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Essentials of Psychosomatic Medicine
Am J Psychiatry 2007;164:1442-1442. doi:10.1176/appi.ajp.2007.07071140
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edited by James L. Levenson, M.D. Arlington, Va., American Psychiatric Publishing, 2007, 604 pp., $85.00.

The recognition of metabolic syndrome as an all too common side effect of atypical antipsychotics, the ever more certain and complex relationship of depression to coronary artery disease, and the increased importance of primary care as a major source of mental health referral all underscore the contemporary salience of psychosomatic medicine for all psychiatrists. This text is a condensed and updated version of the The American Psychiatric Textbook of Psychosomatic Medicine, also edited by Dr. Levenson, which is the official text of the recently (2003) recognized subspecialty of psychosomatic medicine. The author is one of the pioneers of modern consultation psychiatry and has carefully edited the work of many of the leading teachers and experts in American psychosomatic medicine.

The book begins with a preface describing the history of the discipline formerly known as “consultation-liaison psychiatry” and a fine general chapter on psychiatric assessment and consultation in medical patients primarily in the hospital setting, which alone is worth the price of the book. Eighteen other chapters cover the major systems and medical specialties, including heart and lung disease, gastrointestinal, renal and endocrine disorders, oncology, rheumatology, chronic fatigue and fibromyalgia syndromes, infectious diseases and human immunodeficiency virus/acquired immune deficiency syndrome, dermatology, surgery, organ transplantation, neurology and neurosurgery, obstetrics, gynecology, and pediatrics, and two final chapters on physical medicine and rehabilitation and pain. The broad correspondence of the topics in Essentials of Psychosomatic Medicine to the larger book enables interested readers to supplement the excellent overviews provided with more detailed study in the Textbook of Psychosomatic Medicine.

Noticeably absent and sorely missing from the parent volume are chapters on the near ubiquitous ethical and legal aspects of consultation psychiatry, which are among the most challenging tasks for trainees in the field. Similarly, a chapter on palliative care would seem requisite, as hospital psychiatrists must increasingly treat a sicker and older population.

Each chapter truly meets the expectation of the biopsychosocial model of the psychosomatic pioneer Engel in that each covers epidemiology, diagnosis (including differential considerations), psychosocial factors influencing clinical presentation, and treatment encompassing both the psychological and pharmacological. Departing from the traditional psychiatrically-based organization of consultation-liaison textbooks, the medical disorder structure emphasizes how comorbid psychiatric and medical conditions interact, complicate, and amplify each other, requiring broad knowledge and wide competence in practitioners.

The text is crisp and concise, with each chapter able to stand on its own as a reference for a specific patient-case or as a general review of a medical or surgical discipline. Citations and tables are clinically useful rather than the all too often exhaustive and exhausting. An attractive feature for continuing education is the inclusion of self-assessment questions and answers for each chapter. These user-friendly features make the present volume not only an outstanding study guide for psychosomatic subspecialty examinations, but also an excellent textbook for consultation-liaison clerkships and psychosomatic medicine fellowships.

Something can be said to be “essential” in two allied senses: it can be necessary or indispensable or it can be basic and fundamental. This highly readable introduction to the cardinal dimensions of psychosomatic medicine fulfills both functions. The only real danger is that the title may mislead readers into thinking it is only a valuable volume for psychosomatic physicians when in actuality it is an excellent source for all psychiatrists and other mental health professionals seeking to hone their medical identity.

+Book review accepted for publication July 2007 (doi:10.1176/appi.ajp.2007.07071140).




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