Clinical Evaluation of Psychotropic Drugs for Psychiatric Disorders

Clinical Evaluation of Psychotropic Drugs for Psychiatric Disorders; Principles and Proposed Guidelines, Volume 2

P. Grof et al. WHO expert series on biological psychiatry

Hogrefe and Huber Publishers, 202 pp, 1993

In the past decade, clinical psychopharmacology has entered an exciting era of development, rising hopes and expectations. Second generation anti-depressants became the first choice drugs, new atypical antipsychotic drugs are beginning to make their mark and the menu of anxiolytics seems to cater to all tastes. However, this spectacular growth and success represent the end result of a journey through a complex and winding path of psychotropic drug development and evaluation. In the process, conceptual, methodological and ethical issues have been explored, debated and at times resolved. The accumulated literature on the principles and practice of psychotropic drug research is widely dispersed among pharmacology texts, clinical trials monographs, statistical treatises and occasionally psychiatric journals. There have been few works solely dedicated to this subject; the publication of this book is a modest attempt to fill this void.

The purpose, background, development, format, scope and limitations of the document are stated in the brief, well written introduction. This is followed by an overview of the drug evaluation process, summarizing the phases of drug development, testing and monitoring, and discussing the surrounding methodological and ethical issues. This would certainly help the novice to gain a comprehensive picture of the subject and lays a blueprint for the rest of the document. The successive phases of drug evaluation are succinctly reviewed in the first four chapters and special issues involving children, elderly and transcultural studies are addressed in the remaining three chapters. The nuts and bolts of clinical trials are well covered here, discussing the details of protocol preparation, varieties of study designs, sampling techniques, aspects of measurement and data gathering. The liberal use of tables, sub-headings and footnotes has helped to neatly summarize the abundance of information and facilitate an easy access for quick reference.

The aim apparently was to consolidate the existing, established knowledge on the subject, avoiding controversies. Thus, spelling out the scope and limitations of the document, the authors proceeded to organize the information with a logical plan and lucid style. The selected list of references included, mainly for the scales and instruments, help students and young researchers to find their way around the confusing field of measuring mental phenomena.

However, achieving consensus and eagerness to avoid controversy has somewhat limited the scope and impact of the book. The approach is too practically oriented, dealing exclusively with methodological details and execution of clinical trials. Conceptual issues are mostly avoided. A chapter on the contemporary confusion surrounding psychiatric classification, diagnosis and measurement would have been a valuable addition. The book would have benefited from an annotated bibliography at the end of each chapter.

In spite of these limitations, the book certainly fulfils its purpose, serving as a useful reference guide for students of psychopharmacology, pharmacy and psychiatry as well as clinical investigators. The book is unconditionally recommended for all libraries but individuals tempted to buy it should first check the price from their local book stores. In Toronto, the quoted price of $44.00 is slightly expensive. WHO documents, widely referred to in the developing countries, should no doubt be cheaper.