The 2nd edition of the Oxford Textbook of Palliative Medicine is a thorough and compelling treatise on the subject of end-of-life care. It provides a much-needed resource for physicians and other health care providers who care for those who are dying. Nearly half of the text concerns the difficult task of controlling the myriad symptoms from which dying patients suffer. As would be expected from a text on dying, the chapters on pain control and management are exceedingly thorough and informative. Several options for alleviating pain are offered that might not have been considered in a more conventional textbook of medicine. The text also includes excellent chapters on palliative care for symptoms other than pain, including gastrointestinal, respiratory, neurologic, and dermatologic problems. Chapters on interventional radiology and palliative surgery are eye-opening for those who think of palliative care simply as giving morphine to patients at home. I found the well-thought-out discussion on how to break bad news to patients and their families particularly helpful. Authorship input from health care providers from around the globe ensure a perspective that is truly universal. Input from nonphysician health care personnel makes the book useful for nurses, social workers, and others who provide services to the dying patient. These sections make the text a must for any hospice team. The major drawback of this text is its size. Anyone looking for a concise, quick read in palliative medicine will not find it here. The first 200 pages of the book discuss the history and development of the modern hospice movement. While this makes for interesting reading, it would seem more appropriate in a separate text on the sociology or history of medicine. Although most discussions are complete, a paltry 4 paragraphs are devoted to helping the physician convey to patients and families that it may be time to enter a hospice program. In these times of medical miracles, magnetic resonance imaging, and “magic bullet” chemotherapeutic agents, patients and their families often continue to push to “do it all at all costs,” even when the physician who cares for the patient knows that palliative medicine is the best option. One of the greatest challenges practicing physicians face is convincing patients that “comfort care” will improve their quality of life more so than continuing the investigational process with its necessary poking, prodding, needles, and pain. More discussion on how to help patients and their families understand the dying process would have been time well spent. Above criticisms aside, the text is an excellent resource for those who care for the dying and should occupy a prominent place on the bookshelf of anyone who wishes to practice palliative medicine.
{"title":"Oxford Textbook of Palliative Medicine, 2nd ed.","authors":"S. Craig","doi":"10.4088/PCC.V02N0505","DOIUrl":"https://doi.org/10.4088/PCC.V02N0505","url":null,"abstract":"The 2nd edition of the Oxford Textbook of Palliative Medicine is a thorough and compelling treatise on the subject of end-of-life care. It provides a much-needed resource for physicians and other health care providers who care for those who are dying. \u0000 \u0000Nearly half of the text concerns the difficult task of controlling the myriad symptoms from which dying patients suffer. As would be expected from a text on dying, the chapters on pain control and management are exceedingly thorough and informative. Several options for alleviating pain are offered that might not have been considered in a more conventional textbook of medicine. The text also includes excellent chapters on palliative care for symptoms other than pain, including gastrointestinal, respiratory, neurologic, and dermatologic problems. Chapters on interventional radiology and palliative surgery are eye-opening for those who think of palliative care simply as giving morphine to patients at home. I found the well-thought-out discussion on how to break bad news to patients and their families particularly helpful. \u0000 \u0000Authorship input from health care providers from around the globe ensure a perspective that is truly universal. Input from nonphysician health care personnel makes the book useful for nurses, social workers, and others who provide services to the dying patient. These sections make the text a must for any hospice team. \u0000 \u0000The major drawback of this text is its size. Anyone looking for a concise, quick read in palliative medicine will not find it here. The first 200 pages of the book discuss the history and development of the modern hospice movement. While this makes for interesting reading, it would seem more appropriate in a separate text on the sociology or history of medicine. \u0000 \u0000Although most discussions are complete, a paltry 4 paragraphs are devoted to helping the physician convey to patients and families that it may be time to enter a hospice program. In these times of medical miracles, magnetic resonance imaging, and “magic bullet” chemotherapeutic agents, patients and their families often continue to push to “do it all at all costs,” even when the physician who cares for the patient knows that palliative medicine is the best option. One of the greatest challenges practicing physicians face is convincing patients that “comfort care” will improve their quality of life more so than continuing the investigational process with its necessary poking, prodding, needles, and pain. More discussion on how to help patients and their families understand the dying process would have been time well spent. \u0000 \u0000Above criticisms aside, the text is an excellent resource for those who care for the dying and should occupy a prominent place on the bookshelf of anyone who wishes to practice palliative medicine.","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2000-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125996369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This book is a veritable tour de force! The list of names of the 3 editors and the contributors to this book reads like a who's who in the field of American psychiatry, and their effort is no less impressive than their names. By no stretch of the imagination is this a “standard” psychiatric text. It is not a book that catalogs diagnostic categories and the most current status of their management, nor does it attempt to espouse a particular modality of treatment or approach to clinical issues. Instead, it takes a step back and critically examines the currents that have steered psychiatric practice into the new millennium. Not that there is something magical about the millennium, but it “allows us to examine psychiatry and use a universal date as our marker” (p. xxiii). The last century saw psychiatry change from dogma to a discipline with a basis in molecular biology. The last decade of the last millennium was aptly referred to as the “decade of the brain,” and more is known today about the biological basis of psychiatric illness than at any time in the past. The same decade regrettably saw a continued erosion of the role of interpersonal therapies that had provided the discipline with its identity. It is necessary then, to examine how the practitioners of our profession reached this point.
{"title":"Psychiatry in the New Millennium","authors":"S. Verma","doi":"10.4088/PCC.V02N0407","DOIUrl":"https://doi.org/10.4088/PCC.V02N0407","url":null,"abstract":"This book is a veritable tour de force! The list of names of the 3 editors and the contributors to this book reads like a who's who in the field of American psychiatry, and their effort is no less impressive than their names. By no stretch of the imagination is this a “standard” psychiatric text. It is not a book that catalogs diagnostic categories and the most current status of their management, nor does it attempt to espouse a particular modality of treatment or approach to clinical issues. Instead, it takes a step back and critically examines the currents that have steered psychiatric practice into the new millennium. Not that there is something magical about the millennium, but it “allows us to examine psychiatry and use a universal date as our marker” (p. xxiii). The last century saw psychiatry change from dogma to a discipline with a basis in molecular biology. The last decade of the last millennium was aptly referred to as the “decade of the brain,” and more is known today about the biological basis of psychiatric illness than at any time in the past. The same decade regrettably saw a continued erosion of the role of interpersonal therapies that had provided the discipline with its identity. It is necessary then, to examine how the practitioners of our profession reached this point.","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"137 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2000-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128752365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
With the increasing prevalence of depression in the United States, the greater availability of “cleaner” antidepressants, and the downward pressure on reimbursement for primary care office visits, many caregivers have adopted a simplified approach consisting of pharmacotherapy as the only treatment for depression. As a result, the multidimensional aspect of depression is often ignored. In his book directed at individuals and their family members affected by depression, Yapko first presents a complicated multifactorial basis for depression and then breaks down the treatment and prevention into skills for building family strengths. The first part describes the biopsychosocial model of depression. Depression is discussed with respect to its social context and its cognitive, behavioral, and cultural components, with much less emphasis placed on the supposed fundamental role of its biological component. Convincing arguments are presented showing that neurochemistry and life experiences are a “2-way street.” The second part discusses depression from a family perspective. Nurture as opposed to nature is emphasized. Attribution formation and styles, whether constructive or destructive, are shown to be learned skills. The interactions of marriage and depression are addressed from the perspective of the relationship of depression to marital discord, gender roles, and the effect on spouses and children. The author emphasizes the need for inclusion of family members in the treatment. The final part deals with prevention and treatment. Depression is described as a reflection of a problem in the family system or the result of adversity challenging a weak structure. Critical thinking and relationship skills are illustrated with examples. The teaching of emotional intelligence—the ability to tolerate ambiguity and have foresight—is shown to prevent depression. Throughout, Yapko utilizes personally acquired examples, along with good common sense, to effectively help the reader understand the concepts he teaches. The reading level of the book unfortunately seems to fall somewhere between being a resource for a primary care physician treating depression and a tool for an affected lay individual or family member. Although Yapko does admit to a role for pharmacotherapy in the treatment of depression, his book was clearly not sponsored by a drug company. It would be a good patient resource, but only after recovery from an acute episode of depression when concentration abilities are unaffected by the disease process.
{"title":"Hand-Me-Down Blues","authors":"H. Yeates","doi":"10.4088/PCC.V02N0305","DOIUrl":"https://doi.org/10.4088/PCC.V02N0305","url":null,"abstract":"With the increasing prevalence of depression in the United States, the greater availability of “cleaner” antidepressants, and the downward pressure on reimbursement for primary care office visits, many caregivers have adopted a simplified approach consisting of pharmacotherapy as the only treatment for depression. As a result, the multidimensional aspect of depression is often ignored. In his book directed at individuals and their family members affected by depression, Yapko first presents a complicated multifactorial basis for depression and then breaks down the treatment and prevention into skills for building family strengths. \u0000 \u0000The first part describes the biopsychosocial model of depression. Depression is discussed with respect to its social context and its cognitive, behavioral, and cultural components, with much less emphasis placed on the supposed fundamental role of its biological component. Convincing arguments are presented showing that neurochemistry and life experiences are a “2-way street.” \u0000 \u0000The second part discusses depression from a family perspective. Nurture as opposed to nature is emphasized. Attribution formation and styles, whether constructive or destructive, are shown to be learned skills. The interactions of marriage and depression are addressed from the perspective of the relationship of depression to marital discord, gender roles, and the effect on spouses and children. The author emphasizes the need for inclusion of family members in the treatment. \u0000 \u0000The final part deals with prevention and treatment. Depression is described as a reflection of a problem in the family system or the result of adversity challenging a weak structure. Critical thinking and relationship skills are illustrated with examples. The teaching of emotional intelligence—the ability to tolerate ambiguity and have foresight—is shown to prevent depression. \u0000 \u0000Throughout, Yapko utilizes personally acquired examples, along with good common sense, to effectively help the reader understand the concepts he teaches. The reading level of the book unfortunately seems to fall somewhere between being a resource for a primary care physician treating depression and a tool for an affected lay individual or family member. Although Yapko does admit to a role for pharmacotherapy in the treatment of depression, his book was clearly not sponsored by a drug company. It would be a good patient resource, but only after recovery from an acute episode of depression when concentration abilities are unaffected by the disease process.","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2000-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130952525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This first edition of this unique textbook is somewhat of a psychiatrically oriented combination of the Medical Letter Handbook of Adverse Drug Interactions and Goodman and Gilman's Pharmacological Basis of Therapeutics. The purpose is to facilitate the early detection and prompt treatment of neuropsychiatric toxicity resulting from medication use. While the authors state the book is “merely an introduction to the subject,” they have presented a comprehensive guide to the various psychiatric and neurologic side effects that can result from the use of practically any medication. They have achieved this in a highly readable and well-organized fashion. The book is divided into 2 sections. Part I discusses drugs with actions directed at the central nervous system. This section includes chapters on antipsychotics, agents used to treat movement disorders, antidepressants (including psychostimulants), lithium, anticonvulsants, anesthetic agents, sedative-hypnotics (including ethanol), analgesics, and cholinergic agents. Part II details the side effects of agents with actions not directed at the central nervous system. These include antibiotics, cardiovascular agents, antineoplastic agents, antilipemic agents, drugs affecting the endocrine system, gastrointestinal agents, hematologic agents, modulators of immunity, pulmonary agents, and uricosurics. The list of medications discussed appears exhaustive and includes some esoteric and rarely used medications along with drugs that are still being studied but have not yet been released. Each chapter begins with a general discussion of the side effects seen with each class of medication, along with how frequently they are seen. Percentages of side effects listed are based on the authors' best judgment of the literature (the 40 pages of references would indicate a thorough review was performed). Introductions to each chapter begin with interesting historical information on the class of drug, e.g., the 3 stages of bromide encephalopathy. Each chapter then goes on to discuss the pathophysiology of the side effects, along with drug interactions (both pharmacokinetic and pharmacodynamic). The suggested treatment of the side effects is then presented. One of the more remarkable aspects of this book is the range of pharmacologic agents addressed. Information is presented on drugs that range from interferon to digoxin. One does not usually think of antibiotics as a cause of encephalopathy, and yet many common medications that cause various psychiatric and neurologic side effects would appear to be overlooked in such a fashion. Unfortunately, the authors chose to not include information on the psychiatric side effects due to illicit drugs or those caused by herbal and homeopathic remedies. Such a work is sorely needed. While the authors agree that the potential side effects of any given medication are often rarely observed, the side effects detailed in this text are seen quite frequently. They include such
{"title":"Psychiatric Side Effects of Prescription and Over-the-Counter Medications: Recognition and Management.","authors":"K. Ferentz","doi":"10.4088/PCC.V02N0107A","DOIUrl":"https://doi.org/10.4088/PCC.V02N0107A","url":null,"abstract":"This first edition of this unique textbook is somewhat of a psychiatrically oriented combination of the Medical Letter Handbook of Adverse Drug Interactions and Goodman and Gilman's Pharmacological Basis of Therapeutics. The purpose is to facilitate the early detection and prompt treatment of neuropsychiatric toxicity resulting from medication use. While the authors state the book is “merely an introduction to the subject,” they have presented a comprehensive guide to the various psychiatric and neurologic side effects that can result from the use of practically any medication. They have achieved this in a highly readable and well-organized fashion. \u0000 \u0000The book is divided into 2 sections. Part I discusses drugs with actions directed at the central nervous system. This section includes chapters on antipsychotics, agents used to treat movement disorders, antidepressants (including psychostimulants), lithium, anticonvulsants, anesthetic agents, sedative-hypnotics (including ethanol), analgesics, and cholinergic agents. Part II details the side effects of agents with actions not directed at the central nervous system. These include antibiotics, cardiovascular agents, antineoplastic agents, antilipemic agents, drugs affecting the endocrine system, gastrointestinal agents, hematologic agents, modulators of immunity, pulmonary agents, and uricosurics. The list of medications discussed appears exhaustive and includes some esoteric and rarely used medications along with drugs that are still being studied but have not yet been released. \u0000 \u0000Each chapter begins with a general discussion of the side effects seen with each class of medication, along with how frequently they are seen. Percentages of side effects listed are based on the authors' best judgment of the literature (the 40 pages of references would indicate a thorough review was performed). Introductions to each chapter begin with interesting historical information on the class of drug, e.g., the 3 stages of bromide encephalopathy. Each chapter then goes on to discuss the pathophysiology of the side effects, along with drug interactions (both pharmacokinetic and pharmacodynamic). The suggested treatment of the side effects is then presented. \u0000 \u0000One of the more remarkable aspects of this book is the range of pharmacologic agents addressed. Information is presented on drugs that range from interferon to digoxin. One does not usually think of antibiotics as a cause of encephalopathy, and yet many common medications that cause various psychiatric and neurologic side effects would appear to be overlooked in such a fashion. Unfortunately, the authors chose to not include information on the psychiatric side effects due to illicit drugs or those caused by herbal and homeopathic remedies. Such a work is sorely needed. \u0000 \u0000While the authors agree that the potential side effects of any given medication are often rarely observed, the side effects detailed in this text are seen quite frequently. They include such ","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"125 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2000-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122852371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Postgraduate Press in the 21st Century","authors":"J. Shelton","doi":"10.4088/PCC.V02N0100","DOIUrl":"https://doi.org/10.4088/PCC.V02N0100","url":null,"abstract":"","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"123 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2000-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127052739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Our focus is on lifelong learning. The eye that you see above—our new logo—reflects our continuing commitment to this focus. Over the past 60 years, through the efforts of our superb editors and creative staff, bolstered by the encouragement of our readers and commercial supporters alike, we have become an indispensable resource for psychiatrists worldwide. As the 20th century ends, we at Physicians Postgraduate Press hope to become a trusted source of information for you, our primary care readers. Our eye is trained on the evolving field of CNS research. Our focus is to provide the hundreds of thousands of health care professionals with information to use in caring for the tens of millions who suffer from the distress of behavioral disorders. As has the field of psychiatry, we have grown through the past 6 decades, creating an ever expanding family of educational tools. We now offer primary care physicians impactful publications, original multimedia productions, stimulating live and enduring CME activities, and a Web site brimming with useful information. We ask that you, our newest valued readers, also focus on our efforts and provide suggestions and insights to help our company meet the needs of our ever growing audiences. Thus, together, we will shape the vision of improving patient care and increasing the understanding of mental disorders. With your help, Physicians Postgraduate Press will continue to be in the frontline of CNS research by helping to translate that research into the primary care clinicians' vernacular. Our eye is on the future and our vision is trained on helping our readers to improve their treatment of behavioral disorders in the 21st century.
{"title":"Physicians Postgraduate Press in the 21st Century.","authors":"J. Shelton, Irving Shelton","doi":"10.4088/jcp.v61n0101","DOIUrl":"https://doi.org/10.4088/jcp.v61n0101","url":null,"abstract":"Our focus is on lifelong learning. The eye that you see above—our new logo—reflects our continuing commitment to this focus. Over the past 60 years, through the efforts of our superb editors and creative staff, bolstered by the encouragement of our readers and commercial supporters alike, we have become an indispensable resource for psychiatrists worldwide. As the 20th century ends, we at Physicians Postgraduate Press hope to become a trusted source of information for you, our primary care readers. Our eye is trained on the evolving field of CNS research. Our focus is to provide the hundreds of thousands of health care professionals with information to use in caring for the tens of millions who suffer from the distress of behavioral disorders. As has the field of psychiatry, we have grown through the past 6 decades, creating an ever expanding family of educational tools. We now offer primary care physicians impactful publications, original multimedia productions, stimulating live and enduring CME activities, and a Web site brimming with useful information. We ask that you, our newest valued readers, also focus on our efforts and provide suggestions and insights to help our company meet the needs of our ever growing audiences. Thus, together, we will shape the vision of improving patient care and increasing the understanding of mental disorders. With your help, Physicians Postgraduate Press will continue to be in the frontline of CNS research by helping to translate that research into the primary care clinicians' vernacular. Our eye is on the future and our vision is trained on helping our readers to improve their treatment of behavioral disorders in the 21st century.","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2000-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133206767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Obsessive-Compulsive Disorder Casebook, revised ed.","authors":"D. Ramchandani","doi":"10.4088/PCC.v02n0107b","DOIUrl":"https://doi.org/10.4088/PCC.v02n0107b","url":null,"abstract":"","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2000-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132924905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Like its predecessor, The Fifteen Minute Hour, 2nd edition, is essential reading and an invaluable tool for all family practice physicians. During this time when our evolving health care delivery is shaped by ever expanding general medical knowledge and technology, limitations of financial resources, and relative increase in chronic illnesses, comprehensive primary health care may be provided only by incorporating strategies for addressing the psychosocial and biological ailments of our patients. The text outlines the systematic means for integration of psychosocial patient assessment into routine patient care in a format that is well organized and easy to assimilate. The book begins with a discussion of the trends of the current health care delivery system and the need to integrate a biopsychosocial model into the context of existent social, political, and economic realities. A review of pertinent research substantiating the effectiveness of brief psychotherapy is included, as well as an examination of the natural proclivities and characteristics that make primary care physicians ideal psychotherapists. The authors describe the common elements of all psychotherapy techniques and introduce new concepts that simplify the process for physicians. Traditional psychotherapy and psychotherapy taught and advocated in the text are contrasted. The text provides readers with information on the BATHE method, a psychotherapeutic procedure that serves as a rough screening test for anxiety, depression, and situational stress disorders. The BATHE method consists of 4 specific questions about the patient's background, affect, troubles, and handling of the current situation, followed by an empathetic response (i.e., B Background, A-Affect, T-Trouble, H-Handling, E-Empathy). Further discussion includes rationale and techniques of the 15 minute therapy session, methods for handling challenging patients (e.g., hypochondriacs, chronic complainers, substance abusers), and a review of the application of psychotherapy in special situations (e.g., difficult family members, confronting the patient when acceptable limits have been exceeded). For primary care physicians trained in the traditional disease-oriented medical model, this publication is a survival guide to negotiating a course of complete patient care within the context of a truly enjoyable and fulfilling medical practice. For those of us who developed our own strategies for addressing complete patient needs from the first edition of The Fifteen Minute Hour or by other means, the second edition warrants reading for its clarification and expansion of important issues as well as the addition of new care material, concepts, and techniques.
{"title":"The Fifteen Minute Hour","authors":"Laura A Tavernier","doi":"10.4088/PCC.V01N0605B","DOIUrl":"https://doi.org/10.4088/PCC.V01N0605B","url":null,"abstract":"Like its predecessor, The Fifteen Minute Hour, 2nd edition, is essential reading and an invaluable tool for all family practice physicians. During this time when our evolving health care delivery is shaped by ever expanding general medical knowledge and technology, limitations of financial resources, and relative increase in chronic illnesses, comprehensive primary health care may be provided only by incorporating strategies for addressing the psychosocial and biological ailments of our patients. The text outlines the systematic means for integration of psychosocial patient assessment into routine patient care in a format that is well organized and easy to assimilate. \u0000 \u0000The book begins with a discussion of the trends of the current health care delivery system and the need to integrate a biopsychosocial model into the context of existent social, political, and economic realities. A review of pertinent research substantiating the effectiveness of brief psychotherapy is included, as well as an examination of the natural proclivities and characteristics that make primary care physicians ideal psychotherapists. \u0000 \u0000The authors describe the common elements of all psychotherapy techniques and introduce new concepts that simplify the process for physicians. Traditional psychotherapy and psychotherapy taught and advocated in the text are contrasted. The text provides readers with information on the BATHE method, a psychotherapeutic procedure that serves as a rough screening test for anxiety, depression, and situational stress disorders. The BATHE method consists of 4 specific questions about the patient's background, affect, troubles, and handling of the current situation, followed by an empathetic response (i.e., B Background, A-Affect, T-Trouble, H-Handling, E-Empathy). Further discussion includes rationale and techniques of the 15 minute therapy session, methods for handling challenging patients (e.g., hypochondriacs, chronic complainers, substance abusers), and a review of the application of psychotherapy in special situations (e.g., difficult family members, confronting the patient when acceptable limits have been exceeded). \u0000 \u0000For primary care physicians trained in the traditional disease-oriented medical model, this publication is a survival guide to negotiating a course of complete patient care within the context of a truly enjoyable and fulfilling medical practice. For those of us who developed our own strategies for addressing complete patient needs from the first edition of The Fifteen Minute Hour or by other means, the second edition warrants reading for its clarification and expansion of important issues as well as the addition of new care material, concepts, and techniques.","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130479099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
As part of the Clinical Practice Series of the American Psychiatric Press, this book on bipolar disorders integrates current clinical research findings with clinical applications and provides a broad overview of course and outcome for bipolar disorders. The book provides a concise, up-to-date summary of current knowledge about affective relapse, comorbid psychopathology, functional disability, and psychosocial outcome in bipolar disorders. It has been generally acknowledged that bipolar affective disorders are one of the leading causes of chronic disability worldwide. From the perspective of illness-related cost, the total economic impact of bipolar disorder is estimated at several billion dollars. In recent decades, the diagnostic trends in the United States have favored a broadened definition of bipolar illness. Another change in diagnostic approaches may involve new phenotypes of the disorder. These phenotypes may be reflected in cohort effects among contemporary bipolar patients involving factors such as drug and alcohol abuse, past treatment with tricyclic or other antidepressant agents, and cross-generational shifts due to transmission of unstable DNA sequences. As Dr. Frederick Goodwin notes in his foreword, “One fascinating hypothesis suggests that a cross-generational shift to more malignant forms of the illness may reflect a genetic mechanism involving unstable DNA. Trinucleotide repeats would increase the severity of the illness in succeeding generations, perhaps contributing to greater treatment resistance.” Indeed, this hypothesis may explain what clinicians have known for the past several years—that bipolar patients do not appear to be responding to lithium carbonate as before. There is clearly a disparity between what is observed in clinical practice and in controlled clinical trials with lithium carbonate. Clinicians have long known that bipolar disorder is a recurrent disorder. The episodes recur, and recurrences tend to come closer together as the disorder progresses. Furthermore, the degree of environmental stress associated with recurrent episodes becomes progressively less intense over time. These phenomena have generated the “kindling hypothesis.” Another hypothesis posits that the episodic nature of the illness reflects a disturbance in the regulation of biological rhythms. These hypotheses have clinical implications. Antiseizure medications have gradually replaced lithium carbonate as the treatment of first choice for most bipolar patients. It is believed that many of these drugs, such as valproic acid, may act through biological mechanisms that attenuate the kindling phenomenon. Psychosocial factors, at least initially, play an important role in precipitating episodes of either depression or mania. In what is perhaps the best chapter, Miklowitz and Frank explore psychotherapeutic strategies for bipolar disorder. They modify a model proposed by Goodwin and Jamison that posits a role for stressful life events. The
{"title":"Bipolar Disorders: Clinical Course and Outcome","authors":"C. V. Haldipur","doi":"10.4088/PCC.V01N0605A","DOIUrl":"https://doi.org/10.4088/PCC.V01N0605A","url":null,"abstract":"As part of the Clinical Practice Series of the American Psychiatric Press, this book on bipolar disorders integrates current clinical research findings with clinical applications and provides a broad overview of course and outcome for bipolar disorders. The book provides a concise, up-to-date summary of current knowledge about affective relapse, comorbid psychopathology, functional disability, and psychosocial outcome in bipolar disorders. \u0000 \u0000It has been generally acknowledged that bipolar affective disorders are one of the leading causes of chronic disability worldwide. From the perspective of illness-related cost, the total economic impact of bipolar disorder is estimated at several billion dollars. In recent decades, the diagnostic trends in the United States have favored a broadened definition of bipolar illness. Another change in diagnostic approaches may involve new phenotypes of the disorder. These phenotypes may be reflected in cohort effects among contemporary bipolar patients involving factors such as drug and alcohol abuse, past treatment with tricyclic or other antidepressant agents, and cross-generational shifts due to transmission of unstable DNA sequences. As Dr. Frederick Goodwin notes in his foreword, “One fascinating hypothesis suggests that a cross-generational shift to more malignant forms of the illness may reflect a genetic mechanism involving unstable DNA. Trinucleotide repeats would increase the severity of the illness in succeeding generations, perhaps contributing to greater treatment resistance.” Indeed, this hypothesis may explain what clinicians have known for the past several years—that bipolar patients do not appear to be responding to lithium carbonate as before. There is clearly a disparity between what is observed in clinical practice and in controlled clinical trials with lithium carbonate. \u0000 \u0000Clinicians have long known that bipolar disorder is a recurrent disorder. The episodes recur, and recurrences tend to come closer together as the disorder progresses. Furthermore, the degree of environmental stress associated with recurrent episodes becomes progressively less intense over time. These phenomena have generated the “kindling hypothesis.” Another hypothesis posits that the episodic nature of the illness reflects a disturbance in the regulation of biological rhythms. These hypotheses have clinical implications. Antiseizure medications have gradually replaced lithium carbonate as the treatment of first choice for most bipolar patients. It is believed that many of these drugs, such as valproic acid, may act through biological mechanisms that attenuate the kindling phenomenon. \u0000 \u0000Psychosocial factors, at least initially, play an important role in precipitating episodes of either depression or mania. In what is perhaps the best chapter, Miklowitz and Frank explore psychotherapeutic strategies for bipolar disorder. They modify a model proposed by Goodwin and Jamison that posits a role for stressful life events. The ","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115587999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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 reli
{"title":"Clinical Manual of Psychiatric Diagnosis and Treatment: A Biopsychosocial Approach.","authors":"W. Jackson","doi":"10.4088/PCC.V01N0505A","DOIUrl":"https://doi.org/10.4088/PCC.V01N0505A","url":null,"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. \u0000 \u0000Enough 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. \u0000 \u0000The 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. \u0000 \u0000In sum, the layout of this book stifles Pies' penetrating insights and his gift for prose. It is too bulky to reli","PeriodicalId":371004,"journal":{"name":"The Primary Care Companion To The Journal of Clinical Psychiatry","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1999-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130232722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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