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The Diagnosis of Psychosis

James Allen Wilcox, DO, PhD

University of Arizona, Tucson, AZ, USA

By Rudolf N. Cardinal and Edward T. Bullmore. New York, NY: Cambridge University Press; 2011; 978-0-521-164849; pp 400; $63 (paperback).

The lack of precision in psychiatric diagnoses often is criticized by our detractors and even by our medical colleagues. The Diagnosis of Psychosis demonstrates that correct diagnosis, done with precision exists in psychiatry. Moreover, it demonstrates that a proper diagnosis is necessary. Psychosis has many causes and the proper assessment of the cause is critical to the correct treatment. It is a pity that many practitioners simply prescribe antipsychotics without caring about the underlying source of the syndrome. This is like treating a fever and never looking into the cause of the infection. The understanding of the cause of a patient’s psychosis is important in effective management and predicting the course of the illness. One can say, what practitioner would treat a brain tumor or autoimmune disease with a phenothiazine? Yet many doctors who ignore the complexity of psychotic conditions essentially do the same thing. This book is a wonderful example of the complex nature and importance of proper psychiatric diagnosis. Anyone who deals with psychotic conditions should have a copy of this compact manual. It is an excellent resource for any physician and should be required reading for medical students.

This book is well organized and highly readable. Although an enormous amount of material is packed into 29 chapters, it is done elegantly and is easy to follow. The first broad section of the test starts out with details of the many causes of psychotic symptoms and begins with a variety of genetic and neurological conditions. Each syndrome and its associated pathology are discussed in fine detail. The use of tables and the organization of data is attractive and not overly complex. The cross referencing of diseases, laboratory values, and clinical signs is done in a masterful way. One feels as if they are being taught a course on the differential diagnosis of psychosis. The book moves on to autoimmune diseases, poisonings, and miscellaneous causes of psychotic illness. Again the perception of actual learning occurs while reading the chapters. This book is not a dreary dictionary of diseases where the reader feels overwhelmed by dry didactics. On the other hand, the authors act like masterful teachers who make complex material a pleasure to read. A wonderful portion on catatonia is included. This is quite valuable due to the rather puzzling nature of the history of catatonic illness. Following the discussion of catatonia, the text turns to functional psychosis.

It is worth noting that at least 148 pages are spent on the organic, “non-functional” causes of psychotic symptoms. It is an unfortunate fact that many physicians omit their medical obligation to consider many potentially curable diseases in the differential diagnosis of psychotic patients who desperately need their help. This book calls us back to our clinical senses.

The second broad section of the book moves on to the clinical approach to the diagnosis of psychotic syndromes. This portion of the text is just as well organized as the material on pathology. The clinical examination of patients is well covered by the authors. The logic of the authors and the fluid nature of their explanation are impeccable.

The Diagnosis of Psychosis is highly relevant to all psychiatrists, residents, and neurologists. This reference should be on the bookshelf of every practicing physician as it is well written and easy to understand. It fills the gap many psychiatrists see between their clinical practice and the world of internal medicine. It is not really a neuroscience book; it is more specific to the topic of psychosis. This strengthens the overall volume, making it easy to look up any topic of interest. This book is well referenced and has a great index section. This text is a welcome addition to my library. It is a wonderful reference and guidebook. I anticipate using it in my work and teaching it to my residents.