On the 1200+ razor-thin pages of tiny text, this book has something to say about every topic in psychiatry. This is its greatest strength. Some significant shortcomings are there as well: a good portion of this information is too vague, not clinical, or outright irrelevant. A few important things are missing. Also, the book has so much information it is often difficult to find something.

To give its due credit, the book is best pocket guide to psychiatry for residents. However, I can only say that because the authors managed to squeeze an inordinate amount of information in the 1200+ pages, and no other guides are available for a fair comparison.



Closer inspection of the massive amounts of information reveals some shortcomings.

#1 The book is too vague and not clinically oriented. (For an example of what a clinical guide should look like, open Pocket Medicine from Mass General.) Here, a lot of ink is wasted on introductions, history lessons, and extensive epidemiology information (nothing against public health, but this guide goes overboard). A clinical psych reference does not need musings on stigma of psychiatry, history, and the future of the field. The books is trying to talk about everything, and, with this misplaced focus, it misses its target audience (presumably residents, attendings). For example, authors of Chapter 4 on EBM have made an extensive use of diagrams and visual aids to explain different types of clinical studies and trials, roles of participants, etc over many pages. How about a visual diagram on something more clinically relevant like the decision steps in pharmacological management of ADHD or depression. Too little text is devoted to that. Another example: the section on personality disorders does a fair job describing each one; however when it comes to management, all PDs are suddenly grouped as one condition; that's not particularly useful especially when it comes to treatment and behavioral management. The short paragraph on psychopharmacology of PDs is nauseatingly inadequate.

Also some information is duplicated adding to an unwieldy tome that stretches a white-coat pocket: (e.g. Anxiety section (Chapter 9) contains a glossary of phobias; Chapter 3 glossary of psychiatric terms also lists some phobias, but not all).



#2 Some information is missing: ER psychiatry section should contain information on managing TCA overdose - I could not find it anywhere in the book.

More likely than not, a psychiatric resident will witness a few seizures during her training. No word on how to manage them, let alone Vfib/Vtach protocol.



#3 It may be difficult to find what you are looking for. Quick example: Let's say you have an acutely psychotic patient, and you want to know how much Haldol to give him. Trying to find the answer you realize that haloperidol does not appear in the index! (neither is QT prolongation!!). Looking up psychosis in the index will not send you to the right page either. The ER section is silent on this. (The answer is in the middle of the section on schizophrenia, impossible to find, unless you have 20 minutes free to browse through the book).



The bottom line, in an attempt to write a comprehensive text, the authors brought together a lot of information with little regard for its clinical relevance. The book may help medical students learn about psychiatry and study for the shelf exam, but it won't help residents manage TCA overdose, and it does not have specific enough information for an attending to manage outpatient meds. With all it's shortcoming it is the best out there (no one else bothered to write a guide). But this book requires commitment to be useful. It will take time to learn the book's cryptic way of organizing information, and to find hidden clinical answers. And always carry epocrates, pocket DSM-IV and ACLS card for backup.