Abstract
This is an excellent book. It brings to attention, as its title suggests, a number of psychiatric syndromes, some of which will be seen at least once, and probably more often, in the space of a few years of clinical practice by most psychiatrists.
A masterly chapter by Ellis on the group of misidentification syndromes sets the tone of the book. These curious syndromes were once thought of as rare; however, Capgras” syndrome (in which the patient believes that those well known to him are actually doubles) may be seen in several types of psychosis, usually schizophrenia, albeit briefly in some.
Paranoia and delusional disorder are considered in detail by Munro. He develops these themes further in a later chapter on paraphrenia with a schema suggesting a spectrum of paranoia. This moves from the paranoid personality through delusional disorder and paraphrenia to paranoid schizophrenia. His argument is developed with precision, logic and excellent references.
Ungvari and Mullen astutely handle the problems of reactive psychosis. Here, the earlier German and Scandinavian literature (on psychogenic and cycloid psychoses) is carefully examined. Modern work and reference to DSM-IVare made and demographic, biological and treatment aspects are clearly enunciated.
“Disorders of passion”by Mullen is the highlight of the book. It presents in little over 30 pages of text an in-depth view of these distressing and at times quite dangerous syndromes. The presentation is enhanced by a number of clinical vignettes and sensible advice regarding management.
A well-constructed and enlightening chapter on pseudoseizures is presented by Trimble, who pleads that we should go “far beyond the simplistic view that all episodes reported of loss of consciousness are epileptic seizures and that all seizures represent epilepsy”.
The chapter on deliberate self-harm is disappointing. Over half of this is devoted to describing the setting up of a special unit for the management of such patients. However, it fails to offer any convincing evidence of long-term success, as “it is not possible to follow up many of these patients following discharge”. Also there is no mention of the important work of Dawson and MacMillan [1] which, by acknowledging the competence of such patients, fosters the development of accepting responsibility for their actions.
Various other syndromes rate chapters of their own. These include factitious disorders (the diagnosis of which often endangers a good clinical reputation), pseudodementia and recurrent brief depression. Other chapters on paraphilias, atypical and culture bound syndromes complete the book.
The book is obviously not encyclopaedic. For instance, it fails to mention the various catatonic presentations, the difficulties of diagnosing the prodromes of the psychoses or drug-induced states. Similarly, the syndromes that appear to have an organic basis, such as Tourette”s, are omitted. Nor is mention made of the early “psychiatric”presentations of a number of organic conditions such as Alzheimer”s, Huntington's or Lewy Body dementia to suggest a few.
“Troublesome disguises”does present a wide range of syndromes that are less frequently seen but which are important in clinical practice. The book is remarkably well written, organised and referenced.
It describes vividly the rich lode of clinical material that we, as psychiatrists, are offered. It behoves us to use this text diligently as we will be the wiser for it.