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Psychological problems in general practice
Journal of Psychosomatic Research, Vol. 34, No. 6, pp. 709-712, 1990. Printed in Great Britain.
0022-3999/90 $3.00 + .00 Pergamon Press plc
BOOK REVIEWS Psychological Problems in General Practice. A C MARKUS,C MURRAYPARKES,P TOMSONand M JOHNSTON. Oxford: Oxford University Press, 1989. 410pp. Price £17.50.
Tins is a book, written by authors from the disciplines of general practice, psychiatry and psychology. It unashamedly approaches its theme from the viewpoint of general practice, with General Practitioners in mind. The style makes for easy and compulsive reading. Once opened, it is not possible to glance without being drawn into closer perusal. The layout is clear and systematic, with lists, diagrams and tables. There is an attractive, sound initial grounding in the basic psychological sciences. This is followed by an instructive section about methods, merging into consideration of the life-cycle and mental illness. Each chapter is followed by a tidy list of references and suggested further reading. Unfortunately, some of the references are to somewhat obscure journals, or to volumes which may be difficult to obtain. The first appendix considers the more commonly used sections of the Mental Health Act. The second is a short directory of useful voluntary organisations. This is, as the title suggests, more than a book about psychiatry and General Practice. It is pleasant to see discussion of attachment theory, gender role and attribution theory. Unconscious defence mechanisms and transference issues are adequately addressed. Freudian and neo-Freudian concepts could be described a little more elaborately. The chapter on practical management pursues a logical course, moving through the consultation, individual therapy, family and group therapies, to consideration of prescribing and community services. There is a transitional approach to the family and life events. The chapter about functional disorders is hardly expansive but well referenced. In every library there are books gathering dust on the shelves, their titles apparently as old-fashioned a s their subject. The pages of this book may become well thumbed, but certainly not dusty. Composed in captivating style at a reasonable price, it will appeal to general practitioners who enjoy a good read and should rank high on the acquisition list for the practice library, particularly in teaching practices. JULIAN H RACE Academic Department Psychological Medicine University of Wales Clwyd Wales
A Day ltospital Group Treatment Program for Anorexia Nervosa and Bulimia Nervosa. NIVA PIRAN and ALLAN KAPLAN. New York: Brunner/Mazel, 1990. 168pp. Prices $25.00.
Two PER CENT of young female adults have bulimia nervosa and the prevalence is rising in younger cohorts. This increasing clinical need has resulted in growth of specialized eating disorder services. The Toronto group (led by PE Garfinkel) have developed a day hospital in parallel with their in-patient unit and out-patient facilities and this monograph describes how it functions. The specific skills in assessment and treatment brought to the unit by, the psychologist, the physician, the dietician, the occupational therapist, the nurse, and the group and family therapists are covered in the eight chapters. The Toronto group popularized the concept of psychoeducation in the treatment of eating disorders and this approach is clearly illustrated by each of the authors. The chapter which will be of most value to those wishing to develop their own services will be that on evaluation of the program. What is the need for such a facility and which patients does it serve? It appears not to be for severely emaciated restricting anorexics judging by the minimum admission weight which was 39 kg (the mean weight on admission was 46.6 kg). This selective admission of subjects with bulimia nervosa and mixed anorexia nervosa and bulimia nervosa is reflected in the weight gain which ranged from - 1 to 14 kg (poor in comparison to in-patient units where the predominant clinical problem is restricting anorexia nervosa). Bulimic behaviour was more successfully changed and the reduction in bingeing and vomiting was sustained in the few patients who had been followed up after treatment. Thus such a unit may be of value to those bulimic patients who have failed to respond to out-patient treatment of graded intensity. Recent reports suggest that as many as 50% of the patients referred to hospital with bulimia nervosa fail to respond even with the best available therapy. 709
0022-3999/90 $3.00 + .00 Pergamon Press plc
BOOK REVIEWS Psychological Problems in General Practice. A C MARKUS,C MURRAYPARKES,P TOMSONand M JOHNSTON. Oxford: Oxford University Press, 1989. 410pp. Price £17.50.
Tins is a book, written by authors from the disciplines of general practice, psychiatry and psychology. It unashamedly approaches its theme from the viewpoint of general practice, with General Practitioners in mind. The style makes for easy and compulsive reading. Once opened, it is not possible to glance without being drawn into closer perusal. The layout is clear and systematic, with lists, diagrams and tables. There is an attractive, sound initial grounding in the basic psychological sciences. This is followed by an instructive section about methods, merging into consideration of the life-cycle and mental illness. Each chapter is followed by a tidy list of references and suggested further reading. Unfortunately, some of the references are to somewhat obscure journals, or to volumes which may be difficult to obtain. The first appendix considers the more commonly used sections of the Mental Health Act. The second is a short directory of useful voluntary organisations. This is, as the title suggests, more than a book about psychiatry and General Practice. It is pleasant to see discussion of attachment theory, gender role and attribution theory. Unconscious defence mechanisms and transference issues are adequately addressed. Freudian and neo-Freudian concepts could be described a little more elaborately. The chapter on practical management pursues a logical course, moving through the consultation, individual therapy, family and group therapies, to consideration of prescribing and community services. There is a transitional approach to the family and life events. The chapter about functional disorders is hardly expansive but well referenced. In every library there are books gathering dust on the shelves, their titles apparently as old-fashioned a s their subject. The pages of this book may become well thumbed, but certainly not dusty. Composed in captivating style at a reasonable price, it will appeal to general practitioners who enjoy a good read and should rank high on the acquisition list for the practice library, particularly in teaching practices. JULIAN H RACE Academic Department Psychological Medicine University of Wales Clwyd Wales
A Day ltospital Group Treatment Program for Anorexia Nervosa and Bulimia Nervosa. NIVA PIRAN and ALLAN KAPLAN. New York: Brunner/Mazel, 1990. 168pp. Prices $25.00.
Two PER CENT of young female adults have bulimia nervosa and the prevalence is rising in younger cohorts. This increasing clinical need has resulted in growth of specialized eating disorder services. The Toronto group (led by PE Garfinkel) have developed a day hospital in parallel with their in-patient unit and out-patient facilities and this monograph describes how it functions. The specific skills in assessment and treatment brought to the unit by, the psychologist, the physician, the dietician, the occupational therapist, the nurse, and the group and family therapists are covered in the eight chapters. The Toronto group popularized the concept of psychoeducation in the treatment of eating disorders and this approach is clearly illustrated by each of the authors. The chapter which will be of most value to those wishing to develop their own services will be that on evaluation of the program. What is the need for such a facility and which patients does it serve? It appears not to be for severely emaciated restricting anorexics judging by the minimum admission weight which was 39 kg (the mean weight on admission was 46.6 kg). This selective admission of subjects with bulimia nervosa and mixed anorexia nervosa and bulimia nervosa is reflected in the weight gain which ranged from - 1 to 14 kg (poor in comparison to in-patient units where the predominant clinical problem is restricting anorexia nervosa). Bulimic behaviour was more successfully changed and the reduction in bingeing and vomiting was sustained in the few patients who had been followed up after treatment. Thus such a unit may be of value to those bulimic patients who have failed to respond to out-patient treatment of graded intensity. Recent reports suggest that as many as 50% of the patients referred to hospital with bulimia nervosa fail to respond even with the best available therapy. 709