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Human Nature Review 2002 Volume 2: 322-323 ( 20 August )
URL of this document http://human-nature.com/nibbs/02/sugarman.html
Cutting-Edge Medicine: What Psychiatrists Need to Know
Edited by Nada L. Stotland.
2002; American Psychiatric Publishing, Inc. Washington DC and London, England. Paperback, 150 pp
Reviewed by Roy Sugarman PhD, Senior Clinical Neuropsychologist, Glenside Campus/RAH, Clinical Lecturer, Dept of Psychiatry, Adelaide University, P O Box 17, Fullarton SA 5063, Australia.
Nada Stotland, a professor of psychiatry and O&G at Rush in Chicago, has put together a thin volume (150pp) of four chapters, simply written and digestible (with some effort) at a single sitting. Concentrating on psychophysiological medicine, the four divisions cover aspects of cardiology, gastroenterology, transplant surgery and the menstrual cycle respectively. At face value these may be ho-hum constructs for those not directly involved in these four fields, but reading the chapters does persuade the reader that there is much to be gleaned from at least looking through the volume.
Chapter one, entitled, somewhat twee-ly ‘Mind and Heart’ by John Querques and Theodore Stern (both M.D.’s in Boston) produces a somewhat banal exposition of the interplay between psychiatric and cardiac illness. It begins well enough, with an analysis of the effects of trans- and im-planting devices into the body, but the details with regard to the fascinating effects on the very stressed survivors is somewhat thin, and leaves you wanting more. Passing references to psychosocial issues such as financial worries, marital discord, family conflict and sexual dysfunction will not satisfy non-medical professionals and psychiatrists alike, who would like to know more. The discussions that follow with regard to psychiatric disorders that present with cardiac symptoms, such as anxiety and mood, somatoform disorders and seizures are also only brief, and somewhat unfulfilling. More time is given to the discussion of cardiovascular side-effects of psychotropic medication, but again this seems thin, for instance with a relatively prolonged session on QT intervals (pun intended), but with only a mention of the atypical drugs such as clozapine, and with no comment whatsoever on the potentially life-threatening cardiomyopathy or myocarditis that clozapine may induce! Given the title of this section, this is strange: the only information on the atypicals is a reference to the tendency of some to induce type 2 diabetes, with much more input given to the TCA’s, and none to the typicals, which are still in use in many parts of the world. Perhaps the transplant chapter kept the lid on the authors……
In contrast, Chapter two from Steven Epstein, Ahmed Sherif Meguid and Thomas Wise (two from Georgetown, making a sandwich of the Canadian second author) makes for more exciting and informative reading. This chapter, an expansion on an earlier work by the Georgetown authors, covers, to start, the much more prosaic oesophageal disorders, such as reflux, motility and functional disorders precisely, in a tightly written and useful analysis of the psychophysiological interactions of interest here. Here are references also to the efficacy and content of psychotherapy, brief but informed, and the discussions that follow on peptic ulcer, abdominal pain, functional dyspepsia and delayed gastric emptying are useful, and accompanied by informative tables. Food and pseudo-food allergies are discussed in the same way, and the psychiatric factors in inflammatory bowel disease are again subjected to the tight, informative style. Irritable bowel syndrome is given its deserved, more thorough discussion, as are the hepatic conditions, with their associated encephalopathies. Carcinoma of the pancreas is a surprise inclusion here, with some indications that anxiety, depression and panic may serve as the earliest warning signs of this mostly fatal disease, often before formal diagnosis.
Catherine Crone and Geoffrey Gabriel, (Georgetown again, and Korea respectively), produce a likewise readable view of organ transplantation, with a strong focus of value to psychologists, social workers and psychiatrists. Screening for transplant, using both medical and psychological tools are vital to outcome, and there is, for the reader, a good and useful discussion of these areas. The theme of multidisciplinary triage is pursued throughout in a step-by-step analysis of the pre-, peri- and post-transplant scenarios, with their attendant risks, unique events, concerns, and treatment. Highlighting what constitutes problematic patient groups in their many guises is part of this work, and useful insights are given as to what stereotypical views might bias selectors against patients with mental conditions. Useful tables are again present, with detailed discussion of medications and side effects. Depression, anxiety and delirium are dealt with, as are social issues, the intensive care environment, and the neuropsychiatric effects of immunosupressants. Neurocognitive recovery and quality of life issues are suitably included in the authors’ discussion of the post-transplant phase, bringing this chapter to its conclusion. It is a good chapter, by far the best in this book, and interesting enough for most tastes, even if you don’t move in transplant circles, with much of the information relevant to other fields, such as in coronary artery bypass surgery.
The final, unusual inclusion is that of Chicago-based Laura Miller’s look at the menstrual cycle. After a brief introduction to the psychiatric disorders associated here, the contributory factors to the premenstrual syndromes (sic) are evaluated, namely, the genetic, neuro-endocrinal, psychological and sociocultural are all nicely brought into juxtaposition. Treatment options are perused, with the obligatory inclusion of the antidepressants, anxiolytics, but also spironolactone, diet, calcium, carbohydrate, exercise, alcohol, psychotherapy, phototherapy, hormonal interventions, danazol and hysterectomy all considered. Interestingly, Miller includes a section on treatments that are unlikely to work, such as evening primrose oil, Vitamin B6, oral contraceptives, and progesterone all dismissed. A short, mildly informative, but nothing-much-new introduction for the rather uninformed perhaps, despite the drooly blurb on the back cover.
In summary, an easy to read, but sometimes unsatisfying little book, worth the read for the gastro and transplant side, the other chapters a little empty, but short on agony. I’m not sure it is ‘cutting-edge’ nor is it ‘Need to Know’, but, yes, one should know about these things, and one should have it on the shelf, if not in the hallowed halls of the classic works in psychiatry, but perhaps merely for interest. Its cheap enough.
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© Roy Sugarman.
Sugarman, R. (2002). Review of Cutting-Edge Medicine: What Psychiatrists Need to Know edited by Nada L. Stotland. Human Nature Review. 2: 322-323.