The MGH Guide to Psychiatry in Primary Care

I approached the review of this paperback with a smattering of trepidation. Since such handbooks frequently are obsequious reiterations of the DSM, overrun with obfuscation and tenuous usefulness (much like this introduction), I was pleasantly surprised with the utility and breadth of this volume. The book consists of 78 concisely and readably written chapters averaging 8 pages each. Individual topics are “co authored by a primary care professional and a psychiatrist,” and this formula appears to be an effective one. Every chapter clearly identifies and defines key terms, criteria for diagnosis, and approach to treatment. Given the relative brevity of each chapter, several suggested readings are appended to aid the interested party in further study. Topics addressed include the expected approaches to the depressed patient and the anxious patient, but quickly branch off to explore items like smoking cessation, fatigue, headaches, chronic steroid use, and PMS. These frequently encountered problems, while widely understood to have psychiatric aspects, often receive short shrift in similar handbooks. The editors go on to include sections on less common scenarios, providing excellent “quick studies” to aid in patient management. Among others, approaches to the patient who has been sexually assaulted, who is awaiting organ transplantation, or who has celebrity status are all standouts. A healthy dose of pharmacotherapeutics rounds out this selection. The book is not without fault. There is some variability between chapters—some are written in skeleton outline format, while others are in a more friendly, yet still succinct prose. More troubling is that, although the book has a 1998 publication date, several recent (but not novel) chemotherapeutic agents and treatment strategies are glaringly absent, even from cursory mention. Finally, while a few chapters may feel a bit wanting, one should approach the guide not as a comprehensive text, but rather as a handy, focused review that ably directs further study when indicated. When used in this manner, this book deserves a place on every physician's bookshelf.