House Officer Series: Psychiatry, 6th Edition

Common sense tells us that when a book has reached its 6th edition, it means that it is popular with readers and probably prof itable to the publisher. This book is indeed very appealing to house off icers. The pocket size of the publi- cation makes it easy to carry around. It is written in simple English, making it easy to comprehend and very useful to house off icers, who have limited time in which to make decisions. In addition, much of the information contained is systematically arranged into easy to read tables and checklists.

The text also includes colourful photos of commonly used psychiatric drugs, which are very convenient for communication with patients who frequently cannot name their regular medication.

This book is a good introduction to the specialty, beginning as it does with psychiatric classif ication and assessment. Explanations of psychopathological terms are particularly helpful. The strength of this reference lies in its practical approach, giving actual details of ‘how to do it’ rather than general textbook statements. For example, very detailed, step-by-step guidelines are provided for the treatment of alcohol/opioid withdrawal. Communication skills as well as general points to note while working in the outpatient clinic are also provided. Although elementary, these practical pointers are often forgotten, even by experienced staff.

Two frequently confused mood disorders are clearly differentiated in this text — depressive disorder and bipolar affective disorder. The aetiology, risk factors, clinical course, and prognosis of both depressive disorder and bipolar affective disorder are clearly delineated. In other textbooks both disorders are frequently discussed simultaneously, leading to reader confusion. Distinct treatment approaches for different types of anxiety disorders are also suggested in this text, in contrast to most other textbooks where the same treatment solutions are offered for all types of anxiety disorders.

Several excellent chapters of this book are especially worth mentioning. The chapter entitled Grief and the Dying Patient is particularly useful for house off icers involved in consultation-liaison work. Similarly, the chapter on Suicidal and Assaultive Behaviours is highly recommended for Member of the Royal College of Psychiatr y Par t II candidates, for its assistance in answering patient management problems questions quickly and accurately. The chapter on Psychiatric Symptoms of Non-psychiatric Medications is another useful inclusion, which is frequently overlooked in other textbooks.

This text follows an evidence-based medicine approach, quoting the latest research advances in the f ield. For example, information on the latest brain pathology f indings in schizophrenia are outlined, as well as the genetic factors associated with Alzheimer’s disease, and the importance of carbohydrate-def icient transfer rin as a biolog ical marke r for alcoholism, to name a few. Psychopharmacology information included is also up-to- date. Fo r e xample, 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 key sentences from this book are worthy of retention:

“Patients (or their physicians) can often identify a precipitating 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 specif ic disorder”.

Illuminating examples ser ve to illustrate abstract terms. 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 greatly aid a house off icer’s understanding of psychiatric symptomatology.

Despite numerous merits, this book is not without weaknesses. Its major failing is that it reflects psychiatric practice in the USA, rather than usual practice in Hong Kong. The Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) classif ication is used throughout the book, instead of the International Classif ication of Diseases Tenth Revision (ICD-10), which is commonly used in Clinical Inform-ation System (Psychiatry) in Hong Kong, for example. This creates potential confusion for the house off icer who has to switch from DSM-IV to ICD-10 , w hile assimilating the knowledge offered in the book.

Pharmacotherapy practice also differs between the 2 countries — the recommendation for selective serotonin re-uptake inhibitors or newer antidepressants to be used as the initial treatment of choice for depression is at odds with clinical practice in Hong Kong, as is the recommended use of specif ic antipsychotic agents for the treatment of schizophrenia. The last chapter on legal issues is also not applicable to Hong Kong practice.

Surprisingly, child psychiatry is not included in this text. The only related disorder, attention def icit hyper- activity disorder, appears in the chapter on personality disorder, an inappropriate and confusing placement for this content. Other important topics omitted include postpar tum disorders, community psychiatr y, and psychodynamics and defence mechanisms. House off icers probably require more than 1 page of information on eating disorders.

The chapter on alcohol also appears inadequate for their needs, having no infor mation on the alcoholic content of common drinks, the method of calculating units of alcohol, or the recommended safe limit for alcohol in- take. The chapter on mental retardation is again too brief. Differences in the clinical presentation of the mentally retarded, as opposed to the general adult population, should have been highlighted. In addition, a high index of suspicion with respect to organic causes should have been emphasised. In my view, readers should also have been encouraged to think of behavioural therapy before pharmacotherapy when treating mentally retarded patients.

Despite attempts to include the latest advances, some newer drug therapies, surprisingly, are not mentioned — sildenaf il, for example, and donepezil, a safe drug with a modest effect in Alzheimer’s disease. House off icers should also be aware that tacrine has fallen out of favour, due to its hepatic side effects.

This book, although very popular with medical students, is not adequate for their examination preparation. For example, the predominant symptoms of schizophrenia are not mentioned. The book is therefore not suitable for use as a sole text for medical students but rather, should be used as a practical supplement to other more comprehensive textbooks such as the Oxford Textbook of Psychiatry.

All in all though, this text is an important addition to the long list of psychiatric textbooks currently in use in Hong Kong. It is highly recommended for house off icers and junior psychiatrists alike when a quick clinical reference is required.

Dr Karen Wat
Medical Officer
Department of Psychiatry
Kwai Chung Hospital
Hong Kong, China

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