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Book Review   |    
Acute Care Psychiatry: Diagnosis and Treatment
W. Walter Menninger, M.D.
Psychiatric Services 1998; doi:
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edited by Lloyd I. Sederer, M.D., and Anthony J. Rothschild, M.D.; Baltimore, Williams & Wilkins, 1997, 577 pages, $62

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For some years, Lloyd Sederer's Inpatient Psychiatry: Diagnosis and Treatment has been one of the definitive reference texts in the field. Responding to the dramatic changes in the utilization of psychiatric hospitals, Sederer, who is medical director of McLean Hospital in Belmont, Massachusetts, and co-editor Anthony Rothschild, professor of psychiatry at the University of Massachusetts Medical Center, have shifted the focus of this text from inpatient psychiatry to acute care psychiatry. Drawing on the talents of 38 contributors, they offer clinicians working in the acute care field solid information to master the challenge of psychiatric practice in today's managed care environment.

The text is well organized, well referenced, well edited, and practical in its content. Central to the practice of acute care psychiatry—and all psychiatry, for that matter—is an accurate assessment of the patient. The first section of this text addresses that task, with a format following Sederer's "four questions.” These questions address the patient's descriptive and differential diagnosis, ego defenses and character style, current stresses and vulnerabilities prompting the symptom picture, and focal problem or problems to be addressed to restore safety or equilibrium. Subsequent relevant chapters provide a thorough review of risk assessment for suicide, of risk assessment for violent behavior, and of psychiatric triage, crisis intervention, and disposition.

The second section addresses the major psychiatric disorders that present as acute care problems. Each disorder is discussed in a consistent format: definition, diagnosis, epidemiology, the four questions, assessment of level of care, treatment, controversies, course and prognosis, and references. Each discussion includes case examples to illustrate key points. Also included are separate chapters about several specific interventions in acute care psychiatry: case management, family support and intervention, focal psychotherapy, group psychotherapy, and home-based care.

The final section considers administrative aspects of acute care psychiatry, including medical records, legal and ethical issues, quality of care, treatment guidelines, issues in training residents, and professional satisfaction and compensation.

With ten of the contributors affiliated with McLean Hospital, this work includes reference to many current practices at that highly respected institution. As might be expected in a work with multiple authors, not all of the chapters are of equal quality and value to any one reader.

Overall, Sederer and Rothschild's book is an important reference and text for psychiatrists who wish to be up to date on the issues related to acute care psychiatry and the determination of the appropriate treatment venue for their patients. Particularly valuable are the assessment chapters and the excellent overviews of legal and ethical issues. Administrators of psychiatric services will also find helpful information in the chapter on quality of care and in the section that discusses specific interventions and treatments.

Dr. Menninger is chief executive officer of the Menninger Foundation in Topeka, Kansas.




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