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Massachusetts General Hospital Harvard Medical School Boston, Massachusetts
| Edited by Michael B First and Allan Tasman. Published by
John Wiley & Sons, Hoboken, NJ, 2004. ISBN 0-470-86089-8. Clothbound,
xxvii + 1323 pp. (25.5 x 19.5 cm), $225.
www.wiley.com
|
Published Online, November 9, 2004. www.theannals.com, DOI 10.1345/aph.1E447
This is not a newly written text but a compilation and adaptation of the factual information from the Disorders chapters of the textbook Psychiatry. The original chapters from Psychiatry were written by an impressive list of experts; however, these authors did not condense or update the material for the DSM-IV-TR Mental Disorders: Diagnosis, Etiology, and Treatment. It is unclear whether condensing the text from a 2-volume, 2492-page publication to a 1353-page book changed the emphasis or omitted essential topics.
DSM-IV-TR Mental Disorders: Diagnosis, Etiology, and Treatment is well organized, using the same structure as the DSM-TR-IV. The first 3 chapters provide an overview of the diagnosis, etiology, and treatment of mental disorders, with a majority of the space devoted to the history of the DSM and diagnostic issues. Each of the remaining 43 chapters covers a single category of disorder diagnosed in adults and children. Chapters are divided into sections describing the diagnosis, etiology, and treatment of each disorder. The treatment sections summarize both somatic and psychosocial treatments. Although the organization and number of chapters closely follow the DSM-IV-TR, the editors determined the length of each chapter based on their interpretation of the clinical significance of each disorder. In contrast to the DSM-IV-TR, readers will notice a shift in the emphasis of the book due to the expanded coverage of the chapters on substance use disorders. A total of 12 chapters and almost 300 pages are devoted to the diagnosis and management of substance use disorders. This total number of pages is almost equal to the combined length of the chapters on all the psychotic disorders, mood disorders, and anxiety disorders. Two new chapters were added to the text, one on amphetamine-related disorders and the other on reactive attachment disorder. Although there is an extensive reference list at the end of each chapter, it appears that the reference list was not updated when the chapters were condensed from the parent text, Psychiatry.
The diagnostic and etiologic sections of the book are excellent. In contrast to the DSM-IV-TR, this book thoroughly describes the diagnostic criteria in the text and uses tables, figures, and decision trees to illustrate important points. Clinicians less familiar with some of the disorders will find the extensive information on the diagnostic criteria, differential diagnosis, and the onset and course of the disorder valuable and applicable to clinical practice. Each chapter includes an excellent summary of the etiology and pathophysiology of each disorder, presenting a balanced view of the genetic, neurobiologic, and psychological origins of mental disorders.
However, the book misses the opportunity to provide valuable information on childhood disorders. First, for the disorders diagnosed in childhood, the book does not fully address the changes in the clinical presentation or course of each of the disorders for patients who may have symptoms into adulthood. Additionally, although the same diagnostic criteria are applied to identify both children and adults with schizophrenia or a psychotic disorder, bipolar disorder, or depression, these topics are either minimally addressed or not included in the text. This is a serious weakness for clinicians practicing in the areas of child psychiatry, family practice, or pediatrics who may rely on this text.
Each chapter has a section summarizing available somatic and psychosocial treatments for each disorder. Ideally, the treatment section would present a step-wise approach to pharmacotherapy, thoroughly discussing the merits and role of each medication. This discussion would include essential drug data required to prescribe the medications, treatment goals for each phase of the disorder, the expected outcomes and therapeutic endpoints, and monitoring parameters. The structure and quality of the treatment discussions vary from chapter to chapter. For example, the discussion of the treatment of schizophrenia and bipolar disorder are well organized and fairly complete. Charts and figures clearly present the therapeutic approach, goals of therapy, alternative treatments, and monitoring parameters, including drug–drug interactions and adverse drug effects.
The role of psychosocial interventions are also fully described in the text, and the list of references is extensive. In contrast, some of the chapters omit disorder-specific clinical trials or include only short summaries of published data without extrapolating them to the care of the patient. Additionally, results of clinical trials are frequently described in general terms, and details such as the drug dose, duration of therapy, or monitoring parameters are not outlined in the text. Such chapters will be less useful to clinicians in need of specific drug information. The book also misses the opportunity to provide clinicians with valuable information on the pharmacotherapy of the severe disorders in children or to discuss the impact of age on the treatment of childhood disorders as patients reach adulthood. Several chapters use a summary paragraph, while others omit the topic. Overall, the book is less useful for clinicians who may care for children and adolescents.
In summary, the current edition of the DSM-IV-TR Mental Disorders: Diagnosis, Etiology, and Treatment is a valuable resource, providing excellent diagnostic and disorder-specific, clinically relevant information. However, the treatment section should be extensively revised in the next edition. Although Psychiatry is more expensive than DSM-IV-TR Mental Disorders: Diagnosis, Etiology, and Treatment ($299 vs $225), I recommend that psychiatric clinicians purchase the parent text Psychiatry and wait for the next edition.
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