This handbook is primarily a training manual for evaluating and diagnosing the recently created psychosis-risk syndromes. It also serves as an introduction to this emerging field and provides a brief discussion of the inherent benefits and challenges of estimating risk. Practitioners desirous of starting specialty clinics or incorporating into their practices clinical methods of evaluating risk will benefit from the practical information and, schedules and scales described in the book. The authors are a leading group of clinical researchers who have led the efforts in raising our awareness of the importance of secondary and tertiary prevention in schizophrenia (unfortunately primary prevention is still only a theoretical concept in this field) and have established one of the earliest clinics for psychosis risk-assessment.

There are 15 chapters arranged in three parts. The chapters are short with some being only two pages long. Much of the book is devoted to the development and description of a structured interview schedule for psychosis-risk syndromes (SIPS) and a scale for the symptoms of psychosis-risk contained therein (SOPS). Criteria for the risk syndromes are described and their application is richly illustrated with real-life case vignettes. Part A deals with the concept of psychosis risk, description of three risk states, and the developmental history of the instruments. Part B describes the evaluation methodology, and diagnoses and ratings with the help of clinical cases. Part C is a brief section discussing broad issues confronting the psychosis-risk patient and professionals working in this area, such as resistance to help seeking, denial, anxiety and fear of a psychotic diagnosis, stigma, and risks with false-positives, while appreciating the benefits of early detection. For those new to the field, a clear chronology of syndromes related to risk and prodrome is provided. Two critical figures (figures 1.1 and 1.2) provide a schematic of this chronology namely, premorbid behaviors, psychosis-risk states, prodromal phase, overt psychosis and established psychosis. Reference is made to a model of schizophrenia proposed elsewhere by the authors to connect the neurodevelomental theory of schizophrenia especially the process of synaptic pruning with the above chronology. Figure 1.2 outlines potential trajectories for persons with normal and abnormal brain development. Within the psychosis-risk phase, three mutually non-exclusive states originally described by a group of researchers in Australia are noted. These are the Attenuated Positive Symptom State (APS), the Brief Intermittent Psychotic State (BIP) and the Genetic Risk Deterioration State (GRD). It is highlighted that a critical factor in the identification of these states is ‘recent change’ from baseline. Such change may be in the quality of an experience, quantity of an experience or behavior, and/or function. Illustrative cases are provided to demonstrate typical symptoms addressed by the SIPS such as positive, negative, disorganization and general symptoms. Detailed scoring instructions are provided for each set of symptoms on the SOPS, and criteria are provided for diagnosing the risk syndromes. A detailed presentation is provided for differential diagnoses of the risk syndromes from DSM-IV psychotic syndromes such as brief psychotic disorder, schizophreniform disorder and unspecified psychosis. There are three appendices. Appendix A provides the full screening details, appendix B which runs to 57 pages provides the complete SIPS (copyrighted) and SOPS, and appendix C contains an informed consent form used by the authors in a prevention study.

The SIPS was developed by the authors to provide the structure necessary to evaluate the risk syndromes in patients who come to the clinician's attention for varied reasons. The interview schedule is rather detailed and not suitable for general clinics, epidemiological studies or community samples. In the authors' clinic and studies, those who met criteria on the SOPS had a 25% conversion rate to psychosis over a period of 30 months. They note that in other studies around the world, conversion rates have ranged up to 50%. The key point here is that these rates apply to referred or help-seeking samples. In so far as a major challenge in the risk-assessment field is the issue of false-positives, the unanswered question is what the rates might be in general clinics, student health centers and community samples (non-help-seeking). The authors do not address this and only briefly address the many challenges in predicting psychosis. Moreover, the potential negative implications of significant false-positive rates beyond the safe boundaries of research programs such as over-selling by pharmaceuticals, liability and litigation are not discussed. A more thorough discussion of stigma might also have been appropriate.

The best part of the book to this reviewer was the numerous case descriptions. The experiences described are so true to life that the reader is tempted to make his own prediction on whether this person will convert or not. These cases descriptions and knowing that interventions exist that may change the life course of an individual make it worth reading this book.