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Drugs in psychiatric practice
JournalofPsychosomofic Printed in Great Britain.
0022-3999/85 $3.00+ .oO Pergamon Press Ltd.
Research, Vol. 29, No. 2, pp. 219-221, 1985
BOOK REVIEWS Life Change Events Research: 1966-1978. T. H. HOLMES and ELLA M. DAVID, Praeger, p. 331. Price $32.50.
New York,
1984.
THIS BOOK is an annotated bibliography of life events research. It is restricted to periodical articles appearing between 1966 and 1978 on human subjects. Nonetheless some 857 studies are described in a non-evaluative manner, each one appearing only once in the book. There are nine major sections covering life change and illness, performance, psychology, physiology, economics, sociology, studies of specific life change events, and the use of life events inventories in the health care setting. Clear and comprehensive author and subject indexes allow the reader to find works of particular research teams and to locate all the research on a particular topic. Clearly the book represents a monumental effort, and it will be of some use, most especially to students writing dissertations and to others writing reviews including pre-1979 literature. Nonetheless its potential is not fully realised, for this reviewer anyway, because of some of the decisions explicitly taken by the authors. It goes only as far as 1978-the reason being, that in 1977 the designation ‘Life Change Events’ was introduced by Medlars, thus making computer literature search much easier. This decision is understandable but the hard fact is that six years is a long time in life event research and this book is already moving into obsolescence. Restriction of coverage to periodical articles, and to two edited books containing chapters by different authors means, among other things, that Brown & Harris’ 1978 book ‘Social Origins of Depression’ is not cited. The authors state that they wished to include only works describing ‘discrete events’ and to exclude ‘personal experiences of an ongoing nature.’ This could sometimes be misleading, because many of the articles cited rely on derivatives of the Social Readjustment Rating Scale. This contains items such as ‘troubles with the boss’ ‘pregnancy’ ‘sexual difficulties’ and ‘major change in living conditions.’ However the work’s most irritating blemish is the pruning of each abstract to remove all mention of the results of the study. This, no doubt, has the laudable object of forcing the reader to obtain the original article and read it for himself, but the effect is extraordinarily frustrating. So many fascinating stories are left unfinished, and a quick overview of a topic based on related entries is impossible.
PATRICK MILLER Scientific Officer, Medical Research Council Unit for Epidemiological Studies in Psychiatry, Royal Edinburgh Hospital
Drugs in Psychiatric Price f25.00.
Practice.
Edited
by PETER J. TYRER. Butterworth’s,
London,
1983. pp.
442.
PSYCHIATRWS are, as a group, much more ignorant about the drugs they prescribe than are physicians. This is perhaps surprising in that psychiatrists have far fewer drugs to worry about, but may in part be attributed to the inadequacies of their training and in part to a distaste for pharmacology. Conscious of my own deficiencies in this field I was greatly looking forward to reading this book. My spirits were further lifted by the realisation that all the contributors are practising clinicians rather than academic pharmacologists, and by the delightfully modest preface which states ‘this book offers no dramatic claims for novelty or erudition; it is only intended to be a useful aid to the prescriber and the student’. Exactly what I needed! The book comprises sixteen chapters, of which the first three are devoted to short but wholly adequate reviews of general pharmacological principles: classification (Tyrer), evaluation (Tyrer), and pharmacokinetics (Boulanger and Lader) of psychotropic drugs. These three chapters are comprehensive, scholarly and yet of immediate practical value. Thereafter come chapters on the appropriate drugs for different psychiatric conditions and it is here that one begins to realise the varying competence of the various authors. Certain chapters are quite excellent including those by Tyrer himself on anti-anxiety drugs, MAOI’s, drugs in child psychiatry, and ‘other uses of psychotropic drugs’. The three chapters on anti-depressants also amply fulfill their purpose, and one can easily find in them the relevant details on the efficacy and side-effects of, for example, Clomipramine, Nomifensine or Phenelzine. 219
220
Book Reviews
Certain of the other chapters are also excellent but appear somehow to be addressing different audiences. Thus, Mackay contributes a very readable introduction to anti-schizophrenic drugs, full of useful information for psychiatric trainees. This is followed by a chapter on anti-Parkinsonian drugs by Jenner and Marsden who provide a comprehensive guide to almost everything that appears to be known on the subject. However, at 43 pages in length it is longer than the entire chapter on anti-schizophrenic drugs, and clearly belongs in a different book aimed at a more academic audience. Elsewhere it is apparent that the authors had difficulty in deciding what the average psychiatrist should understand about different topics. Will his practice be enhanced, for example, by learning on page 336 that at low levels ‘nicotine stimulates the smooth muscle of the gut, bladder and uterus, increases salivation, sweating and the secretion of bronchial mucous?’ In summary Tyrer has set out to fill a substantial need. He has written some excellent chapters himself and chosen a number of well-known authorities to cover other areas. By and large, the book is informative and well-written and avoids the interminable lists of indications and side-effects of obscure drugs that plague some pharmacology text-books. That Tyrer hasn’t wholly succeeded in his aim is partly because he wasn’t strict enough as an editor and partly because the field of psychopharmacology in Britain is so weak that he has had to press into service a few contributors whose talents are noticeably less than his own. ROBIN M. MURRAY Dean, Institute of Psychiatry
Advances in Medical Social Science, Vol. 1. Edited by JULIO L. RUFFINI. Gordon Publishers, New York (1983). pp. 405 + xvii (Hard Cover).
and Breach
Science
THE STIMULUSbehind this volume, and the series it introduces, is the proliferation of sub-disciplines in the social sciences dealing with illness and Medicine as an institution. By bringing together the latest developments in research in ‘health and illness’ from the numerous sub-disciplines the editor aims to increase communication between practitioners and bring about a greater awareness among them of activities and achievements in related fields. In sequence, the contents are ‘Psychology and the Health System’; ‘Trends and Developments in the Sociology of Medicine’, ‘Power, Health and Service’; ‘Health an Economist’s perspective’; ‘Medical Geography’; ‘Medical Anthropology: A Critical Appraisal’; ‘Uses of Medical History’; ‘Beyond the Germ Theory: Reflections on Relations between Medicine and the Behavioural Sciences’. Singly, and as a whole, the contributions are meant to provide ‘a comprehensive view of the state of the art of the social sciences of health and illness’ for an assumed market of ‘scholars, students, health care providers and interested lay persons’. The level of scholarship is generally high. Most chapters include detailed reviews of work in major areas of research, emphasise landmark papers, offer critical comment on principal themes and, in some cases, point to areas of research potential. However, the discretion given to the distinguished American authors regarding scope and style of their reviews has resulted in some unevenness in quality and breadth of coverage. Thus, whilst the chapter on medical anthropology is outstanding, the piece on ‘The Uses of Medical History’ is short and disappointing. Some of the contributions include a historical dimension, others do not. Several adopt an international perspective; some are parochially restricted-the chapters on politics and economics in particular being essentially about the North American scene. Inevitably perhaps, given a multi disciplinary platform, hints of special pleading about disciplinary value and status will intrude. The chapter on psychology conveys this impression, which is unfortunate, as it is the first chapter. It seems strange that the piece on ‘Relations between Medicine and the Behavioural Sciences’ comes last. This is an excellent orienting chapter with an incisive critical review of a number of fundamental concepts within the field. Given the editor’s wish to encourage dialogue between sub-disciplines both the content and logic indicate that this could have been a helpful opening to the book, cutting as it does across sub-disciplinary boundaries. Finally, in one precise respect semantic confusion runs throughout the book, as it does through all of the social sciences’ endeavours in relation to Medicine. Why do prestigious practitioners continue with the uncritical habit of substituting ‘health’ for ‘illness’? For example, the chapter ‘Health, An Economist’s perspective’ has nothing to say about Health-it deals with the economics of ill-health care. This is not a semantic quibble. At best it is inaccurate, but
0022-3999/85 $3.00+ .oO Pergamon Press Ltd.
Research, Vol. 29, No. 2, pp. 219-221, 1985
BOOK REVIEWS Life Change Events Research: 1966-1978. T. H. HOLMES and ELLA M. DAVID, Praeger, p. 331. Price $32.50.
New York,
1984.
THIS BOOK is an annotated bibliography of life events research. It is restricted to periodical articles appearing between 1966 and 1978 on human subjects. Nonetheless some 857 studies are described in a non-evaluative manner, each one appearing only once in the book. There are nine major sections covering life change and illness, performance, psychology, physiology, economics, sociology, studies of specific life change events, and the use of life events inventories in the health care setting. Clear and comprehensive author and subject indexes allow the reader to find works of particular research teams and to locate all the research on a particular topic. Clearly the book represents a monumental effort, and it will be of some use, most especially to students writing dissertations and to others writing reviews including pre-1979 literature. Nonetheless its potential is not fully realised, for this reviewer anyway, because of some of the decisions explicitly taken by the authors. It goes only as far as 1978-the reason being, that in 1977 the designation ‘Life Change Events’ was introduced by Medlars, thus making computer literature search much easier. This decision is understandable but the hard fact is that six years is a long time in life event research and this book is already moving into obsolescence. Restriction of coverage to periodical articles, and to two edited books containing chapters by different authors means, among other things, that Brown & Harris’ 1978 book ‘Social Origins of Depression’ is not cited. The authors state that they wished to include only works describing ‘discrete events’ and to exclude ‘personal experiences of an ongoing nature.’ This could sometimes be misleading, because many of the articles cited rely on derivatives of the Social Readjustment Rating Scale. This contains items such as ‘troubles with the boss’ ‘pregnancy’ ‘sexual difficulties’ and ‘major change in living conditions.’ However the work’s most irritating blemish is the pruning of each abstract to remove all mention of the results of the study. This, no doubt, has the laudable object of forcing the reader to obtain the original article and read it for himself, but the effect is extraordinarily frustrating. So many fascinating stories are left unfinished, and a quick overview of a topic based on related entries is impossible.
PATRICK MILLER Scientific Officer, Medical Research Council Unit for Epidemiological Studies in Psychiatry, Royal Edinburgh Hospital
Drugs in Psychiatric Price f25.00.
Practice.
Edited
by PETER J. TYRER. Butterworth’s,
London,
1983. pp.
442.
PSYCHIATRWS are, as a group, much more ignorant about the drugs they prescribe than are physicians. This is perhaps surprising in that psychiatrists have far fewer drugs to worry about, but may in part be attributed to the inadequacies of their training and in part to a distaste for pharmacology. Conscious of my own deficiencies in this field I was greatly looking forward to reading this book. My spirits were further lifted by the realisation that all the contributors are practising clinicians rather than academic pharmacologists, and by the delightfully modest preface which states ‘this book offers no dramatic claims for novelty or erudition; it is only intended to be a useful aid to the prescriber and the student’. Exactly what I needed! The book comprises sixteen chapters, of which the first three are devoted to short but wholly adequate reviews of general pharmacological principles: classification (Tyrer), evaluation (Tyrer), and pharmacokinetics (Boulanger and Lader) of psychotropic drugs. These three chapters are comprehensive, scholarly and yet of immediate practical value. Thereafter come chapters on the appropriate drugs for different psychiatric conditions and it is here that one begins to realise the varying competence of the various authors. Certain chapters are quite excellent including those by Tyrer himself on anti-anxiety drugs, MAOI’s, drugs in child psychiatry, and ‘other uses of psychotropic drugs’. The three chapters on anti-depressants also amply fulfill their purpose, and one can easily find in them the relevant details on the efficacy and side-effects of, for example, Clomipramine, Nomifensine or Phenelzine. 219
220
Book Reviews
Certain of the other chapters are also excellent but appear somehow to be addressing different audiences. Thus, Mackay contributes a very readable introduction to anti-schizophrenic drugs, full of useful information for psychiatric trainees. This is followed by a chapter on anti-Parkinsonian drugs by Jenner and Marsden who provide a comprehensive guide to almost everything that appears to be known on the subject. However, at 43 pages in length it is longer than the entire chapter on anti-schizophrenic drugs, and clearly belongs in a different book aimed at a more academic audience. Elsewhere it is apparent that the authors had difficulty in deciding what the average psychiatrist should understand about different topics. Will his practice be enhanced, for example, by learning on page 336 that at low levels ‘nicotine stimulates the smooth muscle of the gut, bladder and uterus, increases salivation, sweating and the secretion of bronchial mucous?’ In summary Tyrer has set out to fill a substantial need. He has written some excellent chapters himself and chosen a number of well-known authorities to cover other areas. By and large, the book is informative and well-written and avoids the interminable lists of indications and side-effects of obscure drugs that plague some pharmacology text-books. That Tyrer hasn’t wholly succeeded in his aim is partly because he wasn’t strict enough as an editor and partly because the field of psychopharmacology in Britain is so weak that he has had to press into service a few contributors whose talents are noticeably less than his own. ROBIN M. MURRAY Dean, Institute of Psychiatry
Advances in Medical Social Science, Vol. 1. Edited by JULIO L. RUFFINI. Gordon Publishers, New York (1983). pp. 405 + xvii (Hard Cover).
and Breach
Science
THE STIMULUSbehind this volume, and the series it introduces, is the proliferation of sub-disciplines in the social sciences dealing with illness and Medicine as an institution. By bringing together the latest developments in research in ‘health and illness’ from the numerous sub-disciplines the editor aims to increase communication between practitioners and bring about a greater awareness among them of activities and achievements in related fields. In sequence, the contents are ‘Psychology and the Health System’; ‘Trends and Developments in the Sociology of Medicine’, ‘Power, Health and Service’; ‘Health an Economist’s perspective’; ‘Medical Geography’; ‘Medical Anthropology: A Critical Appraisal’; ‘Uses of Medical History’; ‘Beyond the Germ Theory: Reflections on Relations between Medicine and the Behavioural Sciences’. Singly, and as a whole, the contributions are meant to provide ‘a comprehensive view of the state of the art of the social sciences of health and illness’ for an assumed market of ‘scholars, students, health care providers and interested lay persons’. The level of scholarship is generally high. Most chapters include detailed reviews of work in major areas of research, emphasise landmark papers, offer critical comment on principal themes and, in some cases, point to areas of research potential. However, the discretion given to the distinguished American authors regarding scope and style of their reviews has resulted in some unevenness in quality and breadth of coverage. Thus, whilst the chapter on medical anthropology is outstanding, the piece on ‘The Uses of Medical History’ is short and disappointing. Some of the contributions include a historical dimension, others do not. Several adopt an international perspective; some are parochially restricted-the chapters on politics and economics in particular being essentially about the North American scene. Inevitably perhaps, given a multi disciplinary platform, hints of special pleading about disciplinary value and status will intrude. The chapter on psychology conveys this impression, which is unfortunate, as it is the first chapter. It seems strange that the piece on ‘Relations between Medicine and the Behavioural Sciences’ comes last. This is an excellent orienting chapter with an incisive critical review of a number of fundamental concepts within the field. Given the editor’s wish to encourage dialogue between sub-disciplines both the content and logic indicate that this could have been a helpful opening to the book, cutting as it does across sub-disciplinary boundaries. Finally, in one precise respect semantic confusion runs throughout the book, as it does through all of the social sciences’ endeavours in relation to Medicine. Why do prestigious practitioners continue with the uncritical habit of substituting ‘health’ for ‘illness’? For example, the chapter ‘Health, An Economist’s perspective’ has nothing to say about Health-it deals with the economics of ill-health care. This is not a semantic quibble. At best it is inaccurate, but