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Massachusetts General Hospital: Comprehensive Clinical Psychiatry

Thomas N. Wise, M.D.

Since the English translation of Wilhelm Griesinger’s textbook, Mental Pathology and Therapeutics, textbooks of psychiatry have played essential roles in mental health, psychiatric education, and treatment.¹ Sadly fewer students or residents actually purchase larger texts in their search for simpler synopses. Although they may rationalize this decision on the basis of cost, it is essential that psychiatric residents have a standard textbook as part of their own library; the cost, when taken over the useful life of such a resource, is minimal.

This comprehensive review of our field demonstrates the inadequacy of such smaller books and reminds the reader of the complexity of the field of psychiatry. It is a remarkable achievement from a department that has already contributed smaller texts since 1978, when The Handbook of General Hospital Psychiatry first appeared.² That this resource took only 2 years from its original proposal to marketplace allows for an up-to-date content with recent references, including landmark studies, such as STAR*D and CATIE.

This is a hefty single volume of 1,273 pages that weighs 8.6 pounds. One need not carry the print edition around, however, since the online version, available to all those who purchase the text, offers the complete book in an easy, Internet format.

Tables and figures are demarked by pleasing colors. Figures include a wide variety of reproductions that range from historical archives, such as 19^th century pictures of myxedema, to generous use of Frank Netter’s anatomy illustrations. Throughout, tables allow quick review of facts. All the chapters are carefully edited to make the writing remarkably uniform for such a large, multi-authored book, whose contributors are primarily from Massachusetts General Hospital and its companion institution, the McLean Hospital.

The book is divided into 22 sections that are logically organized into assessment issues, psychotherapies, reviews of the disorders, and treatment approaches, and other sections that demonstrate the broad array of issues that make up our field. Initial sections contain chapters that outline elements of psychiatric evaluation, such as psychiatric interviewing, appropriate laboratory and diagnostic procedures, and treatment adherence, as well as psychological and neuropsychological testing. Later in the book, the chapter on the neurological examination is a wonderful review for all psychiatrists. The section on psychotherapies covers a wide range of psychotherapeutic interventions and is followed by a section on psychiatric diagnoses (with a focus on the DSM-IV and its multi-axial system). The next section focuses specifically on psychiatric disorders, with a logically sequenced series of treatment interventions. The pharmacologic discussions are outstanding. The chapter on drug–drug interventions utilizes formatted tables of psychotropic agents with specific drugs that are either substrates or inhibitors. The chapter on "natural medications" discusses herbal preparations often popular with patients. The section on electroconvulsive therapy is useful for individuals who know little about the topic. The text explores the current status of evolving technologies such as transcranial magnetic stimulation, vagal nerve stimulation, and deep brain stimulation. The chapter on psychiatric neuroscience incorporates pathophysiology into clinical case formulations and should be a required introduction for both students and residents.

Special sections on the suicidal patient and psychosomatic medicine are clinical gems. The subsequent sections cover a wide range of other issues. The review of Emergency Psychiatry would be essential for any resident beginning such a rotation. The statistics in psychiatric research chapter would be useful for anyone to better understand the psychiatric literature. A chapter on managed care reviews the situation in which we all find ourselves. Chapters on coping with the rigors of psychiatric practice and Psychiatry and the Media demonstrate the broad range of this text.

The price is competitive with other texts. I would hope that the editors could update the online edition of the text to keep its references current. This extraordinary volume should be part of all clinician’s libraries and in all hospital libraries. I look forward to many future editions.

FOOTNOTES

 
Dr. Wise is Chairman of the Dept. of Psychiatry at Fairfax Inova Hospital, Fairfax, VA, and Editor emeritus of Psychosomatics.

REFERENCES

TOP REFERENCES

 

1. Yudofsky SC: Images in Psychiatry: Wilhelm Griesinger. Am J Psychiatry 1995; 152:1203[Free Full Text]
2. Massachusetts General Hospital Handbook of General Hospital Psychiatry. Edited by Hackett TP, Cassem NH. St. Louis, MO, Mosby, 1978

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