Abstract
This book represents yet another quality publication from the American Psychiatric Press. The title captures the essence of the text which delivers exactly what it purports to – the essentials of clinical psychopharmacology. With 31 chapters authored by internationally acclaimed experts in their respective clinical fields, The essentials of clinical psychopharmacology provides an up-to-date and comprehensive overview of psychopharmacology across the life cycle from childhood to old age. Management beyond the pharmacological is also included in a number of chapters as appropriate, for example those on anxiety disorders and insomnia.
The book is broadly divided into two sections. The first section is a series of 16 chapters covering the many different classes of psychotropic medication, including cognitive enhancers and psychostimulants as well as the various subclasses of antidepressants, antipsychotics, anxiolytics and mood stabilisers that you would expect to find in such a text. Broadly speaking, the pharmacological profile, mechanism(s) of action, relevant pharmacodynamic/pharmacokinetic considerations, clinical indications, side-effects, toxicity and important interactions with other agents are noted for each class of psychotropic medication. This first section finishes with an excellent, informative and practical chapter on electroconvulsive therapy.
Fifteen chapters comprise the second section of the book, which covers the treatment of various mental disorders and related clinical problems. Again, this section goes beyond the expected treatment of depression, schizophrenia, bipolar and anxiety disorders and so forth to include separate chapters on the psychopharmalogical treatment of psychiatric emergencies, medically ill and geriatric patients, pregnant and lactating women plus childhood and adolescent disorders.
Although overall an excellent clinical resource, there is some variability in the standard of individual chapters of the book. The majority are very good while some stand out as being of particularly high quality. Fortunately, only a minority are mediocre.
Notable chapters include that on the treatment of depression, which provides a splendid, comprehensive overview including the management of treatment resistance. The chapter on childhood and adolescent disorders is another excellent, practical chapter covering the pharmacological management of the wide range of mental disorders seen in this age group, including intellectual disability. Attention Deficit Hyperactivity Disorder and the mood disorders were particularly well covered. It was great to find such a well-written and comprehensive chapter in a general text of psychopharmacology.
The management of disorders occurring at the other end of the age range was addressed in a separate chapter on geriatric psychopharmacology, which looked at the effects of ageing on pharmacodynamics and pharmacokinetics, as well as the common issue of polypharmacy in this age group. Although the pharmacological treatment of psychosis, depression, mania, anxiety and sleep disorders were discussed, there was disappointingly limited coverage of the management of dementia. However, this was perhaps compensated for by earlier separate chapters on the cognitive enhancers and the treatment of the non-cognitive symptoms of dementia.
Two other chapters warrant special mention as excellent chapters which add to the practicality of this book as a resource for psychiatric clinicians. The chapter on the management of agitation and aggression goes well beyond the pharmacological management of these common problems, while that on the treatment of the medically ill patient comprehensively covers medical considerations relevant to the different classes of psychotropic medication and electroconvulsive therapy.
In contrast to the high standard of the above chapters, that written on the treatment of bipolar disorder was rather disappointing and somewhat underdeveloped. The antipsychotics, including depot preparations and the atypicals, were entirely overlooked despite their common use in clinical practice. Perhaps the chapter's emphasis on the use of mood stabilizers for acute mania and maintenance was a reflection of the American authorship and prescribing bias. The chapter on eating disorders also appeared under-developed but perhaps related more to the limited role of medication in these disorders.
No modern psychopharmacological text would be complete without a chapter on the use of psychotropic medication in pregnancy and lactation and indeed a good review on the subject is included. The chapter on psychiatric emergencies was also very good and again practical, dealing with the different levels of need for pharmacological intervention for a range of acute clinical situations from adjustment disorder to acute psychosis to the homicidal and suicidal patient.
As an overall textbook of clinical psychopharmacology across the life cycle and across diagnostic and clinical problems this text would be hard to beat. Its main limitation for the Australasian reader would be the American focus with the expected differences in availability or licensing of specific drugs and some variation in prescribing practices especially for mood disorders.