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Book Forum: Psychopharmacology   |    
Pharmacotherapy for Mood, Anxiety, and Cognitive Disorders
DONALD F. KLEIN, M.D.
Am J Psychiatry 2002;159:165-a-166. doi:10.1176/appi.ajp.159.1.165-a
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New York, N.Y.

Edited by Uriel Halbreich, M.D., and Stuart A. Montgomery, M.D. Washington, D.C., American Psychiatric Press, 2000, 804 pp., $85.00.

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There are several excellent current psychopharmacological texts; therefore, just what is distinctive and useful about this new volume? The editors are both well-known. Halbreich has been active in psychoendocrine research for many years and is a leading figure in international organizations. Montgomery is one of the most prolific British clinical psychopharmacologists and has often been in the forefront of therapeutic advances. In keeping with these editors, this book has a distinctly international flavor. This is all for the good, because it is easy to fall into parochial ways of thought, and travel is always broadening.

Among the authors, certain authorities from abroad are well-known, even in the Colonies. We have all learned to look forward to stimulating discussions by Florian Holsboer, Herman Van Praag, Robert Belmaker, Herman Westenberg, Johan Den Boer, David Nutt, and Joseph Zohar; in fact, there are too many to list. Canada, Israel, England, Greece, Spain, the Netherlands, Germany, and Estonia are represented. There are some novel ideas and approaches here.

Theoretical discussions attempt to help the reader understand complex interrelationships rather than focusing on simple monovariable theories. Holsboer presents a detailed review of the hypothalamic-pituitary-adrenal (HPA) axis, but he also points out that a corticotropin-releasing hormone (CRH) precursor can inhibit the CRH-induced release of ACTH, as well as several puzzling findings concerning thyroid-HPA interactions.

The contribution of Yvon Lapierre et al. shows discontent with the current U.S. syndromal diagnostic system. These authors argue that advances in therapeutics have driven psychopathological nosology, but that knowledge of specific receptor actions provide a better point of entry to understanding and treatment, even if these do not imply an etiological relationship. Van Praag also argues that DSM confounds severity with depressive phenomenology, since chronicity and premorbid personality characteristics are not related to syndromes. Van Praag protests diagnostic splintering; he argues that validity studies should have taken precedence over all the others and that the concern for measurement reliability neglected the subjective experiential world of the patient. Van Praag would have us give up the morass of comorbidly occurring syndromes and, in fact, the concept of disease entities to focus on the functional impairments that incur the psychopathological state, such as aggression dysregulation.

If we knew the brain functions that allow us to cogitate, emote, and behave, then Van Praag’s suggestion would resonate. But to replace DSM with a functional psychopathological approach seems premature.

This volume is a valuable complement to the more how-to-do-it books and is recommended for thoughtful reading. It also includes useful practical advice.

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