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Obsessive-compulsive disorder in children and adolescents
Book Reviews
125
symposium receiving the raw data, This feeling is not allayed, at least in my case, by the obligatory snippets of discussion at the end of most chapters which merely act as an irritant. The book ends with two more general viewpoints--a pithy chapter from Goldberg on epidemiological aspects and a clinical perspective with vignettes from Rihmer showing ways in which the patient might benefit from medication. There is no grand conclusion, which with such a range of opinion and research material might have been an impossible undertaking without doubling the length of the book, but there is a sense of being abandoned without an answer to the question. Overall I felt better educated for having read this book and judged it to be an invaluable and quickly absorbed source of information for anyone likely to have to deal with such patients. It would therefore be a useful addition to most psychiatric libraries but probably an unnecessary individual purchase. R. J. L. OGLETHORPE Edinburgh
Obsessive-Compulsive Disorder in Children and Adolescents. Edited by JUDITH L. RAPOPORT. American Psychiatric Press Inc. 1989. x + 355 pp. RAPOPORT and her contributors have drawn together into this book their theoretical understanding, clinical and research experience of children and adolescents with obsessive compulsive disorder (OCD). The book is divided neatly into five sections with a useful introduction and summary of the subject matter. Each chapter is referenced well and on the whole the book is clearly written. Much of the content is founded on research which has been carried out over the past decade at the National Institute of Mental Health at Bethesda, U.S.A. The book covers the sociological and psychological factors which may be relevant in the development and maintenance of OCD. It also explores the possible biological substrate of this disorder. As such it gives a broad account of OCD, including issues relating to diagnosis, assessment, treatment and theoretical foundation. It also enriches our understanding of O C D by its use of vivid case histories. In comparison with our knowledge of adult OCD, little is known about childhood OCD. The authors suggest that the prevalence of O C D may be under estimated due to the difficulties in diagnosis and the tendency for sufferers to conceal their behaviours from others. The prevalence of O C D in childhood may be much higher than has previously been estimated. An N I M H study cited in the book suggests a minimal prevalence rate of 0.35 per cent in an unselected school based population. Given that this disorder may not be as rare as has been previously thought and, as in adults with OCD, the long term prognosis in children would seem to be poor, this book is timely. The chapters on diagnosis and assessment of O C D and its differential diagnosis are useful, however, the long term efficacy of behavioural and pharmacological treatment for O C D in this age group is unclear. Although the authors rightly suggest this should be rectified, these studies have yet to be undertaken. The section on treatment provides a comprehensive description of its nature and complexity, though sadly again there is little objective assessment of the treatment. However, to clinicians unfamiliar with OCD, these treatment chapters will be enlightening. One case in particular stands out as being an excellent example of the patience and inventiveness of the cognitive-behavioural therapist. The importance of working with the family is also highlighted in this book, particularly given the secrecy which surrounds O C D and the distressing nature of this disorder for both the sufferer and the family. The possibility of an underlying biological basis to O C D is explored in two chapters. An ethological model for O C D is proposed in which h u m a n obsessional rituals are presented as being analogous to fixed action ritual patterns in animals. This analogy, developed on meagre evidence, receives fuller and clearer exposition in the penultimate chapter which describes the possible role of the basal ganglia in OCD. In spite of these criticisms, this book is and will be for sometime the major reference on childhood and adolescent OCD. it provides a comprehensive overview of current knowledge and research on this subject and importantly provides the reader with clear sight of the direction of future research by suggesting thought provoking ideas on the nature of OCD. The eclectic approach of this book is a consequence of its multi-authorship, however, full credit is due to Judith Rapoport's ability to convey and pull together in an expert and clear fashion the many and varied issues surrounding this debilitating and distressing disorder. KATE M. DAVIDSON Department of Clinical Psychology Royal Edinburgh Hospital
125
symposium receiving the raw data, This feeling is not allayed, at least in my case, by the obligatory snippets of discussion at the end of most chapters which merely act as an irritant. The book ends with two more general viewpoints--a pithy chapter from Goldberg on epidemiological aspects and a clinical perspective with vignettes from Rihmer showing ways in which the patient might benefit from medication. There is no grand conclusion, which with such a range of opinion and research material might have been an impossible undertaking without doubling the length of the book, but there is a sense of being abandoned without an answer to the question. Overall I felt better educated for having read this book and judged it to be an invaluable and quickly absorbed source of information for anyone likely to have to deal with such patients. It would therefore be a useful addition to most psychiatric libraries but probably an unnecessary individual purchase. R. J. L. OGLETHORPE Edinburgh
Obsessive-Compulsive Disorder in Children and Adolescents. Edited by JUDITH L. RAPOPORT. American Psychiatric Press Inc. 1989. x + 355 pp. RAPOPORT and her contributors have drawn together into this book their theoretical understanding, clinical and research experience of children and adolescents with obsessive compulsive disorder (OCD). The book is divided neatly into five sections with a useful introduction and summary of the subject matter. Each chapter is referenced well and on the whole the book is clearly written. Much of the content is founded on research which has been carried out over the past decade at the National Institute of Mental Health at Bethesda, U.S.A. The book covers the sociological and psychological factors which may be relevant in the development and maintenance of OCD. It also explores the possible biological substrate of this disorder. As such it gives a broad account of OCD, including issues relating to diagnosis, assessment, treatment and theoretical foundation. It also enriches our understanding of O C D by its use of vivid case histories. In comparison with our knowledge of adult OCD, little is known about childhood OCD. The authors suggest that the prevalence of O C D may be under estimated due to the difficulties in diagnosis and the tendency for sufferers to conceal their behaviours from others. The prevalence of O C D in childhood may be much higher than has previously been estimated. An N I M H study cited in the book suggests a minimal prevalence rate of 0.35 per cent in an unselected school based population. Given that this disorder may not be as rare as has been previously thought and, as in adults with OCD, the long term prognosis in children would seem to be poor, this book is timely. The chapters on diagnosis and assessment of O C D and its differential diagnosis are useful, however, the long term efficacy of behavioural and pharmacological treatment for O C D in this age group is unclear. Although the authors rightly suggest this should be rectified, these studies have yet to be undertaken. The section on treatment provides a comprehensive description of its nature and complexity, though sadly again there is little objective assessment of the treatment. However, to clinicians unfamiliar with OCD, these treatment chapters will be enlightening. One case in particular stands out as being an excellent example of the patience and inventiveness of the cognitive-behavioural therapist. The importance of working with the family is also highlighted in this book, particularly given the secrecy which surrounds O C D and the distressing nature of this disorder for both the sufferer and the family. The possibility of an underlying biological basis to O C D is explored in two chapters. An ethological model for O C D is proposed in which h u m a n obsessional rituals are presented as being analogous to fixed action ritual patterns in animals. This analogy, developed on meagre evidence, receives fuller and clearer exposition in the penultimate chapter which describes the possible role of the basal ganglia in OCD. In spite of these criticisms, this book is and will be for sometime the major reference on childhood and adolescent OCD. it provides a comprehensive overview of current knowledge and research on this subject and importantly provides the reader with clear sight of the direction of future research by suggesting thought provoking ideas on the nature of OCD. The eclectic approach of this book is a consequence of its multi-authorship, however, full credit is due to Judith Rapoport's ability to convey and pull together in an expert and clear fashion the many and varied issues surrounding this debilitating and distressing disorder. KATE M. DAVIDSON Department of Clinical Psychology Royal Edinburgh Hospital