Pocket Handbook of Psychiatric Drug Treatment, 2nd ed.

“Psychiatrists don’t know a benzene ring from a hole in the wall” was the response of one colleague to whom I showed this book. Although some of my clinical friends may dispute this statement, it is certainly questionable whether chemical structures really constitute useful information in a pocket handbook of drug treatment. The critical reader will find superfluities, deficits, and inaccuracies in almost any text, and this book is certainly no exception. Thirty-five of the 41 chapters provide an alphabetized listing of drugs, from β-adrenergic receptor antagonists to yohimbine, with a somewhat idiosyncratic classification according, in theory, to pharmacological activity and mechanism of action. This avoids the complications associated with the fact that the same drugs are used in the treatment of different disorders (e.g., depression and anxiety). Although there are some advantages to this classification, it assumes that the mechanisms of action of psychiatric drugs are understood. This is an assumption that the most able psychopharmacologist would be loath to make. In practice, there are so many exceptions that most of the chapters address individual drugs, and several others define a drug class on the basis of chemical structure (e.g., tricyclics, benzodiazepines). Dividing the antipsychotics into separate chapters on “dopamine receptor antagonists” and “clozapine” also appears arbitrary.

As one uses the book, however, these idiosyncrasies become less annoying, even endearing, and the fact that the classification is, well, unusual, does not mean that the working psychiatrist could not rapidly come to grips with its use. There is a comprehensive index for rapid identification of the drug or indication wanted, and this is supplemented by two useful tables in chapter 1, each with chapter cross-references, one of which lists both generic and U.S. trade names of psychiatric drugs while the other gives major psychiatric indications and the drug classes used in their treatment. In addition, if you do not know what they look like, the tablets and capsules of many of these drugs are shown in color in a 5-page section at the beginning of the book.

The book contains much to justify the inclusion of medical students and nonphysician clinical staff, as well as psychiatrists and primary care physicians, in its target readership. The first chapter provides a brief introduction to the basic principles of psychopharmacology. Other useful sections include an emergency intoxication and overdose table and a chapter on laboratory diagnostic tests. Intriguingly, there is a chapter on combined psychotherapy and pharmacotherapy. There are some disappointments, however. The authors have tried to overcome the inevitable limitations of a book published in a rapidly developing field by including a chapter on investigational drugs, although having a table of such drugs dated from 1992 does not provide much help. Some other problems are apparent, including the extension of the unsatisfactory term “nootropics” to include all drugs in development for treatment of dementia. Tacrine gets its own chapter, but the statement that this drug “has inhibition of acetylcholine as its primary mechanism” is worryingly inaccurate, which brings me to wonder, not wholly facetiously, When will a handbook on drug treatment include a section on litigation?