Book Review
Psychosomatic Medicine 
Textbook of Psychosomatic Medicine James L Levenson, editor. Washington (DC): American Psychiatric Publishing Inc; 2005. 1092 p. $US169.00.
Reviewer
rating*: Excellent
Review by: C Alex Adsett, MD, FRCPC
Hamilton, Ontario
The term psychosomatic medicine dates back to at least the 1920s and 1930s, with early viewpoints emphasizing psychogenic medical disorders. In 1977, George Engel’s seminal paper refocused the conceptual basis of the field through the biopsychosocial model, an interactional holistic way of looking at illness (1). In the past 2 to 3 decades, solid basic as well as clinical research and evidence-based clinical treatment have evolved rapidly. Psychosomatic medicine is currently a thriving field. It gained official US recognition as a psychiatric subspecialty in 2003, and the American Board of Psychiatry and Neurology is developing the competencies required for this field, accreditation of fellowship programs, and a certification exam in psychosomatic medicine. In Canada, we are slower to introduce change, but under the leadership of the recently formed Canadian Academy of Psychosomatic Medicine, there is an effort to gain subspecialty recognition by the Royal College of Physicians and Surgeons.
Psychiatrists working at the interface between medicine and psychiatry must bring to the medical setting wide expertise in medicine, neurobiology, general psychiatry, psychopharmacology, and psychotherapy, as well as an awareness of psychosocial resources. Most consultation-liaison psychiatrists need these skills to work in a general hospital with a multidisciplinary team including a psychiatric nurse and often a social worker.
This superb textbook presents the current knowledge base of psychosomatic medicine. It has become, and will continue into the near future to be, the definitive scholarly reference and clinical guide in this field. The editor, James Levenson, is a professor of Psychiatry, Medicine, and Surgery at Virginia Commonwealth University and an international leader in psychosomatic medicine and consultation-liaison psychiatry. He has achieved a monumental task in bringing together many outstanding psychiatrists from the United States as well as several from Canada and the United Kingdom to serve on an editorial board and (or) to contribute a chapter. Levenson contributes to 9 chapters. Every chapter has been reviewed by at least one member of the editorial board; many have also been externally reviewed. The chapters dealing with medical specialties have been reviewed by one or more nonpsychiatric medical experts. The book is of remarkably high quality and consistency throughout. This is not to say that the book avoids controversy; at times it presents diverse opinions.
The textbook is divided into 4 parts. Part 1 consists of 5 chapters addressing general principles in evaluation and management. One chapter discusses psychiatric assessment and the process of consultation with a medical patient. Other chapters review psychological and neuropsychological evaluation as well as relevant legal and ethical issues. Part 1concludes with an extensive presentation of psychological responses to illness, including research on personality types, coping styles and defence mechanisms, and emotional responses.
Part 2 includes 13 chapters focused on psychiatric symptoms and disorders. These chapters discuss mood and anxiety disorders, sleep disorders, sexual disorders, substance abuse disorders, eating disorders, and aggression. The chapters on delirium, dementia, and somatization are exceptional.
Part 3 addresses psychiatric problems and their relation to each of the medical specialties. The chapter on neurology and neurosurgery, for example, discusses several categories of clinical problems, including cognitive impairment, neurologic disease accompanied by psychiatric or emotional disturbance, psychiatric symptoms unexplained by neurologic disease, and postneurosurgery mental complications. The chapter on infectious diseases, which notes that psychiatric symptoms may be part of the presentation of many infectious processes and that psychological factors may significantly affect the risk for and course of infectious diseases, is another example. This chapter discusses bacterial, viral, fungal, and parasitic diseases and provides psychiatric side effects of antimicrobial drugs and their interactions with psychotropic medications.
The textbook concludes with Part 4, “Summaries of Psychiatric Treatment in the Medically Ill.” Four chapters, on psychopharmacology, psychosocial treatments, electroconvulsive therapy, and palliative care comprise this section. This section also notes that the use of psychopharmacology in the medically ill is complex and requires careful consideration of the underlying medical illness, potential alterations to pharmacokinetics, drug interactions, and contraindications. No psychiatrist can remember all the information necessary for safe use of psychotropic drugs in the medically ill. It is important to collaborate closely with medical and pharmacy colleagues.
The authors demonstrate that psychosocial interventions with medically ill individuals differ from standard psychotherapy in several ways. Patients are usually worried about their physical illness, not seeking psychological exploration. The illness context may be complicated by the interaction of disease factors, medical treatment, the patient’s personality traits and response to the illness, and the level of social support.
In the general hospital setting, it may be challenging for the consultation-liaison psychiatrist to assist guiding terminally ill patients physically, psychologically, and spiritually through the process of their disease. This is a role most other psychiatrists rarely fill. The authors of the chapter on palliative care provide an extensive and sensitive discussion of this clinical area, emphasizing the need to respond to the unique individual and family needs.
This is an outstanding, encyclopedic textbook that will serve as the standard for psychosomatic medicine and provide a foundation for the newly recognized subspecialty. The book has many clear and useful diagrams and tables, and is well organized, clearly written, and authored by top international experts. It is extensively referenced, typically including 6 to 8 pages of up-to-date references for each chapter. It is a necessary book for any psychiatrist working at the interface of psychiatry and medicine and a valuable reference for many other health professionals. For a 1000-page scholarly textbook, the price is good value.
References
1. Engel G. The need for a new medical model: a challenge for biomedicine.
Science 1977;196:129–36.
2. Gitlin DF, Levenson JL, Lyketsos CG. Psychosomatic medicine: a new
psychiatric subspecialty. Acad Psychiatry 2004;28:4 –11.
*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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