Abstract
Another brief guide is hatched (in its third edition) out of Minnesota, eager to join the throng of condensations of psychiatric practice. Despite competition, this has proved successful enough to warrant three publishings, which instils hope in the cautious reviewer. As with most such guides, the reader is at first disarmed by the obligatory disclaimer, warning those seeking both more and less detail than is presented.
Useful areas of the book include a brief run through neuropsychological and psychological tests, with a firm emphasis on the MMPI (hardly surprising given the provenance of the book).
Tables I found interesting included Antipsychotic Drug Receptor Affinities (p.83), Temporal Onset of Adverse Events (p.87), Opiate Receptor Types and Actions (p.248) and Herbals (pp.139–146), although guarana is not mentioned. Curiously, despite ‘black cohosh’ being listed as used for promotion of lactation, it is also cautioned/contraindicated in lactation (p.140). I also noted that Seroquel apparently causes cataracts in beagles (p.96). Do we instigate eye exams on a 6 monthly basis on all our Seroquel patients as suggested?
There is a reasoned though defensive attitude to ECT, and a useful listing of drugs and medical conditions causing psychiatric syndromes, expanded in the geriatric section.
An intriguing breakdown of premenstrual dysphoric disorder (pure-pure, pure, premenstrual magnification and PMS) is given (p.198). A risk of perimenopausal oestrogen triggering rapid cycling in bipolar patients is mentioned (p.200), although the evidence I have been able to find for this is sketchy at best.
Guidelines for reporting on the child patient are concise and thorough (p.205), and the suggested sleep disorders interview (p.218) appears a useful reminder.
Much of the rest of the book is not overwhelmingly useful to the Australian market. Medication listings are hampered by availability (moclobemide is still not available in the USA) and trade name variability, although the paediatric dose guides are clear, with weight expressed in kilograms. Prior authorization guidelines (p.260) are applicable only to managed care.
The sedative withdrawal conversion (p.242) is almost useless, employing chlordiazepoxide or phenobarbital equivalents. I obtained quite worrying results with the phenobarbitone challenge test (p.241) – definite tolerance results in a daily phenobarb dose equivalent on their conversion to 167–200 mg diazepam/day, marked tolerance to a dose of 267 mg diazepam, and extreme tolerance to a dose of 333–400 mg of diazepam or more. I think few practitioners would be prepared to risk prescribing these quantities routinely, even on an acute withdrawal basis.
Long-term adverse effects of lithium on the renal system are omitted in the otherwise exhaustive list of side-effects (p.122).
Several typographical errors escaped the editors’ eye (pp. 24, 147) and there are some confusing remarks such as ‘widest girth more than 55cm’ as a relative contraindication for MRI (p.13). I also noted a quaint but disturbing phraseology with regard to tardive dyskinesia incidence; ‘Blacks are at greater risk than whites’(p.91) – surely the USA has more to say about distinct racial groups than this dichotomous view.
All things considered, my favourite section of the manual was on pages 231–33. This lists techniques to induce a false negative on urine drug screen for particular substances by interfering with the immunoassay reagents, and how to detect the likely use of these adulterants. I think most substance use populations in Australia are relatively naïve in the use of these adulterants, but with availability of information on the Internet it is certainly worth being aware of the possibilities. Monitored sampling may be the only answer where doubt exists.
Despite covering many issues well, this manual is less than ideal as a primary rapid resource in Australia. More extensive footnoting would assist greatly in weighing the evidence for much of the information given. Some sections are intriguing due to altered perspectives in a very different practice environment, and it would make a useful augmentation to a well-stocked bookshelf.