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Atlas of psychiatric pharmacotherapy
  1. CARMINE M PARIANTE

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    Atlas of psychiatric pharmacotherapy. By roni shiloh, david nutt,and abraham weizman. (Pp 235, £49.95). Published by Martin Dunitz, London, 1999. ISBN 1–85317–630–3.

    What I liked most reading through the Shiloh, Nutt, and Weizman's Atlas of Psychiatric Pharmacotherapy is its completeness. It is indeed a miniencyclopaedia of basic and clinical psychopharmacology, divided into four main sections: basic principles of psychiatric pharmacotherapy, abused substances, drug interactions,and treatment strategies.

    As a basic science researcher, I like the fact that these authors succeed, in the first section, in the very difficult task of translating complex biochemical mechanisms into concise pictures and legends. I particularly like those on second messengers/signal transduction pathways, as these are rare to find and difficult to understand in other books. Switching to more specific psychopharmacology topics, the tables explaining the mechanisms of action of the various drugs are also very well made and updated. For example, the tables illustrating the mechanisms of action of antidepressant drugs go beyond the “catecholamine hypothesis” into explaining the effects, at the genomic level, on the synthesis of growth factors. There is also a great deal of information on the side effects of psychotropic medications, including the pharmacological mechanisms involved. In this regard, the tables describing sexual dysfunctions are particularly useful, as they describe the physiology and the pharmacology of sexual functions in both males and females.

    The second section deals with well established as well as novel findings in the field of substance abuse. For each substance, the book explains the receptor mediated effects, the acute psychiatric and non-psychiatric effects, and the biological mechanisms responsible for dependence, adverse effects, and treatments. The book also gives up to date information on drugs for which biological pathways are less well known, such as phencyclidine and LSD.

    The third section is on drug interactions. For each class of medication—and, if relevant, for each single drug—the book lists different drugs, the serum concentrations of which are decreased or increased by the index one, interact with the index one at the receptor site, or potentiate its side-effects. This section is very useful in a clinical setting, and also gives an interesting theoretical framework with which to understand drug interactions at a pharmacodynamic as well as at a pharmacokinetic level.

    The final section contains algorithms for treatment of 35 (!) different psychiatric conditions. These include well described entities such as treatment resistant depression, acute manic episode, and acute exacerbation of schizophrenia. However, what I find most useful are the treatment strategies for conditions that are frequent in clinical practice but have received less attention as far as treatment protocols are concerned—for example, seasonal and atypical depression, delusional disorder, generalised anxiety disorder, post-traumatic stress disorder, anorexia nervosa, and bulimia nervosa. There are also strategies for treatment of rarer disorders and/or disorders with few evidence based recommendations, such as borderline personality disorder, obsessive-compulsive personality disorder, schizoid personality disorder, and attention deficit hyperactivity disorder adult type. Of notice is that the authors do not restrict the guidelines to biological treatments, but recommend, where appropriate, specific psychotherapies. Also, the authors indicate whether the advised treatment have clear cut, partial, or only anedoctal support from scientific literature.

    So far, so good. So, what is the problem? The authors say in the Introduction that “this book is written, first and foremost, for the clinician who is required to... decide efficiently about options for biological treatments”. A second target is “students in other fields—for example, pharmacology, psychology, and neuroscience”. Unfortunately, one possible problem of this book is that the tables, schemes, figures, and algorithms may be too complex for it to be used as a “quick” reference by the busy clinician or by somebody without prior knowledge of the topic. It is possible, therefore, that the book could not reach these two stated target audiences. However, it is well suited to be used in “various academic spheres” (the third stated target). In an academic setting, this book will be used as a teaching tool or as a consultation book to find important details that are not ready available from other sources. The book also has two other minor shortcomings: the absence of an index and some misspellings.

    In summary, the Atlas of Psychiatric Pharmacotherapy is clearly the result of a detailed and updated revision of the literature in all fields of psychopharmacology, from basic science to treatment of rare psychiatric conditions. It may be too complex to be used as the main or only source of knowledge by a student or by a clinician involved with everyday clinical practice, but is definitively a must for those academics involved in psychopharmacology teaching or research. Also, departmental or medical school libraries should buy this book, because it will be used by those doctors and students who are looking for an answer to specific or difficult psychopharmacology questions.

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