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Secondary Schizophrenia

Balan, Yener MD

The Journal of Nervous and Mental Disease: June 2011 - Volume 199 - Issue 6 - p 428
doi: 10.1097/NMD.0b013e31821cd383
Book Reviews

Assistant Professor Department of Psychiatry and Behavioral Sciences Albert Einstein College of Medicine Bronx, NY and Medical Director Outpatient Psychiatric Services Montefiore Medical Center North Division Bronx, NY

Perminder S. Sachdev and Matcheri S. Keshavan (Eds) (2010) New York: Cambridge University Press. xiv + 436 pp.

The intriguing title of Secondary Schizophrenia immediately prompts the reader to ask, "Secondary to what?" The editors offer answers to this question. To my knowledge, this is perhaps the first book written entirely on the topic of secondary schizophrenia, instantly making it a must-read text.

Sachdev prefaces the book by stating that "for any mental health researcher, finding the cause of schizophrenia would be the ultimate prize" (p. xiii). Although the book describes the current definition and psychopathology of primary schizophrenia and its impact on the patient and society, the book's focus is on the etiology of the secondary causes of schizophrenia. Historically, the terms functional and organic have been used to describe primary and secondary psychotic disorders. The authors use their book to expand on the definition of "organic" psychosis addressing the fields of continued controversy about the term.

The book is edited and written by authorities in the field, and their collaboration in this text documents an international understanding of scientific advancement and schizophrenia in particular. Perminder S. Sachdev, the editor, is the Scientia Professor of Neuropsychiatry at the School of Psychiatry at University of New South Wales and Director of the Neuropsychiatric Institute at Prince of Wales Hospital in Randwick, New South Wales, Australia. He has published over 250 articles and 5 books. Matcheri S. Keshavan, the consulting editor, is the Stanley Cobb Professor and Vice Chair for Public Psychiatry at the Department of Psychiatry at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center at Harvard Medical School in Boston, MA. His career has been dedicated to investigating the causes and treatments of psychotic disorders, and he has published over 350 papers and 3 books.

This book is organized into five sections, with a total of 33 chapters. The first page of each chapter has a Facts Box that acts as an abstract for the chapter, helping the reader appreciate the material to follow.

Section 1, comprised of three chapters, introduces the neurobiology and etiology of primary schizophrenia, the concept of organicity, and secondary hallucinations. The book has multiple well-organized tables that allow the beginner and expert alike to extract the pertinent information. Chapter 1 includes a table of the possible etiologies of secondary schizophrenia and diagnostic tools to establish a relevant differential. Each chapter is rounded out with a wealth of references for further reading, for a total of over 3000 references listed in the book. Chapter 2, written by Sachdev, addresses the controversial concepts and the philosophical underpinning of the terms organic and functional. The timeliness of the book's publication becomes evident in this chapter as definitions and categorizations of diagnoses are debated on the eve of the creation of the DSM-V. Chapter 3 provides a rare collection of specific examples of hallucinations in the context of detailed neurobiology written in a clear, easy-to-understand text. A spectrum of normal to pathological hallucinations is discussed, considering the cultural influences of religion and spiritual rituals.

Section 2 explores the neurological examination and functional neuroimaging in schizophrenia. Chapter 4 serves as a refresher course to the reader, who has not done neurological examinations, and provides an abundance of references for further reading. Although the primary target of the book is psychiatrists, this chapter in particular offers valuable information for neurologists and primary care physicians as well. Like many of the tables in this book, the table on page 54 entitled Guide to interpreting results of the examination to rule out a secondary schizophrenia is an excellent study guide for medical students and residents for examinations and clinical rotations. Chapter 5 is devoted to neuroimaging, predominantly in black and white with detailed explanations. There is one page in the book with color images of the brain. The data provided is current despite the limitation of time from compilation to publication. Even during the most intense scientific explanations, the editors ensured that the text flows and is a pleasant read, as evidenced by a reference to the Kantian theory of apperceptive self-awareness amidst a section on electroencephalographic findings!

Section 3 is the largest and includes chapters 6 to 29. They review syndromes that constitute the major disorders associated with secondary schizophrenia. They include epilepsy, drugs and schizophrenia-like psychosis, traumatic brain injury, cerebrovascular disease, Alzheimer disease, storage disorders, mitochondrial disorders, leukodystrophies, normal pressure hydrocephalus, brain tumors, demyelinating disease, infections, velocardiofacial syndrome, Prader-Willi syndrome, Friedreich ataxia, Wilson disease, Huntington disease, and Fahr disease. Chapter 7 includes a history of electroconvulsive therapy and suggests that a better understanding of the relationship between psychosis and epilepsy will lead to a deeper understanding of the psychopathology of psychosis. The chapters on substance-induced psychosis include drugs such as amphetamines, ecstasy, cocaine, alcohol, cannabis, heroin, nicotine, phencyclidine, ketamine, and lysergic acid diethylamide. The detailed exploration of the neurobiology of the drugs, their effects on animal models as well as on humans, and how the knowledge can be used to enhance our appreciation of the biological factors leading to psychosis are also discussed. The chapters on substance abuse should be a required reading for clinicians training for specialties in dual diagnoses. In contrast with the rest of the book, the chapter on toxic psychosis, also described as delirium, is disappointingly brief. Rather than reviewing the drug classes that may cause psychosis, it provides references for further reading. Although it is understandable to not want to duplicate information found elsewhere, a meatier discussion on the drug classes would have been welcome. This is a minor issue that I hope will be remedied in future editions. Chapter 13 on traumatic brain injury, written by Sachdev, touches on the medicolegal aspects of traumatic brain injury and schizophrenia-like psychosis and the detailed information required to label an illness as caused by, rather than associated with, a trauma. This portion of the text would also be informative to attorneys seeking to address issues of causation associated with personal injury actions.

Section 4 has two chapters that discuss the Charles Bonnet syndrome and acute brief psychosis. Among the core messages conveyed in the text is that correct diagnosis guides proper treatment. The book ends with Section 5, on treatment of secondary schizophrenia. Although "antipsychotics" is the quotidian punch line to the question of how to treat psychosis, the book does an excellent job of providing suggestions for tailoring treatment specific to the underlying disease. The chapters on Wilson disease, leukodystrophies, and multiple sclerosis are exemplary in this manner. The final chapter on nonpharmacological interventions describes the need for engagement, assertive outreach, establishing rapport, psychotherapies, and family interventions.

This book successfully fulfills its objective to help understand the range of disorders that can give rise to schizophrenia-like pathology. As it fills the gap in our library of knowledge, it will serve as a valuable guide to researchers and as an indispensable tool in any clinician's arsenal.

Yener Balan, MD

Assistant Professor

Department of Psychiatry

and Behavioral Sciences

Albert Einstein College of Medicine

Bronx, NY

and Medical Director

Outpatient Psychiatric Services

Montefiore Medical Center

North Division

Bronx, NY

© 2011 Lippincott Williams & Wilkins, Inc.