Book Review

Textbook of Consultation–Liaison Psychiatry

N Engl J Med 1997; 337:58-59July 3, 1997

Article

Textbook of Consultation–Liaison Psychiatry
Edited by James R. Rundell and Michael G. Wise. 1171 pp. Washington, D.C., American Psychiatric Press, 1996. $140. ISBN: 0-88048-336-9

If you are not a psychiatrist or if you are a general psychiatrist not specializing in consultation–liaison psychiatry, please don't dismiss this book out of hand; it could easily become a most useful addition to your shelf of frequently consulted clinical textbooks. A variety of questions can be answered by consulting this book, including the following: Does the immunosuppressant OKT3 (muromonab-CD3) cause delirium? (yes). Should lithium be withheld on the days patients receive chemotherapy? (yes). Can diazepam be teratogenic? (yes). Is methylphenidate effective in human immunodeficiency virus (HIV)–related depression? (yes). At least 15 percent of medical outpatients have serious depressive or anxiety disorders. Physicians often treat these patients with the newest generation of antidepressants, many of which have important interactions with medications such as cisapride, warfarin, and certain antihistamines. Thirty percent of hospitalized medical patients experience some degree of delirium. Thus, the subject of this book is relevant for all physicians who evaluate and treat medical patients.

The textbook consists of 44 chapters by close to 100 authors and is divided into four sections. “General Principles” includes topics such as the mental-status examination, behavioral responses to illness, suicidality, aggression, and agitation. “Psychiatric Disorders in General Hospital Patients” considers psychiatric syndromes such as delirium, depression, and anxiety as they present in medical patients. “Clinical Consultation–Liaison Settings” focuses on medical specialties such as neurology, rehabilitation, internal medicine, and primary care; specific diseases such as cancer and HIV–AIDS; and settings such as the intensive care unit and the emergency room. The final section, “Treatment,” considers psychopharmacology, chronic pain, and psychotherapy in the medically ill, among other topics. Often, each chapter adopts a somewhat different slant on key topics. This does not seem repetitive, but gives the reader an experience such as that of watching the movie Rashomon or hearing variations on a musical theme.

Informing the book is a key concept of consultation–liaison psychiatry — that the biopsychosocial multidimensional approach to the patient increases the accuracy of diagnosis and the effectiveness of treatment. The book addresses behavioral responses to medical illness by patients of different normal personality types, illustrates psychotherapeutic techniques for working with patients, and does not neglect the medical staff, whose members may suffer from such problems as burnout when working on oncology units.

The textbook considers practice in new settings, such as the medical-psychiatry unit and managed care. It deals with actual patient behavior and so advises physicians to inquire about the use of herbal and other alternative medications, discusses special issues in the care of the homeless, and tackles euthanasia and physician-assisted suicide head-on. A brief introduction to structural and functional neuroimaging, a technology that currently has limited practical applications but whose promise is great, is included. Several excellent chapters stand out, including those on organ transplantation, AIDS, psychopharmacology, and surgery.

For the consultation–liaison psychiatrist, the text is solidly in the mainstream of contemporary theory and practice and consolidates the body of knowledge that must be mastered. The history and development of this subspecialty, the tug of war between liaison and case-centered consultation, and improvement of the efficiency of consultation–liaison services at university centers are all addressed. The text also provides general psychiatrists who treat patients with concurrent psychiatric and medical-surgical conditions with sophisticated yet practical discussions of psychotherapy in general and in medically ill and dying patients. For the consultation–liaison specialist, some chapters will prove too elementary, but others, such as the outstanding chapter on consultation–liaison research, are sophisticated.

One of the major strengths of this book is that it presents a body of knowledge in a clinically relevant manner. It has structure and coherence: almost all chapters have a uniform presentation, and the discipline exacted by the editors is readily apparent. The text, although encyclopedic in scope, is easy on the eyes, with large print and figures. The writing is almost uniformly clear and interesting and is often even lively. The book is replete with useful tables printed in large, readable type. Algorithms for diagnosis and treatment are provided throughout the text.

Monica N. Starkman, M.D.
University of Michigan Medical School, Ann Arbor, MI 48109