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Psychiatry: Essentials of Clinical Practice, ed 2
BOOK REVIEWS and relates it to differing models of teaching nonpsychiatric physicians. He outlines the aims of the liaison approach and then discusses how they can be achieved. Levitan reviews the data on outcome of liaison services both in general and for specific patient populations. He points to the pitfalls of research in this area and encourages continued investigation. With this background, the next 11 chapters address various facets of the field. These chapters deal with both general and specific clinical issues of concern to the psychiatrist in consultation-liaison work. A number of these topics are also of interest to physicians in other areas, particularly the chapter dealing with the physician's emotional reaction to his patients and its impact on their care. The two chapters on compliance and the chapter on the female patient look at the patient-physician relationship from the point of view of the patient, the physician, and their interaction. Issues are raised for consideration and suggestions offered to improve the effectiveness of the interaction. In the chapter "Transcultural Issues in the Medical Setting:' Hegeman provides an admirably concise and comprehensive treatment of transcultural issues, delineating the effects of cultural variation on cognitive style and coping methods and revealing how these come into play in the course of diagnosis and treatment. Her discussion of three specific subcultures fleshes out the conceptual models presented, as does the use of case material. Since antidepressant medications are gaining wider use, not only for depression, but for chronic
pain, panic attacks, and sleep disorders, the need for a thorough understanding of their effects in patients with other medical illnesses is crucial. Muskin and Glassman give an excellent review of that topic. This is nicely complemented by Wharton and Zucker's discussion of depression in the medically ill. The remaining chapters in this section give overviews of four other broad areas including organic mental syndromes in the general hospital, liaison psychiatry in obstetrics and gynecology, and children in the general hospital. The last section focuses on specific teaching issues from two perspectives. The first is the application of psychoanalytic understanding of physician development to teaching by the consulting psychiatrist. Careful attention is paid to the use of the consulting psychiatrist's understanding of the growth of professional identity to enhance case-oriented teaching and group work. The author, Marcus, also points out the importance of communication with both attending physicians and hospital administrators to facilitate the process of humanizing medical education. The second perspective is provided in Preven's discussion of the use of the biopsychosocial model in teaching medical students, which gives an excellent guide to effective use of the model. An appendix with examples of the curriculum is offered. This volume, in spite of its diversity, achieves a balance of issues and interests by means of a pointcounterpoint exposition of the material, moving back and forth from psychoanalytic to biologic approaches and from general issues to specific case material. There is
something here for almost anyone practicing or studying medicine. At the same time it serves as a state-ofthe-art view of consultation-liaison psychiatry. Linda G. Peterson M.D. University of Texas, Houston
Psychiatry: Essentials of Clinical Practice, ed 2 By Ian Gregory and Donald J. Smeltzer, Boston, Little. Brown. 1983.410 pp. S19.95 (paperback) .
• The opening chapter of this book, "Development and Dynamics:' starts out by defining "psychiatry,' "psychotherapY,' and "psychoanalysis:' proceeds with a rather brief history of dynamic psychiatry, and ends with a concise but good presentation of Freudian psychoanalysis. The hallmark of this chapter is the definition of the concept of conflict, anxiety, and defenses against anxiety. Nowadays, one expects to read and hear more about the comprehensive and multidimensional approach of modern psychiatry. The next three chapters of the book deal with "Description and Classification:' "Psychiatric Evaluation:' and "Psychological Testing:' DSM-III classifications are described in an orderly way, and subsequent chapters of the volume follow this classification closely. Other chapters cover a variety of subjects, including biologic and psychological determinants of behavior, the psychotherapies, psychiatric drugs and ECT, community and social psychiatry, and psychiatry and the law. The sequence of these chapters does not appear to follow a logical pattern, but the content of each chapter is covered (continued)
154
PSYCHOSOMATICS
BOOK REVIEWS in an orderly manner. Chapters on mental retardation, childhood disorders, and organic mental disorders follow. The authors here appear to have adhered obSessively to the sequence of the disorders presented in DSM-III rather than emphasizing subjects more frequently encountered by medical students during the clinical clerkship. Nevertheless, these three chapters present their subjects adequately. A chapter on "Schizophrenia, Paranoia, and Similar Psychotic Disorders" presents a good deal on the history of psychiatry, but otherwise is not as clear as might be expected. The manifestations and clinical picture of schizophrenia need to be presented in a more detailed fashion. The discussion of the etiology of schizophrenia is good and to the point. The chapter on affective disorders is a clear one, and it also covers the subject of suicide. The important issues of violence and destructiveness are not adequately addressed. There is also a need for a separate chapter on psychiatric emergencies. Chapter 17 is devoted to the important subject of anxiety, somatoform, and dissociation disorders. The chapter on psychosexual disorders is one of the better parts of the book. The one that follows, on "Psychological Factors Affecting Physical Conditions:' would have been better placed if it followed the section on anxiety. The last chapters, on personality and sleep disorders, are clear and informative; the one on sleep particularly deserves a high mark for its clarity and comprehensiveness. In general, this book is well writFEBRUARY 1985· VOL 26· NO 2
ten. Inclusion of review questions along with answers and commentary at the end of each chapter provide a unique quality. Some further attention to the sequencing of the chapters and expansion of parts of the text would make this book one of the better ones recommended for medical students and allied health professionals. Massood R. Babai, M.D. Northeastern Ohio Universities
Inpatient Psychiatry: Diagnosis and Treatment Edited by Lloyd I. Sederer, Baltimore, Williams & Williams, 1983, 337 pp, $35.
• In his preface, Dr. Sederer alludes to the absence of a specific body of literature to serve as a guide in the practice of inpatient psychiatry. He is joined here by 20 authors in presenting a collection of brief, well-rounded discussions of issues relevant to this topic. This book is divided into two major sections, dealing first with major psychiatric disorders and subsequently with selected topics in the field. The first section addresses the diagnosis and treatment of major psychiatric disorders, following DSM-III nomenclature. The format is consistent, encompassing the following areas: diagnostic definitions, differential diagnosis, epidemiology, theories of etiology, evaluation, treatment, and prognosis. The focus on a multiconceptual presentation leads to a generally rich discussion of theories of etiology as well as treatment options. In general, these chapters are succinct, comprehensive, and each is accompanied by a thorough list of classic and recent references. The second section addresses
what Dr. Sederer refers to as a more "microscopic" view of issues in inpatient psychiatry. It includes chapters on specific psychotherapeutic modalities and an overview chapter on psychological testing. A stimulating chapter discusses the choice and interpretation of laboratory data, followed by a brief discussion of neuroendocrine tests and their growing use. Lastly, a chapter on the medical record addresses the clinical and legal value as well as the pitfalls of this document in a practical, condensed fashion. Faced with such a scope, the reader may at times disagree with the selection or omission of topics. In spite of a comprehensive overview of obsessive-compulsive disorders, for example, little is said about other anxiety disorders. One might wish for a discussion of other somatoform disorders to complement the chapter on conversion symptoms, or wonder why the book omits a general discussion of substance abuse, as well as other forensic issues besides the medical record. However, the book's style, conciseness, and content make up for these shortcomings. Dr. Sederer's book serves, in my opinion, as a basic, easy to read reference source, enriched by a multiconceptual scope and complemented by a reasonable list of references. It provides a practical, stimulating reference for clinicians and especially residents and students in psychiatry. Its focus on core concepts of diagnosis and treatment will very likely also serve other professions who work within the field of psychiatry. EduardoA. Colon, M.D. Anolul, Minn. 157
pain, panic attacks, and sleep disorders, the need for a thorough understanding of their effects in patients with other medical illnesses is crucial. Muskin and Glassman give an excellent review of that topic. This is nicely complemented by Wharton and Zucker's discussion of depression in the medically ill. The remaining chapters in this section give overviews of four other broad areas including organic mental syndromes in the general hospital, liaison psychiatry in obstetrics and gynecology, and children in the general hospital. The last section focuses on specific teaching issues from two perspectives. The first is the application of psychoanalytic understanding of physician development to teaching by the consulting psychiatrist. Careful attention is paid to the use of the consulting psychiatrist's understanding of the growth of professional identity to enhance case-oriented teaching and group work. The author, Marcus, also points out the importance of communication with both attending physicians and hospital administrators to facilitate the process of humanizing medical education. The second perspective is provided in Preven's discussion of the use of the biopsychosocial model in teaching medical students, which gives an excellent guide to effective use of the model. An appendix with examples of the curriculum is offered. This volume, in spite of its diversity, achieves a balance of issues and interests by means of a pointcounterpoint exposition of the material, moving back and forth from psychoanalytic to biologic approaches and from general issues to specific case material. There is
something here for almost anyone practicing or studying medicine. At the same time it serves as a state-ofthe-art view of consultation-liaison psychiatry. Linda G. Peterson M.D. University of Texas, Houston
Psychiatry: Essentials of Clinical Practice, ed 2 By Ian Gregory and Donald J. Smeltzer, Boston, Little. Brown. 1983.410 pp. S19.95 (paperback) .
• The opening chapter of this book, "Development and Dynamics:' starts out by defining "psychiatry,' "psychotherapY,' and "psychoanalysis:' proceeds with a rather brief history of dynamic psychiatry, and ends with a concise but good presentation of Freudian psychoanalysis. The hallmark of this chapter is the definition of the concept of conflict, anxiety, and defenses against anxiety. Nowadays, one expects to read and hear more about the comprehensive and multidimensional approach of modern psychiatry. The next three chapters of the book deal with "Description and Classification:' "Psychiatric Evaluation:' and "Psychological Testing:' DSM-III classifications are described in an orderly way, and subsequent chapters of the volume follow this classification closely. Other chapters cover a variety of subjects, including biologic and psychological determinants of behavior, the psychotherapies, psychiatric drugs and ECT, community and social psychiatry, and psychiatry and the law. The sequence of these chapters does not appear to follow a logical pattern, but the content of each chapter is covered (continued)
154
PSYCHOSOMATICS
BOOK REVIEWS in an orderly manner. Chapters on mental retardation, childhood disorders, and organic mental disorders follow. The authors here appear to have adhered obSessively to the sequence of the disorders presented in DSM-III rather than emphasizing subjects more frequently encountered by medical students during the clinical clerkship. Nevertheless, these three chapters present their subjects adequately. A chapter on "Schizophrenia, Paranoia, and Similar Psychotic Disorders" presents a good deal on the history of psychiatry, but otherwise is not as clear as might be expected. The manifestations and clinical picture of schizophrenia need to be presented in a more detailed fashion. The discussion of the etiology of schizophrenia is good and to the point. The chapter on affective disorders is a clear one, and it also covers the subject of suicide. The important issues of violence and destructiveness are not adequately addressed. There is also a need for a separate chapter on psychiatric emergencies. Chapter 17 is devoted to the important subject of anxiety, somatoform, and dissociation disorders. The chapter on psychosexual disorders is one of the better parts of the book. The one that follows, on "Psychological Factors Affecting Physical Conditions:' would have been better placed if it followed the section on anxiety. The last chapters, on personality and sleep disorders, are clear and informative; the one on sleep particularly deserves a high mark for its clarity and comprehensiveness. In general, this book is well writFEBRUARY 1985· VOL 26· NO 2
ten. Inclusion of review questions along with answers and commentary at the end of each chapter provide a unique quality. Some further attention to the sequencing of the chapters and expansion of parts of the text would make this book one of the better ones recommended for medical students and allied health professionals. Massood R. Babai, M.D. Northeastern Ohio Universities
Inpatient Psychiatry: Diagnosis and Treatment Edited by Lloyd I. Sederer, Baltimore, Williams & Williams, 1983, 337 pp, $35.
• In his preface, Dr. Sederer alludes to the absence of a specific body of literature to serve as a guide in the practice of inpatient psychiatry. He is joined here by 20 authors in presenting a collection of brief, well-rounded discussions of issues relevant to this topic. This book is divided into two major sections, dealing first with major psychiatric disorders and subsequently with selected topics in the field. The first section addresses the diagnosis and treatment of major psychiatric disorders, following DSM-III nomenclature. The format is consistent, encompassing the following areas: diagnostic definitions, differential diagnosis, epidemiology, theories of etiology, evaluation, treatment, and prognosis. The focus on a multiconceptual presentation leads to a generally rich discussion of theories of etiology as well as treatment options. In general, these chapters are succinct, comprehensive, and each is accompanied by a thorough list of classic and recent references. The second section addresses
what Dr. Sederer refers to as a more "microscopic" view of issues in inpatient psychiatry. It includes chapters on specific psychotherapeutic modalities and an overview chapter on psychological testing. A stimulating chapter discusses the choice and interpretation of laboratory data, followed by a brief discussion of neuroendocrine tests and their growing use. Lastly, a chapter on the medical record addresses the clinical and legal value as well as the pitfalls of this document in a practical, condensed fashion. Faced with such a scope, the reader may at times disagree with the selection or omission of topics. In spite of a comprehensive overview of obsessive-compulsive disorders, for example, little is said about other anxiety disorders. One might wish for a discussion of other somatoform disorders to complement the chapter on conversion symptoms, or wonder why the book omits a general discussion of substance abuse, as well as other forensic issues besides the medical record. However, the book's style, conciseness, and content make up for these shortcomings. Dr. Sederer's book serves, in my opinion, as a basic, easy to read reference source, enriched by a multiconceptual scope and complemented by a reasonable list of references. It provides a practical, stimulating reference for clinicians and especially residents and students in psychiatry. Its focus on core concepts of diagnosis and treatment will very likely also serve other professions who work within the field of psychiatry. EduardoA. Colon, M.D. Anolul, Minn. 157