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Book Review   |    
Handbook of Medical Psychiatry
David Gitlin,, M.D.
Psychiatric Services 1998; doi:
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by David P. Moore, M.D., and James W. Jefferson, M.D.; St. Louis, Missouri, Mosby, 1996, 545 pages, $49.95

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How do general psychiatrists and other mental health providers choose which reference books to keep in their medical libraries and offices? So many good options are available that at times this choice may seem arbitrary, often related more to what is recommended by one's colleagues or mentors. Most general psychiatry textbooks continue to emphasize classical concepts of mental illness, either with a strong focus on psychodynamic and psychoanalytic approaches or with a more biopsychosocial balance.

However, theHandbook of Medical Psychiatryby David Moore and James Jefferson offers professionals a distinctive alternative. The authors have embraced the "medical model" approach to illness, with the emphasis on biological etiologies and treatments. For many psychiatrists trained in such a model, this text is a welcome sight.

This is theHarrison'sof psychiatric texts. It gives a concise description of each psychiatric disorder based on the medical model, including onset, clinical features, course of illness, complications, differential diagnosis, and treatment. For the major mental illnesses such as schizophrenia or major depression, descriptions of clinical features, course, and treatment that are lengthier but still maintain that concise focus are provided.

Each of the chapters ends with a useful bibliography, typically eight to 12 current reviews or classical articles. Because Moore and Jefferson's book includes 241 generally short chapters on specific clinical disorders, these bibliographies are a wonderful reference tool—particularly for disorders typically considered primarily medical, such as Wilson's disease or normal pressure hydrocephalus.

The authors organize the text in a thoughtful and enticing manner. To start with, they remain true to the medical model, arranging the volume by specific illnesses and syndromes. The introduction is devoted to symptom phenomenology. Here the authors touch on a large number of symptoms, describing their varied presentations and detailing the syndromes they may occur in. The first part of the book then follows theDSM-IVnomenclature, starting with disorders diagnosed in childhood and moving through substance use disorders, psychotic disorders, mood disorders, and so on. Even within this part, the authors add numerous medical conditions that may present with prominent neuropsychiatric features, such as tuberous sclerosis or Kluver-Bucy syndrome.

The second part of the text focuses exclusively on medical illnesses that may present with psychiatric manifestations. It is an exhaustive review of the medicine-psychiatry interface, including endocrine, neurodegenerative, and vascular disorders plus vitamin deficiencies, metal poisonings, infectious disorders, and much more. Any mental health provider who has wanted to review the neuropsychiatric aspects of Huntington's disease, lupus, or porphyria will find this text invaluable. Finally, the authors end with a brief section on psychopharmacology, emphasizing medical features such as pharmacokinetics, side effects, drug-drug interactions, and complications of overdose.

The text does manage to leave out some important medical-psychiatric disorders, such as fibromyalgia and chronic fatigue syndrome. The writing style can be anecdotal at times. But, overall, for any psychiatrist, psychiatric resident, primary care physician, or mental health provider looking for a solid text with a medical perspective, the book is a treasure. I expect it will hold its place in my library for years to come.

Dr. Gitlin is associate professor of clinical psychiatry and associate professor of family and community medicine at the University of Massachusetts Medical School in Worcester.

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