Essentials of Clinical Psychiatry

This book is an excellent abridgment of the third edition of The American Psychiatric Press Textbook of Psychiatry (1), also reviewed in this issue of the Journal. It is intended primarily for use by third- and fourth-year medical students, psychiatry residents, and those in allied fields. In addition, a companion Study Guide to Essentials of Clinical Psychiatry (2) is designed specifically to help readers master the material presented in each chapter by including questions about the key concepts and other important information.

The 25 chapters selected mainly cover the psychiatric disorders. The first five are devoted to fundamental background subjects, specifically, “Neuroscientific Foundations of Psychiatry,” “Normal Child and Adolescent Development,” “Theories of the Mind and Psychopathology,” “The Psychiatric Interview, Psychiatric History, and Mental Status Examination” (an outstanding chapter), and “Laboratory and Other Diagnostic Tests in Psychiatry.” Each of the next 16 chapters deals with a major psychiatric disorder and its closely associated disorders. The final four chapters address “Psychopharmacologic and Electroconvulsive Therapy,” “Brief Dynamic Individual Psychotherapy,” “Psychoanalysis, Psychoanalytic Psychotherapy, and Supportive Psychotherapy,” and “Treatment of Children and Adolescents.” The two appendixes are titled “Diagnostic Criteria From DSM-IV” and “Excerpts From the American Psychiatric Glossary,” and both mainly include helpful definitions.

The 50% reduction of the original chapters is a substantial achievement. Necessary conceptual background material has been retained or successfully summarized, and important clinical information is presented effectively and meaningfully. Marmar’s outstanding chapter, “Theories of the Mind and Psychopathology,” with its presentation of Freudian and other views, wisely has been shortened only slightly, as has Scheiber’s “The Psychiatric Interview, Psychiatric History, and Mental Status Examination.” Almost all of the chapters on the various disorders include a historical and conceptual prologue that enhances understanding of subsequent development of the concepts and scientific advances and enriches the accumulation of the many indispensable clinical principles and facts intrinsic to the disorder discussed. In this respect, Black and Andreasen’s chapter, “Schizophrenia, Schizophreniform Disorder, and Delusional (Paranoid) Disorders,” has retained its excellence.

The treatment section starts with Marangell, Silver, and Yudofsky’s comprehensive chapter “Psychopharmacology and Electroconvulsive Therapy,” which gives readers the principles of drug action, including mechanisms of action, indications and contraindications for use, and recommendations about the selection of medications for specific conditions. The next two chapters, “Brief Dynamic Individual Psychotherapy” and “Psychoanalysis, Psychoanalytic Psychotherapy, and Supportive Psychotherapy,” merit special comment. In our current managed health care era, in which many for-profit companies provide insurance coverage for only 10 psychotherapy sessions, it has become necessary, if not mandatory, for psychiatrists to become expert in the use of brief psychotherapies. This chapter presents specific guidelines, illustrated by tables and outlines of key points, that supply students and residents with the fundamentals of brief therapy. The ensuing chapter complements the presentation of brief dynamic psychotherapy by supplying the psychodynamic background for it and by discussing interpersonal psychotherapy briefly. Moreover, it presents the basic principles and practice of supportive psychotherapy by explicitly defining and listing goals and techniques along with characteristics of the types of patients for which it is indicated. Those two chapters will be especially valuable for students, residents, and even experienced practitioners, who too often consider supportive psychotherapy to consist mainly of somewhat nebulous “reassurance.”

The 42-page chapter on “Treatment of Children and Adolescents” adequately discusses both basic and special issues for young patients, such as pharmacokinetics, pharmacodynamics, and ethical considerations. The chapter also includes specific clinical guidelines for the use of stimulant medications. Although psychopharmacology is adequately covered, family therapy and group therapy are only briefly described, even though Cozza and Dulcan point out that “group therapy offers unparalleled opportunities for the clinician to evaluate youths’ behavior with peers, to model and facilitate practice of important skills, and to provide youngsters with companionship and mutual support.”

Essentials of Clinical Psychiatry was prepared primarily for use by medical students and psychiatry residents; however, I predict with confidence that it will be popular with many psychiatrists in practice, who will use it for ready access to clinical facts and treatment recommendations. In this respect, the 115-page inclusion of diagnostic criteria from DSM-IV and the glossary excerpts in the two appendixes will be especially helpful. The summaries of many of the clinical chapters in The American Psychiatric Press Textbook of Psychiatry (1) will make Essentials of Clinical Psychiatry especially valuable to psychiatrists and other mental health students and workers who are studying for their specialty, graduate, or licensure examinations. Also, for them, the Study Guide to Essentials of Clinical Psychiatry (2) will become indispensable. I urge all psychiatrists, other mental health professionals, and physicians in family medicine, internal medicine, and neurology to obtain this valuable book. It will be both handy and useful.