychotic symptoms and brief limited intermittent psychotic symptoms. In addition, there are chapters on working with families and working with groups, both being essential components of treatment for this age group. The range of symptomatology and interventions discussed in this book make it an important resource for those working not only in the ultra high risk area, but in the broader early psychosis field.

Donna Gee, MA Senior Project Officer, Psychosis Disorder Services ORYGEN Youth Health

Staying Well After Psychosis: A Cognitive Interpersonal Approach to Recovery and Relapse Prevention

by Andrew Gumley and Matthias Schwannauer. Chichester: John Wiley & Sons. 2006. ISBN 0-470-02185-3

Gumley and Schwannauer offer a practical guide for mental health professionals working with individuals who have experienced psychosis. This book is grounded in a solid theoretical foundation and current literature that include CBT for psychosis, social cognition and expressed emotion. The authors skilfully integrate attachment theory, trauma theory and interpersonal constructs within a psychological model of psychosis as a framework for understanding the developmental aspects involved in recovery from and vulnerability to the recurrence of psychotic experiences. The manual is divided into three main parts. Part I provides a theoretical overview of staying well and relapse prevention. Part II outlines the style, structure and organisation of the therapy. Part III details the specific cognitive, behavioural and interpersonal strategies involved in promoting recovery and staying well. Interspersed throughout the book are helpful case examples and client-therapist dialogues to illustrate points and demonstrate the application of theory. Although written to help promote recovery and prevent relapse in individuals who have experienced a psychotic episode, it is also useful for work with individuals who are thought to be “at-high risk” for developing psychosis. The authors conceptualize early signs of relapse in psychosis as an ‘at-risk mental state’ for relapse, which is equivalent to the “at-risk mental state” for individuals experiencing attenuated symptoms.

A central tenet of the book, is that it is not the changes in psychotic symptoms per se that are considered the primary focus for staying well; rather, consistent with CBT conceptualizations, it is the “specific personal meanings attached to the psychotic experiences which signify emotional and interpersonal distress that are of greatest importance” (p. 68). Gumley and Schwannauer, drawing on both the life events and social ranking literatures, conceptualize the experience of a psychotic episode as a “critical life event” (p. 63) with its emotional reactions related to appraisals of humiliation, “entrapment” (p. 106) and the many dimensions of loss. Throughout parts II and III are descriptions of cognitive interpersonal interventions that flow smoothly from discussions of empirical research and theory. Such dialogues and case descriptions are invaluable for the mental health professionals to help the person stay well.

Staying Well After Psychosis, although practical, is not a “How-to” manual and may be more useful for those who have experience and knowledge in CBT. In fact the authors recommend that therapists using the manual have training and experience in either CBT or interpersonal approaches to psychological therapy. Regardless, this book is a great resource for beginning clinicians and students to become familiar with the varied theoretical and research literatures relevant to understanding the developmental, interpersonal and psychological factors in recovery and relapse in individuals who have experienced psychosis.

Maria Haarmans PRIME Clinic, Toronto, Ontario, Canada

Systematic Treatment of Persistent Psychosis: A Psychological Approach to Facilitating Recovery in Young People with First Episode Psychosis

by Tanya Herrmann-Doig, Dana Maude, and Jane Edwards (published by Martin Dunitz, London, 2003)

Kim T. Mueser, Ph.D. New Hampshire Dartmouth Psychiatric Dartmouth Center, Main Building, 105 Pleasant St., Concord, NH 03301 USA

Systematic Treatment for Persistent Psychosis (STOPP) is an excellent newly manualized intervention specifically designed to address the needs of young individuals who have recently developed a psychosis. The manual is authoritative, concise, and clearly written. It addresses an important gap in the armamentarium of clinicians working with individuals who develop severe mental illnesses with psychotic features. STOPP provides important guidance to clinicians in helping their clients learn more about their illness, come to terms with the experience of developing a psychosis and what it means for their perceptions of themselves, develop strategies for coping with persistent symptoms, and to get on with their lives, including the ability to relate to others. There is at present no other manual or book that provides the same useful clinical guidelines for working with this population.

The STOPP program is divided into four specific phases, including: (1) developing a collaborative working relationship, (2) exploring and coping with psychosis, (3) strengthening the capacity to relate to others, and (4) finishing and moving on. The primary orientation of the STOPP program is cognitive psychotherapy, which is delivered in two individual sessions per week (usually) over a 6 to 12 month period of time. The manual describes the rational and clinical strategies involved in implementing each of the different phases of the STOPP program, with excellent clinical examples and resource materials provided throughout.

Effective psychological treatment of individuals who have recently developed a psychosis is of paramount importance for optimizing the long-term outcomes of psychiatric illness. This book provides a critical road map for working with clients with a recent psychosis, understand their experience, and getting onto their personal road to recovery. I highly recommend this book to all clinicians working with individuals with a psychosis.

Experiencing and Recovering from Psychosis

Edited by Dr Choo Chih Huei, Dr Swapna Verma and Associate Professor Chong Siow Ann

Experiencing and Recovering from Psychosis takes on the most difficult work of explaining psychotic disorders and their treatment in a world that struggles still with acceptance of such catastrophic illness and its treatments. Its format of presenting scientific and medical information side-by-side with patient experiences provides a guide that mediates between the world of the clinician and that of the patient. And in the end it brings together the clinician, the patient and the patient's family in such a clear yet sensitive approach that one must feel reassured that the experience of a psychotic disorder can be understood and is not hopeless.

From the very beginning this book is clearly written so that anyone reading the table of contents will know where to find precisely the information being sought. Explanation of the different psychotic disorders and their symptoms are complete yet uncomplicated, and as helpful for the clinician beginning work in the field of psychosis as for the patient or family member. It also thoroughly covers what we know about the causes of psychosis describing genetic, medical, substance use, pregnancy and birth complications as well as environmental stress and expressed emotion. The depiction of the "normal brain" versus the "schizophrenia brain" may be upsetting for some patients who are early in recovery and sensitive to being labeled "abnormal." In a similar way, learning the importance of early treatment may cause distress to patients and families who come into treatment after several years of untreated psychosis. This, or course, is difficult to avoid if we are advocating for early intervention programs, as is EPIP, and can be reframed for clients and their families as the outcome of recent growth in our knowledge of psychosis.

The authors clearly portray a thorough understanding of the difficulties facing newly diagnosed young people and their caregivers as they must work through the issues of medicines and the need for help. However, writing a book that targets patients, families and clinicians is sometimes awkward. For example, when describing individual psychotherapy the authors state, "By being non-judgmental in his or her comments, the therapist encourages free expression to counter suppression or denial of your experiences." True as this is, such statements appear to be more appropriate either being spoken by patients or left for clinician's guides. Putting this awkwardness aside, the material contained is always excellent as the book covers not only medication but psychosocial therapies, and help for recovery and staying well, especially ways to relax, problem-solving skills and positive self-talk techniques. The excellent chapter devoted to caregivers will be one I will use for discussion in multi-family groups in the years to come. Finally, there is a most interesting chapter that addresses the very difficult and often sensitive cultural issues that can stand in the way of treatment. While unique to the cultures of Singapore, this chapter translates-as does the entire book-into universal ways of bringing medicine and human needs together in the treatment of psychosis.