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Essential Psychiatry. Fourth edition

Alan D. Schmetzer, MD

Indiana University School of Medicine, Indianapolis, IN, USA

The first edition of Essential Psychiatry was published in 1979 by Academic Press, Inc., and since then editions have been released approximately every 10 years. Each has been revised and expanded from the prior edition. The current (fourth) edition published by Cambridge University Press has 5 editors and 56 additional contributors from Europe, the United Kingdom, Australia, Asia, Africa, and the Americas. According to the Foreword, this book primarily is for clinicians, and as such, its subdivision into 5 major sections—“Tools of psychiatry,” “Psychiatric disorders,” “Special topics,” “Psychiatry in specific settings,” and “Treatments”—makes sense. Each section is composed of several chapters. The longest section (12 chapters mostly named by diagnostic category) is about “Psychiatric disorders,” and the shortest (3 chapters) covers “Special topics.”

Edited by Robin M. Murray, Kenneth S. Kendler, Peter McGuffin, Simon Wessely, and David J. Castle; Cambridge University Press; New York, New York; 2008; ISBN: 978-0-521-60408-6; pp 747; $96.00 (paperback).

The first section on “Tools” is highly diverse in terms of topics. Chapter 1 is devoted to the mental status examination. Written by Paul Mullen this chapter expresses a healthy dose of skepticism regarding popular diagnostic systems—for example, DSM-IV—and instead concentrates on psychiatric phenomenology covering things such as perceptual disturbances, feelings and affect, and beliefs about the world such as delusions. Chapter 2 contains a focused examination of manualized approaches to classification of psychiatric disorders—DSM-IV-TR1 and Chapter F of ICD-102—and looks briefly at structured interviews for diagnostic purposes. The history of diagnostic approaches is reviewed, but the authors identify the beginning of diagnostic focus as the third edition of DSM in 1980 because it was the start of operational definitions borrowed in part from concepts in the Research Diagnostic Criteria of Spitzer et al.3 Chapter 3 covers research methodology as applied to psychiatric disorders and treatments, with Chapter 4 concentrating on brain imaging strategies in relation to specific diagnoses (major depressive disorders, schizophrenia, and dementia of the Alzheimer type) and Chapter 5 on genetic epidemiology (family, twin, and adoption studies are discussed, followed by segments on more advanced techniques such as genetic modeling, gene finding, and linkage studies). To some extent, with the possible exception of Chapter 2, this is the more theoretical and esoteric portion of this text. The other 4 sections are more pragmatic, which most clinicians probably will more readily refer.

Part 2 is divided into chapters by diagnosis, except when special population or other issues intervene. Therefore, chapters are devoted to personality disorders, anxiety disorders, eating disorders, alcohol problems, drug use and dependence, affective disorders, schizophrenia and related disorders, intellectual disability, and sexual problems, as well as chapters about psychiatric disorders in childhood and adolescence, the psychiatry of old age, and “neuropsychiatry.” Chapters on specific diagnoses and age-related populations contain material related to criteria, differential diagnostics, epidemiology, prognosis, and management, so in this section I will comment mainly on the chapter devoted to neuropsychiatry. This chapter by Perminder Sachdev initially focuses on bedside cognitive exams and specific neurodiagnostic testing such as electroencephalography, event-related potentials, magnetoencephalography, and neuroimaging, followed by discussions of conditions that have both neurologic and psychiatric attributes, such as drug-induced psychoses, disorders due to general medical conditions (for example, the depression associated with Parkinson’s disease) or brain trauma, catatonia, Huntington’s disease, epilepsy, and a host of others. Each discussion is relatively brief, but manages to cover the most salient points about presentation, differential diagnosis, and comments related to management. Diagnostic and, to some extent, age-related chapters generally cover their topics in greater detail because of the less global scope.

Section 3, “Special topics”—like the section on “The tools of psychiatry—is a bit of a mixed bag as one might expect, covering in 3, approximately 20-page chapters material related to social and cultural determinants of mental health, women’s mental health, and suicide and self-harm. As an example, the chapter on suicide and self-harm is divided with roughly two-thirds on completed suicide and one-third on suicide attempts or what some have called “parasuicidal behaviors.” Self-injurious behavior without suicidal intent is not really covered in this chapter, nor given more than passing reference to “self-harm” in chapters on personality disorders and intellectual disability. Danger to others, which some might think could belong in this chapter, is discussed in a chapter on forensic psychiatry in Section 4. Issues involved in persons who complete suicide and those who make 1 or more suicide attempts is explored in some detail and is covered again in the chapter on “Psychiatry in the general hospital.”

“Psychiatry in specific settings” (Section 4) deals with special problems facing psychiatric patients and clinicians in primary care, the community, general hospitals, and forensic settings. In each chapter, brevity is necessary in a short but comprehensive text such as this, but the primary issues, problems cited, and solutions are discussed. The chapter on the general hospital primarily is a discussion of consultation-liaison psychiatry and focuses on issues such as symptoms without a discoverable medical explanation, factitious disorders, malingering, deliberate self-harm, adjustment to physical illness and disability, postpartum disorders, delirium and dementia, and decision-making capacity. Differentials and the influence of depression and anxiety on physical health are discussed. The chapter on forensic psychiatry, which is a discrete subspecialty, is composed of several topics: discussions of violence in different diagnoses such as schizophrenia, clinical assessment of risk, how to assess capacity to stand trial, and a review of history and practical aspects of the insanity defense. Homicide and related matters regarding danger to others are included in this chapter.

Section 5 is about treatment. Some chapters are devoted to general considerations, such as the 1 on somatic treatments, while others feature specific modalities, such as cognitive-behavioral therapy, interpersonal psychotherapy, psychodynamic therapies, and family therapy. Finally, 2 chapters are aimed at biologic treatments specific to diagnostic categories, such as the 1 on treatment of psychoses and another regarding similar considerations in depressive and anxiety disorders. Overall, this section covers the major and most frequently utilized treatments in modern-day psychiatry, with frequent discussion of the strength of evidence associated with efficacy for that approach.

Finally, an extensive subject index appears at the end of the book. This is a general psychiatric text that is international in scope. Because many chapters are authored by clinician-researchers from outside the United States, American readers will need to balance comments about guidelines in such areas as forensic evaluations against their knowledge of rules, laws, and guidelines that apply in the United States. At more than 700 pages, it is a hefty tome even in paperback but because of the scope of material covered, most discussions are necessarily brief, as is mentioned by several of the authors themselves. Nonetheless, the field of psychiatry is pretty thoroughly covered, with tables to summarize large amounts of information in a relatively small space. This book might reach beyond the needs of the average medical student who is not interested in psychiatry as a career, but is a useful reference for students who are considering psychiatry, psychiatric residents, practicing psychiatrists, and even clinicians from other mental health disciplines such as psychology, psychiatric nursing, social work, marriage and family therapy, or mental health or addictions counseling. It touches on the everyday issues that confront the student or practitioner and some unusual questions that occasionally arise. It could even be helpful as a reference for primary care providers because the book’s organization lends itself to looking up a given symptom, disorder, or treatment. The information generally is up to date, and the referenced literature at the conclusion of each chapter will point the reader to more information on nearly every topic.


  1.  Diagnostic and statistical manual of mental disorders. 4th ed, text rev. Washington, D.C.: American Psychiatric Association; 2000.
  2.  International statistical classification of diseases and related health problems. 10th ed. Geneva, Switzerland: World Health Organization; 1992.
  3. Spitzer RL, Endicott J, Robins E. Research diagnostic criteria: rationale and reliability. Arch Gen Psychiatry. 1978;35:773–782.