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The American Psychiatric Press Textbook of Psychiatry, 3rd ed

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The American Psychiatric Press
Textbook of Psychiatry, 3rd ed.
Robert E. Hales, Stuart C. Yudofsky,
John A. Talbott, editors. Washington
(DC): American Psychiatric Press;
1999. 1762 pp. with index. ISBN
0-88048-819-0 (cloth). US$175.
As would be expected of both
the American Psychiatric Press and
the American Psychiatric Associa-
tion as an organization, the latest
edition of the Textbook ofPsychiatry,
edited by Hales, Yudofsky and
Talbott, is an impressive book.
Members of the editorial board, the
intemational advisory board and
the individual chapter authors,
make up a Who's Who of modern
psychiatry, although with a strong
American bias. As examples, the
chapter entitled "Psychiatric edu-
cation" is written by Jonathan
Borus, "Clinical neuropsychiatry"
by Jeffrey Cummings, contribu-
tions on hypnosis and dissociation
are provided by David Spiegel,
and "Group therapy" is by Irvin
Yalom. Thus, in most cases, the
chapters have been prepared by
leading experts in a particular field.
But there is a problem. In many
ways, it is one that is illustrated, in
parallel fashion, by the inclusion of
DSM-IV on CD-ROM in a kind of
"book within a book." The CD-
ROM is fun easy to load on the
computer and browse through but,
in the end, not particularly useful.
It comes on a CD-ROM, so cannot
be downloaded, which means I
have to choose whether to leave it
at home or at work. More impor-
tant, apart from providing another
way to look up something (and I
still think picking up my well worn
*w
mini DSM, which opens automati-
cally to the Global Assessment of
Functioning Scale is quicker), it
really doesn't do much. You can
search key words on it, and find
out how many diagnoses include
anhedonia in the description of
symptoms, and you could cut and
paste sections from the DSM into
other documents, but apart from
that relatively restricted use, it just
doesn't seem to have a role.
Similarly, the question arises:
What is the purpose of a large text-
book like this now? Is it to provide
a quick reference source for the
field of psychiatry, a state of the art
presentation of the field or a study
tool for residents preparing for
their fellowship examinations?
Should it provide sufficient depth
of discussion of topics to allow
clinicians to expand their practical
skills and knowledge substantially,
making the book a large one
indeed, or is it designed to provide
overviews of complex fields?
Clearly, a textbook, no matter how
well produced, is not going to be a
state of the art presentation for long,
although this one does an admirable
job. As a reference tool, the textbook
varies in its ability to deliver. The
depth of discussion is limited by size
constraints so, for example, impor-
tant advances such as Linehan's
work on dialectical behaviour thera-
py for personality disorder, are pre-
sented and described, but not in suf-
ficient depth to do more than stimu-
late interest. Autistic disorders are
discussed fairly thoroughly, but little
useful discussion of autism in adults
is provided, even though the section
is dear and well written. Finally, the
chapter on group therapy restricts
most of its content to a focus on the
interpersonal orientation of Yalom,
without providing a broad overview
of writing on psychodynamic
groups, cognitive behavioural
groups or psychoeducation groups
and the roles of these in various
illnesses.
This limits to some degree the
value of the book as either a quick
reference or a study tool for resi-
dents, and yet this limitation, with
some minor exceptions, stems more
from the restrictions of the art of the
textbook in current medicine than
from the limitations of the authors.
The expansion of knowledge in any
field may have pushed the limits
beyond that which is practically
encompassed in a comprehensive
textbook. Despite my earlier com-
ments, overall, this is a good text-
book. Chapters are generally very
well written and ideas presented
clearly. In most cases, key, up-
to-date references are included.
Clearly, the editors have run a tight
ship to ensure publication of a text-
book as up-to-date as possible.
Organization is fairly standard,
with chapters on the theoretical
foundations of psychiatry, a sec-
tion on assessment, a section focus-
sing on the disorders of psychiatry
(following the DSM system of clas-
sification) and one on treatments.
The editors avoided the pitfall of
excessive reliance on DSM by set-
ting chapters in the final section on
topics such as violence, an area not
well classified in DSM.
There are some excellent sec-
tions. Despite the loss of promi-
nence of psychoanalytic theory
politically, there is an excellent
chapter by Robert Ursano and
..-.
 Bo RteWs

Edward Silberman on psycho-
analysis, psychoanalytic psy-
chotherapy and supportive psy-
chotherapy. It reviews important
writings and research and includes
an extremely useful section looking
at a comparison of psychodynam-
ic, interpersonal and cognitive
therapies, and pointing out the
similarities and common roots that
are often forgotten or ignored in
debates between proponents on
the relative merits of each.
The one main drawback for an
international audience, is that this
text is ultimately an American one.
The chapters on psychiatric educa-
tion, and law and psychiatry are
about medicolegal psychiatry and
education in the United States.
"Public psychiatry," "Managed care
and psychiatry" and "Psychiatry
and primary care" are written about
US models and experiences of these
fields; therefore, for example, the
work by Kates and others on a
shared care model for psychiatry
and primary care is not included.
This is unfortunate because the dis-
cussion on any of these areas could,
with relatively little expansion of
content, be greatly enriched by the
inclusion of the experience in other
countries. Including differing per-
spectives on the legal handling of
dangerousness in the psychiatrical-
ly ill, or different models of post-
graduate education in psychiatry,
would not only benefit readers from
other countries but could expand
the dialogue on these issues
through contrast and comparison.
After all, many of these systems
evolve in a particular way for his-
torical reasons that may not always
reflect the only or the best solution.
Given the inclusion of an expert
international advisory panel, it is
unfortunate that the textbook falls
short in this way.
Textbook of Psychiatry from the
American Psychiatric Press is ulti-
mately a pretty good textbook. It is
comprehensive, well written and
up-to-date. It is limited by its very
nature, but if one feels that one
does need such a book, then this
book is competitive with any other
in the field. It is unfortunate that it
is limited by being essentially an
American textbook. Relatively
minor changes could have made it
a truly international one, of use to
both an American and an interna-
tional audience.
Paul Dagg, MD
Ottawa, Ontario, Canada
Essentials of Clinical Psychiatry.
Robert E. Hales, Stuart C.
Yudofsky, editors. Washington
(DC): American Psychiatric Press;
1999. 1070 pp. with index. ISBN 0-
88048-848-1 (paper). US$60.
A recent publishing phenome-
non in psychiatry, particularly in
the United States, is the creation of
textbooks that are comprehensive,
authoritative and expensive. These
textbooks are usually multi-
authored, and the contributing
authors are selected for their well-
established expertise in a particular
area. In recognition of the needs of
medical students and junior resi-
dents, more affordable synopses
are then created out of these large
textbooks. A well-known example
of such a synopsis is the one edited
by H. Kaplan and B. Sadock enti-
tled Synopsis of Psychiatry that is
based on the comprehensive text-
book of psychiatry. That synopsis
has gone through many editions
and remains a popular reference
for residents and medical students.
A recent addition to this trend is
Essentials of Clinical Psychiatry,
based on the 3rd edition of The
American Psychiatric Press Textbook
of Psychiatry. It is intended for med-

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