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Psychophysiological disorders: Research and clinical applications
Book Reviews
235
the Acts’ does not systematically or exhaustively review the many theories postulated to explain factitious disorder. The chapter on treatment suffers from a similar lack of stringency. The book is poorly referenced. Some articles are referenced in the text in enough detail to allow the reader to refer to the original article. However, a great number of sources are incompletely referenced or not referenced at all. Patient or Pretender is interesting and worthwhile reading for any physician, other health care worker, or any individual who has ever encountered a patient with factitious disorder. However, health care professionals who are hoping to use this book to build on their pre-existing knowledge of factitious disorders, may be disappointed by it. DR AMANDA SUTFIERLANI) University of Ottawa Ottawa, Canada
Psychophysiological Disorders: Research and Clinical Applications. Edited by ROBERT J. GATCHEL and EDWARD B. BLANCHARD. Washington DC: American Psychological Association, 1993. Price $49.95. xi+484pp. THIS is the first in a series of volumes to be published by the Division of Health Psychology of the American Psychological Association. It’s primary aim is to be a resource for health psychologists dealing clinically with psychophysiological disorders. However, it may also be of interest to a variety of other medical-psychiatric clinicians seeking an update on epidemiology, etiology, assessment and treatment issues pertaining to the specific medical disorders reviewed in the text. These are: irritable bowel syndrome (IBS), essential hypertension, headache, asthma, dermatological disorders, Raynaud’s disease, rheumatoid arthritis and premenstrual syndromes. These conditions have been chased for review because of the notable role health psychology has played in them in both research and clinical practice. In fact one of the volume’s purposes is to synthesize the clinical research knowledge emerging in the bio-behavioral aspects of these conditions. As this synthesis requires the rigorous review of a voluminous literature the resulting volume is large and at times bogs down under the weight of its own assignment. Still, many sections are covered succinctly and keep a focus on clinical relevance. Blanchard’s chapter on IBS is perhaps the best example of this. ‘Clinical hints’, such as recommending thorough psychiatric evaluation of IBS patients, are based on research data, in this case that 56% of IBS patients meet criteria for at least one Axia 1 DSM-III-R psychiatric diagnosis. Other chapters vary in their ability to integrate research and clinical data. Some of this difficulty may stem from the sheer complexity of Pactors considered as in the chapter on the Non-Pharmacological Treatment of Essential Hypertension. Here diet, exercise, weight reduction and relaxation and their interactive effects are reviewed. Contradictory results are reported and discussed as in the case of the variable efficacy of relaxation training in essential hypertension. The Headache chapter encompasses both tension-type and migraine. It reviews the continuing efficacy of thermal biofeedback in migraine and the evolving behavioral expertise in tension headache management particularly regarding self-monitoring and self-regulatory skills. Self-regulation is also central to the work presented in the Asthma chapter where the reader is reminded that international asthma experts have called self-management the ‘cornerstone’ of clinical management. Research in compliance indicates that physicians tend to overestimate it and patients tend to falsify it. The self-management model presented is rigorous in establishing ‘contextual variables’ and a ‘risk factor analysis’ but here the reader is left wondering about the pragmatic issue of translating this expertise into clinical applicability in settings where asthma is most often managed. Thus a question emerges from this and other chapters: how can the complexities of behavioral assessment and intervention be simplified for application to general clinical settings? In the Temporomandibular Disorders (TMD) chapter the authors suggest that behavioral techniques are ‘competitive’ with pharmacological and dental interventions for TMD pain. Again a question emerges as to whether the health psychology approach is integrative with or parallel to general medical treatment. This has implications for the shaping of research questions regarding the penetration of complex behavioral knowledge into, for example, medical school curricula and a variety of clinical settings. The final chapter on Premenstrual Syndromes (PMS) includes a critique of emerging ‘biomedically oriented research in this area. It also reflects the tension between a complex contextual perspective of illness and a more simplified ‘undirectional’ model. Here the authors argue that a purely biomedical view
236
Book Reviews
of PMS is socially constructed, reflecting negative ideas about women in summary call for more complex models. In summary, this large book is more than an overview as it delves deeply allows leading researchers and clinicians to show the relevance and scientific field as a whole. Medical practitioners have much to learn from here. As series it succeeds admirably in setting the direction for future publications.
Western
culture
and in their
into each area discussed and rigor of the health psychology a first volume in a landmark
PETBR H. KEEFE, MD Dept of Psychiatry Mt Sinai Hospital Toronto, Canada M5G 1X5
Medical-Psychiatric Practice, Vol. 2. Edited by ALAN STOUDEMIRE, MD and BARRY S. FOGEL, MD. Washington: American Psychiatric Press Inc, 1993. ISBN 0-88048-426-S. Price $92.50 Edn. 606 pp. THE FIELD of medical psychiatry (consultation-liaison psychiatry) is booming. It is quite a task to keep abreast of medical advances in specialized patient cohorts, let alone the complex associated psychiatric issues. This is the challenge ably shouldered by the authors of Medic&Psychiatric Practisr, Vol. 2. The book is divided into six sections: I Psychotherapy in Medically I11 Patients; II Psychopharmacology Updates; III Diagnostic Neuroradiology; IV Special Topics; V Neuropsychiatry and VI Medical-Legal Updates. Section I deals with brief psychodynamically informed therapy in the medically ill, and medical hypnosis. Section II reviews the use of newer psychotropic agents in physically compromised patients, as well as the parental use of psychotropics. Section III on neuroradiology confines itself to SPECT imaging in medical psychiatric management. Section IV reviews a wide range of special interest topics; testing for genetic disorders, cardiac arrhythmias and sudden cardiac deaths, reproductive endocrinology. new reproductive technologies, low back pain rehabilitation, and anaesthesia. The neuropsychiatry section details psychiatric complications ofthree disorders; multiple sclerosis, Parkinson’s disease and Huntington’s disease. The final section on medical~legal issues comprises four chapters, updating readers on competency deterioration, advanced directives, psychiatric malpractice, and ethics in medical psychiatry. The authors have written in a clearly ‘user friendly’ style; each chapter is extensively referenced. Case vignettes are used throughout, but are particularly strong assets in the chapters on psychotherapy and medical--legal issues. Clinical reasoning and process are clearly communicated. Debatable social/ethical issues are approached in a balanced, nonjudgemental fashion. Extensive use of easily read tables, summarises and clarifies research data, and ‘take home messages’ in each chapter. Medical-Psychiafric Practice, Vol. 2, is not simply a smaller version of the larger reference text edited by Stoudemire and Fogel. It is best seen as complimentary to this work, providing ‘cutting edge’ information0 n selected topics in a pragmatic ‘how to’ style. Although, standing squarely in the ‘remedicalization’ of psychiatry, the book clearly reflects the biopsychosocial perspective fundamental to the discipline. It is an appropriate text for clinicians involved in the psychiatric management of medically ill persons, and particularly psychiatric residents in a general hospital setting. It is a most valued source book for specialty fellowship trainees and psychiatrists making a career in consultation-liason psychiatry. In a book of this nature, one can always argue for inclusion of other special patients groups, c.g. dialysis patients, or updates of common clinical issues, e.g. substance use disorders. Volume 2 has complimented and expanded on issues raised in Vol. 1 we can only anxiously await Vol. 3. T. CLARKE, MD, FRCPC Assistant Professor Dept. of Psychiatry, Dalhousie University Consultant/Liason Service Victoria General Hospital
235
the Acts’ does not systematically or exhaustively review the many theories postulated to explain factitious disorder. The chapter on treatment suffers from a similar lack of stringency. The book is poorly referenced. Some articles are referenced in the text in enough detail to allow the reader to refer to the original article. However, a great number of sources are incompletely referenced or not referenced at all. Patient or Pretender is interesting and worthwhile reading for any physician, other health care worker, or any individual who has ever encountered a patient with factitious disorder. However, health care professionals who are hoping to use this book to build on their pre-existing knowledge of factitious disorders, may be disappointed by it. DR AMANDA SUTFIERLANI) University of Ottawa Ottawa, Canada
Psychophysiological Disorders: Research and Clinical Applications. Edited by ROBERT J. GATCHEL and EDWARD B. BLANCHARD. Washington DC: American Psychological Association, 1993. Price $49.95. xi+484pp. THIS is the first in a series of volumes to be published by the Division of Health Psychology of the American Psychological Association. It’s primary aim is to be a resource for health psychologists dealing clinically with psychophysiological disorders. However, it may also be of interest to a variety of other medical-psychiatric clinicians seeking an update on epidemiology, etiology, assessment and treatment issues pertaining to the specific medical disorders reviewed in the text. These are: irritable bowel syndrome (IBS), essential hypertension, headache, asthma, dermatological disorders, Raynaud’s disease, rheumatoid arthritis and premenstrual syndromes. These conditions have been chased for review because of the notable role health psychology has played in them in both research and clinical practice. In fact one of the volume’s purposes is to synthesize the clinical research knowledge emerging in the bio-behavioral aspects of these conditions. As this synthesis requires the rigorous review of a voluminous literature the resulting volume is large and at times bogs down under the weight of its own assignment. Still, many sections are covered succinctly and keep a focus on clinical relevance. Blanchard’s chapter on IBS is perhaps the best example of this. ‘Clinical hints’, such as recommending thorough psychiatric evaluation of IBS patients, are based on research data, in this case that 56% of IBS patients meet criteria for at least one Axia 1 DSM-III-R psychiatric diagnosis. Other chapters vary in their ability to integrate research and clinical data. Some of this difficulty may stem from the sheer complexity of Pactors considered as in the chapter on the Non-Pharmacological Treatment of Essential Hypertension. Here diet, exercise, weight reduction and relaxation and their interactive effects are reviewed. Contradictory results are reported and discussed as in the case of the variable efficacy of relaxation training in essential hypertension. The Headache chapter encompasses both tension-type and migraine. It reviews the continuing efficacy of thermal biofeedback in migraine and the evolving behavioral expertise in tension headache management particularly regarding self-monitoring and self-regulatory skills. Self-regulation is also central to the work presented in the Asthma chapter where the reader is reminded that international asthma experts have called self-management the ‘cornerstone’ of clinical management. Research in compliance indicates that physicians tend to overestimate it and patients tend to falsify it. The self-management model presented is rigorous in establishing ‘contextual variables’ and a ‘risk factor analysis’ but here the reader is left wondering about the pragmatic issue of translating this expertise into clinical applicability in settings where asthma is most often managed. Thus a question emerges from this and other chapters: how can the complexities of behavioral assessment and intervention be simplified for application to general clinical settings? In the Temporomandibular Disorders (TMD) chapter the authors suggest that behavioral techniques are ‘competitive’ with pharmacological and dental interventions for TMD pain. Again a question emerges as to whether the health psychology approach is integrative with or parallel to general medical treatment. This has implications for the shaping of research questions regarding the penetration of complex behavioral knowledge into, for example, medical school curricula and a variety of clinical settings. The final chapter on Premenstrual Syndromes (PMS) includes a critique of emerging ‘biomedically oriented research in this area. It also reflects the tension between a complex contextual perspective of illness and a more simplified ‘undirectional’ model. Here the authors argue that a purely biomedical view
236
Book Reviews
of PMS is socially constructed, reflecting negative ideas about women in summary call for more complex models. In summary, this large book is more than an overview as it delves deeply allows leading researchers and clinicians to show the relevance and scientific field as a whole. Medical practitioners have much to learn from here. As series it succeeds admirably in setting the direction for future publications.
Western
culture
and in their
into each area discussed and rigor of the health psychology a first volume in a landmark
PETBR H. KEEFE, MD Dept of Psychiatry Mt Sinai Hospital Toronto, Canada M5G 1X5
Medical-Psychiatric Practice, Vol. 2. Edited by ALAN STOUDEMIRE, MD and BARRY S. FOGEL, MD. Washington: American Psychiatric Press Inc, 1993. ISBN 0-88048-426-S. Price $92.50 Edn. 606 pp. THE FIELD of medical psychiatry (consultation-liaison psychiatry) is booming. It is quite a task to keep abreast of medical advances in specialized patient cohorts, let alone the complex associated psychiatric issues. This is the challenge ably shouldered by the authors of Medic&Psychiatric Practisr, Vol. 2. The book is divided into six sections: I Psychotherapy in Medically I11 Patients; II Psychopharmacology Updates; III Diagnostic Neuroradiology; IV Special Topics; V Neuropsychiatry and VI Medical-Legal Updates. Section I deals with brief psychodynamically informed therapy in the medically ill, and medical hypnosis. Section II reviews the use of newer psychotropic agents in physically compromised patients, as well as the parental use of psychotropics. Section III on neuroradiology confines itself to SPECT imaging in medical psychiatric management. Section IV reviews a wide range of special interest topics; testing for genetic disorders, cardiac arrhythmias and sudden cardiac deaths, reproductive endocrinology. new reproductive technologies, low back pain rehabilitation, and anaesthesia. The neuropsychiatry section details psychiatric complications ofthree disorders; multiple sclerosis, Parkinson’s disease and Huntington’s disease. The final section on medical~legal issues comprises four chapters, updating readers on competency deterioration, advanced directives, psychiatric malpractice, and ethics in medical psychiatry. The authors have written in a clearly ‘user friendly’ style; each chapter is extensively referenced. Case vignettes are used throughout, but are particularly strong assets in the chapters on psychotherapy and medical--legal issues. Clinical reasoning and process are clearly communicated. Debatable social/ethical issues are approached in a balanced, nonjudgemental fashion. Extensive use of easily read tables, summarises and clarifies research data, and ‘take home messages’ in each chapter. Medical-Psychiafric Practice, Vol. 2, is not simply a smaller version of the larger reference text edited by Stoudemire and Fogel. It is best seen as complimentary to this work, providing ‘cutting edge’ information0 n selected topics in a pragmatic ‘how to’ style. Although, standing squarely in the ‘remedicalization’ of psychiatry, the book clearly reflects the biopsychosocial perspective fundamental to the discipline. It is an appropriate text for clinicians involved in the psychiatric management of medically ill persons, and particularly psychiatric residents in a general hospital setting. It is a most valued source book for specialty fellowship trainees and psychiatrists making a career in consultation-liason psychiatry. In a book of this nature, one can always argue for inclusion of other special patients groups, c.g. dialysis patients, or updates of common clinical issues, e.g. substance use disorders. Volume 2 has complimented and expanded on issues raised in Vol. 1 we can only anxiously await Vol. 3. T. CLARKE, MD, FRCPC Assistant Professor Dept. of Psychiatry, Dalhousie University Consultant/Liason Service Victoria General Hospital