Medical Media and Events Reviews

We independently review relevant medical media sent to us for review. We also review medical conference and events.

Address your media to :
'The Media Review Editor' Priory Lodge Education Ltd., 2 Cornflower Way, Wirral, CH46 1SU


 

Review Ratings

***** Essential - a must have
**** Valuable and original contribution to the field
*** Useful addition to the field
** Average
* Poor

 

Books


Challenging Behaviour.

Emerson and Stewart. 2011

*** Useful Addition to the Field

Cambridge University Press


A comprehensive account of why some people with a severe intellectual disability behave in ways which challenge the system and those who live and work within it. The book builds and elaborates on the earlier editions by acknowledging the social changes of the last decade to achieve contemporary context. It is well researched and provides theory, methods and strategies to deal with a wide range of behaviours. Authoritative guidance is provided throughout which will assist in the application to practice. All strategies are evidenced based and general principles for dealing with challenging behaviours are explained in an accessible manner.
I would recommend this authoritative, user-friendly yet erudite book as essential reading for all professionals involved in working with this client group.

Jacqui Glenning, 2011

 

Antipsychotics and their side-effects
Gardner & Teehan
(2010)

* Poor

Cambridge University Press

ISBN 978-0-521-13208-4

 

Usually the authors can’t be held responsible for the book cover, but a special mention needs to be made of how very bad the cover is for this book. The strange image of a face reminiscent of a Wookie from Star Wars leaves the reader wondering what the painting is meant to say. An explanatory note indicates it is a depiction of depression, which is puzzling for a book on medication primarily intended for schizophrenia.

The drugs that are most heavily featured are the second-generation antipsychotics, particularly olanzapine and risperidone- which might suggest either both drugs are riddled with adverse effects or the authors have a particular dislike for the drugs. This is probably and unfair criticism though and just reflects the current pre-eminence of these prescriptions and the wealth of data on both.

Here then is a run through of the main side effects of antipsychotics. Other interesting aspects of the world of adverse effects – drug development, safety studies, post-marketing notification systems and regulatory agencies – the intrigues of suppressing information and past scandals are relatively overlooked. The issues of counterfeit drugs entering the supply chain are also relatively unexplored.

I searched through the book in vain for a chapter on the adverse effects of antipsychotics taken during pregnancy.

Finally, and this is the critical flaw in the book, is that having identified a myriad of side effects the book is absolutely silent on the highly salient point of what the prescriber should do to manage them. The book is great on the idea of monitoring side effects. However once noticed what does the prescriber do about sexual side effects or tardive dyskinesia? Would it not have been logical to include solutions alongside problems? This omission is astonishing and seriously limits the book’s usefulness

 

Medical Management of Eating Disorders. 2nd Edition
Birmingham & Treasure
*** Useful addition to the field

Cambridge Medicine - 2010

ISBN 978-0-521-72710-5

 

On the whole I’d recommend this book – it’s hugely enjoyable and a valuable resource for those working in the eating disorders field. However the book, despite being a second edition, also seems to have some rather unaccountable gaps and omissions that could have been avoided with insight and better editing. By way of example: I thought thiamine deficiency was under emphasised; and although males with anorexia nervosa are uncommon the book pays virtually no attention to them or their specific medical complications; Chapter 9 on course and prognosis is too brief and unreferenced and chapter 10 just seems so short that one suspects it was left unfinished… On the other hand the chapter on nutritional deficiencies was interesting and informative. Definitely worth buying if your practice includes seeing patients with eating disorders, and worth taking notes from in the library if studying for MRCPsych

 

Outcome Measurement in Mental Health

** Average

Edited by Tom Trauer

Cambridge University Press- 2010

 

 

I have read worse books on outcome measurement. Most of the competitor tomes are worthy, wordy and communicate little. This is a book approaching what is required, but sadly does not hit the mark absolutely.

The book is so divided into various short chapters by differing authors that overall there are omissions.

From a lead clinicians point of view, having been asked to recommend outcome measures in various service over the years I would have appreciated a concise book which covered a range of measures, weighed them all up and having discussed them made recommendations for various patient groups and services.

No measures are particularly discussed in any great detail and many standard services seem to have scant or indeed no cover at all.

For instance I approached the book as if I were an eating disorder professional. The book was of no help. I approached the book as if I was psychotherapy professional – again no help. Similarly I wondered if the book would be of assistance to low secure rehabilitation or indeed high secure forensic services and these too were not covered especially well or at all. It would perhaps matter less if standard mental disorders such as depression or schizophrenia were covered well, but they are not.

In summary therefore the book cannot be recommended.

Professor B Green

 

 

Mental Health Needs of Young Offenders

Carol L. Kessler and Louis J. Kraus

Cambridge University Press- February 2008

 

 

"Mental Health needs of Young Offenders" by Kessler and Kraus gives an insight into the epidemiology, aetiology and co-morbidity of mental illness among young offenders. It further provides an overview of assessment and interview techniques and the management of such individuals. Among a plethora of books about forensic aspects of mental health, this is one of the very few books that addresses issues about the services and needs surrounding young offenders.

It offers a comprehensive overview of the epidemiology and various statistical facts, has highlighted the issues of over representation of ethnic minorities and steps taken to address the situation. It has described the criminal justice procedure nicely; detailed enough to understand the intricacies and yet brief and succinct to keep the reader interested. Of particular interest are the Miranda rights and their application towards youth who might be unable to either understand them or are unfit to plead, an area that readers outside the USA might not be familiar with. The case vignettes provided in this section help to comprehend the difficulties that may arise in such situations. Kessler and Kraus have also devoted a section towards the very serious matter of suicides among adolescents, particularly in juvenile facilities and highlight the need for effective prevention programmes. The highly debatable matter of death penalties for under-18s is also discussed to some extent with facts provided from rulings in the USA. They then move on to discuss the pattern and types of sexual offences prevalent among young offenders and aspects of their evaluation and treatment.

To round up, the book touches upon educational needs, assessment tools, need for screening and treatment options, pharmacology and other issues one may encounter in such settings.

Overall, it is a good book which is easily comprehensible and provides comprehensive references and enough statistics to keep the academic impressed. It can be highly recommended for people working with young offenders or professionals in secure units for adolescents. However, one must exercise caution in adapting the strategies mentioned and shouldn't read too much into the statistics as they are based on the US population, and therefore difficult to generalise outside the country.

Dr Parkar, Staff Grade Psychiatrist, Cheadle Royal Hospital, Cheshire.


 

Psychotic Depression

by Swartz & Shorter

Hardcover: 327 pages

£55 (US $85)
Publisher: Cambridge University Press (31 May 2007)
ISBN-19780521878227

Overall On-Line Rating ***

Psychotic derpession

 

The orientation of this book is both historical and clinical in nature. Some readers may find the tone somewhat opinionated - for instance lamotrigine is 'probably not an antimelancholic' and such opinions in this book are frequently not referenced. If the reader can tolerate this then the book seems to have been based on a wealth of experience. The invaluable role of ECT in the management of depeession is well argued as a lifesaver, which in ths most severe of conditions it usually is. I remember once talking to a  Professor of Primary Care who asserted that ECT was 'no longer required in modern day medicine' and that psychiatry too could be dispensed with as he thought severe depression could be managed at home. I concluded he had probably never seen a truly severe case of depression in his life, and there are inherent dangers in our 'community' orientated psychiatry such that much valuable experience is simply discounted to the detriment of patients who cannot frequently cannot advocate for themselves. The historical aspect of this book argues potently for the recognition of severe depression and aims to redress the blanket ignorance of community based psychiatry - a psychiatry that is frequently blinded to suffering by political idealism.

 

Handbook of Liaison Psychiatry

by Geoffrey Gower Lloyd (Editor), Elspeth Guthrie

Hardcover: 944 pages
Publisher: Cambridge University Press (31 May 2007)
ISBN-10: 0521826373

Overall On-Line Rating ***

Liaison Psychiatry Cover

 

This is a most comprehensive work - a major work that should be on every consultant liaison psychiatrists shelf and on most psychiatric trainees reading lists. It is thoroughly put together by experts, though with a distinctly North Western bias.

The section-by-section approach looking at psychiatric presentations by medical speciality e.g. neurology is most helpful. I thus found the book very helpful in putting together at talk on somatisation for neurologists.

The accessibility of the knowledge in the book could have been improved by a better layout - large and worthy slabs of text with references are perhaps academically satisfying, but of less interest to a generation of junior doctors with a shorter attention span, having been weaned on punchy textbooks with colour, numerous textboxes, scenarios, illustrations and bullet points, and of course, the web.

That editorial point aside the book is highly recommended.

 

Celebrating Small Victories

Montrose & Daley
Hazelden, US ISBN 1 56838 092 5
Overall On-Line Rating ****

 

It must be said that the patients with mental illness and a substance abuse problem get a raw deal. Tooo many services seek to divide the two problems out to an unrealistic degree and the patient can often either be faced with different treatment modalities from different teams or a stony-faced misunderstanding from substance abuse services and mental illness services. This pragmatic little book argues their corner and suggests some valuable insights into developing solutions for this client group.

 

Coping with Psychiatric and Psychological Testimony,
Fourth Edition,
Jay Ziskin Ph.D., LLB. and David Faust, Ph.D.
Law and Psychology Press, 1988.
Overall On-Line Rating ****

 

Psychiatry's scientific and methodological advancements over the past century have unfortunately been exceeded by its faddishness and lapses into shamanistic cultism. Psychobabble, victimology, recovered memories, orgone therapy, orthopsychiatry are examples of faith substituting for science, while claiming the mantle of scientific credibility.

Credible psychiatric criticism is good for the discipline of psychiatry and will prevent the field from descending into the realm of romanticism, voodoo, and witchcraft. I use the term credible to distinguish critical objective assessment from criticism based upon personal vendettas or political agendas. Examples of the latter would be Scientology's organized attack on psychiatry as revenge for dismissing L. Ron Hubbard as a quack, or the rantings of Jeffrey Masson.

Ziskin and Faust's reference book "Coping with Psychiatric and Psychological Testimony" represents credible psychiatric and especially forensic psychiatric criticism at its best. Some of you have no doubt heard of the famous-in-psych-legal circles (or infamous, depending on your point of view) "Ziskin" book for lawyers on how to discredit psychiatric testimony. For a number of years I had searched for this book, and I recently obtained a copy of the three volume fourth edition with supplements. The ultimate testament to the power of the work is that forensic psychiatrists now complain of being "Ziskined" on the witness stand.

The first edition of this book was printed in 1970 and is summed up in the first sentence: "It is the aim of this book to demonstrate that despite the ever increasing utilization of psychiatric and psychological evidence in the legal process such evidence frequently does not meet reasonable criteria of admissibility and should not be admitted in a court of law, and if admitted, should be given little or no weight."

This is the kind of book that should not be read by first year psychiatry residents, or touchy feely Stuart Smalley (the Saturday Night Live character always in some kind of recovery) types with fragile self esteems. Ziskin has few kind things to say about the nature of psychiatric evidence, especially in the courtroom. In a culture of the twinkie defense, the abuse excuse used in the Menendez trials, and years of fraudulent post-termination stress claims, it is difficult to argue with Ziskin and Faust's thesis. Ziskin and Faust go straight for the jugular of the Diagnostic and Statistical Manual of Psychiatry and the sophism of psychiatric testimony. They point out that most psychiatric diagnoses are not based upon hard empirical data, but the result of consensus and politics.

Ziskin devotes a whole chapter on the 1973 Rosenhan study, in which normal volunteers were psychiatrically hospitalized on the basis of psychotic symptoms, but remained in the hospital with the same diagnosis long after the volunteers persistently denied those symptoms. This showed how psychiatrists tend to get locked into a certain impression and stay with it despite lack of evidence.

Ziskin extensively reviews psychological testing, and discusses the methodological problems in using clinical instruments in forensic settings. He has few kind things to say about computerized MMPI narratives. He heartily endorses the use of the MMPI to detect clinical malingering, citing a broad body of evidence supporting the value of the MMPI validity scales based upon actuarial and statistical fact rather than theoretical value. Ziskin recognizes malingering at a much lower threshold than most psychologists and particularly the disciples of MMPI authors McKinley and Hathaway who use the caveat of F-K>11 as indicative of malingering. He convincingly argues for a cutoff point on the F-K index of +5-- "for forensic purposes the probability that only 6.5% of genuine profiles would be considered malingered at that cutoff point, while 83% would correctly indicate malingering according to Gough's data...for example, if there is an F-K of +10, testimony can show that according to Gough's research, there are less than three chances in 100 of error in viewing the MMPI as malingered." The implications of this data for forensic work is staggering.

The authors deconstruct psychiatry from the bottom up and have show mercy on psychiatry's unwillingness to test its theories empirically. There are chapters on how to challenge an expert's clinical judgment, expreience, education. Volume III includes guidelines to cross-examination of mental health experts on the witness stand and in depostion with case illustrations. This is must reading for an attorneys who deal with forensic psychiatric issues and any psychiatrist or psychologist who testifies in court as well.

If the book has any weakness, it is not in its impeccable analysis of the data, but may be in its premise that the modern jury (and, in many cases, judge) can be swayed by reason. I have serious doubts about the capacity of many people to think critically and in certain situations an attack on expert testimony may backfire, since psychobabble is ultimately a religion and not a science. Juries comprised of Ricki Lake addicts and judges influenced by the culture of victimology may see such scrutiny and criticism as cruel, and ultimately blasphemous.

This 3-Volume reference is a must for every forensic psychiatrist or psychologist and should be a part of any law library. Anyone defending himself in an emotional injury case should demand that his attorney read it cover to cover. A newer edition is forthcoming and will include discussions of the newer Daubert standard for expert testimony and other developments.

by James O'Brien, M.D.

 

Mosby’s Medical Surfari
Gibbs et al
Mosby Books
ISBN 0-8151-4817-8
Overall On-Line Rating *

 

Mosby’s Medical Surfari is in two parts, firstly that of a guide to the ‘basics’ of understanding the equipment needed, terminology used, softwre required and search methods used and secondly a review of medical resources and sites. Many of the URLS to these sites and others are contained on a disk which is included.

The first part of the book contains information that can be found in many other magazines and similar books. Such information needs to be well written, illustrated, up to date and entertaining if it is even to begin to attract and then maintain the attention of the reader that needs such information. This is not the source to turn to for such information which, although all there is dull and unattractive in presentation and style.

The second part and disk contains reviews of sites and resources. There are many links to sites on the disk, but only a fraction of these are actually reviewed in the book. Within each speciality, only a handful of sites are described in any detail, which even then is generally insufficient to assist in deciding which site to visit as the information is so generalised and, often already dated.

To attempt to define or describe the internet with a book, is to describe a highly flexible, evolving and interactive medium with the medium it is gradually replacing in many areas. The result is a wide-angled snapshot of poor resolution and definition. The detail is freely available from other sources and the internet itself.

Dr Ian Rogerson,
Senior Registrar, Halton Hospital, Cheshire

 

Stop Dieting Before it Kills You!
Straw, W E
PRC Publishing
ISBN 0 944193 21 2
Overall On-Line Rating ***

 

This is a book designed for the lay public. The title is alarmingly up-front, but the message is clear! European reasders will enjoy its bright and breezy style, whioch was originally intended for a US audience. This is essentially a well written handbook for anyone who needs to go, or thinks they need to go, on a diet. It offers sound advice for those who have an obsession with their weight and dieting. It would be appropriate for setting limits if it happened to be read by someone with anorexia nervosa. The dietary and exercise plans are straightforward, and there has been such a fashion for extraordinary diets that this book makes quite a contrast. I would recommend this to people who are heavily into diets. Practitioners could usefully refer to the charts and structured programmes with their clients.

Dr C P Routh, Lecturer in Child and Adolescent Psychiatry

 

Constructing Realities
Rosen & Kuehlwein
Jossey-Bass, San Francisco
ISBN 0 7879-0195-4

Overall On-Line Rating **

 

Constructing Realities is a series of essays on the theory and practice of psychotherapy. The book covers the wide modern landscape of narrative, constructivism, social constructionism, Postmodernism, epistemology, developmental constructivism, language, and social discourse. The book is serious, worthy and its aim is laudable. The world of psychotherapy is a diverse one however, and in attempting to map it so comprehensively one gets the feeling that what one would really like, in addition to this map, is a reliable human guide. However, in this modern world of psychotherapy there is no cult of personality and no Good Father figure. We must construct our own realities.

 

The Rules of Insanity
Dr. Carl Elliot
[State University of New York Press,
143pp pbk; ISBN 0-7914-2952-0]
Overall On-Line Rating ***

 

Carl Eliot left Medicine and a training in Psychiatry to become a philosopher; he’s now Assistant Professor at the McGill Centre for Medicine, Ethics and Law in Montreal, and has published extensively in the philosophy of mind and ethics. His unusual background provides an invaluable perspective for this book about "moral responsibility and the mentally ill offender."
It is a slim volume that covers this complex area in a lucid, coherent style. Explaining the irony behind the title- there can be no "rules" in what follows- he quotes from King Lear: "I’ll teach you differences". Eliot follows a systematic approach, and outlines a simple taxonomy of wrong-doing: individuals may be excused their actions either through ignorance ("I didn’t know what I was doing") or compulsion ("I couldn’t help doing it").
The philosophical basis of such distinctions begins with Aristotle’s work on voluntariness in the Nicomachean Ethics, and has been causing problems for psychiatrists, philosophers and lawyers ever since. Eliot analyses the ethical difficulties behind such legal constructs as the McNaughton rules, the "Irresistible Impulse Test", the Durham Rule and the American Law Institute Model Penal Code. None are satisfactory, but why?
His philosophical training serves him well here. He points out, for example, that although delusions are immediately recognisable, they are almost impossible to define. How should we distinguish between temptation, duress and justification? Fortunately, each argument is illustrated with case histories, allowing those of us with less incisive cognitive habits to keep up.
His discussion is helpfully divided into categories familiar to psychiatrists: disturbances of desire, personality disorders and
psychotic illness. The author makes a special case for the psychopath: if he is unable to distinguish right from wrong- to understand morality- then he may fall into a moral category of his own.
Eliot has written a concise, readable guide to the ethical dilemmas that underly the insanity defence and diminished capacity. His clinical background has made this book of practical, as well as theoretical, interest to psychiatrists.

Dr. Michael Smith

 

AIDS and HIV. The nursing response.
ISBN: 0 412 56090 9 1 56593 585 3 (USA) (1996)

Edited by Jean Faugier and Ian Hicken.
234pp
Chapman and Hall, 2 - 6 Boundary Row, London, SE1 8HN, UK.

Overall On-Line Rating ***

 

Ten years or so in to the AIDS epidemic, this important book edited by Jean Faugier and Ian Hicken gives nurses (and indeed many other professions) the chance to recap and review. How did we do in the face of "the most devastating personal and public health problem we have faced this century" ? In the fourteen chapters by various authors the answers are at best mixed. The downside is a catalogue of missed opportunies, failure to deliver obvious and simple public education and at worst blind prejudice. At best, many nurses responded selflessly and with astonishing innovation to a new syndrome which threatened and threatens us all.

"AIDS and HIV, The nursing response" looks at the many aspects of the care of people with AIDS and HIV in which nurses have both led the way and at times been embarassingly inadequate in their delivery of care. In particular chapter 3 on Clinical Support and Supervision demonstrates how AIDS - as in so many other ways - forced the previously obscure practice of supervison out from the psychotherapy closet and in to mainstream nursing. 10 years ago the usual response of a nurse manager to a request for supervision was "what's supervision?" - now most senior nurses lay down clear policies and standards for the supervision of staff. They understand that nurses who receive good clinical supervision perform better in their practice.

However, Faugier and Hicken do not confine themselves to a retrospective view of AIDS and its impact on nurses and nursing, they also give a strategic vision for the furture care of HIV patients by nurses. In particular they rightly call for nurses to become far more pro-active in bringing the social injustices which contribute to AIDS to public attention. In effect they tell us that AIDS has a disproportionate effect on the poor, the victims of discrimination, and the disadvantaged and that nurses, if they are to do the best for their actual and potential clients need to address the politicians as well as the patients.

"AIDS and HIV, The nursing response" is a clear, well produced and edited book which holds many lessons for nurses and others involved in the AIDS epidemic and offers ideas for a possible future. It will be interesting to see if the concepts and thoughts in this book make for the better care of people with AIDS in the next ten years.

Mike Blank
Nurse and general manager of a clinical directorate with Derwen NHS Trust in the UK.

 

Examination Notes in Psychiatry - A Postgraduate Text
Third Edition 1995

Buckley, Bird & Harrison
413pp
Butterworth Heinemann
Overall On-Line Rating ***

 

The first edition saw the reviewer through undergraduate finals, and the second through Membership. The third edition was eagerly anticipated for continuing medical education purposes. The book has grown in size over time, but as with most new editions of a successful book you can almost feel the pain of the authors in trying to decide what stayed in and what was edited out. The overall impression is that this hybrid is not wholly successful.

There was once a time when the reviewer naively followed the notion that medical texts were always authoritative. Sadly, revisiting the texts of my student days I can see the joins all too clearly. These joins are apparent in the third edition too. For instance in the Personality section the body builds ectomorph, endomorph, and mesomorph.....are ascribed to Kretschmer, 1921. Surely this classification was due to William Sheldon in 1940?

Chapter headers are sometimes spelt incorrectly eg physcotherapy . In the layout of the text there is an apparent confusion between personality types and traits and personality disorder. The section on uncommon psychiatric syndromes fails to mention the argument that these are not in fact syndromes themselves, but are merely uncommon symptoms. In this section the second and not the latest edition of Enoch and Trethowan's classic work is referred to. No mention is made of Anderson's 'Delusion of Inanimate Doubles'.

However, these are all fairly trivial points, and one would expect a revised edition to follow, in which these rough edges are smoothed out.

On the positive side the updated drug dependence section is extremely thorough, although there is no mention of some of the philosophical aspects of management such as those propounded by Dr John Marks.

The book uses ICD-10 and DSM IV throughout and has a more global appeal. This is a very useful revision aid, but the readers should beware of minor inaccuracies. I would expect it to find a well earned place on the shelves of most junior psychiatrists.

 

Saunders’ Pocket Essentials of Psychiatry (1995)
Basant K Puri
144 pages
W B Saunders Company
Overall On-Line Rating *

 

This newly published, slim, pocket-sized, manual would suit medical students needing an easily accessible guide during their clinical attachments, and an aid for revision. Its eighteen chapters cover the core psychiatric syndromes and sub-specialities, including suicide/parasuicide, substance abuse, the English and Welsh Mental health Act and lists headings from the ICD-10 and DSM-IV. There are useful summaries of common psychiatric signs and symptoms and a guide to case presentation.

The manual is presented as a reference guide rather than adopting the more practical-based approach of the Oxford Handbook of Clinical Specialities psychiatric chapter. Whiles the information is mostly adequate, chapters covering old-age psychiatry, neurotic and related disorders and forensic psychiatry are too brief. Tables are effectively used, but there should be more of them, and the classification appendices need the minimum diagnostic criteria in addition to mere headings. Given these possible improvements the manual would then, and only then, prove a useful guide for the post-graduate trainee and primary care doctor who would find the current format too sketchy. Most undergraduates would though benefit from this slimmed down approach to an often bewildering speciality.

Dr Stephen Gerber,
Registrar in Psychiatry,
Halton Hospital, UK.

 

Cognitive Therapy for Depression and Anxiety (1995)
Ivy-Marie Blackburn & Kate Davidson
Revised edition Blackwell Science, UK

Overall On-Line Rating ***

 

This book was published in hardback in 1990 and has been updated to include DSM-IV, ICD-10 and some new references. The current version is in softback with a distinctly unappealing cover. Nevertheless the book is written by two leading proponents of the technique and is a valuable sourcebook for trainees of cognitive therapy.

Students of the history of psychiatry will be aware of the cyclical fashion in new therapies and treatments. Cognitive therapy, in essence, is not new. Indeed descriptions of a similar technique can be found in works by Soranus of Ephesus. That cognitive therapy might be going out of vogue again today can be assumed by the reactions of psychologist colleagues when asked to consider a patient for cognitive therapy. A look of mild disdain flickers over their face in much the same way as such disdain used to greet enquiries about IQ testing ten years ago.

However, we are talking about a validated treatment method here, which, since depression and anxiety clearly never go out of vogue and will always require effective treatments, should be championed. The book is admirably clear and suitable for trainees of whatever speciality although its theoretical base is not the main emphasis of the book. This is very much a how-to-do-it manual and its useful appendices give a schedule on how to rate therapist performance.

Ever sceptical of cognitive therapy's claims the author has always found his patients unwilling to undertake the tasks set them. Perhaps it is his enthusiasm or lack of it that is at fault. Cognitive therapy has always seemed, well rather Pollyanna-ish. You may recall Pollyanna as the child heroine of a series of book who can always reframe the direst event into one of optimism. To exaggerate Pollyanna horribly: "Oh dear my leg's fallen off, but I've always liked hopping". Happily, the book contains a late section on problem or 'non-compliant' patients which has some good practical advice, although when one is adjured not to be 'schoolmasterish' it is difficult when the term given by the authors to describe self-treatment at home as 'homework' Their term is itself redolent of chalk and school assignments. No wonder some patients default.

The model espoused in the book advocates treatment episodes that include 15-22 sessions; not a brief therapy by any means. Two of the four target audiences of the book include psychiatrists and general practitioners. It is difficult to envisage either profession being able to offer such a protracted treatment to even a few of their patients. Clearly the model needs to be adapted to these target audiences, and one would hope that any future edition would evolve towards this model, or else the therapy will be too expensive to consider instead of or in addition to antidepressants. Nevertheless there are dangers in diluting the model. It may be trivialised or fall into the wrong hands. It may become a PYT therapy (where PYT stands for 'Pull Yourself Together').

Overall, a useful part of the literature by two highly respected innovators and researchers. Simply written and easy to follow with good appendices. A fully revised second edition would have been preferable though given advances in the field.

 

 

Theories of Personality

(1994) 5th Edition. Schultz.,D & Schultz,
S.E. California, Brooks/Cole Publishing Company. ISBN 0-534-16650-4.

Overall On-Line Rating ****

 

This excellent book reviews various personality theories of such notable individuals as Erikson, Cattell, Jung, Freud and Maslow. Each chapter is devoted to a concise explanation of their main contributions to personality theory and gives an admirably balanced critique of this. Each theory is explained within the context of the life history of the individual, which gives a fascinating insight into the genesis of the person's own theory. The book is appropriate to undergraduate psychology and to trainee psychiatrists. A worthwhile addition to any psychiatry library, the book is both informative and entertaining.

Videos

 

Voicing Needs - Advocacy and Empowerment

(1994) NHS Executive, Mental Health Task Force
Overall On-Line Rating *

 

This is the last in a series of worthy, laudable, and above all, trendy aspects of modern mental health care. This one concentrates on the rise of patient advocacy over the last ten years or so in Britain, following on from advocacy projects in Holland and the US. It reviews hospital based groups such as acute ward patient councils, and hospital patient groups such as those at Broadmoor Secure Hospital. From the perspective or community care city-wide users' councils are shown meeting with the executives of NHS trusts (providers), and other groups. There are numerous interviews which allude to concepts such as 'empowerment' and people 'finding their voice'.That there should be a need for such groups really goes to underline the poor quality of communication between patients, and those who represent doctors and nurses. Various managers attest to the benefit of such councils, and one can envisage the benefits of being able to tailor services to their consumers. However, the thing which really does let this video down, (and others in the series) is its reliance on 'talking heads'. This is something of a perennial problem with videos in psychiatry, but here the problem is compounded by the relative overuse of terms like 'empowerment'. Of course one thinks that one knows what all these people are meaning, but it would be exciting to see a case in point. What happens when someone has a real, concrete problem? Could we see an advocate and client talking this through, perhaps, even meeting with service providers and something actually changing as a result of 'advocacy'. The video never really gives such focused examples, and one is left wondering whether the people are merely talking about advocacy in abstract terms and paying lip service to concepts or whether they actually (hopefully) represent a means of change. Two places where the video does come alive are brief images of advocates being trained in non-directive counselling techniques, and an emotive role play of compulsory detention in hospital. Who is the video for? Advocacy groups might relate to this video, and some managers.

 

Computer Programs

 

 

Carl Littlejohn's ECTWIN V.5.5. (1996)
An Introduction to Electroconvulsive Therapy

 

Overall On-Line Rating ***

The program is available from the Compuserve webpage given above. The version supplied self-installed using a Visual basic installer from a 3.5" disk.

The disk gives a menu-driven introduction to ECT with images, graphs and text. The introduction would be appropriate to trainees and also for continuing medical education purposes.

As freeware this program is quite excellent and there are few quibbles with its content. If we must quibble, and in a review quibbling is a must...then we would quibble about the presentation style. The screens are often disparate in terms of background, layout and fonts. One background picture is a version of the front elevation of the old Denbigh Hospital, and although some might remember the old asylums fondly, it might be argued that this is not the image that one would wish to associate with ECT any more.

These style issues aside we welcome the program.

 

 

Steven Hyler's PDQ-4 Personality Questionnaire. (1995)
Steven Hyler
1.4 MB 3.5" disk
Alphalogic
Overall Rating **

 

 

Review One


PDQ-4 is a suite of DOS programs. Pdq4.exe is a computer-administered personality inventory which presents 99 statements beginning "I.... " or about "me" which can be answered as true or false by a mouse click. There is an option to change the presentation format and to make the statement suitable for completion by "the patient" or the clinician. There is one (very simple) lie question, and 12 categories: avoidant, dependent, obsessive-compulsive, histrionic, narcissistic, borderline, negatavistic, antisocial, schizoid, schizotypal and depressive. Responses in each category are counted, and positive responses in each category are re-presented for checking, and to ascertain how long they have affected the respondent, how many areas of the respondent’s life are affected by them, and whether they are dependent on mood (and presumably moo d disorder). Results can only be presented from a separate program (which is supplied) which gives a profile of scores, indicates which are above threshold and suggests a personality disorder diagnosis if appropriate. The statements are then printed grouped under the categories as personality characteristics. Thus the first two characteristics of obsessive-compulsive personality disorder are the following two statements from the questionnaire: "I often get lost in details and lose sight of the big picture" and "I waste time trying to make thing [sic] too perfect". Results can also be output as figures suitable for input into another program, or as a bar chart.

The program is reasonably easy to install in Windows 95 and has a distinctive icon. Once into it, and it is less user friendly. Sometimes a nul response is accepted (e.g. to last name) but sometimes it is not, in which case the program simply fails to progress. There are ways to exit, but these are counter-intuitive and are described in the accompanying manuals, and are not accessible from the screen. I ended up exiting from the program is by crashing out with Ctrl Alt Del. Perhaps this is a device to persuade people to complete the questions, but it gives the program a somewhat claustrophobic feel which is not helped by the rather institutional character of the grey buttons (which do have a nice squelchy click). Rating conventions are not preserved throughout: there is switch, for example, to changing T or F responses by imputting item numbers or letters. There is very little feedback during the program or at the end, so that respondents cannot know whether they answering satsifactorily or wha the significance of their answer is. The rating program presents evidence for personality disorder diagnoses, reminding the user that a clinical interview should be undertaken before a firm diagnosis is made. There is, however, little checking on validity. Answering that 50% of all the questions are true results in all the personality disorder diagnoses being suggested, there being nothing in the program to note the incompatibility of some personality disorders.

There is no information about whence the question set is derived, and this presents a problem since there are no data on which to base a judgement about reliability or validity. Questions have reasonable face validity, although there is probably inadequate testing of deception. Characteristics are all presented as true responses, opening the results to a response bias if respondents tend only to respond T or F.

Although the effectivenss of using computers as a means of administering psychological tests has been established, and it certainly seems a good idea to do this in the case of personality questionnaires, I cannot recommend this program. Further development may improve it, but before it could be recommended I would suggest that there is a ‘help’ and an ‘exit’ button for respondents, that the later receive some feedback as they complete the questions, and that there is a text file in the suite which gives information about the reliability and validity of the questions.

Professor Digby Tantam
Centre for Psychotherapeutic Studies, University of Sheffield

Review Two

The PDQ-4 is a questionnaire designed to screen for DSM-IV personality disorders - and not be confounded by concurrent mental illness. This computer version (about 500k) is written for DOS and runs on the most basic monochrome PC.

The installation mentioned drive 'B' but ignoring that was uneventful. It wasn't immediately clear that the second program PDQFMI not only processes the output of PDQ4 but configures the questionnaire style and the data output, and should be run before and after the PDQ4.

When typing in patient details the program would not allow correction for inadvertent ENTER pressing and could fall through some items. The main questionnaire (configurable between blocks of true/false or individual questions) also goes to the next question without asking the user for reflection. Later the package changes format and asks the user for number presses. This change may confuse and there is quite a lot for the user to read. Could the True/false format be continued without influencing the result I wonder? I would have preferred some indication as to how far through the questionnaire I was.

At the end the user gets the option to review 'true' answers- as a validity exercise. Sometimes however the program fell through to DOS and omitted this section (was that me?) the datafile was intact however and could be browsed by PDQFMI

The PDQFMI is a bit fiddly in loading the datafile, but the text output can be supplemented with comma delimited or SPSS compatible data output and a 3D bar chart and .PCX image of results can be generated which for a compact package such as this was very impressive.

Overall the program handles the task of asking for, recording, displaying and making data machine readable quite effectively. It could be made smoother in operation, but it is certainly useful and interesting in it's present form and is not unattractive in appearance for the user.

Carl S Littlejohns

Last amended: 2007

© Priory Lodge Education Limited 1999-2007

 

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