Makes critical, objective and reliable comparisons between research 'evidence' and clinical 'experience' on controversial issues surrounding schizophrenia. By using systematic reviews with accompanying commentaries from experienced clinicians, this volume is able to assess the key topics such as diagnosis, therapy and prevention of disability and stigma.

This volume provides:

• The best available evidence to enable well-informed clinical decision making

• Valuable insights from some of the world's leading experts in the field of schizophrenia

• Coherent description and discussion of the relevant issues.

It will be a vital source of information for psychiatrists, psychologists, mental health nurses, managers and policy makers.


The gap between research evidence and clinical practice remains substantial in psychiatry. The poor application of findings from research in clinical work is probably due, in part, to the tradition of distance between those engaged in academic pursuits and those working in the service institutions. This separation is not characteristic of psychiatry alone, but is more dangerous in the field of mental health—a field that has been, as a whole, separated from the rest of medicine for a long time. The popularity of psychoanalysis as a self-contained method of thinking about health, illness, social structures, history and other matters may have also contributed to the reluctance to use findings obtained in neuroscience laboratories, and through genetic epidemiology. Other factors might also have been of importance; however, the search for such other reasons must not postpone the effort to bridge the gap and ensure that the vast amount of knowledge is considered and applied in the provision of services to people suffering from mental disorders and in teaching psychiatry to students of medicine and of other health professions. The diagnosis and treatment of schizophrenia illustrate the gaps existing between currently available knowledge and its application in mental health services. Research in this field has been remarkably active during the last decade: new drugs have been developed which have shown an innovative therapeutic profile; new psychotherapeutic techniques have become available, directly targeted to psychotic symptoms; and new rehabilitative techniques and family interventions have been empirically tested and proposed for clinical use. However, these advances are not adequately reflected in clinical practice. Novel antipsychotics remain underused, and several clinicians feel that clearer guidelines are needed concerning their indications and the choice among them. Cognitive-behavioural psychotherapies, in spite of the empirical evidence of their efficacy, are unknown or ignored in several countries, whereas psychodynamic psychotherapies, whose efficacy is not supported by research findings, remain widely used. Rehabilitation has indeed emerged as a priority in the clinical management of psychotic patients, but the techniques that are used in clinical practice are often different from those that research has validated. Furthermore, several clinicians are dissatisfied with the concept of schizophrenia itself, and feel that the primary psychoses which are seen in clinical practice, especially in outpatient or community settings, are unlikely to represent a single illness.

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