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Difficult Clinical Problems in Psychiatry

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    Difficult Clinical Problems in Psychiatry. Edited by malcolm laderand dieter naber. (Pp 246, £39.95). Published by Martin Dunitz, London, 1999. ISBN 1-85317-550-1.

    Difficult clinical problems in psychiatry come in many forms. Diagnosis often causes difficulty, particularly in cases which demand some assessment of the role of physical illness in symptom formation. Perhaps for most psychiatrists practising in community settings risk assessment comes high on their list of concerns.

    Unsurprisingly, given the psychopharmacological expertise of the editors, this book is particularly interested in treatment resist-ance. The first 6 chapters give excellent reviews of the management of clinically relevant topics—for example, refractory schizophrenia or the difficult panic patient. The emphasis is very much on pharmacological management.

    The second half of the book is more of a mixed bag, both in terms of the areas covered and the quality of the chapters. Two excellent chapters covering all aspects of the assessment and management of anorexia nervosa and chronic fatigue are followed by a thorough review of the pharmacological management of substance misuse. Then come two weak chapters on behavioural disturbances in old age and the violent patient in the community. This last chapter will be of particular interest to community psychiatrists but is not one that I would recommend because some aspects of the practical management of violence are missing—for example, a documented risk-benefit analysis, good failsafe communication, or deciding when to detain. One of the last chapters is a very good account of the management of hyperactivity in childhood, with good practical advice on the use of methylphenidate.

    Apart from the chapters on chronic fatigue and the treatment of tardive dyskinesia there is little in this book which is of immediate interest to neurologists. However general psychiatrists wishing to improve their prescribing skills will find this book useful.

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