Recent decades have seen significant research in first-episode psychosis and duration of untreated psychosis, with corresponding changes in clinical practice and policy. Having read extensively the existing literature on risk assessment in first-episode psychosis and schizophrenia, I was unsure what this text would add to my understanding. The book is, however, interesting and helpful.
This is a manual on how to assess early signs and symptoms of psychosis using two new measures, the Structured Interview for Psychosis-Risk Syndromes (SIPS) and the Scale of Psychosis-Risk Symptoms (SOPS). It achieves its stated aim of providing clinical researchers and possibly higher trainees and professionals with up-to-date knowledge and understanding of patients at risk of psychosis. It stresses the need for accurate evaluation and diagnosis of patients at risk as well as highlighting the negative consequences in terms of stigma for those who are falsely identified and followed up as risk-positive.
The book is divided into three parts. Part A consists of seven chapters, with first three introducing the concept of risk syndromes for psychosis, development, reliability and validity of SIPS and SOPS. The following chapters describe symptom classes and characteristics of risk samples. Part B consists of eight chapters describing in detail the process of interview and evaluation. Part C is a chapter on the process of evaluation, treatment and management of risk-positive patients in the Yale PRIME clinic.
The breadth of topics covered is impressive and includes abundant case examples. A particular strength of the book is chapter 12, which provides descriptions of 13 real cases of individuals as they presented to psychosis risk clinics for their baseline assessment. At the end of the book there are practical cases for the reader to test his or her knowledge and skills at evaluating clinical cases for psychosis risk.
This book is highly accessible, practical and not overly burdened by theory. The authors produced a readable and comprehensive account of their experience of using the SIPS at a psychosis risk clinic for more than a decade. Discussions of SIPS with examples or vignettes have enriched the text and made this well-written book inspiring as well as highly informative.
On the whole, the stigma v. prevention section was weak compared with the background and evaluation sections, and one can question whether a comprehensive review of this debatable topic was beyond the scope of this text. The need for more research is highlighted. The authors conclude with suggestions for criteria of the psychosis risk syndrome to become part of every diagnostic examination where risk is suspected. However, the extent to which SIPS may be applied in National Health Service settings will be curtailed by the large number of patients we deal with and a limited time to utilise this interview schedule.
In response to the dramatically increasing interest in identifying patients as early as possible and in initiating intervention at the earliest possible stage of psychosis, a new category - attenuated psychotic symptoms syndrome (APSS) - is being proposed by the DSM-5 Psychosis Work Group for inclusion in DSM-5 that is expected to be released in 2013. This manual will therefore be of great relevance, should this proposal be accepted.