House Officer Series: Psychiatry, 6th Edition

Common sense tells us that when a book reaches its sixth edition, it means that it has been popular with readers and is probably profitable to the publisher. This book is in fact very appealing to house officers. The pocket size makes it easy to carry around. It is written in simple English, with short sentences, making it easy to understand and helpful for doctors who have limited time to make quick decisions. The information is systematically arranged into easily readable tables and checklists. It also has colourful photos of commonly used psychiatric drugs, aiding communication with patients who often do not know the name of their tablets.

This book offers a good introduction to the specialty by starting with psychiatric classification and assessment. Explanations of psychopathological terms are particularly enlightening. The strongest point of this volume lies in its practicality, giving details on ‘how to do it’ rather than general textbook statements. For example, very detailed and step-by-step guidelines are provided for the treatment of alcohol/opioid withdrawal, just like a handy cookbook for the uninitiated. Communication skills and general points to note in the outpatient clinic are also given, which are practical tips based on common sense, yet so often forgotten even by experienced staff. Two frequently confusing topics are also neatly presented. For mood disorders, the different aetiology, risk factors, clinical course, and prognosis of depressive disorder and bipolar affective disorder are clearly distinguished, unlike other textbooks where both disorders are discussed simultaneously leading to confusion. Distinct treatment approaches are suggested for different types of anxiety disorders, again unlike most other textbooks where the same treatment solutions are offered for all types of anxiety disorders.

Some excellent chapters are especially worth mentioning. The “Grief and the dying patient” chapter is useful to house officers involved in consultation liaison work. The chapter on “Suicidal and assaultive behaviors” is also highly recom- mended for candidates taking Part II examinations as it is helpful in answering questions in a quick and accurate way. The chapter on “Psychiatric symptoms of non-psychiatric medications” is another area usually neglected by other textbooks, and often appears simply in the form of a table in small print.

With the advent of evidence-based medicine, this book also quotes useful references for the latest advances in the field. For example, it provides information on the latest brain pathology findings in schizophrenia, updated genetics of Alzheimer’s disease, and the importance of carbohydrate- deficient transferrin as a biological marker for alcoholism, just to name a few. Psychopharmacology is also up-to-date: lamotrigine, gabapentin, and topiramate are mentioned for the treatment of bipolar affective disorder; naltrexone and acamprosate for the treatment of alcoholism; and levo-alpha- acetylmethadol and buprenorphine for the treatment of opioid dependence.

Some inspiring sentences from this book are worth remembering:

“Patients (or their physicians) can often identify a pre- cipitating event for even the most organic of psychiatric conditions – do not be fooled”
“Delirium must clear before a diagnosis of dementia can be made”
“Psychosis describes a degree of severity, not a specific disorder”.

Illuminating examples illustrate abstract ter ms. For instance, “to daydream through a boring lecture yet end up with a complete set of notes without being aware of having taken them” is dissociation. These vivid descriptions are eye opening to house officers.

Despite its numerous merits, this book is not without weaknesses. Its ‘inborn error’ is that it is mainly used for psychiatric practice in the USA, which is not compatible with the usual practice in Hong Kong. Diagnostic and Statistical Manual of Mental Disorders (DSM) -IV is used throughout the book, rather than the International Classification of Diseases (ICD) -10 which is commonly used in Psychiatric Clinical Information System in Hong Kong, making it confusing for the house officer who has to switch from DSM-IV to ICD while assimilating the knowledge from the book. The recom- mendation for treatment of depression is to begin with a selective serotonin re-uptake inhibitor or newer antidepressant, and for treatment of schizophrenia, atypical antipsychotic drugs are the initial treatment of choice. This is not practical in Hong Kong. The last chapter on legal issues is also not applicable to the local scene.

Surprisingly, child psychiatry is not mentioned in this book. The only related disorder, attention-deficit hyperactivity disorder, is included in the chapter on Personality Disorder, which is inappropriate and confusing. Other important topics being missed out include postpartum disorders, community psychiatry, and psychodynamics and defence mechanisms. House officers are probably not satisfied with only one page of information on eating disorders. Neither would they be content with the chapter on alcohol, which brings no informa- tion on the alcoholic content of common drinks, the method of calculating units of alcohol, or the recommended safety limit of alcohol intake.

The chapter on mental retardation is also too brief. The differences in clinical presentation of the mentally retarded compared with the general population should be highlighted. A high index of suspicion for organic causes should also be emphasised. In my view, readers should also be encouraged to think of behavioural therapy before pharmacotherapy when treating mentally retarded patients.

Despite its attempts at including the latest advances, some new drugs were left out. Viagra is one of the hottest topics nowadays. Donepezil, a safe drug with modest effect on Alzheimer’s disease, should have been included. House officers should know that tacrine has fallen out of favour due to its hepatic side effects.

This book is very popular with medical students. However, medical students should be aware that ‘hot topics’ for examination might not be included. For example, first rank symptoms for schizophrenia are not mentioned. The favourite examination question of seven criteria for alcohol dependence syndrome is not included either. Those medical students who quote “anxiety, overconcern and overprotectedness” for high expressed emotions are bound to have a hard time with obsessive examiners. Therefore, this book should not be used as the sole text for medical students. Rather, it should be used as a practical supplement to other classical textbooks such as the Oxford Textbook of Psychiatry, which elaborates on theoretical issues.

All in all, this is a very important addition to the long list of psychiatric textbooks currently in use in Hong Kong. It is highly recommended for house officers and junior psychiatrists alike when they need a quick and easy-to-handle reference.

Dr Karen Wat
Medical Officer
Kwai Chung Hospital
3-15 Kwai Chung Hospital road
Kwai Chung
Hong Kong, China.

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