Approach to the Psychiatric Patient: Case-based Essays

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.

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.