Abstract
Sound preparation for a specialty examination in psychiatry requires broad clinical experience under competent supervision, a systematic building of content knowledge, and familiarity with the examination instruments. The Royal College of Psychiatrists assists candidates for the Membership examination by publishing books in the College Seminar Series, some of which address subspecialty content, and others that address examination format. The clinical texts are written to the brief of ‘all the College requires the trainee to know about a subspecialty, and a little bit more’. In this regard the Royal College of Psychiatrists sets an example for our own College.
The challenges of producing such a text are to maintain the currency of information, convey the level of uncertainty around knowledge without becoming tedious, fairly represent differing points of view when there is controversy, and stimulate critical thinking in the reader. If these challenges are not met there is a risk the text will simply perpetuate dogma. Fortunately, the contributors to the second edition of Seminars in child and adolescent psychiatry have done an admirable job of meeting the aforementioned challenges. There are stimulating chapters on the continuities and discontinuities of mental disorder from childhood to adult life, and the biological and psychosocial factors that may contribute to the onset of disorder. The authors distinguish association from causality, and speculate about mechanisms. Other topics important to the background to child and adolescent psychiatry are covered in chapters about development, classification, epidemiology, and legal considerations. The chapter covering normal development and developmental theories was the only disappointment, because it is pitched at a level more appropriate to undergraduate students.
The chapter on assessment helpfully acknowledged that not all child psychiatric interviews can be conducted over several hours in the luxury of child-friendly surroundings. Adaptation to the limitations of the setting are a reality of modern practice. Boxed material is used very effectively to summarize the main components of the clinical interview. Common child psychiatric disorders and their treatment are covered competently in a series of chapters. Learning disorders, substance abuse and disorders of parenting are given better coverage than in most comparable texts. Seminars in child and adolescent psychiatry was published just after the UK Committee for Safety of Medicines published warnings against the use of antidepressant medication for depression in young people. The author of the chapter on depression handled this issue as well as could be expected in uncertain times, and gave the reader useful leads to follow such as the impending publication of the National Institute for Clinical Excellence Depression in Children Guideline.
The last third of Seminars in child and adolescent psychiatry is devoted to service delivery in various settings. The reader will find in these chapters sage advice that may not assist with exam preparation, but could be invaluable to professional survival. For example, on the topic of unsuccessful treatment: … there is a tendency … to view the death of an adolescent with anorexia nervosa or the suicide of an emotionally disturbed young person as a professional failure and always preventable. In contrast, the same burden of expectation is neither placed upon nor accepted by physicians and surgeons. They will usually view bad outcomes as the consequence of an illness process rather than a reflection of their inadequacies … the myth that every psychological problem has a solution, if only the therapist were good enough, requires challenging.
As expected of a British text, the orientation is towards the ICD rather than the DSM. This is a strength rather than a weakness, because there is none of the slavish adherence to symptom criteria that one would find in a comparable text from the USA. Some health and welfare agencies found in the UK do not readily translate to the Australian and New Zealand context, which could be confusing to readers. Nevertheless, Seminars in child and adolescent psychiatry is an excellent resource for candidates preparing for the RANZCP Fellowship examinations, and a starting point for people entering advanced training in child and adolescent psychiatry. The text usefully bridges the gap between primers, such as Goodman and Scott's Child psychiatry, and comprehensive texts such as Rutter, Taylor and Hersov's Child and adolescent psychiatry.
Philip Hazell
Sydney, Australia
© 2007 Philip Hazell