Abstract
The second volume of selected papers from advances in psychiatric treatment, affective and non-psychotic disorders, seems targeted at general psychiatrists like myself. It comprises a selection of reviews and articles focusing on practical issues relating to the management of affective disorders in a variety of contexts. It also covers the cognitive–behavioural and brief dynamic psychotherapies. There are a smattering of articles relating to the challenging problems posed by obsessive–compulsive disorder, personality disorder, alcohol abuse, trauma and anorexia and bulimia nervosa.
I particularly appreciated the candour of some of the authors regarding the limitations of the knowledge base of the ‘average’ general adult psychiatrist. For example, Moorey, in his chapter on cognitive–behavioural therapy notes that ‘relatively few psychiatrists are trained in cognitive behavioural techniques’. He then provides a succinct and helpful description of the applications and limitations of cognitive–behavioural therapy in a broad variety of conditions. Then he outlines a clinically useful and lucid description of the essential elements of treatment. Similarly, Norten, in his chapter on the management of patients with personality disorder describes the possible adverse effects of the personal interaction between psychiatrist and patient and how this contributes tothe ‘complexity of the case’. He then addresses what he sees as a frequent problem – the psychiatrist's overestimation of engagement of the patient with personality disorder in therapy and subsequently notes the patient's difficulty performing the patient role – ‘here I am! I have done my bit turning up. Now it's over to you. What are you going to do about it?’
There are also articles relating to preventative psychiatry which may be of particular interest to trainees preparing for consultancy vivas. In fact, I think the whole volume would be of relevance to ‘part 1’ candidates.
It contains concise reviews of a variety of subjects including electroconvulsive therapy, treatment-resistant depression, antidepressant medications and lithium. There is also a particularly useful critique of meta-analysis of antidepressant medication and meta-analyses in general. I appreciated the interesting review of the literature relating to the prevention of recurrence of depression comparing newer and older antidepressants. In this chapter, Edwards concludes ‘the benefits of newer over older antidepressants may not be as clearly defined or as large as some believe’.
The review of brief dynamic psychotherapyrekindled ‘Malan's triangles’ in my mind. The chapter on therapy for obsessive–compulsive disorder outlined management principles for the condition but also comments on the limitations of therapy for obsessive–compulsive disorder. An interesting chapter on posttraumatic stress disorder clarified current terminology, risk factors and possible models of psychopathology.
In fact all the chapters in this volume held some interest for me in my practice of adult general psychiatry. I also appreciated that the chapters are generally short and provide compact descriptions of complex issues, yet do not read with the ‘telegraphic’ style common with condensed review articles.
I would thoroughly endorse this volume to trainees and to psychiatrists in general. The cost is reasonable compared with regular journal subscriptions. The whole volume is digestible in 5–6 h. As a result of reviewing this book I am curious to obtain a copy of its comp anion volume on psychotic disorders.