Weighing over four kilograms, this book formed a substantial part of my recent luggage allowance, and as such I cannot recommend it for bedtime reading. It is, however, an excellent read and a valuable reference book. The editors write particularly eloquently and have chosen their authors well. The common structure, organisation and summary of main learning points or ‘pearls‘ at the end of each chapter, irrespective of subject, are testament to considerable editorial skill, and the finished text reflects that achievement.
The first chapter is a well-written and argued discussion of the priorities in liaison psychiatry, reminding us of just who it is we are treating, and the competing interests in this field. For the clinician embarking on a career in this specialty, the breadth of subjects covered is invaluable, but there is much for the experienced psychiatrist too. This book should also be of considerable benefit to specialists in other medical fields; it might aid better understanding of their patients' experience and the interplay between physical and psychological factors. Particularly useful was the succinct description of relevant advances in neuroimaging and other diagnostic investigations, which provided a welcome update.
The breadth of subjects covered does, however, reflect the differences in the American and British healthcare systems. In America it seems possible to offer psychiatric support to a wider range of medical patients, and prescribing habits also differ; some drugs are used for a wider range of conditions, while others have yet to be marketed in the UK and so will be unfamiliar to the British psychiatrist.
This difference is notable in Maldonado's excellent chapter on delirium. Given the increasing representation of frail old people in all health settings, his extensive 70-page review, which emphasises the bleak prognosis, cognitive sequelae and potentially modifiable risk factors, is particularly pertinent. I could not help feeling that we might make greater progress in this field if this chapter were compulsory reading for all clinicians, irrespective of discipline.
I was also fascinated by the chapter on the role of spirituality and religious beliefs in response to, and recovery from, physical illness. The authors' discussion of the putative neural basis for the benefits of spiritual and religious belief, irrespective of affiliation, made this a chapter relevant to everyone.
There are too many other excellent sections to mention individually. The hardback version is expensive and very heavy to transport readily, but I would recommend the investment for hospital and departmental libraries. For individuals, thankfully there is also an online version.
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