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Book Forum: Textbooks   |    
Psychiatry for Medical Students, 3rd ed.
Richard Balon, M.D.
Am J Psychiatry 1998;155:989a-990.
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by Robert J. Waldinger, M.D. Washington, D.C., American Psychiatric Press, 1997, 590 pp., $56.00; $42.95 (paper).

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This is the third edition of a fairly traditional textbook of psychiatry for medical students. The book is divided into five parts—Assessment Skills, Basic Psychopathology, Special Populations, Special Problems, and Treatment. There are five appendixes providing a sample psychiatric evaluation, a list of commonly abused drugs, a copy of the Global Assessment of Functioning Scale, a list of some common psychiatric medications, and a list of trade names of psychotropic medications.

In part 1, the focus is on interviewing skills, taking a psychiatric history, and the mental status examination, as well as basic concepts of psychodynamics. The discussion of the fundamental techniques of the clinical interview is probably the best part of the book. It includes numerous tips on interviewing, such as avoiding jargon, not asking the classic "why" question, and many others. It is clearly written, with good examples. However, this chapter is followed by a misplaced discussion of basic concepts of psychodynamics—logically, this discussion should have been followed by the well-written chapters on history taking and the mental status examination. Furthermore, the discussion of some psychodynamic concepts, such as the primary and secondary process, is probably beyond the scope of a textbook for medical students. This chapter also fails to properly explain the relevance of the developmental stages, defenses, and other concepts to clinical practice.

Part 2 reviews major psychiatric disorders—schizophrenia, mood disorders, and personality disorders as well as anxiety, panic attacks, phobias, dissociative disorders, and somatoform disorders. The chapters are uneven, some (such as the one on anxiety) focus too much on etiology, and treatment discussion is sometimes puzzling (e.g., the discussion of individual insight-oriented psychotherapy for schizophrenia).

Part 3 reviews special "populations"—geriatric psychiatry, children and adolescents, consultation-liaison psychiatry, and neuropsychiatry. Again, the writing is uneven. An example is the chapter on geriatric psychiatry, which includes a good discussion of normal aging but no discussion of the use of tacrine. Another example is a fairly good discussion of a neuropsychiatric evaluation even though standard psychological testing is not explained anywhere else.

Part 4 deals with special problems—human sexuality, substance abuse, eating disorders, suicide, and violence. Again, the material is uneven. Why discuss the issue of the change of sexual orientation in a textbook for medical students?

Part 5 summarizes available treatment modalities. The chapter on psychotherapy overlaps with the introductory chapter on psychodynamics. I think that part 5 is biased in favor of psychotherapy and that the discussion of psychopharmacology is not practical and up-to-date (e.g., there is no advice on what to do during a monoamine-oxidase-inhibitor-induced hypertensive crisis).

This is another average book for medical students that has its pluses—most of part 1, the solid references, incorporation of DSM-IV, and the author's writing style. The minuses have been mentioned. Unfortunately, the book does not stand out among the many available books for medical students. Perhaps the authors of the different textbooks for medical students should concur regarding what in psychiatry is essential for medical students to know and write what is sorely needed—a StandardTextbook of Psychiatry for Medical Students.

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