Medical-Psychiatric Practice

Medical-Psychiatric Practice. Volume 3

A Stoudemire, BS Fogel, editors

Washington (DC): American Psychiatric Press; 1995. 625 p.

Medical-psychiatry (alias consultation-liaison psychiatry, alias psychosomatic medicine) continues to have an identity problem. This is exemplified by its continued search for a name and also by continued uncertainty about its defined area of knowledge. In the United States of America, perhaps more so than in Canada, it is also being affected by economic factors involving health insurance coverage.

In their preface to this the 3rd volume of their series covering the field of medical-psychiatric practice, the editors review the crisis taking place in American psychiatry. They focus on 3 factors: the economics of health care, which discourages referrals to consultants and other specialists; pressure and competition from nonmedical professionals; and the difficulties of recruitment of medical graduates into psychiatry. These difficulties, ironically, are occurring at a time when psychiatric therapies are not only clinically effective but also economically efficient. The editors recommend that the most effective way for psychiatry to counter these pressures is to maintain its close connection to the medical model but to emphasize also its base in the social sciences and humanities. There is no other professional discipline that bridges these spheres of knowledge to an equivalent degree, and the subspecialty of medical-psychiatry is at a leading edge of this development.

The 10 chapters in this volume deal with psychopharmacokinetics and psychopharmacology in medical patients, psychosis in Parkinson’s disease, psychiatric aspects of systemic lupus, HIV infection, bone marrow transplantation, and mild traumatic brain injury. The book also includes chapters on “chemical sensitivity” syndromes and on vulvodynia.

All the chapters are well referenced and have a comparable structure suggesting good editorial control. I particularly appreciated the scholarly and sensitive way that the complex topics of brain trauma and chemical sensitivities were discussed. Chemical sensitivity is a politically explosive area that, whether we like it or not, is assuming increasing importance in the clinical practice of many psychiatrists.

The 3 volumes of this series as a whole can be criticized for the apparent lack of an overall plan. Some topics are dealt with intensively and comprehensively, for example, psychopharmacology, HIV, and the neurological aspects of psychiatry; others are dealt with poorly or not at all, for example, respiratory, gastrointestinal, musculoskeletal, and conversion disorders. This suggests that the editors themselves are not certain which areas should be covered in a compendium of medical psychiatry. These shortcomings make it difficult to recommend this series as the “Bible” of medical-psychiatry. They are likely best used as reference books for residents and psychiatrists requiring updated reviews on particular topics. For this purpose, these volumes can be highly recommended.

The cost of this book was not available in the book reviewed.