BOOK'S REVIEW

TREATING DEPRESSION EFFECTIVELY

 Sydney H. Kennedy, Raymond W. Lam, David J. Nutt, Michael Thase, Martin Dunitz
Taylor & Francis Group, London EC4P 4EE UK, 154 pages, 2004
ISBN: 1-84184-328-8 Price: 29,95 £

This a very didactic piece which grew out of the Clinical Guidelines for the Treatment of Depressive Disorders produced by the Canadian Network for Mood and Anxiety Treatment. It is also enriched by the contribution of two world opinion leaders in the field coming from the UK and the USA.

It provides an up-to-date account of depression in terms of comprehensive clinical management together with a review of depression in specific populations such women, children and adolescents, the elderly and those suffering from other psychiatric and physical disorders. This last chapter needs to be expanded for those practising with complex psychiatric and medical patients.

The authors are to be commended for the achievement of getting an appropriate balance between being comprehensive yet concise. This user-friendly volume should have a wider readership. psychiatric and family medicine residents will definitely find it of value as will general practitioners when trying to review the existing depression clinical guidelines. Medical, nursing and psychology students will undoubtedly benefit from a read which needs to be preceded by other basic pieces on aetiology and psychopathology of depressive states. In this respect, it is of utmost importance to remember the classic distinction between mourning and melancholia, so often overlooked in contemporary psychiatric textbooks.

Dr. Ricardo Campos, MD, PhD
Associate Professor
Department of Psychiatry
University of Zaragoza

SOMATOFORM DISORDERS: A MEDICOLEGAL GUIDE

Prof. Michael Trimble
Cambridge University Press
The Edinburgh Building, Cambridge, CB2 2RU UK, 254 pages, 2004
ISBN: 0-521-81108-2. Price: 50 £; 70 US $

Hysteria, renamed by other terms, is still alive and very prevalent. It is presented in the interface of Medicine and Psychiatry and in different settings such as the legal one. Indeed, it is being a treat to share the experiences of Professor Trimble at the National Hospital for Nervous Disease in London. This book represents a very unique contribution based on their results from many decades of clinical practice and research about these complex patients.

This volume contains 9 up-to-date chapters addressing didactically the history, classification, clinical presentations, assessment and aetiological aspects of these disorders. There are two specific chapters devoted to the medico-legal context and another one reviewing malingering, an often forgotten topic in the official speciality training program.

The author made a complex topic readable. It is written in a clear, easy accessible style and it is edited thoughtfully. This book will be invaluable for psychiatrist working closely with the legal system when assessing physical and psychological damage. It will be also greatly appreciated by those working in the general hospitals and of course by psychiatric trainees. It is also very commendable for those coroners and lawyers willing to broaden their knowledge about human presentations of psychological suffering. As the author is stating this could lessen the risk of the harmful effects that legal process and the contribution of these professionals may have on patient's symptomatology provoking a "lexigenic"morbidity analogous to iatrogenia.

As a minor quibble, and being a South-European psychiatrist, I missed the lack of reference to new developments of psychoanalytic theory on the subject represented by the French Jacques Lacan. In summary, this is a solid helpful book and worthy of high recommendation for those clinicians and researchers interested in this always intriguing clinical presentation at the interface of psychiatry and medicine and the legal system.

Dr. Ricardo Campos, MD, PhD
Associate Professor
Department of Psychiatry
University of Zaragoza

ASSESSMENT SCALES IN OLD AGE PSYCHIATRY

Burns A, Lawlor B, Craig S.
2^nd ed. Martin Dunitz; London, 2004
ISBN: 1 -84184- 168-4 Price: 32.95 £

The challenge and thrill of both old age and CL psychiatry is their complexity given by the interplay between multiple physical, psychological and social factors in the cause of mental disorders and in their treatment. With increasing numbers of geriatrics patients straining health care resources, a book devoted to practical geriatric psychiatric assessment meets a clear need.

This is the second edition of a widely appreciated compendium of scales applied to geriatric psychiatry. More than 200 scales have been collected and they are classified in 8 sections: Depression, Dementia, global mental health, physical examination, delirium, caregivers assessments, memory functioning and other scales. Dementia section is the largest one and it is divided in subgroups such as cognitive assessment (with a special and renewed description of neuropsychological tests), neuropsychiatric assessments, activity of daily living and quality of life. The reader will find a brief description of each scale and a commentary to understand the scope and its application. References and address for correspondence are also supplied.

The authors are to be commended for the achievement of getting an appropriated balance between being comprehensive yet practical and concise. This volume is bound to become a useful resource to health professionals devoted both to care and research in this field. Therefore it should have a wider readership. Among them psychiatric, geriatric and family medicine residents, nursing and social workers teams will definitely find it of value to be aware of the range of measures available. So research projects and care protocols and clinical audits will be enriched by this manual. A caveat is that an inquiry about non-english validations, if any, of existing instruments is mandatory before trying to use them.

Dr. Ricardo Campos, MD, PhD
Associate Professor Department of Psychiatry
University of Zaragoza

TEXTBOOK OF PSYCHOSOMATIC MEDICINE

Levenson J.L.
Editor The American Psychiatric Publishing: Washington,
1092 pages, 2005 ISBN: 1-58562-127-7

This is the new, official textbook of the American Academy of Psychosomatic Medicine. It is a scholarly and comprehensive textbook which brings together the body of knowledge of what in Europe is called Liaison Psychiatry, or Consultation-Liaison Psychiatry. The book coincides with the formal approval of the discipline as a psychiatric subspecialty, with the new name of Psychosomatic Medicine, by the American Board of Medical Specialties.

Whatever the name of the discipline is, clinical practitioners in this field work fundamentally in hospital-based psychosomatic or consultation-liaison services, but also in settings such as mental health services integrated into Primary Care. These clinicians must be prepared to work in some unusual settings, and to provide advice on how to deal with patients that almost never have asked for our help. They are expected to have particular expertise in the diagnosis and treatment of unusual psychiatric disorders and in complex medically ill patients. This book demonstrates the increasing need for sub-specialization that the liaison expert requires; the acceleration of advances in the field, which has been growing rapidly in the past decade; the expanding research base of the discipline; and the difficulties to keep abreast of the latest advances.

The book covers all the major topics regarding the care of medical patients with co-morbid psychiatric disorders, and is organized into four sections. The first one deals with General Principles in Evaluation and Management. It includes an important chapter on psychological responses to illness, written by authors who were able to combine classical observations and very considerable personal experience in our field to clearly categorize a wide range of responses in a convincing way. The chapters on legal and ethical issues are justified by the frequent involvement of general hospital psychiatrists in related non clinical problems. While both chapters include specific American aspects, most issues reviewed are applicable in international settings, including European countries.

The second section relates to Symptoms and Disorders. Adequate coverage is given to the most frequent disturbances seen by European liaison psychiatrists, according to empirical data reported by the ECLW: organic disorders; substance abuse related disorders; major depression and anxiety disorders; adjustment disorders; and somatization. A comprehensive and up-to-date review of the complexity of each major psychiatric disorder, specifically in medical patients is presented. Concepts are reviewed, as well as epidemiological data; clinical features; diagnosis and assessment; differential diagnosis; management; and treatment. Furthermore, the effect of psychiatric disorder on the medical disorders and, conversely, the effect of medical diseases to produce psychopathological problems is also discussed. The reviews on both delirium and dementia are thorough. There are also specific chapters on important subjects, such as suicide or deception syndromes; and chapters on disturbances which are not so frequently referred to the liaison psychiatrist, but nevertheless are clinically relevant, such as non-organic psychoses, eating, sleep or sexual disorders seen in medical patients.

The third section deals with medical Specialties and Subspecialties. Psychiatric aspects of diseases of heart, lung, gastrointestinal systems, etc. are reviewed in specific chapters, as well as aspects related to disciplines such as physical medicine and rehabilitation, which deserve more attention than they often receive in some texts. Very important chapters are dedicated to renal diseases, oncology, HIV/AIDS, organ transplantation and pain. Similarly, the often frustrating issue of chronic fatigue and fibromyalgia is reviewed in a thorough chapter. Field specific issues receive considerable attention, such as the role that emotional factors may play at various phases in the course of specific diseases and the possible psychophysiological mechanisms implicated or, conversely, the psychiatric effects which can arise as a result of some conditions; the relationship of behaviour (compliance) to disease control; or treatment issues, including the possible protective effect of antidepressants in some medical diseases. Useful tables of diagnostic criteria and differential diagnosis in medical patients are included in several chapters; and the clinician will find up-to-date knowledge required to assist the patients at each stage.

The fourth and last part in the textbook relates to Treatment issues. The standard psychothropic treatments in a wide range of psychiatric problems among medical patients are critically reviewed, and include relevant principles of pharmacokinetics in the medically ill. The psychiatric side effects and drug-drug interactions receive important emphasis, and very useful tables are incorporated, such as the tables related to P450 interactions. It is remarkable the section reviewing drugs that require particular monitoring in patients with renal and hepatic insufficiency. There is also information related to complementary medicine, including herbal compounds. The psychosocial treatments are thoroughly reviewed, but the need for well-designed, controlled studies in some specific disorders is adequately emphasized. The timing for the chapter on palliative care could not be better.

It seems clear that the book was intended "to capture the diversity of our field". Therefore, no unanimity should be expected in the 40 chapters, and in the approach of 96 contributors, which include a variety of the world's leading practitioners. However, the editor, assisted by renowned members in his Editorial Board, was able to organize the book into a cohesive whole. Most authors are American, as might be expected, but the number of authors from other countries is considerable, and the book should be useful in all countries.

It is apparent the effort to be comprehensive in this book. While most chapters relate to the most common disturbances and problems that liaison psychiatrists must confront in their clinical routine, others relate to disturbances such as eating or sleep disorders; or to treatment techniques such as electroconvulsive therapy which are not so commonly confronted. Still, the latter chapters also contain relevant and useful information specifically related to the field. This book provides convincing evidence of the importance of this branch of psychiatry, and defines the field for years to come. It is clearly written and easy to use, and the references are up to date and relevant. Therefore, it seems clear that the textbook will be an essential reference in this newest subspecialty of psychiatry. It will be a valuable resource for providers covering for patients with serious co-morbid medical and psychiatric illnesses, certainly for liaison psychiatrists, but also for other physicians, health psychologists, nurse clinical specialists, and medical social workers.

Dr. Ricardo Campos MD PhD
Associate Professor, Dept. of Psychiatry,
University of Zaragoza