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The Hatherleigh Guide to Psychopharmacology
edited by Stacey M. Powell, 400 pp, with illus, $29.95, ISBN 1-57826-022-1, New York, NY, Hatherleigh Press, 1999.
Arch Fam Med. 2000;9:657.
This guide to pharmacology was compiled under the auspices of multiple editorial boards and does not have an individual medical editor. As a result, this book reads as a series of disjointed yet overlapping essays. Each essay is a chapter by different author(s) on various psychiatric issues, with 14 chapters in all. The book, as a whole, has spelling and typographical errors, repeated words, and is generally wordy. It is not a quick and easy reference, nor is it a collection of in-depth reading on the subject of psychopharmacology. This being said, there are pockets of useful information in this book.
Chapter 1, entitled "The Patient's View of Antipsychotic Pharmacotherapy," by Klaus Windgassen, MD, has 2 important and not-so-simple messages. The first is that psychotic patients' perceptions are altered both by their disease and by the medical treatment they receive. This makes the clinician's job of caring for these patients more challenging. Second, the treatment of the psychotic patient should be holistic and include psychotherapy, sociotherapy, and medication. Dr Klaus stresses the important concept that the treatment of the psychotic patient is not just pharmacologic, and emphasizes that the altered perception of the psychotic patient presents a very different participant in the physician-patient relationship. This difference is striking in the present day of informed patients and informed patient consent. Also discussed is that psychotic patients' compliance with their medications is a multifaceted problem. While affording the psychotic patient the ability to think and more clearly function in society, these medications have unacceptable adverse effects (eg, dystonia, restlessness, dysphoric responses, weight gain). Dr Klaus does a nice job convincing the physician caring for a psychotic patient to reframe the treatment plan into a more holistic approach.
There is no chapter in this book dealing with specific common antipsychotic drugs. The chapter, "Atypical Antipsychotics in Schizophrenia," deals only with what its title supposes (eg, the most atypical antipsychotic agents). Chapter 14, entitled "A Cross-Cultural Perspective on Psychopharmacology" by Edmond H. Pi, MD, and Gregory E. Gray, MD, PhD, is a chapter worth reading, but again, its emphasis is more on the psychosocial and cultural aspects and does not deal with psychopharmacology per se.
Otherwise, there are 4 chapters on antidepressant agents and their use and 3 chapters on the pharmacology of bipolar disorder. All of these chapters take different approaches, yet often repeat information from other depression chapters. Chapter 2 discusses important pharmacokinetics of the antidepressants. Unfortunately, there is information in this chapter that conflicts with information in chapter 3 (eg, chapter 2 states "for all the newer and older antidepressants, except nortriptyline, there is a poor correlation between either therapeutic effect or adverse reactions and plasma levels . . . for this reason, the primary use of determinations of plasma levels with the newer antidepressants is to establish patient compliance"; chapter 3 states "the clinician should verify plasma drug levels when assessing the reasons for a lack of response, when encountering a higher than expected degree of side effects or when suspecting toxicity").
The chapter regarding "Pharmacology During the Perinatal Period," by Laura Miller, MD, is both informative and a good reference for individuals taking care of pregnant and lactating women. Chapter 12, "Psychoactive Drug-Drug Interactions in Children, Adolescents, and Adults" is mainly a repeat of the information in previous chapters, although a short section "Special Considerations in Children and Adolescents" and 2 tables, "Drug Interactions Involving Psychostimulants" and "Psychiatric Disorder in Children and Adolescents for Which Pharmacology Has Been Used," are well organized and clinically helpful.
On the whole, the typographical errors, overlapping information, and inconsistencies in information made this a difficult book to read. With that said, this book does provide some useful information.
Judith A. Fisher, MD, Reviewer
Department of Family Practice and Community Medicine
University of Pennsylvania Health System
39th and Market streets
Philadelphia, PA 19104
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