Approach to the Psychiatric Patient: Case-Based Essays [NOOK Book]


Approach to the Psychiatric Patient is a case-based exploration of psychiatry. It is both a general introduction to multiple aspects of the field and a series of sophisticated discussions that clarify controversies, dilemmas, and ambiguities. By covering the psychiatric waterfront while featuring many subspecialties, the book intends to fill a gap that exists between standard psychiatric reviews, specialty texts, and pocket guides. Further, by making use of over 100 essayists, Approach to the Psychiatric Patient ...

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Approach to the Psychiatric Patient: Case-Based Essays

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Approach to the Psychiatric Patient is a case-based exploration of psychiatry. It is both a general introduction to multiple aspects of the field and a series of sophisticated discussions that clarify controversies, dilemmas, and ambiguities. By covering the psychiatric waterfront while featuring many subspecialties, the book intends to fill a gap that exists between standard psychiatric reviews, specialty texts, and pocket guides. Further, by making use of over 100 essayists, Approach to the Psychiatric Patient captures much of the complexity and richness that make modern psychiatry a fascinating challenge.

The ten cases span a broad diagnostic spectrum, from geriatric depression (case 2) and schizophrenia (case 4) to substance abuse (case 6) and disappointment over an exam failure (case 10). The situations range from inpatient hospitalizations (case 1) and emergency room evaluations (case 3) to outpatient assessments (case 7) and long-term psychotherapies (case 8). Perhaps most importantly, the 100 essays have been written by a broad range of specialists who have all been asked to comment specifically on one aspect of their particular case. These essays are brief (about 1500 words) and are intended to serve as "curbside consults" in which the expert dispenses a sharp perspective on the particular situation.

The book highlights a broad span of human experience. For example, in the first case, a middle-aged man has been admitted to a psychiatric unit after having tried to kill himself. Experts comment on depression, suicidality, psychodynamics, the interview, the neurobiology of stress, inpatient psychiatry, brain stimulation, pharmacology, supportive psychotherapy, and couples therapy, and they also describe relevant aspects of the African American experience and the historical development of the field of psychiatry. In the final case, a medical student presents for a psychiatric assessment after having failed a gross anatomy test. This case prompts discussions of her evaluation (e.g., essays on the medical school experience, somatoform disorders, the neurobiology of obsessions, narcissism, and the first-generation Asian American), and on her treatment (e.g. essays on complementary medicine, mindfulness meditation, self psychology, therapeutic zeal, empathy, self-defeating behavior, and evidence-based psychotherapy). An expert then provides an overview for each of the 10 chapters. After the overview, each chapter concludes with a set of thought-provoking assertions that are intended to provoke the reader into further consideration of the patient and situation.

In order to create the book's richly complex mosaic, the editor has attracted some of the country's most eminent psychiatrists and psychologists. There are several ways to attract such a multidisciplinary group and to then encourage their best efforts. In this case, the editor chose to recruit faculty members from one set of interconnected institutions: Weill Cornell Medical College, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, Memorial Sloan-Kettering Cancer Center, and Rockefeller University. This limitation inevitably led to the exclusion of some distinguished authors, but it did lead to the vigorous participation of some experts who might not have otherwise agreed to contribute.

Practical and thoughtful, Approach to the Psychiatric Patient serves as an expert on the shoulder to clinicians who approach psychiatric patients as well as to anyone who is curious about the state of the art of modern psychiatry.

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Editorial Reviews

The British Journal of Psychiatry Amit Nulkar

This book emphasizes the recognition of the usefulness of multiple approaches, presents recent advances to our knowledge base and highlights controversies.

Jeffrey L. Geller
One important achievement of this collection is that it approximates a historical snapshot of the field. Each short essay is written from a well-defined angel. This book provides an educational resource that is valuable not only to trainees bur also to seasoned clinicians in any of our disciplines. This book if filled with wisdom and insight.

(M.D., MPH)

Matthew N. Goldenberg
Readers of Approaches to the Psychiatric Patient will gain an appreciation for these myriad perspectives of a psychiatrist. Indeed, each essay offers a window into how psychiatrists think.

(M.D., Psychiatry: Interpersonal and Biological Processes)

The British Journal of Psychiatry - Amit Nulkar
This book emphasizes the recognition of the usefulness of multiple approaches, presents recent advances to our knowledge base and highlights controversies.
Doody's Review Service
Reviewer: William Miles, MD (Rush University Medical Center)
Description: This softcover book presents 10 psychiatric cases followed by essays discussing various approaches to the case.
Purpose: The purpose is to use a case-based approach to educate readers about the multidisciplinary aspect of psychiatric medicine. These are certainly worthy objectives, and the authors meet them.
Audience: The editor implies that the book is written for psychiatrists, but medical students might find the cases and essays useful in aiding their understanding of the multidisciplinary approach to psychiatric medicine.
Features: Each case consists of a brief history, mental status exam, and summary. Several essays (each written by a different author) then follow, discussing various aspects of the case (e.g. psychotherapeutic, pharmacology, social aspects, etc.). Following each case and collection of essays are summary points, highlighting the major learning topics of each case. There are no illustrations (except for some molecular structures), but numerous tables are used throughout. A comprehensive bibliography and index end the book.
Assessment: This is a unique and interesting book. It is quite useful and refreshing to see a multidisciplinary approach used to discuss the various cases; it is as though each author is offering a "curbside consult" on how he/she might approach the case. Psychiatrists will find this book quite helpful. I personally will consider using the book and its cases/essays in educating my medical students about the necessity of a multidisciplinary approach to psychiatric medicine. This is a very worthwhile contribution to the field.
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Product Details

  • ISBN-13: 9781585628322
  • Publisher: American Psychiatric Publishing, Incorporated
  • Publication date: 10/1/2008
  • Sold by: Barnes & Noble
  • Format: eBook
  • Pages: 565
  • Product dimensions: 0.60 (w) x 0.90 (h) x 0.10 (d)
  • File size: 4 MB

Meet the Author

John W. Barnhill, M.D., is Associate Professor of Clinical Psychiatry and Public Health at Weill Cornell Medical College; Chief of the Consultation-Liaison Service at New York-Presbyterian Hospital/Weill Cornell Medical Center; and a faculty member at the Columbia University Center for Psychoanalytic Training&Research in New York City.

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Table of Contents

Foreword. Preface. Introduction. How to Use This Book. Double Depression and James Avery. Depression. Suicide. The psychodynamic formulation. The interview of the depressed patient. The African American patient. Neurobiology of stress. What is psychiatry? Inpatient psychiatry. Psychopharmacology of depression. Pharmacogenomics. Brain stimulation and neuromodulation. Supportive psychotherapy. Couples therapy. Overview of double depression. Summary points. Geriatric Depression and Peter Burke. Capacity. The psychiatric attitude. Depression and medical illness. Neurotrophins. Testing at the bedside. Interpersonal psychotherapy. Service delivery. Overview of geriatric depression. Summary points. Mood Instability and Amy Cahill. Mood instability. Borderline personality organization. Axis I and Axis II. Eating disorders. Dialectical behavior therapy. Risk management. Pharmacology of mood instability. Overview of mood instability. Summary points. Schizophrenia and Anthony Da Piazza. Schizophrenia. Violence and schizophrenia. Schizophrenia and brain circuitry: a neuroimaging perspective. Psychodynamics of psychosis. Outsider art. Pharmacology of schizophrenia. Cognitive-behavioral therapy. Comprehensive healthcare. Recovery. Homelessness and social history. Overview of schizophrenia. Summary points. Terminal Illness and Dorothy Ewing. Part A. Delirum. Part B. Pain and substance abuse. The psychodynamic consultation. Working with the family. The difficult patient. Genetic counseling. Spirituality. Meaning-centered therapy. The doctor--patient relationship. Overview of hospital psychodynamics. Summary points. Agitation and Stephen Franken. Part A. Managing multiple patients in the emergency department. Evaluating an emergency patient. Stimulant abuse. Part B. Consultation-liaison psychiatry. Informed consent. HIV/AIDS. Internalized homophobia. Sexuality and sexual dysfunction. Jekyll and Hyde. Psychotherapy selection. Overview of connection. Summary points. Adolescent Bereavement and Amelia Gutierrez. An ethical dilemma. Adolescent bereavement. Suicide. Interview of the adolescent. Psychological impact of dislocation. The Dominican patient. Virginia Woolf: on being ill. Neurobiology of attachment. Pharmacology of adolescent depression. Interpersonal psychotherapy. Psychodynamics of depression. Overview of adolescent depression. Summary points. Anxiety and Sophia Hastings. Part A. Anxiety disorders. Alcohol abuse. Neurobiology of alcohol. Pharmacology of anxiety. Cognitive-behavioral therapy. Panic-focused psychodynamic psychotherapy. Part B. After effects of sexual abuse. Overview of countertransference. Summary points. Hypomania and Jennifer Ingram. Attention deficit. Bipolar disorder. Bipolar spectrum disorder. Premenstrual dysphoria. Sleep. Autism's effect on the family. Creativity and mental illness. Being lesbian. Love. Psychodynamic psychotherapy. Overview of hypomania. Summary points. Exam Failure and Grace Jin. Part A. Interview of the medical student. Somatoform disorders and obsessionality. Neurobiology of obsessions. Narcissistic injury and narcissistic defenses. A first-generation Asian American. Complementary medicine and integrative pharmacology. Mindfulness meditation. Part B. Therapeutic zeal. Empathy. Self psychology. The Kohut/Kernberg controversy. Evidence-based psychotherapy. The self-defeating patient. Overview of an evaluation. Summary points. Bibliography. Index.

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Sort by: Showing all of 4 Customer Reviews
  • Posted May 21, 2009

    I just returned from the American Psychiatric Association meetings and read this book on the flight home. I've been reading medical textbooks for many years, and I haven't previously seen such a book. Bravo!

    What makes this book unique?

    First, each of the 10 cases gets about ten discussions from different psychiatrists and psychologists. Among the 100 authors are some of the real stars in the field of psychiatry. To start listing them would inevitably leave out well-known people, but there are some really incisive discussions by George Alexopoulos (geriatrics), Paul Appelbaum (ethics), Bill Breitbart (palliative care), Marty Bruce (sociology), Kathy Halmi (eating disorders), John Markowitz (IPT), a bunch of really astute analysts and analytic researchers (Betsy Auchincloss, John Clarkin, Arnie Cooper, Janis Cutler, Rick Friedman, Otto Kernberg, Eric Marcus, Bob Michels, Roy Schafer, Ted Shapiro, Milt Viederman, etc), some hot shot scientists and basic researchers like Francis Lee, Sarah Lisanby, John Mann, Bruce McEwen, and David Silbersweig, social and cultural commentators like Fran Cournos, Kim Hopper, and Mindy Fullilove. I could easily go on, but it's an impressive list. That they come from one institution is impressive--though the editor is quick to point out that while they generally fall under the New York Presbyterian Hospital umbrella, the authors come from a set of lossely connected institutions like Columbia and Cornell medical schools, Memorial Sloan Kettering, Rockefeller University, etc.

    And that may be why the essays offer up such sharp perspectives--these guys (and gals) know each other and they seemed to have tried to outdo each other in being incisive and thoughtful.

    As I implied, I've been reading textbooks for decades, and I learned quite a lot. But what is most unusual about this book--in addition to its unique format--is that while psychiatrists (and trainees) may be the target audience, it is also the first introduction to the field of psychiatry that is good enough for me to want to buy a copy for my adult son.

    I should add that I know some of the authors (though not all 100!), which might affect my viewpoint a little, but I know lots of psychiatrists who've written books and this is the first time I've felt compelled to write an online review. I'll also add that some of the authors are well known to be intellectual dynamos but not easily "bent into shape;" hats off, then, to Dr. Barnhill for signing everyone up and then getting them to fit their meaty essays into the rather tight space limitations--that couldn't have been easy!

    4 out of 4 people found this review helpful.

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  • Anonymous

    Posted January 11, 2010

    This is the best textbook I've read--good enough that I even decided to do a review!

    The best single thing about this book is its structure. After they lay out one of the 10 interesting cases, about a dozen experts give their angle on that particular case. There isn't a psych textbook like it.

    The second best thing is that the individual essays are really focused, thoughtful, and smart. Each essay is also very easy to read in one sitting, though the diligent among us can probably read a whole chapter without getting out of the chair.

    Overall, it's a really terrific read. Highly recommended.

    3 out of 3 people found this review helpful.

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  • Posted January 21, 2010


    Smart, interesting, provocative. reads almost like a novel.

    1 out of 1 people found this review helpful.

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  • Posted January 30, 2010

    I Also Recommend:


    It was really interesting to read about a clinical case and then see such different perspectives on basically the same information. I'm a medical student who plans to go into psychiatry and haven't had much in the way of psychoanalytic exposure, and I was surprised to read psychodynamic essays on every case, including the delirious guy in the ER, the schizophrenic man, and the dying woman in the hospital. Given all the mixed information that is coming out on medications, DSM, and psychotherapy, this is the sort of book that helps sort out what experts think and do in an imperfect world.

    Was this review helpful? Yes  No   Report this review
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