The Pharmaceutical Journal
Vol 270 No 7252 p799
7 June 2003

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Neatly bridges the gap between theory and practice in psychiatry

'Case studies in psychopharmacology: the use of drugs in psychiatry', 2nd edition, edited by David Taylor and Carol Paton. Pp xii+360. Price £24.95. London: Martin Dunitz; 2002. ISBN 1 84184 154 4

I write as a practising psychiatrist covering an inner London population and well-served by pharmaceutical expertise, including that of some of the contributors to this book. At my fingertips I have access to the excellent national drug information service, whose advice I have come to count on. Not to forget that bible of hands-on prescribing information, the Maudsley Prescribing Guidelines. I therefore rather wondered what additional benefits the second edition of this successful book might be offering.

Much sound evidence has accrued to guide psychiatric prescribing, and yet there remains a significant discrepancy between recommended guidelines and the actual practice of psychiatrists. Theories abound as to why this might be the case and most agree that it is not a situation easily remedied by just providing doctors with further tomes of up-to-date evidence. One of the difficulties with research facts and evidence-based treatment algorithms is that they ignore the uniqueness of patients' lives: their individual difficulties, complexities and idiosyncrasies. The great strength of this book is that it conveys its information as case studies. The emphasis is on patients as they present themselves to doctors, and cases are the way that clinicians tend to think.

Each chapter starts with the knotty kind of patient scenario familiar from everyday practice. There follows a series of questions posed from the perspective of the patient, dealt with in a clear and focused manner in the ensuing chapter. Recommendations are backed up by the latest relevant research findings, critically presented in a digested and readily useable form. Areas of uncertainty and competing management options are openly acknowledged, allowing the patient to be presented with a logical weighing up of the pros and cons of medication decisions. Summary boxes then conclude each case discussion, reiterating the important points at a glance.

Broader issues usefully discussed include ethical dilemmas, such as those arising when considering covert administration of medicines to incapacitated patients with dementia. The topics of sleep disturbance and complementary therapies are also common concerns of patients and well covered in the book.

In every way living up to the reputation of its predecessor, this is an excellent book for psychiatrists and pharmacists alike, neatly bridging the gap between theory and practice.

Charlotte Hanlon

Dr Hanlon is a specialist registrar in psychiatry at the Maudsley Hospital, London