- Email: [email protected]
The role of serotonin re-uptake inhibitors
202
Book Reviews
medicine, reviews in this book the activities of his department over an 8-yr period; the exercise is undertaken in order to allow the development of assessment methods for psychosomatic patients but also in order to provide a data pool as a starting point for future controlled studies. What, however, does the author mean by the term psychosomatic? The population described, secondary and tertiary referrals to a University department, falls under the ICD-9 headings 306 (e.g. ‘cardiac neurosis’), 316 (e.g. colitis, asthma) and 307.1,.5 and 8 (anorexia, bulimia and ‘psychalgia’). Sociodemographic, clinical, psychological and psychophysiological details of out-patients (N = 3354), in-patients (N = 716) and ex-in-patients (4 yr after discharge, N = 110) are presented in an exhaustive but also overwhelming manner necessitating 152 tables with descriptive data. The introductory chapters are interesting especially since they discuss authors rarely mentioned in British literature. It does not become clear, however, how the author justifies, other than with old references, lumping together heterogeneous illnesses and drawing conclusions from their comparisons. Depressive syndromes coexisting or alternating with ‘psychosomatic constellations’ receive a good deal of attention whilst anxiety disorders are virtually neglected. One nevertheless gets the nagging suspicion that the label ‘cardiac neurosis’ may in fact indicate panic disorder. Cognitive-behavioural principles of treatments have apparently not come to the attention of Dr. Gathmann who recommends as treatment for hyperventilation and cardiac neurosis benzodiazepines, psychodynamic interviews, ‘body awareness therapies’ and occasionally the reassurance of a normal ECG (!). Doctor Gathmann’s book represents a tremendous enterprise. In reading the book one gets the sense that there is a great deal of interest hidden in the data. However, what the author says of one of his semistructured interviews; ‘(over)completeness may lead to loss of sharpness’ is also very true of this whole book. Elsewhere it is stated that the book is intended to be hypothesis generating which is certainly the case. In that sense I am eagerly awaiting some of the controlled studies that we are promised. In the meantime, the somewhat ill-defined use of the label psychosomatic, the obvious lack of diagnostic criteria and the author’s frequent recourse to psycho-analytical inferences rather than to modern scientific literature, severely limit the usefulness of this book. Dr JAN NEELEMAN The Maudsley Hospital London SE5 8AZ
The Role of Serotonin Re-uptake Brunner/Mazel, 1991. Price $39.95. Selective Serotonin Re-uptake Price f25.00. 168 pp.
Inhibitors. 349 pp.
Inhibitors.
S.-L.
BROWN and H. M. VAN PRAAG. New
J. P. FEICHNER and W. F. BOYER. Chichester:
Wiley,
York:
1991.
SEROTONIN @hydroxytryptamine, 5-HT) is the subject of intensive research at both the basic and the clinical level. It was established as a neurotransmitter only about 40 years ago and was regarded as an unimportant ‘trace’ substance at first. However, serotonin mechanisms became incorporated into speculations about biochemical abnormalities presumed to underlie affective disorders and later schizophrenia and appetite disorders. More recently, a link has been established between serotonin and aggression. The first of these two books comprises a compendious series of chapters, half emanating from van Praag’s group in New York, the rest from groups of experts in various United States centres. The range of conditions covered is very wide and occasionally one feels the list is overinclusive. Each chapter provides an up-to-date review of the evidence implicating serotonin in that particular condition and deals both with basic and clinical data. Professor van Praag and his group take the view that the nosological viewpoints currently favoured in psychiatry hinder rather than help research in serotonin. Instead, they take a dimensional approach and try to relate these mechanisms to abnormal behaviour such as retardation. aggression, anxiety and anhedonia. This approach is a useful alternative to adopting the rigid disease entities which may be appropriate to descriptive research but have been rather unproductive in biological psychiatry. This book can be recommended as a comprehensive and critical review of the topic. It is better dipped into than read from cover to cover, as there is a certain inevitable repetitiousness about some chaptersthe number of techniques applicable to man is strictly limited. The second book is the first volume in a new series of publications ‘supported by an educational grant’ from a large pharmaceutical company. My initial expectation was that it would be the boring proceedings of yet another drug company supported symposium. I was wrong-this book is very different. It comprises chapters dealing with the entire topic of these selective antia series of useful. even compendious, depressants. The relative risk/benefit ratios of citalopram, fluoxetine, fluvoxamine, paroxetine and sertraline
Book Reviews
medicine, reviews in this book the activities of his department over an 8-yr period; the exercise is undertaken in order to allow the development of assessment methods for psychosomatic patients but also in order to provide a data pool as a starting point for future controlled studies. What, however, does the author mean by the term psychosomatic? The population described, secondary and tertiary referrals to a University department, falls under the ICD-9 headings 306 (e.g. ‘cardiac neurosis’), 316 (e.g. colitis, asthma) and 307.1,.5 and 8 (anorexia, bulimia and ‘psychalgia’). Sociodemographic, clinical, psychological and psychophysiological details of out-patients (N = 3354), in-patients (N = 716) and ex-in-patients (4 yr after discharge, N = 110) are presented in an exhaustive but also overwhelming manner necessitating 152 tables with descriptive data. The introductory chapters are interesting especially since they discuss authors rarely mentioned in British literature. It does not become clear, however, how the author justifies, other than with old references, lumping together heterogeneous illnesses and drawing conclusions from their comparisons. Depressive syndromes coexisting or alternating with ‘psychosomatic constellations’ receive a good deal of attention whilst anxiety disorders are virtually neglected. One nevertheless gets the nagging suspicion that the label ‘cardiac neurosis’ may in fact indicate panic disorder. Cognitive-behavioural principles of treatments have apparently not come to the attention of Dr. Gathmann who recommends as treatment for hyperventilation and cardiac neurosis benzodiazepines, psychodynamic interviews, ‘body awareness therapies’ and occasionally the reassurance of a normal ECG (!). Doctor Gathmann’s book represents a tremendous enterprise. In reading the book one gets the sense that there is a great deal of interest hidden in the data. However, what the author says of one of his semistructured interviews; ‘(over)completeness may lead to loss of sharpness’ is also very true of this whole book. Elsewhere it is stated that the book is intended to be hypothesis generating which is certainly the case. In that sense I am eagerly awaiting some of the controlled studies that we are promised. In the meantime, the somewhat ill-defined use of the label psychosomatic, the obvious lack of diagnostic criteria and the author’s frequent recourse to psycho-analytical inferences rather than to modern scientific literature, severely limit the usefulness of this book. Dr JAN NEELEMAN The Maudsley Hospital London SE5 8AZ
The Role of Serotonin Re-uptake Brunner/Mazel, 1991. Price $39.95. Selective Serotonin Re-uptake Price f25.00. 168 pp.
Inhibitors. 349 pp.
Inhibitors.
S.-L.
BROWN and H. M. VAN PRAAG. New
J. P. FEICHNER and W. F. BOYER. Chichester:
Wiley,
York:
1991.
SEROTONIN @hydroxytryptamine, 5-HT) is the subject of intensive research at both the basic and the clinical level. It was established as a neurotransmitter only about 40 years ago and was regarded as an unimportant ‘trace’ substance at first. However, serotonin mechanisms became incorporated into speculations about biochemical abnormalities presumed to underlie affective disorders and later schizophrenia and appetite disorders. More recently, a link has been established between serotonin and aggression. The first of these two books comprises a compendious series of chapters, half emanating from van Praag’s group in New York, the rest from groups of experts in various United States centres. The range of conditions covered is very wide and occasionally one feels the list is overinclusive. Each chapter provides an up-to-date review of the evidence implicating serotonin in that particular condition and deals both with basic and clinical data. Professor van Praag and his group take the view that the nosological viewpoints currently favoured in psychiatry hinder rather than help research in serotonin. Instead, they take a dimensional approach and try to relate these mechanisms to abnormal behaviour such as retardation. aggression, anxiety and anhedonia. This approach is a useful alternative to adopting the rigid disease entities which may be appropriate to descriptive research but have been rather unproductive in biological psychiatry. This book can be recommended as a comprehensive and critical review of the topic. It is better dipped into than read from cover to cover, as there is a certain inevitable repetitiousness about some chaptersthe number of techniques applicable to man is strictly limited. The second book is the first volume in a new series of publications ‘supported by an educational grant’ from a large pharmaceutical company. My initial expectation was that it would be the boring proceedings of yet another drug company supported symposium. I was wrong-this book is very different. It comprises chapters dealing with the entire topic of these selective antia series of useful. even compendious, depressants. The relative risk/benefit ratios of citalopram, fluoxetine, fluvoxamine, paroxetine and sertraline