Book Review

Adverse Effects of Psychotropic Drugs

N Engl J Med 1993; 329:1135-1136October 7, 1993

Article

Adverse Effects of Psychotropic Drugs
Edited by John M. Kane and Jeffrey A. Lieberman. 511 pp. New York, Guilford Press, 1992. $60. ISBN: 0-89862-885-7

This book contains a wealth of information of practical importance to all who care for patients suffering from psychiatric disturbances. The editors have organized the contributions of the 44 authors into three sections. The first, entitled “General Issues,” includes chapters on the detection of adverse effects in the pre- and post-marketing phases of drug development, abuse liability, drug-drug interactions, and the role of informed consent in clinical psychopharmacology.

The bulk of the material is found in the 21 chapters of the section entitled “Side Effect Profiles of Psychotropic Drugs,” with subsections addressing behavioral effects, neuromuscular effects, cardiovascular reactions, seizures, and endocrinologic effects. Disturbances in motor function are the most common adverse effects we encounter in clinical practice, and for this reason the attention given to this subject is understandable and appropriate. Some authors have organized their subject matter from the standpoint of drug class (such as heterocyclic antidepressants, monoamine oxidase inhibitors, and neuroleptic agents), whereas others have focused on specific motor syndromes, such as akathisia, tardive dyskinesia, dystonia, or parkinsonism. Perhaps for this reason there is inordinate repetition of some clinical descriptions and key literature references. As an example, akathisia is covered by Thomas Barnes in a chapter devoted specifically to that subject, but also at some length in chapter 10 (on motor effects of antidepressants and lithium), chapter 11 (parkinsonism), chapter 14 (assessment of movement disorders), chapter 15 (tardive dyskinesia), and chapter 16 (mechanisms of drug-induced extrapyramidal effects).

The final section of the book, “Special Populations,” addresses the issues of psychopharmacology and adverse effects in the very young and the very old.

There is much to commend in this book. All the authors are authorities in their fields. The chapters are concise and well written, the references are cogent, and the index is complete. The attention to the non-neurologic complications of treatment with psychotropic agents is thorough and enlightening. The chapters by Bitton and Schneider (“Endocrine, Metabolic, and Nutritional Effects of Psychotropic Drugs”) and Pisciotta (“Hematologic Reactions Associated with Psychotropic Drugs”) are particularly well done.

Some omissions aroused my curiosity. There were only scattered references to complications associated with the treatment of affective disorders with anticonvulsants. Our acute-treatment service encounters anticholinergic delirium frequently, occasionally in the young as well as the elderly, and it usually stems from polypharmacy. But this subject was discussed only briefly and unsystematically in the chapter by Leipzig and Saltz. More tables and graphs would have made a number of the chapters more readable. Some minor editorial oversights may be unavoidable in a book of this complexity. My eyes were inevitably drawn to the misspelling of my name on page 220, but there were other lapses as well.

Most clinicians will not choose to read this book from cover to cover because some of the chapters will seem painfully repetitive. However, when used as a reference, as a starting point for the preparation of lectures or presentations, as a resource book for pharmacists, nurses, house staff, and, especially, by practitioners who encounter a serious adverse reaction in their patients, it will be valued as an important contribution. Drs. Kane and Lieberman should be commended for their efforts in bringing the authors together and producing a timely book on an important subject.

Duane Denney, M.D.
Oregon Health Sciences University School of Medicine, Portland, OR 97201