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Book Forum: MOOD DISORDERS   |    
Comorbidity in Affective Disorders
DAVID L. DUNNER, M.D.
Am J Psychiatry 2000;157:656-a-657. doi:10.1176/appi.ajp.157.4.656-a
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Edited by Mauricio Tohen, M.D. New York, Marcel Dekker, 1999, 280 pp., $145.00.

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This book is a multiauthored volume with 12 chapters that focus on unipolar and bipolar disorders and comorbidity among axis I, axis II, and axis III conditions. The book is basically divided into one general chapter by Kessler on comorbidity of unipolar and bipolar disorders; a series of five chapters related to unipolar disorder and substance abuse, medical disorders, personality disorders, medical disorders in the elderly, and children and adolescents; and six chapters on bipolar disorder and substance abuse, medical disorders, other axis I disorders, axis II disorders, old age, and developmental aspects of comorbidity and mania.

The authors were well selected and, in general, are well-known and experts in their fields. As with any multiauthored text, there was some delay in publication. The most recent reference that I found was from 1997. Given that this volume was published in 1999, the references are generally up-to-date. Each chapter is very well referenced, and one of the areas that I personally value in such texts is their bibliography. It is unlikely that an individual would read this volume cover-to-cover. One might be interested in a particular area—the relationship of bipolar disorder to borderline personality disorder, for example—read that chapter and update one’s referencing and get an idea of who is doing research in the field based on the references in that particular section.

Overall, the book is very well written. The editing seems to produce evenness among the chapters in terms of the various subheadings, which were apparently decided on as the book was being designed. There are treatment sections in many of the chapters that are quite useful.

What I find difficult about this book is to determine who might truly enjoy it and benefit from it. It is technical, and it is more of a reference text than anything else—an excellent text for those of us interested in research in mood disorders. It is unlikely that this book would appeal to nonpsychiatric clinicians. Some psychiatrists may find particular chapters of interest, depending on the patients they see.

The statistics in the book are of some interest. Since I was trained in the Washington University concept of primary and secondary disorders, the notion of comorbidity is not news to me. In fact, it is unusual to see a patient today who does not have more than one condition. Thus, comorbidity is the rule rather than the exception. Complexity of psychiatric treatment often gives rise to multiple comorbid disorders in a given patient, and the treatment of such patients poses great difficulties in terms of trying to affect one of the patient’s multiple disorders positively without negatively affecting others. This book gives useful clues as to how to approach these complicated problems, and it is helpful to know the statistics related to comorbidity.

In summary, this well-written multiauthored text covers an important modern topic and does it quite well. It is heavily laden with tables and statistics. It is readable and in its own way enjoyable, although the technical basis of this book makes it perhaps of less practical use to nonpsychiatric clinicians and limits its value among psychiatric specialists.

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