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Book Review

Massachusetts General Hospital Handbook of General Hospital Psychiatry, 6th ed

James H. Shore, MD

Published: July 15, 2011

Massachusetts General Hospital Handbook of General Hospital Psychiatry, 6th ed

edited by Theodore A. Stern, MD; Gregory L. Fricchione, MD; Ned H. Cassem, MA, PhL, MD, SJ, BD; Michael S. Jellinek, MD; and Jerrold F. Rosenbaum, MD. Saunders Elsevier, Philadelphia, PA, 2010, 720 pages, $72.95 (paper).

This handbook, now in its sixth edition, is designed for the medical practitioner in medical and surgical services and was written primarily by psychiatrists in the Harvard system. The volume comprises 54 chapters by over 100 contributors in approximately 700 pages. A comprehensive range of topics is covered, including the psychiatric interview, dementia, addictions, end-of-life and legal issues, and many more. The chapters are succinct and usually include a helpful number of tables and charts to summarize significant clinical priorities. The chapters do not attempt to be comprehensive and remain focused on the overall theme of general hospital psychiatry. All chapters have extensive references to facilitate further reading. In general, the Handbook is organized into sections that roughly follow an introduction to patient interview and evaluation, disorders and conditions, treatments, special concerns, and broader clinical and systems issues.

For example, the chapter "Care of the Suicidal Patient" includes tables on risk factors, the odds of suicide with a particular psychiatric disorder, components of a suicide evaluation, and treatment issues. A table on clinician reactions to suicide is provided in an effort to prepare practitioners for their own emotions after a suicide. The chapter "Psychopharmacology in the Medical Setting" summarizes basic pharmacokinetics and includes a table on drugs that induce or inhibit hepatic metabolism of other medications. Also included is information on drug interactions with commonly prescribed psychotropic medications. Drug-drug interactions are a critically overlooked aspect of hospital medicine, and these tables are a welcomed addition. Two chapters on patients with neurologic conditions discuss seizure disorders, movement disorders, multiple sclerosis, and other conditions.

Because the Handbook attempts to be comprehensive, the chapters are brief and cover many areas in a summary if not superficial manner. One, entitled "Limbic Music," is a brief refresher on the importance of emotions in this part of the central nervous system. A number of chapters address special conditions such as the difficult patient, the aggressive or impulsive patient, and the geriatric patient. In the concluding chapters, the Handbook covers systems issues, including psychiatry and primary care, cost-effectiveness, quality assurance, and research.

The Handbook provides a general clinical guide and overview for the nonpsychiatric physician in the general hospital setting. This newest edition will be a useful reference for the emergency room, hospital inpatient or outpatient setting, or home library.

James H. Shore, MD

Author affiliation: University of Colorado School of Medicine, Denver.

Potential conflicts of interest: None reported.

Volume: 72

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