Book Review
Liaison Psychiatry 
Manual of Psychiatric Care for the Medically Ill Antoinette and Bernard Wyszynski, editors. Washington (DC): American Psychiatric Publishing; 2005. 385 p. US$64.00.
Reviewer
rating*: Good
Review by: François M Mai, MD, FRCPC
Ottawa, Ontario
Liaison psychiatrists play a vital role in bridging the gap between psychiatry and other medical disciplines. Our clinical assessment and communication skills need to be of high quality, not only because of the needs of patient care but also because we are the front line for influencing the perception of internists, surgeons, and others in regard to our specialty.
In the past, the knowledge base for liaison psychiatry was not well defined, which was a limiting factor. Psychiatry’s borders with other subspecialties were unclear, and research on this topic was of mediocre quality. Until recently, there were no textbooks that encompassed the whole field of the subspecialty. Fortunately, the quality of research is rising, and comprehensive textbooks, as well as more focused, practical guides and manuals, are being written. These texts can go a long way toward improving the quality of our clinical management.
This volume aspires to be a “succinct and practical” manual on psychiatric problems encountered on medical and surgical hospital wards and outpatient clinics. It synthesizes the authors’ more detailed and comprehensive 1996 volume (1). The authors and coauthors are almost all staff of the New York School of Medicine.
Eleven of the 16 chapters deal with the following topics: delirium; hepatic disease and alcohol dependence; vascular, kidney, pulmonary, and gastrointestinal disease; obstetric problems; patients on steroids; HIV-infected patients; hepatitis C patients; and solid organ transplant patients. The remaining 5 chapters deal with decisional capacity and informed consent, adaptation to illness, spiritual aspects of illness, the seriously ill patient, and the physician as comforter. An additional 19 appendices briefly highlight some issues not dealt with in the main text. These include various unrelated topics, such as diagnosing depression in the medically ill, electroconvulsive therapy in medical illness, a decision tree for psychiatric differential diagnosis of medically ill patients, and a guide to herbal supplements in a medical setting. The main text includes numerous tables, boxes, and figures that help to summarize and clarify specific issues.
The topics that the book does include are well done. Clear, comprehensive descriptions of psychopharmacological agents are given, and these include the judicious use of psychostimulants for patients with depression and organic illness such as HIV-associated dementia complex. Reference lists are not comprehensive, but they are adequate. The appendices are a curious part of the book: one is never quite sure why a particular topic is selected for inclusion. Several are worksheets, guidelines, or assessment scales for assisting in the evaluation of patients who suffer from delirium or depression or who are on psychotropic drug therapy. As such, they are a useful, succinct, and practical addition to the manual.
Unfortunately, the book also has large gaps and imbalances. With the exception of dementia and delirium, neurologic conditions—including epilepsy and multiple sclerosis, both of which have important psychiatric aspects—receive scant mention. Cerebrovascular accidents are discussed, but superficially. Some nonneurologic conditions, such as rheumatoid arthritis, fibromyalgia, and chronic pain—all problems that are common in liaison psychiatric practice—are completely absent from the index and from the text. Conversely, other topics, such as the HIV-infected patient and, in particular, the obstetrics patient, are dealt with in extensive and overinclusive detail relative to other subjects in the book. Because of these gaps and imbalances, I cannot recommend the book as a comprehensive guide to psychiatric problems in the medically ill. However, it is lucidly written, and regarding the areas that it covers, it is a suitable summary for residents and liaison psychiatrists. It is also useful because it covers topics that are poorly or inadequately dealt with elsewhere, such as the use of herbal supplements in a medical setting.
The book is softcovered and ring-bound. Its price is steep, but that seems to be where all books are heading these days.
Reference
1. Antoinette and Bernard Wyszynski. A case approach to medical-psychiatric practice. Washington (DC): American Psychiatric Press; 1996.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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