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The American Psychiatric Publishing Textbook of Clinical PsychiatryReview - The American Psychiatric Publishing Textbook of Clinical Psychiatry
Fourth Edition
by Robert Hales and Stuart Yudofsky (editors)
American Psychiatric Publishing, 2002
Review by Christian Perring, Ph.D.
Aug 27th 2003 (Volume 7, Issue 35)

In this new edition, there are significant changes from the third edition of The American Psychiatric Publishing Textbook of Clinical Psychiatry.  John A. Talbott is no longer a co-editor, and the word "clinical" has been added to the title.  The American Psychiatric Association's publishing arm has been changed from "Press" to "Publishing."  The editors explain in their preface that they wanted to maintain the book as one volume, but as the knowledge base of psychiatry has grown, so has the length of the chapters, so they had to eliminate some chapters and return the book to its original focus on clinical psychiatry.  The chapters in the third edition that were removed for the fourth edition were

·        The Neuroscientific Foundations of Psychiatry

·        Psychiatric Classification

·        Public Psychiatry and Prevention

·        Administrative Psychiatry

·        Psychiatric Education

·        Psychiatry and Primary Care

·        Managed Care and Psychiatry

·        Practice Guidelines in Psychiatry and a Psychiatric Practice Research Network

·        Clinical Neuropsychiatry

·        The Future of Psychiatry. 

A chapter on "Interpersonal Psychotherapy" was added, and in many chapters, the list of authors has expanded to include new junior authors to keep the details completely up to date.  Other authors have been dropped. 

The book is organized into four parts: Theoretical Foundations and Assessment (6 chapters), Psychiatric Disorders (17 chapters), Psychiatric Treatments (10 chapters) and Special Clinical Topics (7 chapters).  The book also comes with a CD-ROM containing a searchable text of DSM-IV-TR, the APA Practice Guidelines, the complete American Psychiatric Glossary, Seventh Edition, the Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry, and Opinions of the Ethics Committee on the Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry.

The Textbook of Clinical Psychiatry is a massive resource, that even with the elimination of chapters is 1734 pages long.  Much of it is written in technical language that will be somewhat inaccessible to lay readers.  But those with some background in psychology or medicine who are persistent will probably be able to understand much of the content. 

The Textbook is a large format heavy book that is only really suitable for use spread out on a large table.  The print is large enough to read comfortably, and it is sturdily manufactured.  It has an 85-page index, which should be comprehensive enough for most purposes.  The CD-ROM, the Electronic DSM-IV-TR Plus Version 1.0 is basically a slightly expanded version of the Electronic DSM-IV Plus Version 3.0 that came with the third edition.  It is slightly easier to navigate between the different parts -- DSM-IV-TR, the Diagnostic Criteria, the Practice Guidelines, the Glossary, the Principles of Medical Ethics, and the Opinions of the Ethics Committee.  It can be useful to have the information on one's computer, and it is possible to copy the text for pasting in other documents, although one loses formatting.  It is possible to export whole sections in plain text or rich text format, which preserves formatting.  When one part of a document refers to another part, there are links so one can move directly to that other part.  It is possible to create bookmarks and even annotations for different pages, which is a nice feature.  It may be very useful for some readers to have searchable versions of these texts.  These features make the CD-ROM more useful, but on the whole it is still far more convenient to have the printed book of DSM-IV-TR in which one can leave post-it notes, make marginal annotations, and browse more easily.  Maybe the most obvious problem for the CD-ROM version is that it really requires a large screen to be able to view the text and the tables of contents at the same time. 

As a philosopher with no specific training in psychiatry, I'm not in a strong position to judge the comprehensiveness or objectivity of the content of most of the chapters.  It's worth noting that even many psychiatrists and psychologists would also be hard pressed to have expertise on all the areas covered in this book.  Most of the chapters set out the current state of scientific knowledge and practice in modern psychiatry.  They are very well documented, thorough, and well organized. 

In Stephen Marmer's chapter on "Theories of the Mind and Psychopathology," it is surprising how much he focuses on Freudian theories, since much of psychiatry has come to reject Freud.  In 41 pages of text, all but two are devoted to psychoanalytic approaches.  Marmer asserts that "Freud and psychoanalysis constitute a kind of 'basic science' from which the schools [of psychotherapy] make their modifications and their 'applied science'" (p. 147).  His chapter is really mistitled, and should be retitled "Theories of Mind in Psychotherapy" or something similar.  It is good that psychiatry is not trying to completely wipe out its origins, but it is striking that there is no equivalent chapter on "Theories of Mind in Psychopharmacology" maybe because psychopharmacologists tend to avoid any grand theorizing about the nature of self.  However, given that Freudian approaches to the self are becoming increasingly irrelevant to modern practice, it behooves psychiatry to start thinking more about what models of the mind underlie the modern understanding of psychopathology. 

In Part II, there are a few short chapters (Factitious Disorders and Malingering, Adjustment Disorders, Sexual and Gender Identity Disorders) and other chapters are substantial (Mood Disorders has 114 pages), but by far the largest is that on Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence, at 142 pages -- it was also the largest chapter in the third edition.  It's also noteworthy that often the chapters on specific kinds of mental disorder also have sections devoted to children and adolescents.  In contrast, the chapters on Women's Mental Health and Geriatric Psychiatry are in the Part IV on Special Clinical Topics and are both less than 25 pages.  These simple statistics suggest that child and adolescent psychiatry is firmly part of the psychiatric mainstream now, and constitutes one of the major sub-specialties of the field.  The authors, Charles W. Popper, G. Davis Gammon, Scott A. West and Charles Bailey, devote 28 pages to Attention-Deficit/Hyperactivity Disorder alone.  At the end of their long survey of child and adolescent psychiatry, they make a particularly interesting comment: "If we are imbedded in a medical model of the psychiatric disorders first diagnosed in youth, young patients will see that we do not perceive an important side of their beings and the promise of their realistic hopes. … If, instead, we view these individuals as having medical conditions that are part of 'the human condition' that they can struggle against and use their abilities to overcome, we will be able to understand these children -- and the adults they become -- in a more accurate, balanced, and complete way."  It is the presence of remarks such as these in a book that represents the mainstream of psychiatric thinking that gives one hope that psychiatry still has an open mind and has not become completely reductionist in its approach.

In Part III the length of chapters also varies dramatically.  Some chapters are short, at about 20 pages, (Behavior Therapies, Interpersonal Psychotherapy), while other chapters are long, at over 100 pages, such as that on Psychopharmacology and Electroconvulsive Therapy, by Lauren Marangell et al.  This chapter contains detailed discussion of most psychotropic medications and will serve as a useful resource for both doctors and others wanting reasonably objective information.  As one would expect, the authors take seriously the many possible side effects of medication but on the whole recommend the use of such drugs when carefully monitored.  More controversially (at least for the general public) they endorse the use of ECT as a "safe, specific, and effective treatment regimen" (p. 1126).  The information they give in this chapter is similar to that in most psychiatric books on physical treatments in psychiatry and so it is not aimed to settle the long-standing debates over psychotropic drugs and ECT, but it does provide a long list of references in support of its claims. 

There are chapters on Brief Dynamic Individual Psychotherapy, on Psychoanalysis, Psychoanalytic Psychotherapy, and Supportive Psychotherapy, on Interpersonal Psychotherapy (associated with Gerald Klerman and Myrna Weissman), on Behavior Therapies, Cognitive Therapy, and even on Hypnosis.  There are also chapters on Group Therapy and on Couple and Family Therapy, which provide useful information, and focus more on practical issues rather than theoretical issues concerning the conceptualization of the problems facing systems of more then one person.  One of the central theoretical questions concerns whether the emotional problems of groups can be best understood as additive combinations of the problems of individuals, or whether it is possible to have a disordered group when none of the individuals has a mental disorder.  However, despite their focus on the clinical, these two chapters say little about one of the central practical problems for clinicians treating families and couples, which is how to get managed care administrators to authorize reimbursement for such treatment.  The final chapter in this part is on the Treatment of Children and Adolescents.  Since this covers a wide range of treatments including medication, various forms of psychotherapy and other kinds of intervention, it is inevitable that the discussion of each is somewhat abbreviated.  Nevertheless, the chapter does an impressive job of summarizing a large amount of information.

The final part of the book, on Special Clinical Topics, contains some of the most fascinating content all too briefly discussed -- no chapter here is more than 44 pages and most are about 20 pages.  The chapters on Suicide, Violence, Women's Mental Health and Geriatric Psychiatry contain information that is probably familiar to most experts in mental health, but they do a great job of succinct summarizing and synthesis.  The final three chapters, on Cultural Psychiatry, the Law and Psychiatry, and Ethics and Psychiatry will be of special interest to researchers in the humanities and social sciences. 

In all, The American Psychiatric Publishing Textbook of Clinical Psychiatry is an excellent resource for those seeking up-to-date and thorough information about clinical psychiatry.  It is especially notable for its clarity of prose, at least compared to some other psychiatric textbooks.  Those without a background in medicine or biology may have difficulty understanding some of the scientific explanations in the book but even for such readers it contains a wealth of information explained in straightforward ways.  It makes few apologies for adopting a medical stance, and so will come under criticism from those who believe a medical model for mental illness is inappropriate.  However, it does present a rich and sympathetic picture of the medical model with an even-handedness between biological and psychological theories of mental illness and its treatment.  Therefore, it is a particularly good starting point for both those who believe modern psychiatry is following the right path, those who are highly critical of the profession, and those who simply want to know more about it.

 

 

Link: Review of The American Psychiatric Press Textbook of Psychiatry

 

 

© 2003 Christian Perring. All rights reserved.

Christian Perring, Ph.D., is Chair of the Philosophy Department at Dowling College, Long Island, and editor of Metapsychology Online Review.  His main research is on philosophical issues in medicine, psychiatry and psychology.


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