Psychosomatics 42:447-448, October 2001
© 2001 The Academy of Psychosomatic Medicine
Psychiatric Treatment of the Medically Ill
Edited by Robert G. Robinson and William R. Yates, New York, Marcel Dekker, 1999, 564 pp, ISBN 0-8247-1958-1
Molly Shores, M.D., and
Marcella Pascualy, M.D.
Key Words: Books Reviewed
This book examines the boundary between medical and psychiatric disorders, which is an intriguing and important area for psychiatrists. Multiple studies have shown that psychiatric illness increases medical morbidity and mortality, increases cost of care, and decreases quality of life. In addition, the number of patients having both medical and psychiatric problems will likely increase markedly in the next decade as the population continues to age. Psychiatrists and primary care practitioners will find this book to be a useful reference that provides an overview of the relevant psychiatric issues in a broad range of medical disorders.
The book is divided into three sections: an introduction, a large section that discusses psychiatric aspects of specific medical disorders, and a concluding section on psychopharmacologic issues.
The introductory section starts off with a well-written chapter on the significance of psychiatric illness in the medically ill and indications and usefulness of screening for psychiatric disorders. This is followed by chapters on the specificity of psychiatric symptoms in the medically ill and the epidemiology of psychiatric disorders in the medically ill. The introductory section is well-referenced and provides a useful framework for the subsequent chapters.
The comprehensive section on medical illnesses consists of eighteen chapters that cover the most common medical disorders as well as those in which psychiatric issues may play a significant role. Generally, the chapters provide solid overviews and include several noteworthy chapters written by experts in the field. Highlights include an excellent review of cerebrovascular disease by Robinson and Paradiso, which begins with a historical perspective and then proceeds to review the different categories of cerebrovascular disease. This chapter is detailed and well referenced with thoughtful critiques of the published literature. The chapter on traumatic brain injury by Jorge and Robinson is equally comprehensive with excellent clinical descriptions of the cognitive, behavioral, and personality changes that these patients suffer. The neuropathology and neurochemical studies in this area are well summarized, and the treatment section offers the practitioner sound advice in the management of these difficult patients. The chapter on headaches by Merikangas et al. is well-written with an excellent overview of the classification of headaches. The case example, differential diagnosis, and clinical evaluation sections will ensure that the clinician will be able to perform a thorough evaluation of such patients. Yates provides an excellent review of liver disease, medical complications of liver disease, and treatment recommendations for psychiatric disorders in patients with liver disease. In addition, this chapter discusses how to perform an in-depth consult to evaluate a potential liver transplant candidate from a psychiatric perspective. The menstrual cycle disorder chapter by Johnson is succinct and clear with excellent figures and a comprehensive section on management, including self-help therapies, pharmacological therapies, ovulation inhibition, and surgical intervention.
Other chapters that are particularly informative include the chapter on dementia by Ranen and Rovner, Parkinson's disease by Starkstein and Petracca, and HIV by Treisman et al. These chapters provide pertinent information for any practitioner who treats patients with these disorders.
Although, as indicated above, the chapters generally provide solid reviews, the chapter on sleep disorders by Barthlen is disappointingly brief and superficial. It does not address this highly prevalent clinical problem with the depth it deserves, and the inadequacy of this chapter is reflected in its scant reference section.
The final section on psychopharmacology in the medically ill includes chapters on disorders affecting pharmacokinetics, monitoring serum drug levels, and the effects of aging on psychotropics and drug interactions. This section has many useful clinical gems that all practitioners could benefit from reading and reviewing. In particular, the chapters on psychotropic drug interactions provide a detailed yet clinically useful overview of the P450 system, and the chapter on aging provides an excellent overview of issues related to aging and psychotropics.
A disappointing aspect of this book is the quality of the graphics. Some of the charts and graphs have excessively small or blurred print, hand-drawn arrows, or errors due to mislabeling. Overall the graphic figures were difficult to read and were not of a quality comparable to the written text.
In summary, given the profound impact that psychiatric illness has on medical disorders, an understanding of the interface between medicine and psychiatry is increasingly important for all psychiatrists. Although this book has some weaknesses, overall it will provide a highly useful reference tool for primary care physicians and psychiatrists at all levels of training.
FOOTNOTES
Dr. Shores is an assistant professor in the Department of Psychiatry and Behavioral Sciences, University of Washington and is a geriatric and consultation-liaison service psychiatrist at the Puget Sound VA Health Care System.
Dr. Pascualy is an associate professor in the Department of Psychiatry and Behavioral Sciences, University of Washington and is a geriatric psychiatrist and chief of the Consultation-Liaison Service at the Puget Sound VA Health Care System.
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