The second edition of Massachusetts General Hospital’s guide to primary care psychiatry provides an update to a classic textbook of interest to psychiatrists and primary care practitioners. This new edition is an expanded volume of 78 chapters divided into seven sections. Ninety-seven authors have contributed to the second edition. As implied by the title of this book, the vast majority of authors have a Massachusetts General Hospital and Harvard appointment. The breadth and expertise of the contributors are quite impressive.

This soft-cover book follows a general outline strategy. This strategy makes it quite helpful as a bedside or office reference resource to answer important clinical questions as they arise. The outline format is complemented by a variety of helpful tables. The outline format would make this reference ideal for a personal data assistant (PDA) version, although I am not aware that a PDA version is available.

The first three sections provide a general overview for management of psychiatric problems in primary care. Key chapters include a synopsis of interviewing as well as a chapter outlining the use of the primary care version of DSM-IV. Additionally, the book highlights the value of cognitive behavioral strategies for dealing with a variety of psychiatric syndromes relevant to primary care populations.

These introductory sections set up the core feature of the book, a section highlighting approaches to specific conditions. This section is the obvious strength of the book and covers 54 clinical conditions ranging from the suicidal patient, the patient with fatigue, the patient with a postpartum mood disorder, and even the celebrity patient.

The final three sections focus on psychopharmacology, quality of life, and "physician-assistance issues." The final section addresses important issues in breaking bad news, maintaining boundaries, and dealing with the complexities of addressing psychiatric issues in a managed care environment. A final chapter provides strategies for physicians in coping with the rigors of medical practice.

The Guide to Primary Care Psychiatry might better be called the Guide to Adult Primary Care Psychiatry. Although two chapters focus specifically on childhood issues (attention deficit disorder and behavioral problems), the vast majority of the book is focused on adult clinical conditions. Therefore, this book might be more specifically helpful for adult consultation-liaison psychiatrists and practicing internists than practicing pediatricians and family physicians.

Nevertheless, I think this second edition of the Massachusetts General Hospital Guide to Primary Care Psychiatry is an outstanding reference. The $69.00 list price is very competitive compared with other options. Although the book is a little too big to fit in the pocket lab coat, it will find a place as a handy reference in a variety of clinical settings.