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Book Forum: Schizophrenia   |    
Handbook of Social Functioning in Schizophrenia
MAURICIO TOHEN, M.D., Dr.P.H.
Am J Psychiatry 1999;156:1286-1287.
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edited by Kim T. Mueser, Nicholas Tarrier. Boston, Allyn & Bacon, 1998, 423 pp., $62.95.

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This edited book is divided into five sections: Assessment and Description; Developmental Course; Psychological Factors and Individual Differences; Social, Environmental, and Economic Factors; and Treatment and Rehabilitation.

In the first section there is a good balance among the seven chapters, with the possible exception of some redundancy between chapters 5 and 7. The first chapter, "Social Functioning in the Community," is the best of the section. It is an example of good methodology in writing a review chapter. It clearly describes a methodology applied to the conduct of the literature review. The authors clearly operationalized criteria to select instruments that have been used to assess social functioning. They come up with 16 instruments that they carefully review, including their goals and psychometric characteristics, and they provide useful examples. They also make good recommendations on when to use each specific instrument.

Chapter 2, "Social Functioning in Residential and Institutional Settings," has a good discussion on how staff’s behavior affects patients’ symptoms. The chapter would have been more valuable had it included more discussion of elderly patients as well as further discussion on instruments that are valuable in the assessment of psychiatric patients in institutional settings. Chapter 3, "Social Adjustment of Patients Living at Home," has a good discussion on expressed emotion. It would have been desirable, however, to include more data on the influence of families on treatment compliance and the effects that living with a patient with schizophrenia has on the well-being of families. Chapter 4, "Quality of Life," is particularly good in the discussion of the relationship between quality-of-life assessment and social functioning. There is also a comprehensive assessment of diagnostic instruments. Chapter 5, "Psychopathology and Social Functioning in Schizophrenia," has a thorough discussion on baseline symptoms as a predictor of outcome. The chapter would be improved by the addition of more discussion on the advantages of different instruments in the prediction of social outcome. Chapter 6, "Social Skills and Social Functioning," is a good review of the authors’ own work at the Medical College in Pennsylvania. There are also important points made in the section on future directions. Chapter 7, "Phenomenological Perspectives on the Social Functioning of People With Schizophrenia," addresses a topic similar to that of chapter 5. The discussion on clinical approaches is particularly well covered.

Section 2, Developmental Course, would have benefited from a chapter on first-episode studies. Chapter 8, "Developmental Origins of Interpersonal Deficits in Schizophrenia," includes a description of an interesting approach taken by the authors in the use of films of families before the probands developed schizophrenia. Chapter 9, "Long-Term Outcome of Social Functioning," reviews seven major studies that have followed patients with schizophrenia for 20 or more years. It provides a somehow less pessimistic approach than other authors have displayed regarding the long-term outcome of schizophrenia.

The next section, Psychological Factors and Individual Differences, starts with one of the best chapters in the book, "Gender Differences in Social Functioning." It carefully and critically reviews the existing literature, including psychosocial and biological aspects of gender in schizophrenia. Chapters 11 and 12 both address affect and social functioning in schizophrenia. The strength of chapter 11 is the review of different scales to measure affect in patients with schizophrenia. Chapter 12 is a good complement to chapter 11 because it focuses on patients’ perceptions. The section on social knowledge is the strength of this chapter. Chapter 13, "Cognitive Factors and Social Adjustment in Schizophrenia," complements chapters 6 and 8 by the same authors; it reviews the effects cognition has on social adjustment in patients with schizophrenia.

The next section, Social, Environmental, and Economic Factors, starts with a well-written chapter on sexuality and family planning with the chronically ill psychiatric patient. The chapter stays away from technical terms and constitutes helpful reading for patients and their families. Chapter 16, "Stigma," is a well-written paper that should be read by all physicians treating patients with schizophrenia. Chapter 17, "Substance Use Disorders and Social Functioning in Schizophrenia," covers major studies in the area; the section on interventions is particularly helpful. The last chapter in this section, "Economics of Social Dysfunction," covers an area that is little-known to many clinicians and is written in clear and concise language.

The last section of the volume, Treatment and Rehabilitation, starts with a chapter on social skills training that is a good summary of the approach of Lieberman and his group at the University of California, Los Angeles. Chapter 20, "Social Functioning and Family Interventions," includes a comprehensive review of intervention studies and the prevention of relapse. It also includes a good description on clinical interventions.

The next chapter, "Cognitive Remediation in Schizophrenia," focuses on laboratory-based studies, and, of importance, it addresses the relationship between laboratory findings and interventions used in clinical settings. The strength of chapter 22, "Models of Case Management and Their Impact on Social Outcomes of Severe Mental Disorders," is that it covers approaches from the United Kingdom and the United States. Chapter 23 is a good review of the relationships between social and vocational functioning. The summary of different rehabilitation approaches, although brief, covers the main strength of each approach.

The chapter on pharmacological treatments is a good review of the literature up until 1997. It does not include studies conducted in the last couple of years with some of the new atypical antipsychotic agents. The last chapter, "Social Functioning and Challenging Behavior," is clinically focused on an important area—the management of aggression in patients with schizophrenia. It provides a number of insights of great interest to clinicians.

In summary, this handbook meets the goals of the editors in that it provides a comprehensive review of social functioning in schizophrenia. It constitutes a valuable addition to the field.

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