Clinical Manual of Psychiatric Diagnosis and Treatment: A Biopsychosocial Approach.

Abstract

The wisdom of the adage about books and their covers is often lost on this self-confessed bibliophile. Little books, big books, paperbacks, leather-bound behemoths—I am easily seduced. So I was surprised (and embarrassed) to find that I delayed this review for 2 months for none but the shallowest of reasons: I didn't like the feel of it. A wire-bound softcover, its title states it is intended to be a manual (literally, a book for the hand). But at a size of 75 cubic inches and a weight of 1 lb 8 oz, that's some hand. The spiral binding is impractical in a book this large; after a few uses, it invariably becomes bent, rendering the pages difficult to turn. The end result is predictable, and it seems the pages central to the discussion always tear loose first. Enough ranting about mundane practicality; on to the content. Try as I might to resist this book, I could not. The organization of the material is prosaic and not conducive to quick reference. The information presented is 5 years old (a virtual eternity in postmodern medicine). The DSM nosology is a hybrid between III-R and IV, offering a nice time capsule, but not anticipating the next generation of nomenclature. Despite these weaknesses, Pies' writing is superb. Underneath the casual, conversational tone lies a profound understanding of the disorders discussed that is communicated with aplomb. Seven chapters cover most of the usual topics in good depth; notable exceptions are impulse disorders and eating disorders. Most of the clinical syndromes are treated systematically via a refreshingly clear schema; sections are titled “The Central Concept,” “Historical Development of the Disorder,” “The Biopsychosocial Perspective,” “Pitfalls in the Differential Diagnosis,” “Adjunctive Testing,” “Treatment Directions and Goals,” and “Integrated Case History.” In particular, the sections on the bipolar spectrum and unipolar depression flow easily and resonate well with the experience of mood disorders in primary care. The historical information and smattering of clever quotes help keep the reader's interest in lively fashion. The real strength of the book, however, is in Pies' treatment of the integrated, Engelian model of illness. Unlike most authors, he does more than lip service to the idea that elements of a patient's medical, psychologic, and social milieu may intertwine. He demonstrates these facts by case histories, showing how ignoring any 1 of the 3 spheres may lead to gross errors in diagnosis and treatment, owing to the oft-neglected fact that identical symptoms may spring from vastly different etiologies. His brief descriptions of the various psychological tests available are the most useful for generalist physicians that I have found to date. Finally, his discussion of biomedical disorders having an impact on (or presenting as) psychiatric disturbances is outstanding. In sum, the layout of this book stifles Pies' penetrating insights and his gift for prose. It is too bulky to reliably serve his target audience (upper-level residents in psychiatry) or generalist physicians as a handy guide. It is too sketchy to serve as a comprehensive reference. Still, it earns a place on my shelf, until Pies fleshes out his ideas in a full-scale text.