Edited by Herbert Y. Meltzer

New York, Raven Press, 1987. 1,824 pp.

The utility and desirability of Psychopharmacology: The Third Generation of Progress is attested to by the fact that it was the first book to be stolen from our newly established psychiatry library. This book is the third in a series, updated every decade since 1967, from the preeminent biological psychiatry organization in the United States, the American College of Neuropsychopharmacology (ACNP). This comprehensive review of clinical neuroscience was “trimmed” to 184 chapters by 350 authors and amounts to more than 1,800 pages.

For a book that is so large and cumbersome, relevant information on most topics in neuroscience is surprisingly accessible. Topics are presented as clusters of individual reviews covering specific interest areas rather than as a single comprehensive review chapter. Thus, an experienced clinician or researcher seeking an update on a specific topic, such as maintenance pharmacotherapy for schizophrenia, is likely to find a brief, focused review. In contrast, readers with limited psychiatry or neuroscience backgrounds may find that the magnitude of the text and its somewhat fragmented presentation style make information more difficult to integrate. For example, in order to learn about schizophrenia, the novice neuropsychiatrist must read two introductory chapters, at least four preclinical chapters, and 24 clinical chapters from over thirty authors. Although this mountain of information would appear to be daunting, I have found that the chapters are quite popular as review materials among second-year psychiatry residents.

Despite the excitement and interest that a book such as this generates, it suffers from some flaws that are characteristic of multi-authored texts. Some parts of the book, such as the section on neuroanatomic and neurochemical mechanisms, contain several excellent chapters but lack a central focus or clearly apparent organization. The scope of reviewed materials also varies widely between chapters. As an illustration of this problem, “animal models in psychiatry” is included in the section on “Biology of Depression,” a review of animal models is absent from the section on “Biology of Schizophrenia,” and two of the four chapters in the “Biology of Anxiety” section review animal models. Also, the quality of the chapters varies noticeably in this book. In contrast to many chapters written with depth and clarity, others appear sketchy or even poorly written.

Although generally skeptical about the utility of purchasing expensive scientific books that rapidly become outdated, I wanted to own this text in order to insure continued access to the many useful reviews that it contains. In addition, it is one of very few books that I recommend to psychiatry residents interested in clinical neuroscience. Despite its flaws, Psychopharmacology: The Third Generation of Progress is clearly an important contribution to neuroscience and psychiatry.

Edited by John G. Looney

Washington, American Psychiatric Press, Inc., 1988. 267 pp.

For many, the notion of chronic mental illness in children is hard to accept. Children, even emotionally disturbed children, usually engender a sense of optimism and hope in the future. For those who work in the fields of child welfare and child psychiatry, however, it is well known that there exists a fraction of children and adolescents whose disturbance is both severe and enduring. This book focuses on severely disturbed youngsters, describes these children, and illuminates their needs.

The book, with fifteen contributors, is an outgrowth of a national conference held in 1985 aimed at this same population. There are four major sections in the book and a total of thirteen chapters; each of the major sections addresses a particular aspect of the larger picture of child mental health services. Although the volume evidences some repetition, it is well organized; each chapter builds on previous chapters.

The first section deals with the nature and scope of the problem and moves nicely from the case examples of Chapter 1 to Chapter 2’s discussion of these children in the aggregate. Some readers may find the methods used in Chapter 3 to estimate the prevalence of severely emotionally disturbed children and adolescents from existing data a bit facile, but, given the state of the art of child psychiatric epidemiology, the estimates offered may not be far out of line. Another chapter in this section, written by Jane Knitzer, provides a lucid review of recent policy concerning this population and offers some ideas regarding pressing policy questions. The major theme of this section is that, as a group, severely emotionally disturbed children have needs that require careful treatment and planning.

Section two considers the role of the public and private sectors in the treatment and programmatic planning for severely disturbed children and adolescents. Two of the chapters in this section point out the continuity of care problem, which is compounded by the fragmented service system and the multiple treatment needs of these youngsters. The problem is described in Chapter 5, and a model for solving the problem is outlined in the last chapter of this section. Included in this section is an essay on private inpatient care. Unfortunately, this chapter describes long-term treatment of children and adolescents in a private psychiatric hospital, in contrast to the current trend, driven to a great extent by economic pressures, which is clearly toward brief hospitalization.

In the third section, special issues such as the training needs of mental health professionals, the value of family treatment with this population, and the importance of evaluative research to assess the effectiveness of various treatment programs are considered. Although the chapters in this section are not as unified as those in other sections of the book, each of these chapters is particularly strong.

The last section considers the policy and funding issues that require resolution in order to confront the needs of these children and adolescents. The first of the two chapters reiterates the need for a high degree of cooperation between public and private agencies to build an integrated system of care. The author, Donald Gair, returns to the notion of chronicity and cautions against building a system of care for these children. He warns that the definition of chronicity may result in the exclusion of troubled children from services. Rather than being exclusionary, the service system should focus on the tasks of childhood and provide interventions that are commensurate with developmental needs. In such a child development model, public schools would form the foundation of the service system, and psychiatry would have to relinquish the medical model to some extent. The final chapter outlines a strategy for constructing an organized system of care for children; here, John Looney, also the book’s editor, carefully maps out the barriers to building such a system and provides an agenda for further discussion and planning. This chapter could stand as a summary of the entire book.

This volume was intended for mental health professionals, though others interested in child development and public policy for children will also find the book worth reading. It does not consider in any detail the effect of current economic pressures on child psychiatric services — especially on inpatient services, which is an unfortunate omission because as inpatient stays decrease, there may well be an increase in referrals of more acutely disturbed children to residential and public facilities. Hence there is an urgent need to achieve coordination between public and private service sectors. The book effectively describes the difficulties confronting severely emotionally disturbed children and their families in human terms. The magnitude of the problem is estimated, and possible solutions are described — perhaps the major contribution of the volume. It goes beyond mere complaining about the fragmented service system that currently exists and offers an agenda for further discussion of this problem and its solution.

Edited by John W. Swann and Anne Messer

New York. Alan R. Liss, 1988. 269 pp.

Disorders of the Developing Nervous System: Changing Views on Their Origins, Diagnoses, and Treatments is a volume based on the proceedings of the Birth Defects Symposium XVIII, held in Albany, New York, in September 1987. The book contains thirteen chapters written by 32 individuals, and is edited by John Swann and Anne Messer of the Birth Defects Institute, New York Department of Health. A possible criticism of this book is that many of the experimental findings are published by these authors elsewhere (e.g., The New England Journal of Medicine, Neurology, and Annals of Neurology). This circumstance is often a characteristic of books derived from symposia, however, and the strength of this work lies not in the novelty of its experimental results, but rather in its broad and masterful coverage of numerous “hot” areas in neurobiology. Thus, the reader is introduced to neuroimaging techniques being employed for the diagnosis and study of neurological disorders (e.g., PET scan in the diagnosis of epilepsy, MRI changes specific to the cerebellum of autistic individuals), the role of NMD A receptors in mechanisms of hypoxic-ischemic brain injury, and gene mapping and cloning in Duchenne muscular dystrophy. Other disorders dealt with in this book are cerebral palsy, dyslexia, Down’s syndrome, PKU, and storage diseases.

The individual chapters are written with exceptional clarity, and are easy to follow; each contains appropriate amounts of background information to orient the reader, which is probably due to the fact that each chapter is based on a talk at the Birth Defects Symposium. Although the central themes of this volume are the developing nervous system and childhood disorders of the nervous system, several papers contain information relevant to disorders of the adult nervous system (e.g., hypoxia-ischemia, epilepsy, and Alzheimer’s disease). This feature will undoubtedly provide the book with a larger audience. In addition, its emphasis on histopathology (especially those chapters dealing with neuroanatomic changes observed in autism), will be of interest to neuropathologists. The majority of the chapters are extremely readable and provide enough interesting information to maintain the reader’s attention, without becoming overly detailed and dry. Certain chapters tend toward the obscure, however, and their subject matter is more difficult to follow. This criticism is particularly true of the chapter entitled “Timing of cell interactions in cerebellar development.” The chapter contains a veritable maelstrom of information on cerebellar mutations in several mice strains (e.g., sg/sg, Lc). In addition, the chapter entitled “Synaptic mechanisms of focal epileptogenesis in the immature nervous system” would be more readily understood if it contained a more extensive introduction to elementary neurophysiology.

On the whole, I would recommend this book. I think it will be of interest to adult and pediatric neurologists, neuropathologists, and neurobiologists. Its strength lies in its clear presentation of the research being conducted in neurobiology today.

J. Thèze, editor

New York (NY): Oxford University Press; 1999. 373 pp with index

ISBN 0-19-850136-6 (cloth)

Like the brain, which orchestrates behaviour principally through the secretion by neurons of various neurotransmitters that act on other neurons, the immune system displays similar finesse by synthesizing and secreting a large variety of chemical messengers, generically referred to as “cytokines.” As readers of The Cytokine Network and Immune Functions will appreciate, this function of the immune system is no less complex and exquisitely sophisticated than the exchange of information between neurons in the brain or the response of endocrine tissues to hormones. Indeed, from a behavioural perspective, the immune system — like the brain — evolved to mediate defensive functions that would optimize successful adaptation and survival. Whereas the brain scans and processes information in response to stimuli with circumscribed physical and sensory dimensions, the immune system performs similar functions at a molecular level, responding to viruses and bacteria that our more traditional senses are unable to perceive. Ultimately, the “foreigness” of viruses and bacteria elicits a coordinated set of defensive actions (what immunologists call an effector function) by a variety of immunological cells that ultimately rids our bodies of the would-be colonizers.

What this book summarizes in some detail, is that from the point of initial pathogenic stimulus exposure to the ultimate effector response, the defensive functions of the immune system are orchestrated by several families of cytokines, acting in coordinated fashion — as a network — and mobilizing in cascade fashion, and according to specific needs, the fatal blow to foreign microorganisms.

However, all networks possess the potential for dysregulation. Hence, aberrant cytokine responses are believed to be responsible for allergies, asthma and numerous autoimmune disorders. Moreover, there is a growing recognition that cytokines can affect brain function. Unfortunately, this is exclusively addressed in only a single — and lamentably, brief — chapter (”Cytokines in the brain” by Laye et al). Additional indirect treatment of the relation between neuroendocrine function (e.g., the hypothalamic-pituitary-adrenal axis) and cytokines is rendered in a chapter on cytokines and inflammation (”Cytokines and the cellular mechanisms of inflammation” by Cavaillon and Duff). Therefore, for researchers and practitioners in the brain sciences, there is little in this volume that cannot be obtained in other publications that provide a more comprehensive discussion of the relation between the immune system, cytokines and neural and behavioural functions.

Alternatively, a considerable amount can still be learned about basic cytokine biology, receptors and signal transduction mechanisms. To echo the foreword by William Paul, which was perhaps directed to a more immunological audience, there is much in this book that can greatly inform and equip those of us involved in research in neuroimmunology and the behavioural consequences of immune responses and inflammation. Indeed, subsets of mood disorders, such as dysthymia, have been hypothesized to involve an autoimmune component that is mediated by cytokine dysregulation. Similarly, multiple sclerosis is an autoimmune disorder, but with severe depressive symptomatology and cognitive deficits. A greater knowledge of cytokines and their cellular actions at the molecular level would certainly enhance efforts toward understanding central nervous system diseases that involve the immune system. In fact, this book is probably indispensable to all whose work involves cytokines, no matter what biological system is being scrutinized.

As witnessed in recent years, the leaps-and-bounds advance in molecular biology has not so much rippled, as ripped its way through much of the biological sciences, and as readers of The Cytokine Network and Immune Functions will no doubt appreciate, has also served to propel the study of cytokines. For example, it was not that long ago that the number of known cytokines could be counted on a single hand. However, currently, and as well described in the book, cytokines are bunched into at least 6 families, based on the structure and characteristics of the receptors to which they bind (i.e., the hematopoietin, interferon, tumour necrosis factor, interleukin-1 and chemokine receptor families and the immunoglobulin superfamily). For the uninitiated, this may be somewhat perplexing and confusing, but an introductory overview chapter (”General aspects of cytokine properties and functions” by Dy et al), although not exactly smooth sailing because of a plethora of abbreviations and acronyms that do not fall immediately into coherent place, does prepare the reader for the tone and level of complexity in subsequent chapters. For those comfortable with molecular levels of analysis, these should not be turbulent waters. However, those wishing a more superficial description of cytokines and their functions may find the going tough. This book is not light reading, but it is a well-organized and broad overview for those who are serious about wanting to know more about cytokine biology. Indeed, seasoned researchers and teachers of immunology will easily find it a valuable resource in a field that is incredibly dense with information and complexity.

The organization of chapters revolves around 3 sections, beginning with basic, fundamental discussions and moving on to more immunobiological and clinical considerations. In the first and largely molecular section, chapters are devoted to classes of cytokines, such as the hematopoietin or class I receptor family of cytokines (e.g., interleukins 2,4, 7,9,13 and 15), as well as specific chapters on individual cytokines, including tumour necrosis factor, interleukin-1, interleukin-6, interleukin-10, inter-leukin-12 and transforming growth factor (3. There is also a chapter devoted to the Type I (wherein there are up to 21 different types) and Type II (viz., interferon y) interferons, as well as an update on more recently discovered cytokines (interleukins 16, 17 and 18). These chapters characterize the biochemical structure, genetics and cellular origins of these cytokines as well as describe the localization and structure of their receptors. Additional chapters also address signal transduction mechanisms, the role of accessory surface molecules (e.g., CD40) in cytokine regulation of function and cytokine gene regulation.

These initial 13 chapters are followed by 7 chapters that consider cytokines within their biological context, largely the immune system, but as mentioned above, also in the brain. The immunological profile of mice with deletions and/or overexpression of various cytokine genes and/or their receptors is discussed, as is the role of cytokines in immunological development. In addition, separate chapters address the way in which cytokines regulate specific (e.g., T cells) and nonspecific (e.g., macrophages) arms of the immune system. This segregation ultimately reveals a great deal of overlap, because it has become clear that many cytokines are pleiotropic and redundant.

The book concludes with a section on pathological conditions, wherein cytokine dysregulation is believed to either be at the root of various diseases (i.e., allergies, asthma, infectious disease, autoimmune disorders and cancer) or, conversely, where their immunotherapeutic use may promote recovery from disease.

The book accomplishes its goal of attempting to provide a more synthetic and “network-oriented” view of how cytokines serve their purpose. The treatment is broad, and of course, at some expense. There appears to have been a conscious effort to emphasize facts and predominant points of view, giving the book a textbook quality. In-text citations are not provided, although each chapter does conclude with a reference list. Therefore, one should look to this book, not as a literature review, but more an informed statement of the current state of knowledge in cytokine immunobiology.

Ladouceur R, Marchand A, Bois-vert J, editors

Montreal: Gaetan Morin Editeur; 1999. 213 pp

ISBN 2-89105-736-8 (paper)

This book addresses anxiety disorders and their treatment with cognitive-behaviour therapy. Each of the 6 chapters, coauthored by 1 of the 3 main authors, covers a different anxiety disorder The authors (Robert Ladouceur of Université Laval, André Marchand of Université du Québec a Montréal and Jean-Marie Boisvert of Université Laval) are renowned researchers and have considerable international reputations. Several chapter coauthors are also well-known in their areas of expertise (e.g., Michel Dugas in generalized anxiety disorders, and Mark Freeston in obsessive-compulsive disorders, among others).

The introduction details the theories, the difference between normal and abnormal anxiety, the different causes of anxiety and finally, the outline of the book. The content of each chapter follows somewhat the same format: a review of diagnostic criteria, a clinical description, prevalence and precipitating factors and comorbidity. Then, evaluation and rating scales for each specific disorder are reviewed. Finally, theoretical models of etiology and therapeutic strategies are discussed.

The authors review the current literature well, and research avenues to be pursued are also elicited. Several chapters have extended clinical examples of therapeutic techniques and detail the objectives and content of therapeutic sessions.

Some chapters — for example the one on generalized anxiety disorder — also propose some very innovative models of explanation of the disorder. Obviously, these proposals are in accordance with cognitive-behavioural therapy theory.

This book is manifestly meant for mental health professionals who do cognitive-behaviour therapy with patients suffering from anxiety disorders. Psychologists, psychiatrists, family physicians, social workers and others who feel a need to better understand cognitive-behaviour therapy will also find this book very helpful.

Because it is written in French with a North American flavour, it will be popular with French-speaking Canadians and in Europe where several of the coauthors are very well known. It should be of interest to all psychiatrists and clinicians who see patients with anxiety disorders in consultations and are aware from the literature of cognitive-behavioural therapy’s encouraging results.

This is an excellent multiauthored book which reviews the up-to-date theories and therapeutic approaches for the treatment of anxiety disorders within a cognitive-behavioural framework. It is clearly written and readable by all health professionals. The format and presentation make it an agreeable work to consult. Finally, because it is so well documented, it could well become a very useful work of reference in the French literature.

Goldstein S, Reynolds CR, editors

New York: The Guilford Press; 1999. 602 pp. with index

ISBN 1-57230-448-0 (cloth)

I found this book very interesting to read and extremely informative. It consists of 3 sections, which are authored by individual professionals well known in their fields. The book’s presentation, as well as the specific information in each section, are very attractive to the reader and easy to follow.

The first section addresses the basic principles and applications relevant to neurodevelopmental and genetic disorders in children. The principal editors and contributing authors address rather difficult and, in some way, controversial areas of specific neurodevelopmental disorders, their origin and the basic interplay of “nature versus nurture.” The section also contains various ways of assessing these disorders and various interventions that are helpful for each subcategory.

In the second section the authors contribute a great deal of knowledge in the areas of specific disorders that primarily affect learning and behaviour. They shed new light in the exploration of such disorders such as learning disabilities, attention-deficit/hyperactivity disorder, Tourette’s disorder, anxiety disorders, and autism and other pervasive developmental disorders.

This section of the book is particularly interesting, as the various contributing authors offer general, updated information on the definition and genetics of each disorder, as well as the associated phenomenology, assessment methods and available interventions. The state-of-the-art knowledge presented is linked to relevant research and clinical data, offering a wealth of references as the literature has evolved during the past 3 decades. As a professional child psychiatrist, specialized in neurodevelopmental and genetic disorders of childhood and dealing daily with these issues, I found this section very useful, not only for its knowledge base, but also for its clinical implications and suggested services related to these disorders.

The third section of this volume deals with disorders with broader-spectrum effects. This is very relevant and important for professionals in this sphere, as well as for parents and other interested readers. I believe that each group can profit from the richness of the contributions offered in the areas of specific genetically transmitted disorders with associated neurodevelopmental deficits. The conditions explored in this section are Turner’s syndrome, fragile X syndrome, mucopolysaccaridoses, Noonan’s syndrome, neurofibromatosis, sickle cell disease, Down’s syndrome, Klinefelter’s syndrome, phenylketonuria, Rett’s syndrome, Lesch-Nyhan syndrome, seizure disorder, Prader-Willi syndrome and Williams’ syndrome.

This section has a presentation similar to the previous 2 sections. It is well written, with up-to-date information in the areas of genetics and neurodevelopment, classification assessment and clinical presentation, as well as interventions for these disorders. I found each chapter in this section to be very informative and well researched, with extensive references.

In summary, this book presents extremely interesting, important and relevant information for specialists in child psychiatry, neurology, psychology and allied sciences such as social work and speech or occupational therapy. It also offers good insights and general information for families with children with such disorders and suggests relevant interventions, which are so important for these families. I believe that this book is a “must-read” for all concerned with the specific topics that are covered.

Gatchel RJ, Turk DC, editors

New York: The Guilford Press; 1999. 510 pp. with index

ISGN 1-57230-285-2

The preface to this book stakes out its claim. We are told that 4 main developments, each involving psychologists, served as the impetus for a revolution in thinking about pain. This revolution consists in the rejection of a “medical model” in favour of a “bio-psychosocial approach.”

The volume comprises 30 chapters. Of these, the first 9 make up Part I, on biopsychosocial context. In Part II 11 chapters deal with special topics and populations, and Part III provides 10 more on issues in prevention and management. The book finishes with an overview on resolution and evolution. Three out of the 43 authors of the 30 chapters are physicians dealing with pain and AIDS (a magnificent review), the epidemiology of low-back pain, and work style and work-related upper extremity disorders. There is an epidemiologist or two, a dentist with qualifications in psychology, and almost all the rest are psychologists dealing with pain. These include 3 Canadians (Gagliese, Katz and Melzack), Flor from Germany, and Main (from Glasgow and now Manchester).

The great bulk of the material reflects the work and views of US psychologists and their special psychosocial context.

This is a long volume, well produced and full of information, often very well worked out. The text itself is easy to read and very solidly written for the most part. Some chapters are excellent in whole or in part, while others seem to exist only to disappoint.

It is an irritating pity that what could have been a superb volume is marred by 2 faults of emphasis. One is needless special pleading and the other is an ill-founded, albeit highly sophisticated, tendency to revise the understanding of what it means to favour a back-pain disability model.

The special pleading begins with the listing of 10 contributors to the psychological approach. Three of these were actually physicians but not identified as such. More important, and tellingly, there is a lack of understanding or recognition that psychosocial factors have always been strong in medicine. Psychologists now dwell in a field long inhabited and not relinquished by internists, family doctors, neurologists, psychiatrists and a host of others.

Psychologists are much more numerous than psychiatrists in the field of pain and have made great contributions, starting with Hebb and Melzack. But some of their contributions (e.g., behavioural therapy of pain) remain controversial, and the field in which they have gained most recognition and added most to the subject appears to be cognitive treatment, which, incidentally, was applied to pain by a psychiatrist, A.T. Beck. Thus, what should have been a friendly and sociable claim to have made a large contribution has been spoiled by exaggeration.

More important, the way in which the biopsychosocial construct is now treated serves to reduce the biological element and to suggest that pain is largely due to psychological causes. I partly made that mistake myself and can sympathize, but the fact is that we have very few genuine indications that pain for which physical explanations are lacking is due to psychological causes except when it occurs with or after the onset of an obvious affective disorder. In other cases, and especially with musculoskeletal pain that arises with questionable indications of psychological difficulty, there is insufficient evidence to support the view that pain is due to vaguely alleged “behavioural factors,” but there is growing evidence from systematic controlled investigations that the determining factor is the state of the facet joints or degeneration (not prolapse) of intervertebral disks.

One of the most insidious practices connected with rejecting the patient’s pain consists in describing correlated information as “predictive.” Every psychologist knows that correlations do not demonstrate a causal link, except when there is a serial position, and should not be thought of as a causal consequence. Yet the insinuating word “prediction” is used repeatedly to corroborate some argument for psychological causation.

I do not want to leave the impression that Gatchel and Turk, as editors, make no attempt to acknowledge evidence that complicates their message. They recognize much of it. However, overall the book states the problems softly when they relate to weaknesses in psychological achievement, and overstates the failures of the organic approach. This is the more distressing because the authors and editors have all made significant contributions in the past, and continue to do so. Unfortunately, as one of my colleagues puts it, those who state their adherence to the biopsychosocial approach most loudly do not appear to be as serious about the “bio-” element.

Oyewumi LK, de Wit R

London (ON): Zxmaxx Communications; 1998. 263 pp. with index

ISBN 0-9684372-0-6 (paper)

As the authors note in their Introduction, the plethora of new psychopharmacological agents introduced in the last decade has led to an extensive literature on the use and proposed mechanisms of action of these drugs. However, the literature on the side effects of these medications is limited at best. Rare is the patient who does not have at least some side effects from our treatments, yet far too often the patient’s only source of information on the drug and its side effects is the Compendium of Pharmaceutical and Specialties (CPS).1 Unfortunately, more often than it should be, the CPS is also the physician’s side effect “handbook”!

The authors have attempted to bridge this gap in our psychopharmacological knowledge base with a user-friendly, spiral-bound “handbook” on managing side effects of psychotropic drugs. They have done a good job.

The 8 chapters begin with an overview of the different classes of psychoactive agents, which includes an excellent table listing all antipsychotic and antidepressant agents (generic and trade names) and the average daily dose ranges. Unfortunately, hypnotics, anxiolytics, mood stabilizers and stimulants are omitted from the tables without explanation.

Chapter 2 reviews predisposing risk factors, epidemiology and classification (e.g., predictable v. idiosyncratic, initial v. tardive) of side effects, while the bulk of the handbook — Chapter 3 — is a detailed overview of these side effects. The format of Chapter 3 is unique, with “generic” headings such “dermatological” followed by subheadings (e.g., acne, allergic rash, alopecia, etc.). Under the subheadings, prevalence, occurrence, presentation, mechanism of action, and commonly associated drugs with this specific side effect are outlined. This is a very useful presentation for mental health professionals (physicians, nurses and students), but I suspect that drug “consumers” would have difficulty navigating this section. (Would they know to look under dermatological and alopecia for “hair loss”?)

Chapter 4 is a more academic chapter on evaluating side effects, and provides a listing of the various rating scales available to measure and monitor side effects.

Chapter 5, “Management of Psycho-tropic Drug Side Effects/’ offers very practical, clinically relevant treatment guidelines. These “bedside tips” in the management of dry mouth, pruritis, incontinence, etc., is clearly lacking in most pharmacology and clinical psychiatry textbooks.

The last 3 chapters review the consequences of drug side effects (compliance, economic effects); administrative aspects (the lack of postmarketing data on side effects); and psychodynamic/psychological aspects of side effects, such as placebo effect, “catching” side effects, drug side effects, and the transference/counter-transference in the doctor-patient relationship. All good stuff! The bibliography and references are detailed and up to date.

This is a very good start as a handbook that will be of value to psychiatrists, residents, nurses and consumers. It should find its way to psychiatric inpatient units, mental health centres and mental health support organizations as an excellent reference book. I do hope the authors are working on their second edition, as new drugs such as citalopram, reboxitine, and mirtazapine are already here, and additional new drugs could soon make this useful book outdated.

Some minor editing (e.g., in one section, it should have read “pharmacodynamic” not “psychodynamic” parameters) and combining the chapters on identifying and managing side effects would be helpful in the next edition. Further, more detail on the specifics of managing side effects (the book is entitled Managing Side Effects), such as specific dosages of drugs used to treat specific side effects, would enhance this work.

Wilens TE. New York: The Guilford Press; 1999

ISBN 1-57230-204-6 (paper)

In general, psychiatry has come a long way — from a pure psychoanalytical focus to a strong medical-neurobiological approach to treating psychiatric disorders. It is now well known in our clinical practice and in psychiatric literature that biologically based treatment with psychotropic medications, combined with other traditional and non-medical treatments, has proven superior to either treatment modality used alone. Similarly, child psychiatry and psychopharmacology have gained significant positions, both within the fields of medicine and general psychiatry.

Psychiatric conditions are recognized earlier in children who present with behavioural/emotional and developmental problems. These special children are more at risk of academic difficulties and parental rejection. In the best interests of the child and family, the challenge facing child psychiatrists is to provide an integrated assessment from a bio-psychosocial perspective before proceeding with specific treatment modalities; treatment should be conducted within interdisciplinary teams in which parents and their children are encouraged to participate actively. Physicians can expect parents and youth to be more active in questioning and decision-making. Medication may be indicated if behaviour modification and other therapies achieve only partial success; however, parents may still be reluctant to accept medication trials as a first-line approach. This book fills a need as a comprehensive reference source on current psychiatric medications.

The author is a well-known child psychiatrist and associate professor of psychiatry at Harvard Medical School. He specializes in pediatric and adult psychopharmacology and addiction psychiatry, and does his clinical work at Massachusetts General Hospital. He has published widely on psychiatric medications and their uses.

This book is the result of Wilens’ extensive clinical experience; it focuses on questions typically raised by parents concerning the assessment and treatment of their children. I believe it can serve as a useful information package for parents, educators and trainees in the field of psychiatry.

The contents are divided into three main parts. Part I describes and explains in straightforward language the general clinical processes of psychiatric evaluation, diagnosis and treatment plan. A central theme is that, as parents become familiar with the treatment process, they learn the importance of working collaboratively with the psychiatrist treating their child.

Part II informs the reader about common childhood psychiatric disorders as well as neurobiological conditions such as temporal lobe epilepsy, tic disorders, Tourette’s syndrome and organic mental disorders. For each condition, the author succinctly summarizes basic factual information; this is followed by information about coexisting emotional/behavioural conditions. The range of dosages is given for different medications.

With this basic understanding, the reader is prepared for Part HI, in which each class of psychotropic medications used in children is described with respect to names, dosages, indications and contraindications. Whenever needed, specific baseline testing or monitoring is also included.

Definitions of medical terms and expressions are interspersed appropriately in the text and framed in double lines for easy reference. Questions are printed in bold. Medications in each class are presented in a table form with names, preparations and strengths.

The last 37 pages include an appendix, medication log, resources, bibliography and index. The appendix is a table listing both generic and brand names of medications, with strengths and preparations. I found the example of a completed medication log useful for keeping track of each medication with respect to start date, dosage, response, side effects and comments.

The section on resources supplies the names and addresses of community and organizational supports within the United States, broken down by general mental health and specific disorders. The bibliography lists journal articles and books by recognized clinicians in different disorders. The section on tics and Tourette’s syndrome mentions 4 excellent references, but could have included Tourette Syndrome & Human Behavior, by David E. Comings, which is widely used by parents and professionals.

The author does not mention the use of psychiatric medication in preschool children (ages 2 to 6 years). Parents of these children are even more reticent to accept medication, even when their child’s condition is severe. There is no information on treating children with the amino acid tryptan (L-tryptophan) for various conditions. Also, the text does not clearly convey the serious potential risk of dependence on benzodiazepines. For this reason, it is better to avoid the use of benzodiazepines in children and youth. It is known that they may mix these prescribed drugs with other substances once the body develops a tolerance.

Overall, this book may enable mental health professionals to feel confident about addressing parents’ concerns and questions regarding psychiatric medications. It may save time for health care providers by giving parents the understanding they need to collaborate with professionals in the treatment of their child with psychiatric and mental health problems. Despite some weaknesses, the book does provide an abundance of valuable information. In clinical practice, however, it should be used as an adjunct to current literature on each drug in question, providing the reader with a balanced perspective.

Barry Blackwell, editor

The Netherlands: Harwood Academic Publishers; 1997. 325 pp. with index

ISBN 90-5702-546-9 (cloth)

Many clinicians take the “compliance” of their patients for granted. They assume that medications are taken as ordered and rarely check pill boxes or take any action other than questioning the patient to ensure that instructions are being followed. Yet we know from well-designed studies that as many as 50% of patients do not take their medications as prescribed. Contrary to expectation, psychiatric patients are not notably less compliant than nonpsychiatric “medical” patients. Compliance also is impaired in older patients when medication requirements are complex, and in socially isolated people, and it is adversely affected by a poor doctor-patient relationship.

The philosophy of compliance is also changing, to keep up with changes taking place in the role of the physician in our society. The older paternalistic medical model of “the good doctor knows best” no longer holds. Patients are far better informed about their health problems and their treatment options and are encouraged, and rightly so, to take charge of their medical treatment. With some exceptions, the medical profession has come to terms with these changes, and most physicians have accepted their new role as health educators and advisers rather than treatment directors.

This book deals with many of these issues, in particular the doctor-patient relationship. Yet it is curiously uneven in content, philosophy and quality. It is divided into 3 sections: “Compliance research, theory and social context,” “Participants in the alliance” and “People with special needs.” The first section provides a useful and practical overview of the field. The chapters entitled “Models of the compliance process, “Medication noncompliance in schizophrenia,” “Insight and compliance” and “Compliance and decision making capacity” were of particular interest and value. The second section includes chapters on community mental health programs, the role of families, and the role of the physician in the therapeutic alliance. The final section has chapters on schizophrenia, manic depression, developmental disabilities, alcoholism and the elderly.

The quality of the book starts at a high level but rapidly deteriorates in the middle and later chapters. Many of the later chapters are written by “consumers” or health care professionals with antiestablishment axes to grind. Their tone tends to be adversarial, and they write as if nothing has changed since the days of the paternalistic medical model. There is much discussion of the individual’s right to refuse treatment but little or no discussion of a patient’s right to have effective treatment when such is available. The topical issue of community treatment orders is barely mentioned. Although the editor (who authored 2 of the chapters) commendably attempts to integrate compliance into the therapeutic alliance, the book nevertheless lacks philosophical coherence and consistency. One has the impression that no decision was reached on whom the book is addressed to, and too wide an audience has been targetted.

Despite the importance of the subject, this book is likely to be of value only to those with a special interest in compliance.