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Doody's Review ServiceReviewer: Michael Joel Schrift, DO, MA (University of Illinois at Chicago College of Medicine)
Description: I was truly looking forward to reading and reviewing this book since a large part of my professional life is in the practice of psychopharmacology. I was hoping that the chapter authors would give a truly critical review of this important literature. Unfortunately, my hope was, in many of the chapters, unfulfilled. The book is certainly written and edited by internationally recognized clinician-researchers in psychopharmacology, but my major disappointment is the relative lack of discussion addressing the biases in the literature regarding sponsorship of studies and outcome, the burying of negative results, and researchers' conflicts of interest. There is no mention of the editors' potential conflicts of interest and I only counted 2 or 3 chapters that disclosed industry sponsorships of the authors.
Purpose: The purpose of the book, according to the editors, is to provide systematic literature reviews of the psychopharmacology literature in the major psychiatric disorders and, specifically, discuss selection and duration of treatment strategies based on the scientific evidence.
Audience: The target audience is mainly psychiatrists.
Features: Topics covered in the 12 chapters are evidenced-based pharmacotherapy of major depression, bipolar disorder, schizophrenia, generalized anxiety disorder, post-traumatic stress disorder, social anxiety disorder, OCD, eating disorders, attention-deficit hyperactivity disorder, and Alzheimer disease. Each chapter contains relevant scientific citations and the index is helpful. The chapters, overall, contain high quality literature reviews but several chapters lack critical analysis. For example, the schizophrenia chapter does not address the issue of whether atypical neuroleptics actually improve negative symptoms or just don't induce them, compared to conventional neuroleptics. Also, meta-analyses are only as good as the studies selected to be in the analysis. The author seemed to either not mention or underplay the flaws in methodology, diagnostic issues, and biases in the studies. The chapter on major depressive disorder lacked even a mention of electroconvulsive therapy!
Assessment: Of course industry sponsorship does not automatically translate into biased conclusions from studies or chapter authors. But if the public trust in the integrity of research and researchers is threatened, as I believe it presently is (just read the New York Times or Wall Street Journal), we must go out of our way in critiquing the problems with industry-sponsored research and make an effort to correct them. It is most unfortunate for our patients that pharmacologic treatments for the major psychiatric disorders have had relatively few advances. The newer medications are in some respects less toxic; disappointingly, there has been no real improvement in efficacy since the development of the early agents. This situation is not unrelated to the problems in the psychopharmacologic literature. Doing and reporting the results of meta-analyses is not enough without a critical review of the randomized control trials that are included in the analysis! If you buy this book, you're on your own in interpreting the evidence basis for psychopharmacological treatments.