The first edition of this book appeared in 1990 and it rapidly became the standard work on bipolar disorder. Some of the tables are still very useful as reviews of specific topics. However, since 1990 there have been changes and advances, including broadening of the clinical concept into a spectrum, accumulating neuropsychological studies, use of functional imaging, emerging molecular genetic findings, much expansion in clinical use of anticonvulsant mood stabilisers accompanied by better evidence, and a recent burgeoning of randomised controlled trials of psychological treatment approaches. There have also been those sure signs of specialisation – a journal and a scientific association. A second edition is therefore timely.
Now part-way to being multi-authored, fifteen collaborators wrote first drafts of chapters which were then revised by the two authors. The collaborators are not attributed to specific chapters, although you can sometimes guess, and I believe it would have been better to know explicitly. The general approach is still consistent and unified.
The authors declare a Kraepelinian orientation, regarding severe recurrent unipolar disorder as closely linked to bipolar, and decrying the widening of unipolar disorder to the milder non-recurrent disorders now included in most diagnostic schemes. In truth, nevertheless, this is a book about bipolar disorder. The attempts to include unipolar disorders tend to be desultory and inconsistent, in contrast to the excellence of the bipolar material. There is, for instance, no chapter on depression in the elderly, although some of the studies of vascular depression are mentioned elsewhere. The book is generous to the newer spectrum of bipolar disorders, dismissive of the unipolar one. This is not a book that would be of use to the general practitioner to guide understanding and management for the milder cases of major depressions seen in the surgery every week.
This is a single large volume, about a third longer than the first edition, which most readers will use as a reference work. The chapter list is extensive. There are many references and summary tables of research. The references are listed by chapter in a large section at the end of the book losing the advantage of easy finding with the relevant chapter, without gaining the alternative advantages of a single unified list. For a British readership, although the references are comprehensive and international, there are some gaps. The self-help resources listed are all American, and the chapter on follow-up studies omits the two classic papers from the same issue of the British Journal of Psychiatry, by Lee & Murray and Kiloh et al, which established the high recurrence rates shown by many cases of severe, hospital-treated unipolar depression. The index is fairly large, but it is so indispensable for anyone who wishes to look up specific topics and studies that the authors might consider one day making a searchable CD-ROM of the text available.
The chapters are spacious and sometimes discursive, usually prefaced by a quotation from a patient or a classical figure, with following sections on history and methodology. Much of the material is research-oriented, with detailed summary tables of studies. In the earlier chapters I found particular highlights in those on epidemiology, genetics, assessment scales, and neuropsychology. The treatment chapters are more practical in approach, with less summary of the evidence base than in the first edition. The chapter on neurobiology is the longest, at 140 pages, and is particularly comprehensive and detailed. I would guess it to have been authored by Frederick Goodwin with Huseini Manji, a listed collaborator, since their combined credentials to look over the field are excellent. Sadly, and no fault of the authors, the field it exposes is still confused and inconclusive. A particular masterpiece is the chapter on creativity, which bears the hallmarks of having been written by Kay Jamison. Herself a person of remarkable creativity and with manic–depression, she has written most movingly elsewhere on her personal experiences, has made large scientific and educational contributions to the field, and is also an altruist whose royalties from this book go to a foundation for public education in bipolar disorder. Her touch is also evident in the chapter on psychotherapy which is full of detailed material about the reactions to illness which the therapist needs to handle, but also manages to be current (up to 2006) in summarising the controlled trials of psychoeducation, family approaches, cognitive–behavioural therapy and interpersonal and social rhythms therapy. This chapter also gives a welcome psychosocial element to what is mainly a biological and psychopharmacological book.
Like the first edition, this is destined to be a standard reference work on bipolar disorder. There are some lesser cavils but, overall, it is a tour de force. It should again be good for 15 years, the rapidity of modern advances notwithstanding.
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