edited by Peter Manu, M.D., Raymond E. Suarez, M.D., and Barbara J. Barnett, M.D.; Arlington, Virginia, American Psychiatric Publishing, 2006, 605 pages, $74 softcover
Dr. Gitlin is the director of the Division of Medical Psychiatry, Brigham and Women's/Faulkner Hospitals, and assistant professor of psychiatry at Harvard Medical School, Boston.
This textbook lays bare its goal in the preface, to "reflect the [medical] realities confronting clinicians in self-standing inpatient psychiatric settings." The lead editor, Peter Manu, M.D., has been addressing these realities for years as the director of medical services at Zucker Hillside Hospital, a large, academic free-standing psychiatric hospital. Manu has previously attempted to address the issues of medical presentations with psychiatric patients during his many years of well-received workshops and conferences at the annual American Psychiatric Association meetings. Here he and his colleagues have attempted to pull together a comprehensive approach to the problem facing psychiatrists in these settings, how to rapidly and adequately assess evolving medical symptoms of their patients.
Much like the classic Merck Manual, this text is organized by organ systems but with a primary focus on specific somatic symptoms or abnormal laboratory findings. Each chapter begins with an elementary discussion of the clinical presentation of that symptom as well as a solid review of the differential diagnosis. Unfortunately, many of these discussions of presentation and differential diagnosis are extremely basic, written more for medical students' or interns' understanding. Practicing psychiatrists will likely find these sections of lesser value. However, each chapter concludes with a useful focus on the appropriate assessment of a symptom of psychiatric patients. Virtually every chapter includes a helpful algorithm to determine whether the symptom is of an urgent nature and whether emergency medical assessment or intervention is indicated. Although many of these sections are quite useful, some are overinclusive and thus unlikely to diminish the desire for consultation with an internal medicine or surgical colleague.
Ultimately, the authors appear to have succeeded in creating a practical reference tool for medical students, interns, junior residents, and perhaps some attending psychiatrists in the assessment and management of somatic problems among patients cared for in inpatient psychiatric settings. It remains to be seen whether it will have any impact on the tendency toward medical or surgical consultation or referral to emergent medical settings. However, this is one of several efforts to consider practice guidelines for the management of patients, and the authors should be commended for their efforts.