CLINICAL HANDBOOK OF SCHIZOPHRENIA

PREFACESchizophrenia is arguably the most serious major psychiatric disorder, usually developingin late adolescence or early adulthood, and often having a profound effect over thelifetime on daily functioning. People with schizophrenia frequently have difficulties livingindependently and caring for themselves, working or attending school, fulfilling parentalor other role obligations, and enjoying close relationships and rewarding leisure activities(American Psychiatric Association, 2000). Although schizophrenia develops in about 1 in100 individuals, it accounts for a disproportionate share of treatment costs and, accordingto the World Health Organization, is ranked as the second highest contributor tooverall burden of diseases, behind cardiovascular disease (Murray & Lopez, 1996).Despite the severity of schizophrenia, in recent years there has been enormous progressin our understanding of the illness, and the treatment for it is a rapidly evolving field.Two to three decades ago only a few treatments had been shown to be effective forschizophrenia, and most people with the illness continued to be substantially disabledthroughout their lives. Although no “cure” for schizophrenia is currently known, a growingnumber of treatments, both pharmacological and psychosocial, have been shown tobe effective. Of equal or greater importance, there has been a sea change in how the treatment,course, and outcome of schizophrenia are conceptualized. Whereas treatment usedto focus primarily on a reduction or containment of psychopathology, traditional conceptsof medical recovery have been challenged and recently have given way to new andmore meaningful definitions of recovery that emphasize improved functioning, client selfdirection,empowerment, and hope (Anthony, 1993; Bellack, 2006; Deegan, 1988). Thereare now solid grounds for optimism in the treatment of schizophrenia, and the potentialto help individuals with this disorder lead rewarding and productive lives. The change inthe perception about schizophrenia (although still quite limited in the public mind) maybe exemplified by two films that won the Oscar for the best film of the year: One Flewover the Cuckoo’s Nest in 1976 versus A Beautiful Mind in 2002. The former depictedprevalent treatment of serious mental illnesses within a rigid, authoritarian, impersonalchronic mental institution, whereas the latter focused on a person with schizophreniawho not only had a remission of his illness, but also received a Nobel Prize for his earlierscientific work.Because knowledge about schizophrenia and its treatment has grown at an exponentialrate in recent years, clinicians have a critical need to keep abreast of the latest developments,within the constraints of limited time, resources, and their own expertise.Specifically, clinicians require access to authoritative information and recommendedxiii