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Benzodiazepines.
  1. CHRISTOPHER BENCH

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    Benzodiazepines.Edited by michael r trimble and ian hindmarch(Pp154, £33.50). Published by Wrightson Biomedical Publishing Ltd, Petersfield, 2000. ISBN 1 871816 432.

    This book claims to examine objectively the basic pharmacological and clinical aspects of the use of benzodiazepines. The agenda is clearly laid out in the introduction where the editors emphasise that the valuable use of these compounds in neurological disorders was overlooked because of the “political turmoil and confusion about the use of benzodiazepines in psychiatry”. In practice the book primarily sets out to make the case for benzodiazepines as acceptable pharmacological treatments for epilepsy, with seven out of 13 chapters devoted to this specific topic. The consensus statement in the introduction suggests that the origins of the publication were a workshop organised by the editors on the use of benzodiazepines in epilepsy, although this is not explicitly stated. Clearly, the balance of the book is heavily weighted towards the treatment of epilepsy and as such the title is a little misleading. This is not a book for the general physician or psychiatrist looking for an overview of the clinical pharmacology of benzodiazepines. The first five chapters examine the pharmacological properties of benzodiazepines, their amnesic activity, and their utility in the management of anxiety and sleep disturbance. These are not all written with equal objectivity. The chapter on the management of sleep disorders delivers a clinically relevant and balanced review and includes eclectic, practical advice. By contrast, the chapter on the use of benzodiazepines in anxiety disorders focuses on these compounds to the exclusion of other interventions. Whereas the potential problems of tolerance and dependence are acknowledged, the problems of cognitive and psychomotor impairment, which are discussed in a previous chapter, are not. There is also little mention of SSRI antidepressants, despite their proved efficacy in anxiety disorders and limited discussion of the relation between drug and non-drug treatments. The epilepsy chapters present short expert reviews of specific clinical indications for benzodiazepines with some new pharmacoeconomic data. In summary, this is a really a specialist text with a general title that is most relevant for and likely to be read by clinicians treating patients with epilepsy.

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