| This book provides exactly “what it says on the tin”: prescribing
guidelines in order that prescribing decisions can be based on the best
available evidence for the enhancement of patient care. The book was
first published in 1994 and along with the ‘Psychotropic drug directory’ has
established itself as a first-line choice on the book shelves of clinicians
working in mental health.
The book is written in a user friendly and concise manner. The rationale
for the guidance is provided by a substantial number of references at
appropriate stages in each chapter. Guidance on further reading is interspersed
throughout the book and provides added value.
The authors state that they have employed a standardised method of sifting
through the evidence base in an effort to improve the robustness of the
process and clearly establish a link between the quality of evidence
and the guidance provided. Importantly, however, a balance has been struck,
in that in areas where quality evidence is lacking, practical information
based on lower graded information is still provided rather than excluded.
Included in the new edition is guidance issued by the National Institute
for Clinical Excellence. Although NICE guidance is not directly applicable
to Scotland, its Technology Appraisal Guidance is processed by Quality
Improvement Scotland.
An important caveat in this or any other book is that guidance can quickly
become out of date. This simply reinforces the importance of not placing
undue reliance on a specific source.
Chapter 1 describes the reasons for, and pitfalls associated with, plasma
level monitoring for certain psychotropic drugs. The subject of the second
chapter is schizophrenia and it includes detailed information on clozapine.
Chapter 3, concerning bipolar affective disorder, could have benefited
from enlargement, with the inclusion of recent American Psychiatric Association
or British Association of Psychopharmacology guidance in this area. Chapter
4 covers depression and anxiety.
Information on switching antidepressants, apart from monoamine-oxidase
inhibitors, is lacking in the British National Formulary, which makes
the information provided in this book invaluable to the reader. A thorough
understanding of underlying pharmacological principles is demonstrated
by excluding clomipramine from the advice that tricyclic antidepressants
can be cross tapered with selective serotonin reuptake inhibitor or serotonin
and noradrenaline reuptake inhibitor compounds. Every local primary care
depression guideline should make such switching information available
to health care professionals.
Chapters 5 and 6 cover the treatment of childhood mental disorders and
neuropsychiatric conditions, the latter principally concerning alcohol
and substance misuse. Chapter 7 covers special patient populations. Chapter
8 contains miscellaneous information. Of particular use, is the addition
of a section on driving and psychotropic drugs, although advice on hypomania
and mania in the summary of Driver Vehicle Licensing Agency regulations
is conspicuous by its absence.
In summary, I would regard this book as mandatory for any pharmacist
directly involved in the care of patients with a psychiatric diagnosis,
be they primary or secondary care-based.
This new edition achieves its objective of being an improvement on the
previous edition without sacrificing any of its user friendly qualities.
Thom Shaw
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The
Pharmaceutical Journal