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Atlas of Psychiatric Pharmacotherapy By R. Shiloh,D. Nutt & A. Weizman. London: Martin Dunitz. 1999. 235 pp. £49.95 (hb). ISBN 1-85317-630-3

Published online by Cambridge University Press:  02 January 2018

C. Heather Ashton*
Affiliation:
School of Neurosciences, Division of Psychiatry, University of Newcastle, The Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP
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Abstract

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Columns
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Copyright © 2000 The Royal College of Psychiatrists 

Some people (usually males) have superior visuo-spatial abilities. Such men excel at map-reading, a skill at which women are allegedly abysmal. Those of either gender who delight in maps will enjoy this book. Those with predominantly linguistic tendencies may feel like a hippocampamised rat lost in a maze.

The book, by title and aim, is an atlas “written… for the clinician required to know, understand, and decide efficiently about options for biological treatments”. It contains a series of intracellular road maps depicting not only the main highways travelled by psychotropic drugs but also the smaller roads and footpaths, some of which peter out, ending in “ unknown cellular mechanisms”. These maps are ingenious, intricate but difficult. They follow the route, for example, of an antidepressant drug from a serotonin receptor through many stages to its effect on “cAMP response element binding protein (CREB) and the ‘proper production’ of ‘brain-derived neurotropic factor (BDNF)’ ”, leading finally to resolution of the depressive state. It is doubtful whether many psychiatrists will penetrate this far into the jungle. However, the maps, with their densely written texts, could be valuable for research workers requiring detailed information, and may serve as a reference for clinicians to absorb at leisure. Students and trainees would do better to start with something simpler.

Other maps, more easily followed, include flow charts of treatment strategies and grids of adverse drug effects. The former are available from other sources, but this book has the merit of stating how firmly evidence-based are the strategies suggested. Nevertheless, the text requires close searching for important clinical information such as dosage titration, dosage in the elderly and individual metabolic differences. Withdrawal reactions from antidepressants or antipsychotics are not mentioned among adverse effects, although the flow charts advise slow tapering of dosage on withdrawal (no reason given). Readers may disagree with various items such as the statements that withdrawal reactions occur “only if stopped quickly” for several short half-life benzo-diazepines and are “ relatively insignificant” with zopiclone.

These are perhaps minor criticisms considering the wealth of information the book contains, and its wide coverage spanning basic pharmacodynamics and pharmacokinetics, drug interactions, drugs of misuse, sexual dysfunction, personality and eating disorders and attention-deficit hyperactivity disorder. The authors deserve congratulations for their originality and courage in presenting in black and white (and colour) their micro- and macroscopic perspectives on an extremely complicated subject. This book is a must for the library.

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