Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry, 3rd Edition

As the authors emphasise, the Pocket Handbook of Clinical Psychiatry is not meant to be a substitute for a major textbook of psychiatry. Rather, it aims to serve as an easily accessible guide for medical students, psychiatric residents, and psychiatrists to consult in their clinical work. Thus, one would expect features to suit this purpose, being brief, concise, clinically oriented, and convenient to use. Is it so?

The book is written in note form with clear headings and points. Useful information and clinical tips are tabulated for easy reference. There are 28 chapters. The first 3 chapters are general introductions covering history taking, mental state examination, psychopathology, and classif ication of mental disorders. Mental phenomena that relate to signs and symptoms are listed in alphabetical order followed by their def initions. The list is by no means complete but is comprehensive enough for a quick reference, which will inevitably be most welcomed by medical students who like to recite definitions without necessarily understanding what they really mean. The part on clinical assessment does highlight important features and summarises them in tables, which are abundantly utilised in other parts of the handbook as well. Of particular interest is a table summarising special interview situations, such as ‘seductive patients’, ‘patients who lie’, and ‘patients from different cultures and backgrounds’, which may alert novices and offer them advice on how to deal with the situation.

The other chapters are mainly arranged according to diagnostic categories in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Concise summaries covering essential aspects of aetiology, epidemiology, clinical features, and treatment for a range of psychiatric disorders are given. They include delirium, dementia, mental disorders due to a general medical condition, alcohol-related and substance-related disorders, schizophrenia and other psychotic disorders, mood disorders, anxiety disorders, somatoform and factitious disorders, dissociative disorders, sexual dysfunction and paraphilias, eating disorders, sleep disorders, impulse-control disorders, and personality disorders. Information is given in the following format: def inition, epidemiology, aetiology, diagnosis, signs and symptoms, laboratory tests, differential diagnosis, course and prognosis, and treatment. Everything is mentioned briefly but concisely. It is assumed that the readers have already understood the concepts and the terms are simply reminders. Otherwise, referral should be made to the parent text Comprehensive Textbook of Psychiatry edited by the same authors.

There are also overviews of management, including psychotherapy, psychopharmacology, laboratory tests, and brain imaging. The chapter on psychopharmacology is especially wor th mentioning, as it includes updated information on new antidepressants, new antipsychotics/ serotonin-dopamine antagonists, and the cholinesterase inhibitors. Not only are the pharmacological actions, side effects, drug interactions, and clinical guidelines provided but one can also ‘see’ the drugs as there is a 5-page guide containing colour reproductions of commonly prescribed psychotherapeutic drugs. There is a separate chapter on medication-induced movement disorders, which covers neuroleptic-induced parkinsonism, acute dystonia, acute akathisia, tardive dyskinesia, neuroleptic malignant syndrome, and postural tremor. Each disorder is described in detail and the Abnormal Involuntary Movement Scale examination procedure is also included, which may help to remind medical students and trainees who often overlook these common side effects.

There are also several chapters covering different subspecialties such as child and adolescent psychiatry, geriatric psychiatry, psychosomatic medicine, and forensic aspects of psychiatry. This arrangement, however, causes considerable overlap within the chapters and may be the biggest drawback to the book. For instance, there is a chapter on delirium, dementia, and other cognitive disorders, classified in the diagnostic category, but information on dementia is also given in the chapter on geriatric psychiatry. Another example is that there is a chapter on psychosomatic medicine/consultation liaison psychiatry but relevant aspects are only highlighted in the chapter. The details are scattered throughout the other parts of the book. If one looks at the table summarising the common consultation-liaison problems, one will f ind ‘suicide attempt or threat’, ‘disorientation’, and ‘non-compliance or refusal to consent to procedure’, but the details of how to deal with these problems are found in different chapters. The assessment and management of suicidal patients are found in the chapter on suicide, and violent and other psychiatric emergencies. Delirium is described in detail in the chapter on delirium, dementia, and cognitive disorders. Issues on consent are discussed in the chapter on legal and ethical issues. As a pocket reference, this layout may cause considerable confusion. The commonest way of using a handbook is to look for a subject in the index, but this handbook is not particularly user-friendly as some of the relevant pages are not shown under a particular subject in the index. For instance, when looking for ‘vascular dementia’ only the page numbers on vascular dementia in the elderly are shown and the general information for vascular dementia in the other chapters is not indexed. This means that unless one is familiar with the layout of the handbook as a whole, one is unlikely to get all the information that is provided for a particular topic.

To answer the initial question of whether this handbook serves its purpose, we can thus conclude that it satisfies 3 of the 4 features – concise, brief, and clinically oriented. However, as a pocket reference, it lacks the convenience and seems to be more of an abridged version of the Comprehensive Textbook of Psychiatry edited by the same authors. Despite the authors’ emphasis that this is not a textbook, it has to be read thoroughly as a textbook before one can use it as a day-to-day clinical guide. Indeed, the authors never forget to remind the readers to look up the more detailed discussion in the full textbook by giving the cross-reference page numbers. For medical students or junior trainees, this handbook may be useful for revision for examinations and is not too overwhelming.

Dr Irene Kam
Department of Psychiatry
Prince of Wales Hospital Shatin
Hong Kong
China

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