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Book Reviews |
Key Words: Book Reviews
Challenges in Clinical Practice addresses pharmacologic and psychosocial strategies for treatment-resistant disorders. Opening each chapter is like personally inviting the authors to sit down with you and share the wealth of their clinical wisdom and expertise. What is refreshing is the practical and very specific nature of the information presented. For example, where other books may make vague suggestions to "augment with thyroid" in refractory depressed patients, these authors give exact T3 and T4 dosages, with recommendations about response time and duration of augmentation after response. In discussing the strategy of combining selective serotonin reuptake inhibitors (SSRIs) and bupropion to treat refractory depression, again the authors are specific, recommending that the clinician "add bupropion in twice-daily doses of either 75 mg or 100 mg to the original SSRI." Besides being very thorough and clearly written, the book conveys a tone of compassion and respect for persons suffering from these difficult disorders.
The book is divided into five major sections: mood disorders, anxiety disorders, eating disorders, side effects of neuroleptics and antidepressants, and other disorders. The section on other disorders covers schizophrenia, substance use disorders, personality disorders, attention-deficit/hyperactivity disorder, premenstrual disorder, and refractory insomnia. If you don't find information in the text, there are generous listings of references after each chapter. Even the relatively short, 14-page chapter on management of refractory insomnia contains 64 references.
Challenges in Clinical Practice makes a significant contribution to the literature by providing so much practical information that is well organized and thoroughly researched. The discussions on antidepressant-induced side effects should be mandatory reading for every psychiatry resident and practicing psychiatrist. In a few pages, the authors succinctly outline the areas of sexual function affected by antidepressants, and they give up-to-date management recommendations. Fatigue, myoclonus, and paresthesias are just a few of the other side effects that receive careful attention.
This book presents extensive cognitive-behavioral strategies for several disorders, including major depression, social phobia, generalized anxiety disorder, panic disorder, and eating disorders. The discourse on eating disorders is sufficiently clear and detailed that after reading this chapter, one could incorporate at least some aspects of the cognitive- behavioral approach into one's treatment. The cognitive-behavioral therapy (CBT) described in this book for bulimia nervosa, for example, consists of three stages. The first stage (sessions 1–8) stresses patient education and normalizing eating patterns through the scheduling of regular meals and healthy snacks. In stage 2 (sessions 9–16), there is an emphasis on cognitive structuring, focusing on the distorted perceptions of shape and weight. Patients are taught to identify and question dysfunctional reasoning and "black-and-white thinking." Stage 3 (sessions 17–19) is designed to prevent relapses by doing exercises such as writing a list of interventions that helped in the past. It is welcome to find a book that emphasizes the importance of both psychopharmacology and psychotherapy, even if most of the psychotherapy discussions are limited to CBT. Therapists who engage in other forms of psychotherapy may be disappointed in the authors' focus on CBT to the exclusion of other valued psychotherapy approaches.
I highly recommend this book to all mental health professionals. I believe psychiatry residents and practicing psychiatrists, in particular, would find the text and accompanying references invaluable in their day-to-day management of treatment-refractory patients.
Footnotes
Dr. Tamburrino is Associate Professor and Director of Psychiatry Residency Education at the Medical College of Ohio, Toledo, OH.
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