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Atlas of clinical polysomnography, (volumes I and II)
626
Book Reviews
6. Iatrogenic factors, deriving from an overcautious concern about physical causes and from ineffective reassurance that provides no acceptable explanation, are important contributors to distress, disability, and health costs. An interactive view of etiology makes possible a comprehensive view of the role of psychological and physical factors in all physical problems. Thus, chronic fatigue attributable to major depression, complicated by physical deconditioning, can be seen at the opposite extreme of the patient spectrum to chronic rheumatoid arthritis, whose pain and disability is made worse by depression. The evidence and the conclusions seem simple enough but they have been ineffective. Medical care is not providing what patients need and the result is dissatisfied and disabled patients and frustrated doctors along with an increasing demand for alternative medicine, which in ineffective, but at least offers patients hope. DR. RICHARD MAYOU Department of Psychiatry University of Oxford Warneford Hospital Oxford OX3 7JX, UK S0022-3999(97)00018-4
Atlas of Clinical Polysomnography, (Volumes I and II). NIc BUTKOV,RPSGT. Ashland, OR: Synapse Media Inc., 1996. $225.00 (two-volume set, hard cover). 397 pp. THIS COMPREHENSIVEATLASof polysomnography is a basic reference book for sleep technologists, physicians, students--everyone learning about or working in the field of sleep medicine. It is published in two volumes and, although it is not the only one in this area, it provides probably the most comprehensive collection of sleep recordings in an easy-to-handle format. The atlas is a major achievement from a single author, who is an experienced polysomnographic technologist. The appearance of the atlas is remarkable, including a wide range of visually appealing examples of normal and abnormal polysomnographic recordings. The atlas is well written, highly organized, and the quality of the recordings reflects high standards. The short text of the atlas, as well as the figures, are presented in a style that is easy to read, understand, and interpret. For easier orientation, the first volume provides a list of figures and recording samples. Each chapter begins with a short, basic, theoretical overview, followed by examples of recordings. The book covers the major areas of polysomnography organized in the following ten chapters: an overview; a chapter about scoring and interpretation; an extended chapter about clinical record samples, as well as detailed description and presentation of sleep-related breathing disorders, CPAP and Bi-level pressure titration, periodic limb movement disorder, ECG arrythmias, the Multiple Sleep Latency Test, recording artifacts, and a short chapter of digital recording samples. A more detailed description of electrode placement and the indication of the use of different montages could have been included, as well as information about the relevance of monitoring penile erections during sleep. A major advantage of the atlas is that it covers both normal and abnormal recordings. The latter of which has a significance for professionals working in a sleep clinic where patients present with different sleep disorders, take medications, and have diverse medical disorders. All of these can alter the quality and quantity of sleep in many different ways and result in abnormal polysomnographic findings. The short interpretations provided with each record sample are easy to understand and include useful comments from a clinical point-of-view, pointing out polysomnographic features of various sleep disorders or drawing attention to some drug effects. I was pleasantly surprised to see an entire chapter about abnormal ECG recordings. When polysomnographic technologists learn more about these abnormalities and comment on them in their reports, it provides unique and important information for the physician. The chapter about the recording artifacts is very useful because it not only describes and shows the artifacts, but also gives suggestions on how to correct them. Each chapter includes a few of the most relevant references for further reading. The glossary at the end of the second volume is helpful, but could have been more detailed with the explanations. Although an atlas can not replace a textbook on sleep medicine, a more extended bibliography might be useful in a later edition. The atlas achieves its goal to educate technologists, physicians, and students about standard polysomnographic monitoring techniques, as well as the proper interpretations of polysomnographic data.
Book Reviews
627
It was a real pleasure to read and study this atlas. I highly recommend that it find a place on the shelf of every sleep clinic and sleep laboratory. MARTA NOVAK Sleep and Alertness Clinic The Toronto Hospital (TWD) University of Toronto Toronto, Ontario, Canada S0022-3999(97)00113-X
Chronic Fatigue Syndrome: An Integrative Approach to Evaluation and Treatment. Edited by MARKA. DEMITRACK and SUSAN E. ABBEY. New York: Guilford Press, 1996. Price £25. 317 pp. THE PUBLICATIONof a book that describes an integrated approach to the misunderstood syndrome of chronic fatigue (CFS) is timely. Demitrack and Abbey have assembled six physicians, four psychiatrists, and a psychologist to give an authoritative account of assessment and treatment. The first "background" section starts with the book's approach: "specific pathophysiological antecedents (e.g., acute infection, stress, preexisting or concurrent psychiatric illness) may ultimately converge in a final common psychobiological pathway resulting in the clinical syndrome of chronic fatigue." Manu and colleagues make a case for "idiopathic chronic fatigue." Abbey then reviews the overlap with psychiatric disorders. Demitrack writes one of the best chapters, describing the psychobiology of chronic fatigue. He argues that CFS is a consequence of an impaired hypothalamic-pituitary axis response to an infectious or other stress, which leads to an increased delta sleep and immune activation; all three pathophysiological processes leading to the syndrome. Further disability, he suggests, may be determined by the patient's own psychosocial approach to their illness. The next section provides a sensible description of neuropsychological, psychiatric, and medical assessments. The final section makes this book unique by including five chapters on treatment, comprising 40% of the book; substantially more than any previous medical book on CFS. Four of the chapters describe psychotherapeutic and psychopharmacological approaches. Whatever criticisms have been made of psychiatrists regarding this illness, these authors cannot be accused of not trying to help the patient. Abbey has written the most comprehensive and eclectic review of the psychotherapies used in CFS that I have read. It includes individual, group, and family approaches, using everything from relaxation to dynamic therapies. Wessely gives us the "why?" and Sharpe the "how?" of cognitive-behavioral therapy, with some very useful practical guidance and a case vignette for illustration. Demitrack concludes that "it is unrealistic to present [psychopharmacological] medication as a sole treatment for this illness." Engleberg reviews "medically oriented therapy" and wisely concludes that some drugs may help certain symptoms, but "no drug trial to date has provided convincing and reproducible proof of substantial efficacy in CFS..." Other recently published books give more extensive reviews of the possibly etiological roles of infections and physical deconditioning, as well as the role of graded exercise in treatment. The strengths of this particular book are the comprehensive and practical descriptions of psychosocial assessments and treatments, along with a bold attempt to integrate psychobiology. This book is currently the best available guide for mental health professionals wanting to understand and treat patients with CFS. Other health professionals will recognize the abundant practical experience of the authors and will want to enhance their own treatment skills by incorporating the good advice available within the book. PETER WHITE Department of Psychological Medicine St. Bartholomew's and the Royal London School of Medicine 61 Bartholomew Close London EC1A 7BE, UK S0022-3999(96)00353-4
Book Reviews
6. Iatrogenic factors, deriving from an overcautious concern about physical causes and from ineffective reassurance that provides no acceptable explanation, are important contributors to distress, disability, and health costs. An interactive view of etiology makes possible a comprehensive view of the role of psychological and physical factors in all physical problems. Thus, chronic fatigue attributable to major depression, complicated by physical deconditioning, can be seen at the opposite extreme of the patient spectrum to chronic rheumatoid arthritis, whose pain and disability is made worse by depression. The evidence and the conclusions seem simple enough but they have been ineffective. Medical care is not providing what patients need and the result is dissatisfied and disabled patients and frustrated doctors along with an increasing demand for alternative medicine, which in ineffective, but at least offers patients hope. DR. RICHARD MAYOU Department of Psychiatry University of Oxford Warneford Hospital Oxford OX3 7JX, UK S0022-3999(97)00018-4
Atlas of Clinical Polysomnography, (Volumes I and II). NIc BUTKOV,RPSGT. Ashland, OR: Synapse Media Inc., 1996. $225.00 (two-volume set, hard cover). 397 pp. THIS COMPREHENSIVEATLASof polysomnography is a basic reference book for sleep technologists, physicians, students--everyone learning about or working in the field of sleep medicine. It is published in two volumes and, although it is not the only one in this area, it provides probably the most comprehensive collection of sleep recordings in an easy-to-handle format. The atlas is a major achievement from a single author, who is an experienced polysomnographic technologist. The appearance of the atlas is remarkable, including a wide range of visually appealing examples of normal and abnormal polysomnographic recordings. The atlas is well written, highly organized, and the quality of the recordings reflects high standards. The short text of the atlas, as well as the figures, are presented in a style that is easy to read, understand, and interpret. For easier orientation, the first volume provides a list of figures and recording samples. Each chapter begins with a short, basic, theoretical overview, followed by examples of recordings. The book covers the major areas of polysomnography organized in the following ten chapters: an overview; a chapter about scoring and interpretation; an extended chapter about clinical record samples, as well as detailed description and presentation of sleep-related breathing disorders, CPAP and Bi-level pressure titration, periodic limb movement disorder, ECG arrythmias, the Multiple Sleep Latency Test, recording artifacts, and a short chapter of digital recording samples. A more detailed description of electrode placement and the indication of the use of different montages could have been included, as well as information about the relevance of monitoring penile erections during sleep. A major advantage of the atlas is that it covers both normal and abnormal recordings. The latter of which has a significance for professionals working in a sleep clinic where patients present with different sleep disorders, take medications, and have diverse medical disorders. All of these can alter the quality and quantity of sleep in many different ways and result in abnormal polysomnographic findings. The short interpretations provided with each record sample are easy to understand and include useful comments from a clinical point-of-view, pointing out polysomnographic features of various sleep disorders or drawing attention to some drug effects. I was pleasantly surprised to see an entire chapter about abnormal ECG recordings. When polysomnographic technologists learn more about these abnormalities and comment on them in their reports, it provides unique and important information for the physician. The chapter about the recording artifacts is very useful because it not only describes and shows the artifacts, but also gives suggestions on how to correct them. Each chapter includes a few of the most relevant references for further reading. The glossary at the end of the second volume is helpful, but could have been more detailed with the explanations. Although an atlas can not replace a textbook on sleep medicine, a more extended bibliography might be useful in a later edition. The atlas achieves its goal to educate technologists, physicians, and students about standard polysomnographic monitoring techniques, as well as the proper interpretations of polysomnographic data.
Book Reviews
627
It was a real pleasure to read and study this atlas. I highly recommend that it find a place on the shelf of every sleep clinic and sleep laboratory. MARTA NOVAK Sleep and Alertness Clinic The Toronto Hospital (TWD) University of Toronto Toronto, Ontario, Canada S0022-3999(97)00113-X
Chronic Fatigue Syndrome: An Integrative Approach to Evaluation and Treatment. Edited by MARKA. DEMITRACK and SUSAN E. ABBEY. New York: Guilford Press, 1996. Price £25. 317 pp. THE PUBLICATIONof a book that describes an integrated approach to the misunderstood syndrome of chronic fatigue (CFS) is timely. Demitrack and Abbey have assembled six physicians, four psychiatrists, and a psychologist to give an authoritative account of assessment and treatment. The first "background" section starts with the book's approach: "specific pathophysiological antecedents (e.g., acute infection, stress, preexisting or concurrent psychiatric illness) may ultimately converge in a final common psychobiological pathway resulting in the clinical syndrome of chronic fatigue." Manu and colleagues make a case for "idiopathic chronic fatigue." Abbey then reviews the overlap with psychiatric disorders. Demitrack writes one of the best chapters, describing the psychobiology of chronic fatigue. He argues that CFS is a consequence of an impaired hypothalamic-pituitary axis response to an infectious or other stress, which leads to an increased delta sleep and immune activation; all three pathophysiological processes leading to the syndrome. Further disability, he suggests, may be determined by the patient's own psychosocial approach to their illness. The next section provides a sensible description of neuropsychological, psychiatric, and medical assessments. The final section makes this book unique by including five chapters on treatment, comprising 40% of the book; substantially more than any previous medical book on CFS. Four of the chapters describe psychotherapeutic and psychopharmacological approaches. Whatever criticisms have been made of psychiatrists regarding this illness, these authors cannot be accused of not trying to help the patient. Abbey has written the most comprehensive and eclectic review of the psychotherapies used in CFS that I have read. It includes individual, group, and family approaches, using everything from relaxation to dynamic therapies. Wessely gives us the "why?" and Sharpe the "how?" of cognitive-behavioral therapy, with some very useful practical guidance and a case vignette for illustration. Demitrack concludes that "it is unrealistic to present [psychopharmacological] medication as a sole treatment for this illness." Engleberg reviews "medically oriented therapy" and wisely concludes that some drugs may help certain symptoms, but "no drug trial to date has provided convincing and reproducible proof of substantial efficacy in CFS..." Other recently published books give more extensive reviews of the possibly etiological roles of infections and physical deconditioning, as well as the role of graded exercise in treatment. The strengths of this particular book are the comprehensive and practical descriptions of psychosocial assessments and treatments, along with a bold attempt to integrate psychobiology. This book is currently the best available guide for mental health professionals wanting to understand and treat patients with CFS. Other health professionals will recognize the abundant practical experience of the authors and will want to enhance their own treatment skills by incorporating the good advice available within the book. PETER WHITE Department of Psychological Medicine St. Bartholomew's and the Royal London School of Medicine 61 Bartholomew Close London EC1A 7BE, UK S0022-3999(96)00353-4