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Managing Mental Health Problems: A Practical Guide for Primary Care
by Nick Kates, MBBS, FRCP, Marilyn Craven, MD, PhD, CCFP, 390 pp, $49, ISBN 0-88937-124-5, Seattle, Wash: Hogrefe & Huber Publishers, 1998.
Arch Fam Med. 1999;8:453.
Mental disorders are commonly encountered, diagnosed, and treated in primary care. Some evidence suggests that primary care physicians could improve in their recognition and treatment of mental disorders. Managing Mental Health Problems: A Practical Guide for Primary Care is an attempt to be exactly what the title suggests—a clear, practical book for recognizing mental health problems and indicating appropriate treatment in primary care. This book does not have a theoretical or scholarly orientation; there are no citations. It should be noted that although Kates and Craven do not include a list of referenced articles, they do include a list of "further readings that will be of interest to primary care providers." This style may be a publishing strategy to expand the audience beyond physicians. This is an easy book to read, but the lack of citations is in contrast to the current move toward evidence-based discussions, particularly of treatments. Consequently, I am a little concerned about supporting evidence for some of the statements.
The book is relatively exhaustive in its coverage of mental health problems, with chapters on depression, anxiety, grief, psychoses, schizophrenia, and bipolar affective disorder. Kates and Craven also touch on other important emotional issues that might be encountered in primary care, such as sexual problems and abuse. I was, however, a little disappointed that personality disorders were not specifically addressed; these patients are commonly encountered in primary care, and they often frustrate primary care physicians.
In addition to focusing on specific types of problems, the book does a nice job of introducing the reader to interviewing techniques and problem assessment. As opposed to many psychiatry texts, these techniques are presented in the context of a long-term relationship between the patient and the physician. This book is interesting and engaging. Kates and Craven offer many cases and scenarios to illustrate problems and treatment. These illustrations are particularly helpful once the reader understands the advantage of the book as a practical resource.
The real benefit of this book lies at the end of every chapter. Following in-depth discussions of treatment options, including both pharmaceutical and behavioral therapies, the chapters have bulleted sections on "When to Refer to Psychiatry" and, importantly, "Reasonable Expectations of a Primary Care Provider." These sections are particularly valuable, providing a synthesis of the complexity of the problem and what is entailed in treatment. Kates and Craven are aware that not every aspect of management needs to be handled by the primary care physician, and they explain what should happen in interactions with the consultant who is comanaging the patient. This is an easy-reading book with significant value to primary care physicians.
Reviewer Arch G. Mainous III, PhD
Department of Family Medicine
Medical University
of South Carolina
Charleston, SC 29425
(e-mail: mainouag{at}mus.edu)
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