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Clinician's manual on anxiety disorders and comorbid depression

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    Clinician's manual on anxiety disorders and comorbid depression. Edited bydavid nutt, spilios argyropoulos, and sean hood(Pp 56, £ 7.25). Published by Science Press, London, 2000. ISBN 1 85873 397 9.

    This is a small book with a formidable task. The editors describe it as written for “busy clinicians, especially general practitioners”. The layout of the book is certainly clear and the writing mostly jargon-free as intended. Chapters are arranged roughly in accordance with the divisions of chapter F40-48 of ICD-10: “Neurotic, stress-related and somatoform disorders”. These initial chapters cover the symptoms, diagnosis, epidemiology, comorbidity, and aetiology of each of the five main disorders covered. A useful if perhaps somewhat confusing chapter deals with the important subject of comorbid depression and anxiety. The final chapter, which will almost certainly be the most heavily thumbed, deals with treatment. The book includes many clear diagrams and tables and the final treatment chapter includes some easy to follow treatment algorithms.

    There is no doubting the psychopharmacological emphasis and expertise of this book, as would be expected from the editors. Psychological aetiologies and treatments appear as appetisers to virtuoso descriptions of the latest theories and applications of drug treatments. In the section on psychological treatments it is stated that “unfortunately, many of the psychological techniques used require specialised training, and access to practitioners with these skills is often difficult”. This is arguably the case, but in practice psychological interventions probably still come somewhat higher up the treatment algorithm than 6 to 12 months of high potency benzodiazepines. The rationale for judicious use of benzodiazepines as the most potent anxiolytic agents is argued and the words tolerance and dependence do not appear in this context.

    In summary, this is a satisfyingly concise text with a good balance of scientific facts and interesting historical detail. The busy clinician will find it an invaluable guide to pharmacological treatments of anxiety disorders but will they really wait so long before referring to a clinical psychologist for adjunctive treatment?