This short, thoughtfully laid out publication is specifically targeted at the busy primary care doctor where clear and concise information, presented in a readily usable format, is critical. The book is the result of a collaboration between three pre-eminent professors of Psychiatry and Primary care. Often, the temptation is to give long, wordy descriptions of aetiology, epidemiology, psychopathology, etc.; clearly, the authors took great care in avoiding this trap, presenting information in a short algorithmic style while still preserving all the crucial details.
Psychiatry Algorithms for Primary Care is divided into seven parts, namely Introduction, Common Psychiatric Disorders, Common Presentations in Primary Care, Complex Scenarios, Special Considerations in Prescribing, Appendices and Self-Assessment.
The introduction presents the core areas of Psychiatric History-Taking and the Mental State Examination (MSE). The MSE section gives very clear instructions on what to look out and enquire about under the following headings: appearance, behaviour, speech, mood, affect, thought, perception, cognition and insight. Commonly used tools used to extend the MSE to include the MMSE and MOCA are presented in the resources section, and I really like that all resources throughout the book are hyperlinked in the electronic version enabling the clinician to access the information readily and easily.
The main body of the book is divided into three parts, namely Common Psychiatric Disorders, Common Presentations in Primary Care and Complex Scenarios. Typically, chapters are four–five pages in length and are all presented as algorithms with text boxes giving key information on assessment, diagnosis and management. This style allows for a brief yet confident assessment. It probably makes this a resource that will rarely leave the clinicians desk, bag or mobile device.
The Common Psychiatric Disorders section covers all the commonly encountered psychiatric disorders including anxiety, mood and psychotic disorders as well as substance use disorders, eating disorders, personality disorders, ADHD, autism, dementia, delirium and more. Each chapter brings the reader through the assessment by citing criteria for suspected illness, duration, evaluation of symptoms, evaluation of impairment before going into initial treatment, and when to refer to secondary care. For example, Chapter 11, Psychosis, prompts the clinician to explore positive symptoms such as delusions and hallucinations and negative symptoms including withdrawal, reduced speech, energy or emotions. It then prompts the clinician to consider co-morbidities, organic disorders or substance misuse. It briefly presents types of antipsychotics and their side effects and provides advice on ongoing treatment. Chapter 14, Alcohol Use Disorder, follows this same step-by-step format in terms of diagnosis and goes on to give advice on pharmacological and non-pharmacological interventions. The resources section provides links to the AUDIT-C and SADQ-C assessment tools.
Under Common Presentations in Primary Care, the authors guide us through the assessment of patients presenting with insomnia, fatigue and medically unexplained symptoms. The insomnia chapter, for example, guides the physician through the evaluation and investigation of symptoms; the resources section then gives links to a sleep diary, sleep hygiene and tips for sleep websites (hyperlinked in electronic edition). The MUS chapter will prove especially useful as this can be very challenging both in terms of diagnosis and treatment. It explains MUS succinctly in table format; again resources such as PHQ-15 (Somatic Symptoms Severity Scale) and patient guides are referenced with links to the appropriate websites.
The Complex Scenarios section contains chapters on suicide and self-harm assessment, aggression and the use of involuntary care. Suicide and self-harm can be particularly stressful to deal with in the busy clinic. The well-structured assessment algorithm and additional guidance on treatment and referral will aid in ensuring that a thorough assessment is conducted and the clinician is confident that all the key areas are explored with the patient.
There is a useful final section covering special considerations in prescribing for older adults, patients with intellectual disability, young people as well as pregnant and breastfeeding mothers.
An appendix of commonly prescribed drugs in a handy table format lists the drug, indications, dosage, side effects and advice on stopping treatment. The second appendix gives guidance on physical health considerations for those with enduring mental illness and advises on the investigations required. The final part of the book contains a self-assessment, which presents 12 thoughtfully set out scenarios to think about with suggested answers provided.
In summary, this is a very user-friendly aid specifically designed to be used on a day-to-day basis and empower clinicians to conduct efficient yet thorough assessments. Resources included at the end of each chapter have clearly been chosen to not be overly onerous; they prompt efficient information gathering. Again, the authors exercised restraint in what they included and the publication is all the richer and more useful for this.
Having gone through the book over the past several weeks and utilised it in my clinical practice, it strikes me that its usefulness is not limited to primary care. It is equally helpful for trainee psychiatrists, trainee GPs, specialist mental health crisis nursing staff, liaison psychiatry staff and hospital doctors not specifically training in psychiatry.
Conflict of interest
The author has no conflicts of interest to disclose.
