Hong Kong J Psychiatry 2008;18:82

BOOK REVIEW

This is the latest in a series of psychiatric seminars published by the Royal College of Psychiatrists. The editors indicated clearly that the book was intended specifically for junior doctors. The new edition contains 31 chapters by 41 contributors and more than 800 pages of text. General adult psychiatry constitutes a major component of our specialist training. Seminars in General Adult Psychiatry provides a very comprehensive review of modern psychiatric diagnoses and treatment. It is an invaluable reference to our training and preparation for the MRCPsych examination.

The book is organised into 31 chapters that cover a broad range of issues from nosology to organic psychiatric disorder. Each chapter provides detailed clinical descriptions of both common and rare psychiatric disorders, and highlights important historical aspects, epidemiology, diagnosis and management issues. Case vignettes are employed to demonstrate the salient features of psychiatric disorders. By integrating at least 250 tables throughout the text, the book summarises the most important core information in a clear format.

The first 19 chapters cover all the common clinical problems, with a major emphasis on depression and schizophrenia. The remaining chapters cover the main subspecialties in general adult psychiatry, namely liaison psychiatry, neuropsychiatry, eating disorder, perinatal psychiatry, and psychosexual and medical aspects. As most trainees do not have chances to rotate through all these subspecialties, the materials presented provide a succinct and yet a reasonably in-depth overview of these topics.

Apart from providing factual information on psychiatric disorders, a commendable feature (not found in previous editions) was the sections on clinical guidelines. These tackle issues that include: ‘situations where admission is indicated’, ‘rationalization of treatment’, ‘antipsychotic drug interactions’, and ‘clinical features of tardive dyskinesias and akathisia’.

Another feature that makes it the best compendium for the membership examination is the organisation of the Index. The Index is meticulously thought-out and user- friendly, enabling readers to look up information very quickly, and highly relevant to the examination format of the UK MRCPsych transitions from PartI/II to Paper I/II and Paper III. From my personal experience in tackling MRCPsych Part I written papers (especially the MCQs), I could readily find the answers to questions in past papers.

Furthermore, the text is heavily referenced; more than 4000 peer-reviewed publications are cited. The NICE guideline is also conveniently incorporated into the relevant sections. Despite the breadth and depth of the materials presented, this book achieves a remarkable balance between the clinical information and the underlying scientific evidence, without overwhelming the reader with too many research details.

Compared to the previous edition published in 1998, this 2nd edition is now compacted into 1 volume, yet retains the most valuable part, namely: the background history of different psychiatric diagnostic and nosological concepts. These historical aspects are the foundation of our field, yet are often under-emphasised in modern psychiatric training. The new chapters cover: liaison psychiatry, clinical epidemiology, psychosexual medication, and international and cultural psychiatry.

I particularly want to highlight a few of the chapters, which are very impressive. Chapter 12 on ‘Schizophrenia: psychological and social approaches to treatment and care’, written by Frank Holloway and George Stein is inspiring. It takes a different perspective on the bio-psychosocial model of schizophrenia; based on the cognitive model, the authors detail the rationale for different types of psychotherapy and the evidence-based effectiveness of each type of intervention. It also looks at the role of early interventions for psychosis and an in-depth discussion of the psychosocial management of schizophrenia. The latter offers a new horizon to junior trainees and convincingly argues that medication is not the sole answer to schizophrenia management. Chapter 29 on ‘Mental health service’ provides a thorough contextual background of the Mental Health System in the UK, the role of non-government organisation as well as a succinct description of the Mental Health Acts in the UK. It is particularly important in stressing that clinical psychiatric problems should be approached and managed with reference to the context where they occur. Appraisal of the Mental Health System, Service Organization and the Legal System of the local context are prerequisites for a specialist qualification in psychiatry. Non-UK trainees have difficulties understanding patient problems in the right context, when they prepare for clinical examinations in the UK.

This new edition of Seminars in General Adult Psychiatry is a book specifically tailored for specialist training in psychiatry, and guarantees its readers a solid foundation in psychiatry. It is also a great companion for the career development of all trainees.

Dr SC Chan, MBChB
Department of Psychiatry Tai Po Hospital
Tai Po
Hong Kong, China