Book Review
Schizophrenia 
Juvenile-Onset Schizophrenia:
Assessment, Neurobiology and Treatment Robert L Findling, S Charles Schulz, editors. Baltimore (MD): Johns Hopkins University Press; 311 p. US$49.95.
Reviewer
rating*: Good
Review by: Mary V Seeman, MDCM
Toronto, Ontario
The title of this book echoes the more familiar diagnosis of juvenile-onset diabetes and thus implies an illness different in cause and in course from one that begins in later adult years—an interesting speculation that is unfortunately not addressed in this book.
The first chapter discusses the phenomenology of adolescent-onset psychosis, which immediately introduces the core question: What is psychosis? As Gabrielle Carlson and others, the authors of Chapter 1, point out, the definition is “by no means fixed.” It is generally acknowledged that a relation exists between the various definitions of psychosis and the illness schizophrenia, but psychosis occurs in many other illnesses, and schizophrenia, by definition a psychotic illness, can at times be diagnosed without the usual signs of psychosis (that is, delusions and hallucinations). Nonetheless, the authors conclude that, whatever the diagnosis, psychosis in adoelscence is preceded by poor cognitive functioning and childhood psychiatric symptoms that need attending to as much, if not more, than the psychosis—a clinically relevant recommendation.
Chapter 2 zeroes in on schizophrenia and attempts a unitary and integrative glutaminergic developmental hypothesis to account for the known facts about this elusive illness. From a clinical point of view, this suggests that drugs that reduce glutamate release, such as lamotrigine, would be useful for treating schizophrenia. Lamotrigine has proven highly successful in the treatment of mood disorder, which again brings up the questions raised in Chapter 1: What is included in the term psychosis? In what way is schizophrenia a stand-alone illness?
Chapter 3, by Tonya White and Charles Nelson, is an informative review of neurobiological development during childhood and adolescence. Logically, however, it should have come at the beginning of the book.
Chapter 4, on genetic factors in schizophrenia, could have attempted a distinction between juvenile-onset and later adult-onset forms of this illness, but the opportunity was missed. Chuck Schulz and others then discuss the results of imaging studies and conclude that, on brain imaging, adolescent and adult schizophrenia show little difference. The Schulz group proceed to tackle neuropsychological deficits in early schizophrenia and reiterate the findings of Chapter 1—that cognitive deficits precede illness and schizophrenia is so heterogeneous that a specific neuropsychological profile is difficult to identify. No comparisons are made with later-onset illness.
The next chapter deals with physiological endophenotypes and makes the point that studying young people near the beginning of overt illness will yield etiologic information that the study of a more chronic and long-treated sample would not provide.
Chapter 8, by Elaine Walker and her team, discusses premorbid development of children at risk for schizophrenia and the manifestations of impending illness that form the prodrome and the triggers. They believe that the hormonal surges of puberty can alter the expression of genes responsible for the schizophrenia cascade.
The following chapter, by the Pat McGorry group, takes up the topic of the prodrome and its management but, disappointingly, does not send a clear message to clinicians about what needs to be done or not done during the prodromal phase of illness to prevent progression.
Chapter 10 deals with other psychotic disorders of childhood and adolescence, emphasizing the fact that this book’s title does not reflect its contents. The next 3 chapters offer useful, if tentative, pharmacologic and psychotherapeutic recommendations for treating young persons with a psychotic illness, stressing the special needs of the adolescent stage of life.
Altogether, this book reviews what is currently known about adolescent schizophrenia from various viewpoints. While different perspectives expand the landscape of knowledge, they make reading difficult. A single-authored book would have kept readers on a more trackable path with a clearer destination. As it stands, readers are left not knowing quite what to do with the information provided.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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