There's something about a book with a white cover that invites reading, as if the reader expects that, not just the binding, but the content itself will be lighter. The crisp, white covers with red lettering, boasting the color illustration of a SPECT brain image super-imposed upon an MRI scan - the Lexus of neuroanatomic imaging - imply that the Comprehensive Textbook of Psychiatry, sixth edition will be entertaining as well as timely. Once the books are opened, the layout further visually encourages reading. Illustrations, tables, graphs, changes in font size, or bold subheadings break up the blocks of text on every page.

Data on functional brain imaging currently make a good index of the recency of published neuro-psychiatric material. Several pages of color plates of PET and SPECT scans start educating the reader before page 1. Close by, a section entitled "Principles of Neuroimaging" in the first chapter, "Neural Sciences," explains the physical principles underlying these diagnostic investigations. In the next chapter, the section "Neuroimaging in Clinical Practice" patiently details the expected findings of CT, MRI, and functional neuroimaging studies such as SPECT scans in stages of psychiatric and neurological disorders. The compulsive researcher who demands even more data or the clinician who skips the basic science chapters and begins reading in the more clinically oriented topics will find even more material. "Schizophrenia: Brain Structure and Functions," a subchapter under Schizophrenia," explains the research and clinical imaging findings in schizophrenia, and illustrates the brains of schizophrenics compared to the brains of their non- afflicted identical twins, for example.

To write for such a disparate audience as psychiatrists must be daunting. The contributors, numbering some 300, plotted two paths in order to satisfy such a variety of interests: providing an encyclopedic text of adequate breadth and depth and discussing the contributions from each subspecialty and school of thought in psychiatry.

The scope of these two volumes is so broad that the psychiatrist, or any mental health professional, can find adequate material to update himself in practically any related subject. A consultation psychiatrist, for example, will find drawings of organ transplantations and will read about the behavioral side effects of immuno-suppressant drugs used in such surgery.

Information is layered in such depth that an academician can prepare entire lectures from the two volumes, saving time he would otherwise spend challenging the maze of the medical center library or driving his modem through the electronic data bases.

In addition to clinical sections devoted to disease entities, chapters and subchapters are dedicated to the interests of subspecialties such as geropsychiatry, child psychiatry, addictionology, and others. Further, devotees to different schools of thought or disciplines, such as psychoanalysis or psychopharmacology, will find chapters addressing their basic theories. Psychoanalysts will be pleased with their own chapter of 55 pages, including no fewer then 7 photographs of Freud.

Then, as each illness is discussed, the theories that each school of thought has contributed to the etiology, pathology, and treatment are presented. Mental health professionals of all disciplines will find this edition a rich resource and will readily make room on their shelves by tossing out several books of more narrow scope, now unneeded.

Forensic psychiatry seems curiously under-weighted in these volumes. Only one chapter of 28 pages is nominally assigned to the subject. Fortunately, it is authored by Thomas Gutheil whose lively and concise writing style and capacity to preserve clinical judgment as focus moves into the courtroom give us great value per line of print in this brief chapter. The brevity forces him to focus on issues that are urgent for most practicing psychiatrists, such as consent, confidentiality, commitment, and malpractice - treatment related matters. The consultative work of the forensic psychiatrist enjoys less attention.

An attorney, especially one experienced in malpractice litigation, might be discouraged to find these scant pages tucked near the back cover as if an afterthought. But a wealth of information that is of value to the forensic assessment is scattered throughout the two volumes. The neuroimaging devices referred to above, for instance, are often used to assess head trauma in personal injury or worker's compensation conflicts and to assess mental illness in addressing criminal responsibility and competence. The phenomenon of behavioral disinhibition from benzodiazepines, presented by the defense as a mitigating factor, is described.

While on the subject of drug abuse, one will be amused to read that the official policy in Singapore is to allow abrupt, or "cold turkey," withdrawal from opiates, since the discomfort is viewed as a deferent to relapse. Photographs of the "skin popper," with countless sores and scars from drug injections, and the heroin addict who is puffing out her cheeks in order to distend the jugular vein to a size that would accommodate a needle, chill the reader.

Descriptions of psychiatric symptoms, psychiatric rating scales, and neuropsychological testing are detailed enough to help the lawyer assess the appropriateness of his expert witness's report. Specific drugs indicated for psychiatric disorders are described, including usual doses, side effects, and even potential drug interactions, providing the attorney with insight into his client's psychiatric treatment.

Annoying proofreading errors seem to be the principal fault of this textbook. An explanation of benzodiazepine intoxication ends abruptly in mid sentence, leaving the puzzled reader flipping pages to see if it might surface later. The word "within" was misprinted as "without," sneaked through the spellchecker in disguise, and tried to reverse the meaning of a sentence. Various authors paraphrased or even repeated comments in consecutive sentences. On occasion a phrase or even half a paragraph was so jumbled as to defy comprehension.

But the reader forgives such flaws in a book with such an attractive cover, enticing layout, and rich content.

Dr. Ruth is a Diplomat of the American Board of Psychiatry and Neurology. He has been in private practice in Lexington, Kentucky, since 1978. He recently became certified with added qualifications in forensic psychiatry.

Back to the Table of Contents