Posts Tagged ‘psychiatric treatment’

Treating the Elderly with Psychotherapy

Treating the Elderly with Psychotherapy: The Scope for Change in Later Life

Edited by Joel Sadavoy and Molyn Leszcz

Madison, CT, International Universities Press, Inc., 1987. 366 pp.

As emphasized early in this book, the elderly will represent nearly 20 percent of the U.S. population in the twenty-first century. This fact underscores the importance of a work for physicians, therapists, and health workers which focuses on issues specific to clients who are 65 and older. Editors Sadavoy and Leszcz have put together a series of essays by some of the pioneers in geriatric psychiatry (e.g., George Pollack, Jerome Grunes, Martin Berezin, Ralph Kahana, and others), each of whom has brought an expertise to different aspects of psychotherapeutic care. The essays are well-written, interesting, and full of eye-opening clinical vignettes, and the book as a whole has met its challenge of encouraging “hopefulness” in geriatric care. One problem, however, is that in presenting essays largely from a psychodynamic perspective, it lacks coherent underlying theories. Several essays, moreover, fail to distinguish the elderly patient from any other client. The overall collection, however, is pioneering and should encourage more specific studies.

The book is divided into three parts. Part I, entitled “General Psychodynamic Perspectives,” comprises essays by Pollack, Grunes, and Berezin, respectively. Each focuses on a general theme: Pollack emphasizes the wealth of psychodynamic material in therapy with the elderly and presents his own notion of a mourning-liberation process in bereavement. Grunes writes about the unique features of transference between an older client and a younger therapist and provides the concept of reverse empathy to account for the elder’s regard for the therapist. Berezin presents a wonderful introduction to clinical work, stressing the depth and vitality of the elderly. Taken together, these three essays break many stereotypes of the older client and provide a much deeper sense of age-specific therapeutic needs.

Part II, entitled “Manifestations of Psychopathology,” is the most theoretical section of the book and, as a result, the weakest. Its essays, which cover such topics as paranoia in the aged, the impact of massive psychic trauma, and character disorders, are well-organized and yet tangential to the stated goals of the general collection. The flaw seems to lie in the dearth of relevant psychodynamic theories; each essay provides concise theoretical introductions, yet never adequately adapts them for a geriatric population. In addition, no essay attempts to define the elderly. Are clients in their 60s similar to others in their 80-s and 90-s? One is left with little regard for the life cycle as a viable force past adulthood. Several of the cases presented raise interesting issues but, again, do not place them within a meaningful context. One exception in Part II is an essay by Lawrence Breslau on the Exaggerated Helplessness Syndrome. This syndrome, in which elderly patients become maladjusted to their disabilities, highlights their passivity and serves to maintain the support of primary caregivers. The psychodynamic issues here are ripe for intervention, and Breslau provides good clinical examples.

Part III, entitled “Specific Psychotherapeutic Modalities,” picks up many issues from Part I and ends with a real gem: an essay entitled “The Whole Grandfather: An Intergenerational Approach to Family Therapy” by Etta Ginsberg McEwan. The other essays focus on crisis management and short-term and group geriatric psychotherapy, and the information provided here is perhaps the most practical for readers, since it addresses the appropriate structure of therapeutic intervention. For example, Kahana’s chapter on crisis management presents a crucial skill for the intake of elderly clients. He provides a working definition for geriatric crisis, along with many useful clinical pieces. Ginsberg McEwan’s essay, coming second to last, is poignant and informative, presenting an entire case study within the context of family and intergenerational therapy. It speaks to the very intent of the book in tying together the therapeutic goals of the elderly with those of children and grandchildren. By juxtaposing these issues, Ginsberg McEwan illustrates points of common interest as well as age-specific ones.

Sadavoy and Leszcz’s collection of essays will, it is hoped, serve to encourage study along the lines of its distinguished contributors. Although several essays are a bit incongruous with the book’s focus on treating the elderly, one should not be discouraged. There has simply not been enough longitudinal work on the elderly, and the very concept, both before and after reading the book, remains a diffuse notion of “people 65 years and older.” What emerges from the book, then, is not a specific definition, but a well-rounded appreciation for the complex issues facing the elderly and the enormous potential for therapeutic intervention.

Handbook of Parkinson’s Disease

Handbook of Parkinson’s Disease

Edited by William C. Koller

New York, Marcel Dekker, Inc., 1987. 505 pp.

Although the tremor of Parkinson’s disease has been described intermittently throughout recorded history, the increasing life expectancy of human beings has made it a commonly treated illness today. Due to its slow progression and many coexistent symptoms, it is quite likely that most medical practitioners will encounter patients with this disease. Recognizing the need to understand and treat this debilitating illness, James Parkinson ended his 1817 description of shaking palsy with this admonishment to basic and clinical scientists:

Before concluding these pages, it may be proper to observe once more, that an important object proposed to be obtained by them is, the leading of the attention of those who humanely employ anatomical examination in detecting the cause and nature of diseases, particularly to this malady. By their benevolent labors its real nature may be ascertained, and appropriate modes of relief, or even of cure, pointed out.

Dr. Koller and his associates have answered his call by producing a handbook that provides up-to-date information on the pharmacology, physiology, pathology, and psychology of Parkinson’s disease. In this comprehensive text, topics range from genetics to stereotactic surgery and include such varied subjects as pharmacologic therapy, rehabilitation, epidemiology, and history. There are also chapters that deal with patient concerns, such as sleep disorders and psychosocial interaction. The appendix includes common staging scales, drug availability and cost, organizations that help patients to cope with their disease, and books that the patients can consult to understand it. The danger in attempting to produce a book of such magnitude is the creation of a tedious morass that a reader must wade through to find the useful facts, but the contributors to this book fall into this pitfall only occasionally.

On the whole, I found this handbook to be well written, well referenced, and interesting. Dr. Koller’s text offers the clinician current useful information about the disease and gives the researcher a comprehensive review of the progress other disciplines have made to understand and treat Parkinson’s disease.

Psychosomatic Medicine and Contemporary Psychoanalysis

Psychosomatic Medicine and Contemporary Psychoanalysis

Graeme J. Taylor

Madison, CT, International Universities Press, Inc., 1987. 391 pp.

Psychoanalysis is often criticized for not keeping up with advances in modern medicine. In an attempt to expand one area for development, Graeme Taylor has shown how contemporary thought in psychoanalysis can provide a new disease model for psychosomatic illness. Taylor’s review is meticulously researched and presented and provides a logical and relevant basis for further work. Most notable is his clear presentation of a psychobiological perspective, integrating behavioral and neurobiological research with object relations theory.

Taylor begins with a historical review of psychoanalytic approaches to psychosomatic illness, suggesting that the latter grew out of the former. Early studies tried to discern a personality type which correlated with classic psychosomatic illnesses, such as asthma and hypertension. Franz Alexander regarded conflict and dependency as correlates of illness. In the 1950-s and 60s, disillusionment with psychoanalytic approaches led to studies which looked at stress and bereavement in generating a susceptibility to illness. Work along the lines of Hans Seyle’s general adaptation syndrome largely replaced psychoanalytic research during this period. To counter this perception, Taylor refocuses discussion on the more recent notion of “alexithymia,” a clinically derived concept which he defines as “a specific disturbance in affective and symbolic functions which renders [the] communicative style sterile and colorless.” According to Taylor, this term has reintroduced discussion of the role of psychoanalytic therapy for psychosomatic illness. In his opening chapters, Taylor clearly presents the successes and failures of each of these developments along with numerous illuminating cases.

In Parts II and III, Taylor discusses current research in object relations theory and neurobiology, respectively. The mother-infant relationship, which he describes as a regulatory factor in the child’s homeostasis, is shown to be highly relevant for research purposes. Animal studies have linked separation from the mother to variations in heart rate, sleep, growth, and thermoregulation. Recent attempts to create bridges of thought between neurobiology and psychoanalysis are discussed with respect to dream theory, and here the author seems to stray. He provides an extensive review of neurobiological studies on sleep and dreaming and ties in early psychoanalytic theory, but he does not pursue the issues sufficiently. Little is said about how sleep research — which has become the most popular area of mind-brain discussion — can bridge enormous epistemological dilemmas between psychoanalysis and neurobiology. Moreover, how is this research relevant to psychosomatic illness? Taylor’s point here is elusive and leaves too much extrapolation to the reader.

Gathering together a rich history of research and theorizing on psychosomatic illness, Taylor approaches the last chapters stressing the potential contribution of object relations theory. As stated above, an understanding of the mother-infant bond, taken here as the most original interpersonal relationship, is crucial for studying predispositions to illness. A truly biopsychosocial approach to psychosomatic illness can only gain from such an understanding, and psychoanalysis is one logical tool of study. Although the author’s overall work is successful in defining a role here for psychoanalysis, he falls short — despite a gallant effort — in establishing a clearly “new” model for disease. He has merely pointed in one direction and provided numerous signposts.

The groundwork for any psychobiological or biopsychosocial model is difficult to construct, because there are endless considerations from each direction. Despite this fact, Taylor has done a masterful job in bringing together many diverse threads of research, thought, and theory. Consequently, he has defined a unique and viable role for psychoanalysis in the study of psychosomatic medicine.

Therapy of Parkinson’s Disease

Therapy of Parkinson’s Disease

Edited by William C. Koller and George Paulson

New York, Marcel Dekker, Inc., 1990. 583 pp.

Therapy of Parkinson’s Disease represents volume five in a series written on neurologic disease and therapy. It focuses on the therapeutic approaches to Parkinson’s disease (the second in this series dealing with that disorder). In addition to treatment issues, other areas are covered, including clinical evaluation, imaging, pathophysiology, neurochemical systems, and behavioral aspects. A clear strength of this text is that it covers a range of very specific treatment approaches in depth, which in sum provide a broad review of the clinical and research aspects of Parkinson’s disease therapeutics.

The volume is divided into five parts, composed of chapters on specific topics. Part 1 is cfevoted to the assessment and measurement of symptoms and signs and provides a review of clinical assessment via rating scales, videotape analysis, measures of motor disability, neurochemical evaluations, and various neuroimaging techniques. Part 2, an extensive review of pharmacological interventions, addresses traditional agents, novel agents, various routes of administration, preventive therapy, and treatment of secondary disorders. Part 3 discusses surgical interventions such as stereotaxic thalamotomies and neurotransplantation. Part 4 is concerned with the dietary issues related to Parkinson’s disease treatment, and part 5 addresses the behavioral and psychiatric issues, along with physical therapy issues, in Parkinson’s disease.

As indicated, each chapter provides a condensed, in-depth account of a highly specific topic and cites numerous references. The reference list is both comprehensive and timely (through 1990) and provides a good base from which to search for further literature on a specific topic. Most chapters are succinct and well organized. Tables, graphs, photographs, diagrams, and photomicrographs are used extensively throughout the volume. The contributors to the text (numbering 69) represent the mainstream of basic and clinical research and practice in the area of Parkinson’s disease, from academic centers in the U.S. and abroad. Errors are present in the arrangement of some material (for example, a section on dopamine receptor blocking drugs describes both agonists and antagonists). The chapter on neuroimaging could be difficult to get through without knowledge of various imaging techniques. The chapter on the management of behavioral symptoms reviews depression, drug-induced psychosis, and cognitive impairment, but does not discuss other (less common) neuropsychiatric issues, such as non-iatrogenic psychosis, the therapy of which is a timely issue in the psychiatric literature.

Therapy of Parkinson’s Disease is an expensive book, and not appropriate for everyone. Those who are involved in the clinical or research aspects of Parkinson’s disease and the related neuroscience, or who have an interest in that area, will find this text a valuable resource.

Comprehensive Neurology

Comprehensive Neurology

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.

Psychiatric Emergencies

John Chapman Urbaitis

Norwalk, Apple-ton-Century-Crofts

1983. x + 166 pp.

This small volume dealing with psychiatric emergencies is one of many such compilations, but has its own particular merits. One of these is its brevity. Emergency management requires the clear grasping of specific principles, unencumbered by more or less remotely related data which may safely be left for less immediate attention. The language of this treatise is what it should be considering the nature of its subject matter. Concision, pithiness, and solid substance are its meritorious attributes.

The orderly presentation of topics to be considered characterizes this book. It contains what it should and omits the nonessential.

Anyone who has worked in a psychiatric admitting office or emergency room will appreciate the author’s directives for procedure. Some pathologic conditions have been omitted or alluded to only in generalizations, but the book is not intended to be encyclopedic.

One appreciates the author’s emphasis on general medical procedures and neurologic diagnostic problems. Such conditions are always prominent in psychiatric emergencies, and their accurate diagnosis may make the difference between life and death.

The volume is to be recommended to all medical personnel required to deal with these disorders. It reminds us to bear in mind the admonition of Sir William Osier as to the necessity of equanimity for every physician.

Neurodevelopmental Disorders

Neurodevelopmental Disorders

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.

Psychopharmacology of Cognitive and Psychiatric Disorders in the Elderly

Psychopharmacology of Cognitive and Psychiatric Disorders in the Elderly

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.

The Neurology of Eye Movements

The Neurology of Eye Movements, 3rd ed. CD-ROM

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.

Assessment Scales in Old Age Psychiatry

Assessment Scales in Old Age Psychiatry

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.