Abstract
Pharmacotherapeutic treatment of psychiatric disorder has evolved dramatically since the introduction of the phenothiazines in the late 1950s. A part of this revolution has been the recognition that the benefits of psychopharmacology require a close consideration of the risks versus benefits for prescription in any given case and high levels of practitioner awareness about risk. The need for practitioner education in these issues appears to be stronger in psychiatry than other branches of medicine, given what at times appear to be high levels of public mistrust of psychotropic prescriptions. Every active practitioner will also be familiar with the growing level of public information available about psychotropics and their risks through variably reliable sources such as the Internet. Quality texts such as this one that aim to increase practitioner knowledge about adverse consequences of psychotropic prescriptions are thus potentially invaluable references for psychiatrists, registrars, general practitioners, and others involved in advising patients about use of psychotropics such as mental health nurses or pharmacists.
This publication provides a series of expert chapters focusing on specific areas of potential risk with psychotropics. The areas selected range from those that are currently topical such as the sections on antidepressant discontinuation syndromes and that on antidepressants and sexual dysfunction; areas that relate more to older but still widely use psychotropics such as the sections on extrapyramidal syndromes, neuroleptic malignant syndromes and the side-effects of lithium; and other chapters that looked at rare and serious events such as that examining the issue of torsades de point and sudden death. Each of the chapters represents a self-contained and generally very neatly expressed collection of expert knowledge about a specific side-effect syndrome. Each chapter contains a description of the relevant clinical features, pharmacological basis, differential diagnosis, management, risk factors and prevention of the relevant negative effect of drug treatment. While each chapter represents a relatively brief read for the very quick reference sometimes required in clinical practice, each chapter contains a convenient boxed summary at the end of the chapter outlining the main points.
One of the difficulties in the production of such a volume is that inevitably some areas escape attention. This may reflect changing patterns of relevance depending on the current trends in psychotropic prescription; for example the growing awareness of the issue of possible cerebrovascular risk with atypical antipsychotic prescription in elderly patients with dementia. Further, it may be impossible to predict which issues will become topical in a broad public way in advance. The most glaring omission in that respect from this volume relates to issues around the prescription of antidepressants to children and adolescents and the debated risk of emerging suicidal ideation. It is also arguable that by choosing to focus on certain specific adverse syndromes with psychiatric drugs these syndromes may be given a prominence relative to those issues not discussed. For example, focus on the adverse affects of lithium may add to a false impression about its safety or otherwise relative to other available mood stabilizers. For many clinicians an adequate analysis of risk versus benefit requires an analysis relative to the other compounds available for a specific indication. It is acknowledged, however, that to create a complete reference on all psychotropics side-effects and their relative frequency between all available compounds, would represent an impossibly exhaustive task!
The quality of material available within this volume is very high and, consistent with many publications from this publisher, easily readable. The information available should clearly complement the core working knowledge of any specialist practitioner in psychiatry and I would strongly commend this volume to registrars in psychiatry preparing for their examinations. This text would also prove to be an extremely useful reference for general practitioners, mental health nurses and pharmacists. The depth of knowledge contained within the text, for example, about the common side-effects of antipsychotic therapy would make it an extremely good reference to be found on the shelves of any community mental health clinic or private psychiatric clinic.
Malcolm Hopwood
Melbourne, Australia
© 2007 Malcolm Hopwood