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Mood Disorders Across the Life Span
Arnold Werner, M.D.
Am J Psychiatry 1998;155:143-143.
View Author and Article Information
East Lansing, Mich.

edited by Kenneth I. Shulman, Mauricio Tohen, Stanley P. Kutcher. New York, Wiley-Liss, 1996, 425 pp., $69.95.

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With no sign of the Age of Narcissism receding, the Age of Mood is surely upon us. Comorbidity, perhaps. Only the professionally comatose have been unaffected by the influences of epidemiology and neurobiology on psychiatry's diagnosis and treatment of mood disorders. Modern understanding of old, even ancient, observations of the chronic nature of some depressions and manic-depressive states compels us to examine mood disorders from a longitudinal perspective.

This edited volume, whose contributors include well-known clinical researchers, has an excellent organization to accomplish a life-span approach to examining mood disorders. After introductory chapters on conceptual issues, epidemiology, and some genetic matters, the book is divided into three sections: Childhood and Adolescence, Adulthood, and Old Age. Each section follows the same format. Chapters on clinical features and pathogenesis, outcome, and treatment for depression are followed by three similar chapters for mania. So far, so good.

With some exceptions, the promise of the book breaks down in its execution. For the most part, the chapters are review articles written in wooden prose, with little evidence of editing. Not only are there the usual redundancies and inconsistencies between chapters so common to multiauthored works, the quality of the writing leaves much to be desired. Ambiguous references to "these findings," sentences that are more than 70 words long, typographical errors, and inconsistent terminology should not have seen the light of day. "Factorizing," "onsetting," and "prepubertally" would not have passed an editor's pencil. Telling us that treatment of depression is challenging and rewarding does not enlighten. Low on analysis and high on regurgitation of facts, large parts of the book make for slow reading. However, each chapter has a long bibliography, even though there is a lot of chaff in with the wheat. One chapter has 16 pages of text and 11 pages of references. In addition to the poor editing job, the publisher helps makes the book difficult to read by using a type size that seems smaller than what you are reading now. The references are printed in yet smaller type. The reader is confronted with an eyeball-numbing sea of print.

Many useful points are made throughout the text. Certainly, the emphasis on the relation of early mood disorder to subsequent disability and the cautions with regard to both overuse and premature termination of medication are worth heeding. Authors are candid about the lack of consistency in research findings regarding treatment in children and adolescents and the problems with outcome studies in the aged. Generally good chapters on treatment are sometimes maddening in their repetition of basic information. The chapter on pharmacological treatment of bipolar disorder is noteworthy for its excellent, clear writing and for its discussion and analysis of the information presented.

There are many missed opportunities for discussion and analysis. For example, in spite of the predominantly recurrent nature of bipolar disorder, the fact that there is a not inconsequential rate of single-episode mania poses a dilemma in the face of a strong tendency to prescribe continuous treatment following the first manic episode. A more coherent text would have noted the dilemma and discussed the presence or absence of guidelines for clinical decision making. Another example of a missed opportunity is the relative absence of discussion of psychotherapy of mood disorders except in adolescents and the aged. In the chronic mood disorders, successful medication management often depends on the consistency of the psychiatrist's relationship with the patient as well as the ability and willingness of the psychiatrist to help the patient find ways to identify and reduce stressors associated with relapse.

The raw data and the format are here. Missing are the writing and editing that take information and turn it into readable, useful prose.




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