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50 Signs of Mental IllnessA Beautiful MindA Beautiful MindA Bright Red ScreamA Casebook of Ethical Challenges in NeuropsychologyA Corner Of The UniverseA Lethal InheritanceA Mood ApartA Research Agenda for DSM-VA Slant of SunA War of NervesAbnormal Psychology in ContextADD-Friendly Ways to Organize Your LifeAddiction Recovery ToolsAdvance Directives in Mental HealthAggression and Antisocial Behavior in Children and AdolescentsAl-JununAlmost a PsychopathAlterations of ConsciousnessAm I Okay?American ManiaAmerican Psychiatric Publishing Textbook of Neuropsychiatry and Clinical NeurosciencesAn American ObsessionAngelheadAnger, Madness, and the DaimonicAnthology of a Crazy LadyApproaching NeverlandAs Nature Made HimAsylumAttention-Deficit Hyperactivity DisorderAttention-Deficit/Hyperactivity DisorderBeing Mentally Ill: A Sociological Theory Betrayal TraumaBetrayed as BoysBetter Than ProzacBetter Than WellBeyond AppearanceBeyond ReasonBinge No MoreBiological UnhappinessBipolar 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in AmericaCrazy Like UsCreating HysteriaCritical PsychiatryCruel CompassionCultural Assessment in Clinical PsychiatryCulture and Mental HealthCulture and Psychiatric DiagnosisCultures of NeurastheniaDaddy's GirlsDante's CureDarwinian PsychiatryDaughter of the Queen of ShebaDaughters of MadnessDeinstitutionalization And People With Intellectual DisabilitiesDelivered from DistractionDepression In Later LifeDepression SourcebookDepression-Free for LifeDescriptions and PrescriptionsDestructive Trends in Mental HealthDevil in the DetailsDiagnosis: SchizophreniaDiagnostic and Statistical Manual of Mental Disorders DSM-IV-TRDirty Filthy Love DVDDisorders Of DesireDisrupted LivesDissociative ChildrenDivided MindsDr. Andrew Weil's Guide to Optimum HealthDr. Weisinger's Anger Work-Out BookDSM-IV SourcebookDSM-IV-TR CasebookDSM-IV-TR in ActionDSM-IV-TR Mental DisordersE-TherapyEccentricsElectroshockEmergencies in Mental Health PracticeEmergency PsychiatryEmotional and Behavioral Problems of Young ChildrenEmotions and LifeEmpowering People with Severe Mental IllnessEssential PsychopharmacologyEssentials of Cas AssessmentEssentials of Wais-III AssessmentEthics and Values in PsychotherapyEthics in Mental Health ResearchEthics in Psychiatric ResearchEthics, Culture, and PsychiatryEverything In Its PlaceFamily Experiences With Mental IllnessFatigue as a Window to the BrainFear of IntimacyFinding Iris ChangFinding Meaning in the Experience of DementiaFlorid StatesFolie a DeuxFor the Love of ItForensic Nursing and Multidisciplinary Care of the Mentally Disordered OffenderFountain HouseFrom Madness to Mental HealthFrom Trauma to TransformationGandhi's WayGender and Its Effects on PsychopathologyGender and Mental HealthGenes, Environment, and PsychopathologyGetting Your Life BackGracefully InsaneGrieving Mental IllnessHandbook of AttachmentHandbook of DepressionHandbook of Self and IdentityHealing the SplitHerbs for the MindHidden SelvesHigh RiskHope and DespairHow Clients Make Therapy WorkHow People ChangeHow to Become a SchizophrenicHow We Think About DementiaHughes' Outline of Modern PsychiatryHumanizing MadnessHysterical MenHystoriesI Hate You-Don't Leave MeI Never Promised You a Rose GardenI Thought I Could FlyI'm CrazyImagining RobertImpulse Control DisordersIn Others' EyesIn Two MindsInsanityIntegrated Behavioral Health CareIntegrative MedicineIntegrative Mental Health CareIntuitionJust CheckingKarl JaspersKissing DoorknobsKundalini Yoga Meditation for Complex Psychiatric DisordersLaw and the BrainLaw, Liberty, and PsychiatryLegal and Ethical Aspects of HealthcareLiberatory PsychiatryLife at the BottomLife at the Texas State Lunatic Asylum, 1857-1997Life Is Not a Game of PerfectLithium for MedeaLiving Outside Mental IllnessLiving with AnxietyLiving With SchizophreniaLiving with SchizophreniaLiving Without Depression and Manic DepressionLost in the MirrorLove's ExecutionerLoving Someone With Bipolar DisorderMad in AmericaMad TravelersMad, Bad and 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the SoulOf Two MindsOn Being Normal and Other DisordersOn Our Own, TogetherOn The Stigma Of Mental IllnessOrigins of Human NatureOut of Its MindOut of the ShadowsOvercoming Compulsive HoardingPathologies of BeliefPathways through PainPersonal Recovery and Mental IllnessPersonality Disorder: Temperament or Trauma?Pillar of SaltPoints of ViewPoppy ShakespearePosttraumatic Stress DisorderPsychiatric Cultures ComparedPsychiatric Diagnosis and ClassificationPsychiatric Genetics and GenomicsPsychiatric Illness in WomenPsychiatrists and Traditional HealersPsychiatryPsychiatry and ReligionPsychiatry in SocietyPsychological Dimensions of the SelfPsychology and the MediaPsychopathia SexualisPsychopathologyPsychopathyPsychotic DepressionQuitting the Nairobi TrioRaising a Moody ChildRapid Cognitive TherapyRebuilding Shattered LivesReclaiming Soul in Health CareReclaiming the SoulRecollection, Testimony, and Lying in Early ChildhoodRecovery from SchizophreniaRecovery in Mental IllnessRedressing the EmperorRelational Mental HealthRemembering TraumaRepressed SpacesResearch Advances in Genetics and GenomicsRestricted AccessRethinking the DSMReviving OpheliaRewarding Specialties for Mental Health CliniciansSaints, Scholars, and Schizophrenics: Mental Illness in Rural IrelandSchizophreniaSchizophrenia RevealedSchizophrenia: A Scientific Delusion?Self-Determination Theory in the ClinicShunnedShynessSigns of SafetySilencing the VoicesSlackjawSocial Cognition and SchizophreniaSocial Inclusion of People with Mental IllnessSoul Murder RevisitedSounds from the Bell JarSpeaking Our MindsSpontaneous HealingStop PretendingStraight Talk about Psychological Testing for KidsStranger Than FictionStreet CrazyStudy Guide to the DSM-IV-TRSurviving Manic DepressionSurviving SchizophreniaSurviving SchizophreniaTaking Charge of ADHD, Revised EditionTaking the Fear Out of ChangingTalking Back to PsychiatryTarnationTeen LoveTelling Is Risky BusinessTelling SecretsThe Age of InsanityThe American Psychiatric Press Textbook of PsychiatryThe American Psychiatric Publishing Textbook Of Child And Adolescent PsychiatryThe Anger WorkbookThe Anorexic SelfThe Behavioral Medicine Treatment PlannerThe Betty Ford Center Book of AnswersThe Bipolar ChildThe Bipolar Disorder Survival GuideThe Body in PsychotherapyThe Borderline Personality Disorder Survival GuideThe Broken MirrorThe Burden of SympathyThe Cambridge Medical Ethics WorkbookThe Case for Pragmatic PsychologyThe Center Cannot HoldThe Chemical Dependence Treatment Documentation SourcebookThe Chemical Dependence Treatment PlannerThe Child and Adolescent Psychotherapy Treatment PlannerThe Clinical Child Documentation SourcebookThe Clinical Documentation SourcebookThe Complete Adult Psychotherapy Treatment PlannerThe Condition of MadnessThe Construction of Power and Authority in PsychiatryThe Couples Psychotherapy Treatment PlannerThe Criminal BrainThe Cultural Context of Health, Illness, and MedicineThe Day the Voices StoppedThe Death of PsychotherapyThe Depression WorkbookThe Difficult-to-Treat Psychiatric PatientThe Early Stages of SchizophreniaThe Employee Assistance Treatment PlannerThe Employee Assistance Treatment PlannerThe Epidemiology of SchizophreniaThe Essential Family Guide to Borderline Personality DisorderThe Essentials of New York Mental Health LawThe Ethical WayThe Evolution of Mental Health LawThe Explosive ChildThe Fall Of An IconThe Fasting GirlThe Forensic Documentation SourcebookThe Forgotten MournersThe Gift of Adult ADDThe Good EaterThe Green ParrotThe Healing Power of PetsThe Heart of AddictionThe Heroic ClientThe Insanity OffenseThe Invisible PlagueThe Last Time I Wore a DressThe Limits of Autobiography The LobotomistThe Madness of Our LivesThe Mark of ShameThe Meaning of AddictionThe Meaning of MindThe Medical AdvisorThe Mind/Mood Pill BookThe Most Solitary of AfflictionsThe Mozart EffectThe Naked Lady Who Stood on Her HeadThe Older Adult Psychotherapy Treatment PlannerThe OutsiderThe Pastoral Counseling Treatment PlannerThe PDR Family Guide to Natural Medicines & Healing TherapiesThe Places That Scare YouThe Plural SelfThe Problem of EvilThe Psychology of Religion and CopingThe Quiet RoomThe Real World Guide to Psychotherapy PracticeThe Right to Refuse Mental Health TreatmentThe Rise of Mental Health NursingThe Roots of the Recovery Movement in PsychiatryThe Savage GirlThe Self-Help SourcebookThe Talking CureThe Trick Is to Keep BreathingThe Unwell BrainThe Virtuous PsychiatristThe Way of TransitionThe Wing of MadnessThe Wisdom in FeelingTheoretical Evolutions in Person-Centered/Experiential TherapyTherapy's DelusionsTheraScribe 3.0 for WindowsThis is Madness TooThoughts Without a ThinkerThrough the Looking GlassTo Have Or To Be?Toxic PsychiatryTransforming MadnessTraumaTraumatic PastsTraumatic Relationships and Serious Mental DisordersTreating Affect PhobiaTreating Chronic and Severe Mental DisordersTreating Self-InjuryTreatment and Rehabilitation of Severe Mental IllnessTreatment Plans and Interventions for Depression and Anxiety DisordersTwinsUnderstanding and Treating Violent Psychiatric PatientsUnderstanding Child MolestersUnderstanding DepressionUnderstanding ParanoiaUnderstanding the Stigma of Mental IllnessUnderstanding Treatment Without ConsentUnholy MadnessUnspeakable Truths and Happy EndingsUsers and Abusers of PsychiatryViolence and Mental DisorderVoices of MadnessVoices of RecoveryVulnerability to PsychopathologyWarning: Psychiatry Can Be Hazardous to Your Mental HealthWashing My Life AwayWhen History Is a NightmareWhen Someone You Love Is BipolarWhen the Body SpeaksWhen Walls Become DoorwaysWitchcrazeWomen and Borderline Personality DisorderWomen and Mental IllnessWomen Who Hurt ThemselvesWomen's Mental HealthWrestling with the AngelYou Must Be DreamingYour Drug May Be Your ProblemYour Miracle Brain
Psychiatry is under siege. The past president of the NIMH, Dr Steve Hyman, has documented the difficulties in a recent invited article, "Can neuroscience be integrated into the DSM-V?," Nature Reviews Neuroscience 8, 725-732 (September 2007). In this editorial, Hyman documents the difficulties and pondered whether neuroscience has the capacity yet to inform on biological markers that can support a DSM V version.
In the meantime, psychiatry continues with a flawed signs and symptoms manual as its bible, a useful but much critiqued body of knowledge. People who present with signs and symptoms related to their psychosocial functioning are categorized by shoehorning them into one size fits all categories which in turn inform on what broad medication selection might be efficacious. This is largely trial and error, current attempts at personalized medicine as championed by Ed Abraham's Personalized Medicine Coalition, have focused on genes. No one can criticize Hyman's article, some have tried, but it was an invited article. No one can fault attempts to isolate biological markers, but these are likely to succeed in providing ant-viral therapies that protect against cervical cancer rather than in Schizophrenia.
By page 5, Gill has acknowledged there are problems with the signs and symptoms approach despite the money that has gone into their elucidation. Consequently Gill proceeds with caution and colors his comments with guarded statements about the complicating comorbidities, 'causes and need for prevention', only a recent addition to the literature. He therefore introduces neurochemistry, neuroradiology and epidemiology under the headings above, as well as the individual life experience. Together with comments on prevention, this is a brief flirtation with the tenets of personalized medicine.
Chapter three concerns itself with the examination, briefly touching on the physical examination, as well as other more standardized techniques of assessment.
Part two now addresses the clinical conditions themselves, beginning with schizophrenia, This is not an in depth book, so the outline skims vital issues, but covers what one would expect from such a primer.
There are no prizes for guessing the content of the next chapter, it's of course mood, meaning depression and mania. Early on there is a caveat of accepting at face value the serotonin or other hypotheses, which deny or simplify the complex feedback regulating mechanism of such complex systems. Particularly useful are the NICE guidelines on page 88, in keeping with the British approach. It is also interesting, as an aside, that the NICE guidelines on some medications in general medicine, indicate that payers will only release funds for drugs that work, in proven outcomes. So if a cancer drug works only in 30% for instance, then payers will only pay for that 30%. So far this has not been applied to mental health, but with the cost of the spend for instance in Schizophrenia at $21billion p.a. this could make a huge financial difference.
Anxiety and stress related disorders follow in the next chapter. Little detail is offered, but this is only an introductory tome, so discussions are limited, especially in PTSD for instance.
Similarly, the chapter on the personality disorders is brief, and together with the last one, probably don't do justice to the commonality of the former, and the difficulty in engaging with the other. For those who are DSM centric, it is important to notice the difference with using the ICD, which for instance do not have a Borderline category. I doubt many American psychiatrists could comment on a Haltlose presentation, immature or psychoneurotic styles or treatments. They might manage anankastic when they realize its an OCD presentation. Paranoid states follow, dealt with in three pages.
The physical problems chapter is the most interesting, of course including somatoform-type illnesses, with controversy boiling, such as Munchasen by Proxy and other contentious conditions, often not in the ICD 10, and neurasthenia amongst others such as malingering and exaggeration.
'Organic' brain syndromes is next. Delirium and dementia dominate immediately, moving on to focal lesions. Its another short chapter with very little attention to the frontal or executive areas.
The insertion of a brief chapter on liaison psychiatry is unusual, but useful. These are the psychiatrists that work with other doctors in general medical or specialist wards.
One of the longer chapters is devoted to drug misuse, and then an entire separate chapter on Alcohol abuse. Not many references are used, one only in this latter case, so the student is not really assisted in that regard.
Another unusual chapter is the next one, on self harm. This includes DSH but with little or much more than a passing reference to sexual abuse and other issues in childhood that are so common, as reviewed over the years by Glaser, Parry and others.
No such book would be complete without eating disorders, and very few would include the next, namely disorders related to the female reproductive cycle. These are focused on perinatal events more than perimenstrual.
Sex-related disorders are canvassed, and even homosexuality gets almost a page, apologized for on the basis of the high rates of mental illness, not the entity as a disease or disorder.
Chapters are devoted to child and adolescent psychiatry as well as learning disorders. No real discussion is presented on the current controversy related to medication in this group, but Gill seems to rely on non-medication therapies anyway. A few pages are devoted to the elderly, which seems a bit too little considering the complexity of this group. Forensics follows, with about double the coverage in page count anyway.
The third section covers treatment specifics. The first chapter is a reasonably extensive one, but devoted more to CBT rather than the host of other therapies available. A similarly thorough chapter is devoted to psychopharmacotherapy, as well as ECT and even psychosurgery, follow. A United Kingdom focused chapter on mental health services and another on the mental health act of 1983 are a useful reference for those in the rest of the world, and for those naïve on such matters in the UK, needing frequent revision as things change rapidly in that industry there.
There is a glossary, as befits a primer, and this is the only truly thorough feature of the book. The index is small, as there are few references for each chapter, Gill takes the view that a mere outline needs little referencing. I take the opposite view, students and neophytes need a lot of referencing or at least a reading list to inform on who might be the best to read in each subject, or what other opinions there might be.
Otherwise, the book outlines psychiatry well, with caveats that are necessary, and with clarity where it needs to, for the most part, but with weaknesses, such as in the elderly.
It will I am sure remain a popular textbook, now in its fifth revision. It surely does this by relying on its clarity, and its brevity, without losing much detail.
© 2007 Roy Sugarman
Roy Sugarman, Ph.D., Director of Clinical and Neuropsychological Services, Brain Resource Company, Ultimo, Australia