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Essentials of Clinical Psychopharmacology, Third Edition

edited by Alan F. Schatzberg, , M.D., and Charles B. Nemeroff , M.D., Ph.D. Washington, DC, American Psychiatric Publishing, 2013, 899 pp., $159.00.

Reviewed by Edmond H. Pi, M.D.
Am J Psychiatry 2013;170:1064-1065. doi:10.1176/appi.ajp.2013.13050639
View Author and Article Information

The author reports no financial relationships with commercial interests.

Los Angeles, Calif.
Dr. Pi is Professor Emeritus of Clinical Psychiatry and the Behavioral Sciences at the Keck School of Medicine, University of Southern California, Los Angeles.

Accepted May , 2013.

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During the past six decades, there has been steady progress in the field of psychopharmacology, serving to greatly alleviate human suffering from various types of psychiatric disorders. The impact of psychopharmacology is illustrated by the progressive decline in the number of psychiatric inpatients, so-called “de-institutionalization” since the discovery of the first antipsychotic medication (i.e., chlorpromazine) in the early 1950s. The widespread use of psychotropic medications made outpatient and community-oriented treatment programs possible for patients who suffer from psychiatric disorders. Furthermore, psychopharmacology has immensely accelerated progress in biological psychiatry and understanding of the neurosciences, which, in turn, have provided hypotheses regarding the etiology of and possible explanation for certain psychiatric conditions. There are now data from systematic and scientifically designed studies of psychotropic medications that probe the underlying mechanisms and clinical significance of pharmacogenetics, pharmacokinetics, and pharmacodynamics.

Psychopharmacology is moving in the direction of more specific treatment for specific diagnosis or symptom clusters, a step in the direction of the “right” drug for the “right” patient, as careful diagnosis is essential to the prediction of the outcome of the treatment. There are reasonably specific indications for prescribing psychotropic medications, and these indications are, in general, tied to diagnostic criteria. There is now abundant evidence of the therapeutic efficacy of a variety of psychotropic medications: antipsychotics for schizophrenia and other psychotic disorders, antidepressants for many depressive disorders, lithium salts and mood stabilizers for bipolar disorders, and anxiolytics for anxiety disorders.

The third edition of Essentials of Clinical Psychopharmacology is a timely update, well organized, easy to read, and delivers core knowledge and information in a succinct and accessible manner to clinicians. Overall, the editors have updated the material with the latest research findings and references in the chapters.

The book is divided into two parts. Part I is titled “Classes of Psychiatric Treatments: Animal and Human Pharmacology.” This part includes 34 chapters, which systematically review psychotropic medications within each drug class, focusing whole chapters on a single drug. This part also features new chapters on recently introduced medications, including desvenlafaxine, pregablin, paliperidone, lurasidone, asenapine, and iloperidone, as well as cognitive enhancers, and updated chapters on other psychotropic medications. Overall, the chapters are well done and uniformly good; most of them provide concise description and evidence for each contention that is discussed. It is easy to find specific drug information given that there are specific chapters for each drug and racemate. A medication-specific chapter presents key information on preclinical and clinical pharmacology and discusses general issues regarding the mechanisms of drug action, pharmacokinetics, pharmacodynamics, approved indications, routes of administration, dosage schedules, common side effects, drug interactions, and other prescribing factors. This part contains good clinical information on psychotropic medications, but it would be more efficient to discuss the similarities of medications in a section on each class of psychotropic medications and then highlight clinically significant differences, the common side effects with information on the clinically significant differences for each medication. For example, for selective serotonin reuptake inhibitors (SSRIs), discussion could include which one carries the greatest risk of insomnia, bleeding, QTc prolongation, or antiplatelet effect or a greater propensity for weight gain and sexual side effects, even though weight gain and sexual side effects are possible with all SSRIs. If the textbook were organized differently, this comparison could more easily be made.

Part II is titled “Psychopharmacological Treatment.” This part has seven chapters, which outline current pharmacotherapeutic approaches in the major psychiatric disorders (e.g., depression, bipolar disorder, schizophrenia, anxiety disorders, substance-related disorders), as well as in specific patient populations (e.g., children and adolescents, pregnant and lactating women). Although in this new edition, part II has been streamlined by the deletion of chapters on management of noncognitive symptoms of dementia, treatment of eating disorders, agitation and aggression, personality disorders, disorders during late life, insomnia, and psychiatric emergencies (compared with the second edition), it incorporates well the latest research and treatment advances, providing clinicians with detailed information on selecting, prescribing, and monitoring medication treatment. However, there should have been a section on cross-cultural psychopharmacology addressing ethnicity, culture, and psychopharmacology, such as a review of the clinical significances of genetic differences in cytochrome P450 (CYP) isozymes

In summary, this latest edition of Essentials of Clinical Psychopharmacology is a resourceful, comprehensive, and concise book of clinically focused pharmacotherapy for clinicians. This book has achieved the goals stated in the title: essential and clinical. Clinicians seeking a reliable reference and guide in the core knowledge base and practice of clinical psychopharmacology should purchase this new edition; keep it handy with you. Read the relevant chapter when you treat a patient with a specific psychiatric disorder and prescribe a particular psychotropic medication.

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