Edited by Roger N. Rosenberg

New York, Raven Press, 1991.920 pp.

Comprehensive Neurology proposes to review “all aspects of neurologic disease,” providing yet another addition to the ever-growing list of neurology references. Its editor, R.N. Rosenberg, claims substantial experience in neurology editorship with The Treatment of Neurological Diseases (1979), Neurology (1980), and the five-volume Clinical Neurosciences (1983); more recently, he has produced shorter studies, including Neurogenetics: Principles and Practice (1985) and Molecular Biology of Neurological Disease (1988). In contrast to other textbooks like Asbury, Mckhann, and McDonald’s Diseases of the Nervous System, which contain two cumbersome volumes of material, Rosenberg hopes with the present volume to produce a comprehensive neurological reference in a single volume, while providing a “detailed, scholarly account” of neurological diseases, synthesizing the basic and clinical neural sciences for clinicians and interested researchers.

Unfortunately, Rosenberg only partially accomplishes his goal, instead producing a book that conveys a fragmented view of neurology. Compared to other comprehensive textbooks, like Asbury et al.’s Diseases of the Nervous System, or even smaller works much as Rowland’s Merritt’s Textbook of Neurology, Rosenberg’s haphazard contribution simply pales. Comprehensive Neurology attempts to touch upon every aspect of neurological disease with chapters by various specialists, on topics from teratology to psychiatric disorders to coma; but the book fails to tackle an in-depth discussion of neurology. Indeed, most chapters do not consider all aspects of their respective topics, and the accounts tend to be either all-encompassing but superficial or else informative but specialized. For example, such chapters as “Diseases of the Autonomic Nervous System” or “Cerebellar Disorders” provide only brief descriptions of clinical phenomena, while “Headache Syndromes” and “The Comatose Patient” provide informative detail on pathogenesis, clinical presentation, and treatment, albeit limited to their specialized disease. The book treats more general topics rather lightly, though it offers excellent timely information on particular specialized subjects. The result is, by avoiding a thorough coverage of basic neurological concepts and disorders, its utility as a reference diminishes.

Comprehensive Neurology further suffers from a lack of focus or direction in editorship. The table of contents itself reflects a dense conglomeration of chapters without any obvious logical sequence. Many chapters overlap in coverage of several topics, including such conceptual issues as the principles of magnetic resonance imaging and computerized tomography, or such background issues as the neuroanatomy of the vestibular or ocular systems. As the most obvious example, even though Rosenberg generally devotes, at most, one chapter to individual sensory systems, the eighth nerve system alone receives two chapters of coverage, and the majority of their content reiterates information found in other chapters. Moreover, despite Rosenberg’s expressed desire to coordinate basic science with clinical disease and treatment, chapter formats vary tremendously, with some chapters presenting mostly background information, like G. Rosenberg and Wolfson’s chapter on brain fluid and electrolyte disorders, while other chapters present only clinical information, for example, Damasio and Tranel’s chapter on disorders of higher brain function. Some chapters even stray from their title topics: Hecox and Hogan’s chapter, “Diagnostic Principles in Neuro-otology,” for instance, scarcely even addresses diagnostics and instead focuses on neuroanatomy and physiology, while Richter and Corder’s “Neurotoxic Syndromes” chapter concentrates mostly on substance abuse, virtually skipping the role of biological toxins or metabolic toxicities. On the other hand, such chapters as Kase et al.’s on cardiovascular disease, Chad and Munsat’s on muscular disease, and Wray’s on neuro-ophthalmologic disorders clearly and concisely provide thorough, up-to-date information about their respective fields. Laudably, these chapters provide informative, thoughtful presentations. In my view, this volume contains a great diversity of writing quality and content, reflecting an editorship that allows the book’s contributors overmuch free rein to digress. The end product strays too far from the claim “comprehensive neurology.”

In light of other alternative neurology references, a clinician or any interested scientist might therefore find little of interest in Rosenberg’s Comprehensive Neurology, other than some specialized topics such as multiple sclerosis, metabolic encephalopathy, and the aforementioned cardiovascular, muscular, and ophthalmologic diseases. The book’s chapters generally offer unsatisfying whirlwind tours of neurological disorders, never providing a unique or novel presentation of the material. Other contemporary works provide identical information, presented in a more pragmatic, informative, and concise manner, such as Swash and Oxbury’s Clinical Neurology (1991) or, particularly, Asbury et al.’s thoughtfully organized and edited Diseases of the Nervous System (1992). Rosenberg’s present work fails to satisfy the requirements for a comprehensive neurological work in one volume because it rambles through neurological discourses. The editor and his contributors have unfortunately and disappointingly produced a weak overall contribution to the neurological library.

Tager-Flusberg H, editor

Cambridge (MA): The MIT Press; 1999. 614 pp with index

ISBN 0-262-20116-X (cloth)

This book presents an account of recent advances in the knowledge and understanding of neurodevelopmental disorders. At the same time, it raises questions to be addressed by ongoing research endeavours.

The great advances during the past decade in molecular biology, behaviour genetics, developmental neurobiology, neuroimaging technology, cognitive science and developmental psychology have allowed exploration from various angles of a wide spectrum of disorders, from Down syndrome to dyslexia to autism. The authors bring together new knowledge for the “creation of a new scientific frontier: the integration of molecular genetics with developmental cognitive neuroscience.”

The book’s ultimate goal — “to understand the basic mechanisms that explain how genes and environmental processes contribute to the development of specific structures and regions of the brain” and to explain how these brain structures and associated functions are directly related to specific cognitive processes (p. 4).

In the introductory chapter, the editor addresses methodological issues with clarity and conciseness and lays the groundwork for the 23 chapters which follow. The contributing authors are all distinguished researchers in their fields.

The book is divided into 3 main sections: neurodevelopmental disorders of known genetic etiology (fragile X, Williams, Prader-Willi, Down and Turner syndromes), disorders of unknown or complex genetic etiology (dyslexia, specific language impairment and autism) and 6 chapters on broader perspectives on neurodevelopmental disorders (teratology, environmental toxicants, synesthesia, congenital hydrocephalus, neural mediation of language development and advances in cognitive neuroscience [views from child psychiatry and medical genetics]).

The authors review a wealth of new evidence from disciplines hitherto separate, to form a new synthesis, linking molecular genetics and environmental variables with the development of the brain structures and function and with clinical phenotypes. The links are clear for some disorders, but are speculative for others. This novel synthesis provides a new paradigm and a new vocabulary toward a better understanding of neurodevelopmental disorders.

The clinician who has limited access to journals and can hardly keep up with the great advances made in fields such as molecular genetics, developmental neurobiology and neuroscience will find this volume illuminating. Although most chapters are compelling, there is some repetition in chapters that address related disorders (e.g., dyslexia and specific language impairment). It might, however, be argued that each chapter can stand on its own, forming a comprehensive entity. The limited use of graphs, figures and photos is one drawback. Because this book covers a dynamic field of inquiry, whereby new knowledge is constantly being acquired, it is likely a new edition will be needed every few years.

This is an excellent book, and I recommend it as essential reading for child psychiatrists and psychologists, speech-language pathologists and clinicians in other related disciplines.

Wheatley D, Smith D, editors

London: Chapman & Hall Medical; 1998. 228 pp. with index

ISBN 0-412-82470-1 (hardcover)

Psychopharmacology is a rapidly growing field. The elderly population is also expanding, especially the oldest of the population, who are major consumers of pharmaceutical drugs. However, elderly patients are under-represented in clinical studies because of difficulties in recruitment, greater interindividual variability and the lack of consistent changes in pharmacokinetics associated with the aging process. They also have increased susceptibility to adverse effects for various reasons, including multiple chronic or degenerative physical illnesses, multiple pharmacotherapies, difficulties with compliance, lack of reporting of side effects and lack of recognition of adverse drugs effects that may be attributed to other causes. For all of these reasons, the astute clinician working with the elderly must have a good understanding of the aging process, of the pharmacokinetic and pharmacodynamic changes of psychotropic drugs and potential adverse drug reactions. This international contribution attempts to critically review the vast field of psychopharmacotherapy in a concise, clinically useful and well-written monograph. The book is divided into 3 parts: basic concepts, cognitive disorders and psychiatric disorders. Like most textbooks, it has the drawback of not being up-to-date with the most recent advances in pharmaceutical drugs available to the clinician, especially as there is a dearth of information concerning elderly patients. Its major contribution is in providing guiding principles that will help the clinician choose a proper drug and monitor its effects on patients. Most authors are recognized experts in their respective fields of pharmacology or clinical pharmacology, but, as is the case of multi-authored books, there is an unevenness in the chapters. The editors succeeded in avoiding duplication within the book, however. The chapters on neurochemical substrates, neuropathology and drug therapy for Alzheimer’s disease were well integrated. Only one chapter, on measuring memory, lost my interest. Although the discussion on the different types of memories was insightful, examples or diagrams would have been helpful. It listed several assessment and screening tests of cognitive functions which are, for the most part, more suited for research purposes and have little use in the clinical setting.

The major psychiatric syndromes are covered in part 3 of the book; however, a discussion on bipolar illness, which often presents as a major clinical challenge in the elderly, is lacking. Newer anticonvulsants used in psychiatry, such as lamotrigine and gabapentin, are not discussed. There is no mention of the use of bupropion (antidepressant) or quetiapine (atypical antipsychotic) in the elderly. Other newer treatments, such as risperidone, olanzapine and venlafaxine are only briefly discussed, yet they are used commonly in clinical practice and are rapidly becoming a first treatment choice because of their favourable adverse effects profile.

Of the many textbooks of psychopharmacology, few are dedicated specifically to the elderly. Overall, this is a comprehensive, yet concise, well-written and clinically applicable monograph which does what it proposed to do — review the nature of the aging process, the pharmacokinetics and pharmacodynamics, and the side effects of the various drugs used to treat elderly patients. It would be of interest to all clinicians seeing elderly patients and to residents in psychiatry, geriatric medicine and family medicine.

Leigh RJ, Zee DS. New York: Oxford University Press; 1999

CD-ROM – ISBN 0-19-512974-1

656 pp. with index – ISBN 0-19-512972-5

The neurology of eye movements sometimes seems to be an esoteric concern to many in the neurosciences. However, the analysis of eye movements often turns out to be extremely valuable in clinical practice. Eye movements are examples of other motor phenomena and, because they are more simple than limb movements, they often give greater insight into problems of paresis, fatigue or coordination. They particularly lend themselves to quantitative evaluation. The knowledge of specific types of eye movement deficiencies is an important tool for localizing disease and diagnosing neurological disorders.

Drs. John Leigh and David Zee have issued the third edition of their highly praised book, The Neurology of Eye Movements. In addition to the classic text, they have also produced, for the first time, a CD-ROM version. Both text and CD versions follow a similar outline, with an initial survey of the basic forms of eye motions. There follows an analysis of the vestibular-ocular system and the classical saccadic and pursuit systems, conjugate gaze, gaze holding, eye-head movements and vergence movements. These are superb chapters and give up-to-date information on the anatomical and physiological basis of these movements. The text is accompanied by excellent tables and figures.

Part II provides 2 sections on diagnosis, the first is on the diagnosis of peripheral ocular motor palsy and strabismus. Many would think of this as the “classical section” of a text on ocular motor problems. It details clinical testing of diplopia and, for neurologists, a must read description on how to diagnose strabismus (which is often left out of the classical neurological education). This is followed by a superb section on central disorders of motility, with enlightening dissections of the various forms of nystagmus and saccadic intrusions, as well as a useful discussion of vertigo and its treatment. Specific disease entities are treated in this latter section. There are discussions on eye movements and psychiatric disorders, stupor and coma, multiple sclerosis and metabolic deficiencies, all of which are excellent.

The CD-ROM version allows easy movement between chapters. It provides excellent access to the often-cited tables and figures that one has to find again when they are referred to in subsequent chapters. This is a more difficult task when reading the book because page headings do not indicate chapter numbers, which would help one locate the tables and figures more easily. The CD version has something that the hard cover version does not have — video clips. The videos, 60 in number, include virtually every sort of eye movement disorder one could want to view. These videos alone are worth the price of the CD; although they are relatively short, each shows the eye movement clearly. My one problem with the CD version is that the key word search feature often failed to reveal all of the important references; I found it much easier to use the index in the back of the book for this endeavour.

The authors suggest that this book is for neurologists, ophthalmologists, otolaryngologists, optometrists, neurosurgeons, psychiatrists and basic researchers. I suspect neurologists and ophthalmologists would enjoy it the most. Otolaryngologists who have a specific interest in vertigo would certainly find this text useful, though the vestibular systems are probably dealt with in more detail in other works. There are likely few neurosurgeons and psychiatrists who will purchase this, which is a shame because I think everyone could learn from this text.

I think everyone in neurology should own a copy of this text. The major question is which version to buy, the hard cover or the CD. I would guess that a neurology resident on a restricted income might want to buy the CD version for the videos alone. However, if you have seen these eye movements many times and just want a review of the neurological basis of eye movements, perhaps the book, which offers a better index, would be easier to read. Whichever one you decide to purchase, the price is quite reasonable for the information enclosed. I would suggest both versions.

Dementia — and Alzheimer’s disease in particular — has become a major public health problem, and the expected prevalence of this class of illness is expected to double by the middle of the next century. Health delivery systems have been generally slow to keep up with the need for services to affected individuals. One trend that has appeared in the past 20 to 30 years has been multidisciplinary memory disorder clinics. This model of diagnosis and provision of treatment seems to work very well in a number of centres, but these specialty units are still not widely available, particularly outside of tertiary care centres. Setting up and running such a clinic is a topic of this new book. Many recent publications address either the pathophysiology or the medical treatment of dementia; however, a more practically oriented book such as this one has not previously appeared.

The book is divided into 3 major sections. The first is on establishing and organizing a clinic, the second is on the diagnostic process and the final section is on management. The book has a multidisciplinary and multinational authorship, and the authors have experience in working with patients in multidisciplinary clinics.

The first section on establishing and organizing a clinic covers all aspects — from administrative and logistical concepts, to information management, medical, psychiatric, neuropsychological, speech, occupational and community assessments. In addition there is a brief chapter on the research potential of such clinics. They are all covered well, although some rather briefly.

There is a small section on the diagnostic process for dementia. This stresses the differential diagnosis and indicates how one differentiates between age-related memory and cognitive decline and pathological conditions.

The final section of the book is concerned with treatment, and this covers topics that have not previously been covered well in publications. This includes support for caregivers and nonpharmacological approaches to treatments, such as behavioural modification and management of associated problems. There is a chapter on medical management, which reviews the current state-of -the-art in therapy and gives a glimpse of some of the therapies that may appear in the future. There is also a final chapter on the role and perspective of the primary care physician.

There is an appendix, which I found to be one of the more useful parts of the book. It is a paper that surveyed the memory disorder teams represented by the contributors to this book. This survey covers clinics in North America, the United Kingdom, Europe and Australasia. Anyone already running such a memory clinic or anticipating setting up one would find the information conveyed in this section quite useful as a benchmark. The survey asked such information as how many clinics are held per week, how long the first visit or appointment takes and how long the waiting lists are.

I think this book is potentially very useful for those already running clinics, those anticipating setting up clinics and those involved in rationalizing health care services for older individuals with cognitive impairment.

Burns A, Lawlor B, Craig S, editors

Martin Dunitz Ltd.; 1999. 302 pp. (paper)

ISBN 1-85317-562-5

Being asked to review Assessment Scales in Old Age Psychiatry was like being let loose in a candy store: fun, filled with many new experiences and ultimately vaguely disappointing, although definitely worth the visit.

About 150 diverse instruments are described, including neuropsychological assessments, tests for activities of daily living and quality of life, and tools for assessing depression and delirium. But to keep with the candy analogy, not all of the goodies are what they seem. Sometimes there is only a list of test contents, at other times only a description, and often there is nothing to help digest a complex mouthful.

The layout of this book is appealing. Each scale is described on one page, and the facing page lays out test elements. There is space on every page for notes and annotations; to use this book effectively, cross-referencing and additional notes from one’s own experience are necessary. Each chapter has an introduction that outlines the purpose of that domain of test and reviews the history of old or modified tests. Some analysis is given about which tests might be more useful for certain circumstances and why. The book usually indicates how long a test should take to administer and who is best suited to give it, along with information on how to score tests and what different total scores mean.

Disappointments include the following. Some of the “additional references” are oriented principally towards researchers or those interested in developing new tools, rather than clinicians. There are too few up-to-date references. For example, references are to articles re-evaluating older tools versus newer techniques, information that is essential where tests are unknown or where a choice has to be made between a tried-and-true older tool and a more recent tool. A few of the tools referred to “updated guidelines,” which may score an old test on a new scale, but unfortunately, in at least one instance, the new guidelines are not referenced and there is no example of the newer scale (for example, see Bartel on pages 132-3). One test is described as a “visual analogue” scale, but lacks a visual presentation. Primary sources are missed in a few cases.

Some information is given on the reliability, validity and accuracy of different tools, but the editors have not done a consistent enough job here. As a result, it is difficult for anyone unfamiliar with a test to choose between tools.

The editors excuse some of their lapses in editing in the introduction. However, I cannot accept their excuses. The job of a technical editor should be an arduous one. The editors of this book have not met the many technical requirements of their task and therefore fail their readers.

Despite my many reservations about this book, if you have the time to do your own homework, and the $77.50, it might be a fun addition to your library.

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.

Hauser P, Rovet J, editors

Washington: American Psychiatric Press; 1999. 312 pp. with index

ISBN 0-88048-767-4 (cloth)

This book, by a group of distinguished authors, presents the neurobehavioural science underlying and a clinical overview of thyroid deficiency and excess in the growing human organism.

The current knowledge of thyroid physiology and molecular genetics is reviewed in detail and is well referenced. Hence, this book is more than enough for the busy clinician.

A historical review of newborn screening programs over the past 25 years includes the complete history of thyroid screening in North America, from the Quebec experience starting in the mid-1970s to the present. The problem of false-positive results in term as well as premature infants is elucidated.

For the basic scientist, pediatrician or pediatric endocrinologist seeing newborns with positive thyroid screening tests, the later chapters on screening and long-term results of L-thyroxine therapy heighten awareness of the potential behaviour, intellectual and hearing problems faced by these children due to an otherwise treatable disorder. The association between thyroid hormone resistance syndrome and attentional disorders is intriguing. The neurobehavioural aspects of acquired thyroid disorders in children has been adequately highlighted for the clinician.

Finally, the chapters on neurodevelopmental change with thyroid-disrupting contaminants is thought-provoking for the environmentally conscious reader.

The book as a whole presents a balanced perspective on the neurobehavioural consequences of thyroid disease in infants and children and should be on the bookshelf of every pediatric library for current and future basic scientists and clinicians involved with children. It is a “must read” for every pediatric endocrinologist and child psychologist.

Peter E. Nathan and Jack M. Gorman, editors

New York, Oxford: Oxford University Press; 1998 . 594 pp. with index

ISBN 0-19-510227-4 (cloth)

This kind of book has to be written from time to time in any area of knowledge, in an attempt to establish benchmarks. In this case the aim is to highlight current “state of the art” aspects of the treatment of psychiatric disorders. It is a brave effort, tightly edited and with a large number of eminent and expert authors who are, in general, balanced and incisive in their viewpoints. They consist of a judicious mix of MD psychiatrists and PhD clinical psychologists, and there is a refreshing lack of inter-profession infighting in their writings.

The editors have insisted that the contributors’ approach should be evidence-based, and they have clearly delineated the relative degrees of investigative rigour present in the many studies under review. In their introduction, they say that, to be reputable, treatment studies must show that patients got “better” (acknowledging the difficulties in defining and measuring that concept). They also say that treatment simply as an exercise in promoting self-awareness is a more appropriate approach for religion than for a science-based medical specialty. Now there’s a brisk, no-nonsense send-off, so why is the last word (”Afterword — a plea”) given to a writer who makes a pitch for the supremely intuitive psychoanalytically based forms of psychotherapy? And why is that writer advocating impracticable methods of research that have never been effective in giving them a verifiable basis in the past? I can only assume that this is a manifestation of that aspect of the American psychiatric Zeitgeist that has never quite lost its awe of psychoanalysis even when knocking it, and which has to indulge in little propitiatory rituals to allay some possible ”Furor Sigmundicus.” That said, it should be emphasized that the psychological contributors adhere mostly to reviews of behavioural and cognitive therapies, with a strong emphasis on psychosocial intervention, and take a very objective view of what constitutes psychotherapy and how its outcomes may be assessed.

This is a solid tome, with 28 dense, closely-argued chapters on 18 wide-ranging areas of psychiatric disorder, mostly grouped in complementary pairs of presentations reviewing pharmacologic and psychosocial approaches. Despite this diversity and apparent depth, however, there is an introductory section entitled “Summary of treatments that work,” which occupies only 13 pages. It seems extraordinarily sad that in 1998 all our verifiable knowledge of psychiatric treatment can seemingly be encapsulated in 13 pages of text (reading time approximately 30 minutes).

But to some extent this brevity is misleading, since we are considering a highly-selected filtrate of the best-attested results available. The editors have been further selective in appearing to concentrate on disorders that seem more treatable than others, and there is a sense that some of the choice is influenced by what the psychology contributors consider “sexy” these days. The result is a number of notable omissions, including, for example, delusional disorder, schizoaffective disorder and dysthymic disorder.

Although the book is entitled A Guide to Treatments that Work, relatively little attention is given to the question, Work on what? The authors have meticulously culled their literatures, and most of the references are impressively recent. Nevertheless, we have to be aware how crude our nosologic system remains and what a moving target it is. DSM and ICD have become very intent on narrowing their diagnostic criteria to exclude false-positive findings. A result of this is an over-refinement of case identification in formal investigations and the provision of a number of residual diagnostic categories to which “atypical” cases may be consigned. The latter are so heterogeneous that they virtually deny investigation. Also, small but significant differences in diagnostic criteria between DSM and ICD, or between successive editions of these authorities, are sometimes enough to make superficially similar treatment studies incompatible with each other. So, when the editors use refinement of technique in the measurement of quality of treatment studies as their major criterion of credibility they narrow the scope of their work very considerably. They may be, in effect, investigating Jello with techniques appropriate to the testing of properties of high-tensile titanium. This feeling, in my mind at least, is accentuated when so many dramatic results are reported for behavioural cognitive treatment methods. I know how effective they can be, but when I read of their apparent success as primary intervention in what are reputed to be severe psychotic disorders, I just know that we are not talking about the unselected cases the front-line psychiatrist meets in everyday practice.

I do not intend to belittle this book because I think it serves a very useful purpose in hammering home the need for much more science in our clinical and research activities. The editors are at pains to point out that it is neither a comprehensive textbook nor a therapeutic vade mecum. But read uncritically, it could give an unbalanced message. Like it or not, “state-of-the-art” treatment in psychiatry still has a great deal of art in it, and the more difficult the patient, the greater is the need for that very art.

If we regard this book as a starting point from which we can move on and begin to validate the much bigger, much messier and much more demanding world of non-academic psychiatry, then we need not be discouraged by these mere 13 pages of summary. It is good to see a psychiatric work aim high, and it is a trenchant reminder of how far we have to go in psychiatry before we can be regarded as a scientifically-based discipline. I would suggest that every psychiatric library have a copy of this text.

Robert E. Hales, Stuart C. Yudofsky, editors

Washington (DC): American Psychiatric Press; 1999. 1070 pp. with index

ISBN 0-88048-848-1 (paper)

A recent publishing phenomenon in psychiatry, particularly in the United States, is the creation of textbooks that are comprehensive, authoritative and expensive. These textbooks are usually multi-authored, and the contributing authors are selected for their well-established expertise in a particular area. In recognition of the needs of medical students and junior residents, more affordable synopses are then created out of these large textbooks. A well-known example of such a synopsis is the one edited by H. Kaplan and B. Sadock entitled Synopsis of Psychiatry that is based on the comprehensive textbook of psychiatry. That synopsis has gone through many editions and remains a popular reference for residents and medical students.

A recent addition to this trend is Essentials of Clinical Psychiatry, based on the 3rd edition of The American Psychiatric Press Textbook of Psychiatry. It is intended for medical students to use during their 3rd year of clerkship or in 4th-year psychiatry electives and for junior psychiatry residents who want a comprehensive overview.

The editors reviewed the 50 chapters in the parent textbook and selected the 25 chapters they felt were “most important and relevant for clinical practice in a variety of settings.” The authors of these chapters were asked to prune their text by 50%, selecting the most important material for their target audience. The resulting text contains 2 sections, “Theoretical foundations and assessment” and “Psychiatric disorders,” and 2 appendices, “Diagnostic criteria from DSM-IV” and “Excerpts from the American psychiatric glossary.”

Compared with its competitors, the major advantage this synopsis has is its discussion of current controversies in the field. An example is the rediscovery of trauma: “The most exciting development for theory of the mind and psychopathology in the 1980s and 1990s has been the rediscovery of the role trauma plays in shaping personality and creating symptoms.” This ambitious claim is well developed in the section on theories of the mind and psychopathology, which includes a discussion on repressed memory.

How should a medical student decide on the appropriate textbook? The following criteria should be used.

• Comprehensiveness. This book can make a strong claim for comprehensiveness. However, there are notable omissions, such as separate sections on Geriatric Psychiatry and Emergency Room Psychiatry.

• Relevance. The book is relevant to the theory and practice of psychiatry and will remain so for the next few years. However, another consideration for relevance is its value as a quick reference text, specifically in emergency situations. Apart from a few sentences in the section on interviewing skills, this book does not provide quick references.

• Examinations. In my experience, the great value of Kaplan and Sadock’s Synopsis of Psychiatry is that it lends itself more easily than this book to the setting of examination questions (and as a result is of greater benefit to residents when studying for these examinations).

• Integration. Because of the rapid developments in psychiatry, particularly in neurobiology, there is an increasing need to integrate the information in a meaningful way for medical students and residents. Essentials of Clinical Psychiatry is weak in this area, and, particularly in the theories of the mind and psychopathology, a student may be left with the sense that these theories hang loosely, separate from each other.

• Authoritativeness. This book reads as an authoritative text that incorporates the latest information. However, medical students may still need to read other texts for some areas. I recommend the chapter on the alcohol-dependent and drug-dependent person, by George E. Vaillant, in New Harvard Guide to Psychiatry. Also, this book does not contain a chapter on the history of psychiatry. Students should be well informed on this subject, therefore I refer them to Synopsis of Psychiatry. The book contains a number of superb chapters: “Neuroscientific foundations of psychiatry,” “Theories of the mind and psychopathology and the psychiatric interviews” and “Psychiatric history and mental status examination.” “Laboratory and other diagnostic tests in psychiatry” also provides important information, and the section on psychiatric disorders is extremely well done, providing comprehensive information on most of the major diagnostic groups. “Anxiety disorders” stands out as an excellent rendering of this important diagnostic area. • Cost. Choice of a text may depend entirely on cost. Now that the 3rd edition of The American Psychiatric Press Textbook of Psychiatry is available in synoptic form as Essentials of Clinical Psychiatry, it should be an important option for libraries, medical students and psychiatric residents.