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Book Review

Approach to the Psychiatric Patient: Case-Based Essays

James W. Lomax, MD and Carla Bejjani, MD

Published: December 15, 2009

Approach to the Psychiatric Patient: Case-Based Essays

by the faculties of Weill Cornell Medical College and Columbia University College of Physicians and Surgeons. Edited by John W. Barnhill, MD. American Psychiatric Publishing, Inc, Arlington, VA, 2009, 535 pages, $62.00 (paper).

Approach to the Psychiatric Patient: Case-Based Essays is a novel approach to education and communication about psychiatric disorders. As the title indicates, it is "case-based" as opposed to a diagnostic or treatment-based perspective. The 10 cases are each titled with a "problem," which may or may not be a typical psychiatric disorder. The cases range from schizophrenia to exam failure. Each case is personalized by identification with a particular, illustrative patient name. Each case is then approached via short chapters, the content of which varies considerably based upon the challenges presented by the case. The focus of the chapters also varies considerably, ranging from typical clinical topics like suicide for a case on depression and violence in a case on schizophrenia, to pharmacology of mood instability in a particularly interesting patient with both mood and personality disorder features. There are also creative and frequently underrepresented topics: outsider art, spirituality, and internalized homophobia. Many of these chapters are written by the true leaders of the topics they address (Paul S. Appelbaum on ethics, J. John Mann on suicide, James H. Kocsis on depression, John C. Markowitz on interpersonal psychotherapy, and Ethel C. Person on love). The individual chapters are rather short and, therefore, function better as stimulators of discussion or thinking than as in-depth sources of reference for either psychopharmacologic or psychosocial topics.

Nonetheless, the book provides a rich intimation of the breadth of our field. The great majority of the chapters are well written and intellectually stimulating.

A few audiences might benefit greatly from this text. One would be those nonpsychiatric physicians who are responsive to the realities of their practice and want help to provide better treatment themselves or make better referral to the patients in their practice with mood, anxiety, and substance use disorders. These practitioners will have ideas and resources brought into their awareness that may not have occurred to them before. A second audience would be those medical students who are considering psychiatry but are uncertain about it and those for whom psychiatry is their "second choice" of endeavor with a primary care specialty as their first choice. These individuals are often part of "psychiatry interest clubs" at academic medical centers, such as "The Couch," a student club at Baylor College of Medicine. This book would be a wonderful text for their monthly meetings with a faculty mentor/sponsor of the group and could lead to very useful discussions. Such discussions would provide more substance for the psychiatric referrals for those students who did not choose psychiatry and would probably tilt the ones "on the fence" toward choosing psychiatry as their professional pathway. A third audience could well be the national cohort of PGY-I psychiatry residents, for whom this textbook might provide an excellent stimulus for the PGY-I meetings and introduction to the biopsychosocial/spiritual pluralism of our specialty.

From a PGY-I perspective, this book is an excellent tool for teaching the "how to" of a multidisciplinary approach to the psychiatric patient. Reading the essays after each case provides an intimation of the different facets of the clinical presentation, a valuable perspective to develop during the first years of training and a foundation for a broader and deeper approach to mental illnesses. It also stimulates a rich curiosity about patients, making each clinical encounter more intellectually stimulating and countering the tendency to dehumanize patients when feeling overwhelmed by the demanding "routine" of internship. Although very different from a traditional textbook, this book would be informative in a novel way for the new psychiatrist. Each essay is brief and presents complex concepts in a very accessible manner, allowing the reader to easily assimilate "pearls" that might be overlooked in more detailed chapters or textbooks. It also helps clinicians to feel more at ease with certain patients and illnesses that they might normally be hesitant to approach.

Approach to the Psychiatric Patient: Case-Based Essays includes basic knowledge about psychiatry but also gives a taste of advances and research, which can stimulate the new residents’ curiosity and lead them to explore more evidence-based medicine or participate in research about a subject that might have particularly interested them.

Having names and "real" patients associated with each chapter not only makes it easier to acquire information but also helps the PGY-Is to connect the person of the patient with the illness. Furthermore, the variety of the patients presented in the book goes beyond the cases that residents typically encounter during their first year and might be one of the few connections they have with the real diversity of psychiatry.

Finally, this book gives the new psychiatrist not only a solid basis of knowledge and structure for "approach" but also an inspiration for personal investment and creativity in exploring the yet unknown.

James W. Lomax, MD

Carla Bejjani, MD

Author affiliations: Baylor College of Medicine, Houston, Texas. Potential conflicts of interest: None reported.

Volume: 70

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