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Book Forum: Textbooks   |    
Emergencies in Mental Health Practice: Evaluation and Management
DANIEL G. HERRERA, M.D., PH.D.
Am J Psychiatry 1999;156:1112a-1113.
View Author and Article Information
New York, N.Y.

by Phillip M. Kleespies. New York, Guilford Publications, 1998, 450$45.00.

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This book is designed as a text for mental health professionals-in-training, particularly clinical psychologists and social workers. The book’s structure, as described by the editor, "is intended as a curriculum for teaching a knowledge base in emergency services."

The first section of the book introduces the reader to basic components of psychiatric emergency training, including crisis theory, the emergency interview, and the scope of feasible intervention in the emergency setting. A high-quality and concise literature review is provided. The next section focuses on the evaluation and management of life-threatening behavior, including suicidal and violent patients. These chapters are easy to read, primarily as a consequence of meticulous organization, which provides a coherent framework facilitating absorption of the somewhat disparate knowledge required in emergency psychiatry. More important, I could imagine this framework easing operationalization of this information in the stressful emergency milieu.

An unexpected but much-appreciated section is devoted to management of the emergency telephone call, a potentially danger-laden situation for even the most veteran clinician. This chapter provides solid practical advice regarding clinical and legal aspects of the emergency telephone call, as well as a discussion of the impact such a situation has on the beginning clinician.

A separate section is devoted to medical problems presenting as psychological emergencies. These chapters provide essential and understandable diagnostic guidelines that nonphysician mental health professionals will appreciate. The discussion of psychopharmacology and other neurobiological aspects of emergency psychiatric phenomenology and intervention, however, may be inadequate for the psychiatrist-in-training.

A separate section concentrates on risk management in emergency clinical encounters with suicidal and violent patients, and the final section discusses the impact of the emergency psychiatric work on the clinician, especially the effect of managing suicidality. Although coming last, this information is as relevant to clinicians-in-training as the knowledge base they must acquire, since the psychiatric emergency setting presents a myriad of charged, complex, and subtly dangerous challenges that often test the conventional boundaries of clinical care (e.g., involuntary administration of treatment). The potential effects of such situations on the beginning clinician deserve the detailed attention they receive.

Overall, this textbook provides a thorough review of the fundamentals of mental health emergencies. The structure easily lends itself to the foundation for a course syllabus. Although primarily intended for nonphysician mental health professionals-in-training, except for the more medically related aspects of emergency psychiatric practice, it provides a useful resource text for those training in the provision of emergency psychiatric service in all mental health disciplines. In summary, this is an excellent textbook of mental health emergencies, useful for clinicians in general.

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