Hong Kong J Psychiatry 2001;11(3):23-27 Book Reviews

Kaplan & Sadocks Comprehensive Textbook of Psychiatry, 7th Edition

It has been more than 3 decades since the first publication of the Comprehensive Textbook of Psychiatry in 1967. Over the years, more than 1500 behavioural scientists and psychiatrists have contributed to the subsequent editions of this book. This new edition contains 3334 pages in 2 large volumes, posing a challenge for anyone wishing to read the text in its entirety. The aim of this review is therefore to highlight important features of this book as a quick reference for busy readers. This new edition follows the framework of previous editions but has been expanded significantly it is 15% larger than the 6th edition and 60% of the contributors are new. Moreover, there are major additions to chapters covering neurosciences, neuropsychiatry, and behavioural neurology in volume 1, including developmental neurobiology, neurotrophic factors, and the use of radiotracers and magnetic resonance imaging. Neuropsychiatric aspects of neuromuscular diseases, traumatic brain injury, and brain tumours are also discussed, and there is a section on psychiatric aspects of child neurology. Important new sections have also been added on genetic linkage analysis of psychiatric disorders, and neuropsychiatric aspects of HIV and AIDS. This edition is printed in soft-tone and delightful colour. The text is organised under clear and logical subheadings. The highly informative illustrations and tabulations have made diff icult concepts easy to comprehend. Clinical materials are largely syndromeoriented, based on the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) classification with references to International Classification of Diseases Tenth Revision (ICD-10) from time to time. Other particularly commendable features of the book are the cross-references given at the end of each subsection with the 6 most important references highlighted, as well as the inclusion of many psychiatric rating scales, which researchers will find extremely useful. The text opens with in-depth chapters on basic neurosciences, psychology, and sociology, which will be, particularly useful for Member of the Royal College of Psychiatry Part II examination candidates. Following these are chapters on bread and butter clinical psychiatry. Chapter 7 describes the examination of psychiatric patients, encompassing the psychiatric interview, history taking, mental status assessment, the psychiatric report, and typical signs and symptoms of psychiatric illnesses. Subsequent sections on personality and neuropsychological assessments

for children and adults will be of great relevance to researchers. Supplementing standard sections on medical assessment, laboratory testing, and psychiatric rating scales, there is a new section titled Computer-based Testing of the Psychiatric Patient. In the historical section, a fascinating chronology of famous psychiatric cases is given. With DSM-IV in use for some time, this editions Classification of Mental Disorders focuses more on nosological systems and the theory of classification than did the 6th edition. The chapters on Schizophrenia and Other Psychotic Disorders provide up-to-date clinical information, while the chapter on Mood Disorders has been expanded to include psychotherapy and the treatment of bipolar and depressive disorders. The current chapter on Anxiety Disorder is greatly expanded, providing an introduction and overview, and subsections on epidemiology, biochemical aspects, genetics, psychodynamic aspects, clinical features, somatic treatment, and psychological treatments. Dissociative disorders are covered in 5 distinct sections in accordance with the DSM-IV clinical entities. While volume 1 deals with the more serious and common clinical problems, volume 2 covers topics at the interface between psychiatry and physical medicine. It starts with a comprehensive account of eating and sleep disorders, impulse control, adjustment, and personality disorders. In the chapter on Psychological Factors Affecting Medical Conditions, psychosomatic disorders are covered along with the topics of stress, behaviour and immunity, psychooncology, and consultation-liaison psychiatry. This chapter is relevant to both psychiatrists and physicians/surgeons making requests for consultation. Other clinical scenarios commonly encountered within the consultation-liaison service or the interface between primary and tertiary care are dealt with in detail in subsequent chapters, as follows: Chronic Pain and the Placebo Effect Physical and Sexual Abuse of Adults Alternative and Complementary Health Practices Nonprofessional Therapies, Quacks, and Cults Death, Dying, and Bereavement. There is also a section on psychiatric emergencies, including suicide. A comprehensive table outlining presenting symptoms, emergencies, and treatment issues supplements the full text. Although therapeutic issues are discussed alongside disorders throughout, there are a further 2 large sections
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Book Reviews

devoted to psychotherapies and biological therapies, which offer busy readers an up-to-date summary of clinical management in different modalities. The chapter on psychotherapies includes new sections on interpersonal psychotherapy, and Eriksonian clinical theory, while the large chapter on biological treatment reflects the many new pharmacological agents available during the past decade. A particularly useful inclusion is a summary table outlining the major mental disorders and their common pharmacotherapies. Medication-induced developmental disorder is discussed in a separate section, and there are also novel sections including one on combined psychotherapy and pharmacotherapy, which bridges the gap between these 2 major arms of management. The 18 chapters on child and adolescent psychiatry form the main bulk of volume 2 and span the standard syllabus of the subject, from infancy to late adolescence. New inclusions in this area include coverage of adult manifestations of attention deficit hyperactivity disorder, and anxiety disorders in children. In addition, the chapter on the Psychiatric Examination of the Infant, Child, and Adolescent now has an Infant and Toddler Mental Status Exam, reflecting developments in the assessment of very young children. The chapter on Special Areas of Interest in Child Psychiatry discusses a wide range of issues day care, adoption, foster care, child maltreatment, childrens reaction to illness and hospitalisation, the sequelae of HIV and AIDS, antisocial behaviour, dissociative disorders, gender identity and sexual issues, identity problems and borderline disorders, adolescent substance abuse, forensic child and adolescent psychiatry, ethical issues in child and adolescent psychiatry, school consultation, community-based treatments, and psychiatric prevention. The revised chapter on geriatric psychiatry has new sections on special issues in neuroimaging, health care delivery systems, and managed care. Long-term care as well as forensic, ethical, socio-cultural, minority, gender and

abuse, neglect, and exploitation issues are also addressed. Practical information for US-trained psychiatrists is given in a concise chapter entitled Psychiatric Education, which contains a new section on examining psychiatrists and trainees. A chapter on Ethics and Forensic Psychiatry deals with a range of relevant topics, including confidentiality, and boundary guidelines for psychotherapy, as well as matters such as physician-assisted suicide, and the insanity defence. The book concludes with a chapter on Psychiatry: Past and Future that includes a new section on world aspects of psychiatry. It may seem unreasonable to find fault with the content and format of this book, which has served as an outstanding psychiatric encyclopaedia and textbook for decades. However, it is worth noting that there are still gaps to be bridged by the next edition. For instance, psychiatric care in correctional facilities is omitted despite the large mental illness caseload in prisons worldwide. Moreover, within the section on Forensic Child and Adolescent Psychiatry, juvenile competency is inadequately addressed. Although this edition appropriately includes the Chinese classification of mental disorders, as well as the psychiatric and social problems of Chinese Americans, and epidemiological and mental health care data from China, this is covered in less than 30 pages in total. Hopefully by the time of the next edition, the current robust research undertaken in China on the nosology and epidemiology of psychiatric illnesses will be seen in a major expansion of this encyclopedia. This would serve to not only increase our material knowledge but also to deepen our insight into sociocultural aspects of psychiatry.

Dr Sandra Chan Assistant Professor Department of Psychiatry Chinese University of Hong Kong Hong Kong, China

Guide to Psychiatric Research

With the introduction of Part III of the Hong Kong College Fellowship Examination, undertaking research has become a basic requirement in order to qualify as a psychiatrist in Hong Kong. Yet, at this point in time, medical training does not adequately cover the fundamental concepts and techniques necessary for designing and conducting meaningful research. The availability of mentors with extensive research experience is also limited, requiring senior trainees to be more self-reliant with regards to research.
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Many psychiatric textbooks contain little information on research methodology. There are a few comprehensive information compendiums on research methodology but these are too detailed, in turn, for the beginner. In contrast, Guide to Psychiatric Research is written in simple English, is easy to read, and can be finished in a couple of hours, yet covers the necessary material. It presents concise information on how to refine a research idea into specific aims or hypotheses, select the right sample

Book Reviews

of subjects and controls, employ the correct instruments, and measure and analyse clinical and biological data, as well as how to write the research project, and deal with journal editors and funding bodies. To a beginner in research, the book serves as a step-by-step, cookbook guide to devising a research protocol and writing a dissertation, as well as a quick reference when problems arise. Consequently, I would highly recommend this book for inclusion in the libraries of psychiatric

hospitals and psychiatric units, as well as recommending it to any junior psychiatrist planning to embark on a research project. Dr WK Tang Assistant Professor Department of Psychiatry, The Chinese University of Hong Kong Hong Kong, China

House Officer Series: Psychiatry, 6th Edition

Common sense tells us that when a book has reached its 6th edition, it means that it is popular with readers and probably prof itable to the publisher. This book is indeed very appealing to house officers. The pocket size of the publication makes it easy to carry around. It is written in simple English, making it easy to comprehend and very useful to house officers, who have limited time in which to make decisions. In addition, much of the information contained is systematically arranged into easy to read tables and checklists. The text also includes colourful photos of commonly used psychiatric drugs, which are very convenient for communication with patients who frequently cannot name their regular medication. This book is a good introduction to the specialty, beginning as it does with psychiatric classification and assessment. Explanations of psychopathological terms are particularly helpful. The strength of this reference lies in its practical approach, giving actual details of how to do it rather than general textbook statements. For example, very detailed, step-by-step guidelines are provided for the treatment of alcohol/opioid withdrawal. Communication skills as well as general points to note while working in the outpatient clinic are also provided. Although elementary, these practical pointers are often forgotten, even by experienced staff. Two frequently confused mood disorders are clearly differentiated in this text depressive disorder and bipolar affective disorder. The aetiology, risk factors, clinical course, and prognosis of both depressive disorder and bipolar affective disorder are clearly delineated. In other textbooks both disorders are frequently discussed simultaneously, leading to reader confusion. Distinct treatment approaches for different types of anxiety disorders are also suggested in this text, in contrast to most other textbooks where the same treatment solutions are offered for all types of anxiety disorders.

Several excellent chapters of this book are especially worth mentioning. The chapter entitled Grief and the Dying Patient is particularly useful for house officers involved in consultation-liaison work. Similarly, the chapter on Suicidal and Assaultive Behaviours is highly recommended for Member of the Royal College of Psychiatry Part II candidates, for its assistance in answering patient management problems questions quickly and accurately. The chapter on Psychiatric Symptoms of Non-psychiatric Medications is another useful inclusion, which is frequently overlooked in other textbooks. This text follows an evidence-based medicine approach, quoting the latest research advances in the field. For example, information on the latest brain pathology findings in schizophrenia are outlined, as well as the genetic factors associated with Alzheimers disease, and the importance of carbohydrate-deficient transferrin as a biological marker for alcoholism, to name a few. Psychopharmacology information included is also up-todate. For example, lamotrigine, gabapentin, and topiramate are mentioned for the treatment of bipolar affective disorder, naltrexone and acamprosate for the treatment of alcoholism, and levo-alpha-acetylmethadol and buprenorphine for the treatment of opioid dependence. Some key sentences from this book are worthy of retention: Patients (or their physicians) can often identify a precipitating event for even the most organic of psychiatric conditions do not be fooled. Delirium must clear before a diagnosis of dementia can be made. Psychosis describes a degree of severity, not a specific disorder. Illuminating examples serve to illustrate abstract terms. For instance, to daydream through a boring lecture yet end up with a complete set of notes without being
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Book Reviews

aware of having taken them is dissociation. These vivid descriptions greatly aid a house officers understanding of psychiatric symptomatology. Despite numerous merits, this book is not without weaknesses. Its major failing is that it reflects psychiatric practice in the USA, rather than usual practice in Hong Kong. The Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) classification is used throughout the book, instead of the International Classification of Diseases Tenth Revision (ICD-10), which is commonly used in Clinical Inform-ation System (Psychiatry) in Hong Kong, for example. This creates potential confusion for the house officer who has to switch from DSM-IV to ICD-10, while assimilating the knowledge offered in the book. Pharmacotherapy practice also differs between the 2 countries the recommendation for selective serotonin re-uptake inhibitors or newer antidepressants to be used as the initial treatment of choice for depression is at odds with clinical practice in Hong Kong, as is the recommended use of specific antipsychotic agents for the treatment of schizophrenia. The last chapter on legal issues is also not applicable to Hong Kong practice. Surprisingly, child psychiatry is not included in this text. The only related disorder, attention deficit hyperactivity disorder, appears in the chapter on personality disorder, an inappropriate and confusing placement for this content. Other important topics omitted include postpartum disorders, community psychiatry, and psychodynamics and defence mechanisms. House officers probably require more than 1 page of information on eating disorders. The chapter on alcohol also appears inadequate for their needs, having no information on the alcoholic

content of common drinks, the method of calculating units of alcohol, or the recommended safe limit for alcohol intake. The chapter on mental retardation is again too brief. Differences in the clinical presentation of the mentally retarded, as opposed to the general adult population, should have been highlighted. In addition, a high index of suspicion with respect to organic causes should have been emphasised. In my view, readers should also have been encouraged to think of behavioural therapy before pharmacotherapy when treating mentally retarded patients. Despite attempts to include the latest advances, some newer drug therapies, surprisingly, are not mentioned sildenafil, for example, and donepezil, a safe drug with a modest effect in Alzheimers disease. House officers should also be aware that tacrine has fallen out of favour, due to its hepatic side effects. This book, although very popular with medical students, is not adequate for their examination preparation. For example, the predominant symptoms of schizophrenia are not mentioned. The book is therefore not suitable for use as a sole text for medical students but rather, should be used as a practical supplement to other more comprehensive textbooks such as the Oxford Textbook of Psychiatry. All in all though, this text is an important addition to the long list of psychiatric textbooks currently in use in Hong Kong. It is highly recommended for house officers and junior psychiatrists alike when a quick clinical reference is required. Dr Karen Wat Medical Officer Department of Psychiatry Kwai Chung Hospital Hong Kong, China

Understanding Psychiatric Treatment: Therapy for Serious Mental Health Disorder in Adults
Editors: Gerald OMahony, James V Lucey. John Wiley & Sons, Inc., New York, USA, 1998; 1st edition. US$70; pp 151; ISBN: 0-471-97570-2.

The essence of this book can be ascertained from this excerpt from the preface:This book originated from case discussions in the Department of Psychological Medicine, St. Bartholomews Hospital, London. It is about therapy. It is not a textbook of psychiatry. We have drawn together a group of contributors to set out brief, accessible accounts of a variety of common treatments. Not every treatment in psychiatry is described. Neither do we attempt to prescribe the management of specific conditions. Instead, we have
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asked contributors to describe the essentials of the most widely applied methods in clinical practice. The end-product of these accounts is a text, however, that is not in-depth enough for veterans, and also, unfortunately, not systematic and explanatory enough for beginners. Following an introductory chapter on treatment planning, specific areas are featured, including psychoanalytical thinking, group therapy, social and community psychiatry,

Book Reviews

behavioural and cognitive therapy, electroconvulsive therapy, physical treatments for depression, prophylaxis for affective disorders, and antipsychotic therapy. Overall the book is useful as a general textbook, but it does not offer a great deal more than other general textbooks currently available. Lastly, there are a number of printing errors which detract from this publication notably, the substitution of the heading Social and Community Psychotherapy in place

of Social and Community Psychiatry throughout chapter 4, as well as incorrect drawings for the structures of the compounds desipramine and nortriptyline. Dr HK Cheung Chief of Service Castle Peak Hospital Hong Kong, China

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