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Management of Mental Disorders (Vols 1 & 2, UK edn) Edited By Gavin Andrews & Rachel Jenkins. Sydney & London: World Health Organization Collaboration Centres in Mental Health. 1999. 661 pp. ISBN 0 9587052 2 4

Published online by Cambridge University Press:  02 January 2018

Patricia Casey*
Affiliation:
Mater Misericordiae Hospital, Eccles Street, Dublin 7, Republic of Ireland
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Abstract

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Copyright
Copyright © 2001 The Royal College of Psychiatrists 

These volumes are a contradiction. On the one hand, they are a novel attempt to present in punctilious detail all aspects of management that were not heretofore available in standard textbooks. On the other, all the material is familiar and instantly recognisable as a synthesis of the wisdom and expertise of clinical management accumulated over years — in that sense these volumes contain nothing new. Therein lies their strength, as they describe practices that are the bread and butter of clinical intervention driven by practical rather than theoretical considerations. Not confining themselves to pharmacological interventions, they describe techniques such as problem-solving and goal-setting, rendering more than just a vade-mecum of treatments and covering a diverse range of issues that arise in the day-to-day management of patients.

The two volumes begin with a helpful description of core management skills that include history-taking and mental state assessment, motivational interviewing and encouraging adherence to treatment. The single chapter that deals with medication is succinct and accessible. Other chapters examine a broad category of disorder (e.g. anxiety and somatoform disorders), sub-sectioned to focus on specific conditions within the overall group. All the disorders classified in ICD-10 are included. A description of pharmacological interventions is comprehensive with particular attention to unwanted side-effects and drug interactions. Case vignettes are used to good effect to illustrate the essentials of psychological management. Other crucial aspects of intervention are to the forefront such as feelings and fears about the particular disorder, working with relatives, early recognition of relapse and addressing the common questions posed by patients and carers. Resource material provided at the end of each chapter is invaluable consisting of well-established questionnaires such as the BPRS and the CAGE as well as material that can be used on its own or supplemented by therapists for use by patients.

The chapters are presented in a pleasing and modern style, with bullet points, highlighting boxes, headings and subheadings for ease of assimilation. However, there are some presentational inconsistencies; for example, many, but not all, chapters provide reading material for patients and carers. Also, two chapters include no resource material at all — that tentatively entitled ‘Personality problems’ (rather than ‘personality disorders’) and that on child and adolescent disorders. Cross-referencing between chapters is done by chapter and section, rather than by page number, and this is both irritating and frustrating as is the positioning of the index at the end of Vol. 2. These two simple publishing errors are most likely to limit the books' usefulness to busy health care professionals.

There are other noticeable weaknesses. Coverage of the management of post-traumatic stress disorder is skimpy, saying little more than that it is a “ severe disorder that is difficult to treat” and recommending referral to a clinical unit with expertise in the area. Some of the advice for dealing with the immediate aftermath of a traumatic event, such as “Talk about the incident with others. Talking will help you get over the reactions”, are more appropriate to a television chat show than a volume for professionals and might, arguably, be dangerous. Adjustment disorder merits only half a page, although three-and-a-half pages are devoted to bereavement. Regrettably, there is no mention of bereavement in special circumstances, such as following the death of a child or death by suicide. The failure to grapple with interventions that are popular but unproven or dangerous is striking, particularly as these books might find a home in the briefcases of those mental health professionals who may favour such techniques. Included among such treatments are critical-incident stress debriefing and counselling for depressive illness.

All in all, these are well-presented, useful and easily digested handbooks, which will be well thumbed and will have an extensive usership. In trying to be assiduously comprehensive, the editors have left several breaches but these can and must be filled in the second edition.

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