Hong Kong J Psychiatry 2005;15:63-64


Clinical Handbook of Psychotropic Drugs

Editors: Kalyna Z Bezchlibnyk-Butler, J Joel Jeffries
Hogrefe & Huber, Cambridge, 2004
US$59.95; pp344; ISBN: 0-88937-293-4

pdf Full Paper in PDF

The Clinical Handbook of Psychotropic Drugs is a resource book that offers guidance on the use of psychotropic medication. It is more than a psychotropic drug directory as it covers the basic pharmacology of individual drug groups that helps one to understand the effect and side-effect profiles of psychotropic drugs, as well as their interactions with other medications. The book lists the published litera- ture pertaining to the drugs, including basic science data, controlled clinical trials, and case reports, as well as noting clinical experience to provide concise but comprehensive information on the evidence for indications and effective- ness of these agents.

The approach of the book is practical. The chapters are organised according to the clinical application of the medication — antidepressants, antipsychotics, agents for treating extrapyramidal side effects, anxiolytic agents, hypnotics/sedatives, mood stabilisers, drugs for attention deficit hyperactivity disorder (ADHD), drugs of abuse, drugs for treatment of substance use disorder, and antidementia agents. Charts and tables are used to make the information easily accessible by clinicians. The charts are used to list the drug interactions in each chapter, to show the drug’s effects on neurotransmitters/receptors, and to compare the side-effect profiles between psychotropics within a group, for example atypical neuroleptics and newer antidepressants. This information helps clinicians to map the use of a psycho- tropic agent for an individual patient according to his/her clinical presentation, for example employing an atypical agent with 5-hydroxytryptamine 1 blockade may be more effective for reducing depression, anxiety, or aggressive symptoms in a psychotic patient. On the other hand, the book also provides precautions for consideration before the drug is used in different groups of patients according to their age and sex. Remedies are suggested to manage toxicity by overdose and to relieve the side effects caused by a psycho- tropic medication, for example, use of sodium chloride to help reduce orthostatic hypotension caused by trazodone. There are also comments that remind readers of the approach for stopping treatment with psychotropic medication to minimise the withdrawal symptoms.

The chapter on antidepressants is most extensive, espe- cially for newest antidepressants where individual sections cover selective serotonin reuptake inhibitors, norepinephrine dopamine reuptake inhibitors, selective serotonin norepineph- rine reuptake inhibitors, serotonin-2 antagonists/reuptake inhibitors, and noradrenergic/specific serotoninergic anti- depressants. This enables clinicians to obtain information on the pharmacological properties of these newer types of antidepressants, which may appear confusing, especially for a non-psychiatrist. The table on the frequency of adverse reaction compares the percentage of different side effects for more than 20 older and newer antidepressants. This appeals to me, as individual differences in the side effect profile, albeit small, is a determining factor for choosing a drug for an elderly patient. There is a section that describes the clinical efficacy of different antidepressant augmen- tation strategies, which aids the management of more resistant patients.

Unlike the chapter for antidepressants, the chapter for antipsychotics describes the indications and application of all atypical antipsychotic medications in one section, while the individual differences in pharmacology and side effects are shown in charts and tables.

Three chapters are offered to outline the use of electro- convulsive therapy, bright light therapy, and repetitive transcranial magnetic stimulation. The reasons for includ- ing them in a psychotropic handbook are obscure. It may be because they are often used in conjunction with psychotro- pic medications for the management of mental illness. This part includes a section that plots the interaction of psycho- tropic drugs with physical treatment, for which information may not be otherwise available in a textbook.

There is an interesting chapter that describes some newly emerged and yet unapproved treatment for psychiatric disorders. Based on biochemical theories of the aetiology of specific psychiatric disorders, these drugs tmay help to ameliorate the neurotransmitter imbalance that underlies the disorders. These include hormonal treatment/steroid biosyn- thesis inhibitors for depression, serotonin antagonists for schizophrenia and adrenergic agents for ADHD. The au- thors advise that this unapproved treatment should only be prescribed for patients who are highly resistant to conven- tional therapies.

The last part of the book provides patient information sheets on the use of different drug categories. Although they may not be directly applicable for Chinese patients, these sheets provide a useful framework for the education and counselling for Chinese patients. The sheets inform about what symptoms will be helped by the medication and how quickly it will start working, how long the drug should be taken, what drugs are available, the side effects, and how to manage the side effects. They also provide reminders of the precautions that a patient should take while he/she is on medication.

To conclude, this handbook equips a clinician with the most important and updated information on drug treatment for psychiatric illness. There is a separate handbook written for children and adolescents from the same publisher. It is worthwhile to keep a copy on your desktop. However, it would be even better and more user-friendly if this drug information was available for downloading to a handheld device as the volume of the book precludes it being carried during daily clinical work.

Dr Vivian Leung Pui Yiu
Psychiatric Department
Shatin Hosptial
Hong Kong, China

View My Stats