Dr Neel Burton in the preface to his book reminds us of the poet Henry Wadsworth Longfellow's words, ‘Art is long, and Time is fleeting’. With this he captures the dilemma of the review manual: make it useful, and keep it brief. Overall Dr Burton is able to artfully do both, while hopefully sparking students' interests to learn more about psychiatry.
The book's greatest strength throughout is the inclusion of interesting anecdotes, historical perspectives, and excerpts from literature, art, and film. Dr Burton does a wonderful job engaging the reader with these delightful and captivating interludes. Succinct historical background, starting with Ancient Greece in Chapter 1, provides context for current mental health perspectives, including the anti-psychiatry movement. Cases presented throughout the book suitably illustrate the material. Dr Burton's somewhat informal tone makes the reader feel he or she is getting the inside scoop on the growing field of psychiatry.
Other strengths of the book include Chapter 2 on patient assessment, which incorporates a biopsychosocial formulation and management plan. Chapter 4, on psychotic illnesses is particularly well done and incorporates historical and biological perspectives, including brief case studies of Schneider's first rank symptoms. Additional standout chapters include those on affective disorders, suicide and self-harm, delirium and dementia, and substance misuse.
A significant weak-point in the book is Chapter 7 entitled ‘Neurotic, stress-related and somatoform disorders (anxiety disorders)’. The chapter is surprisingly disorganized and insufficiently covers the basics of anxiety disorders. This is especially disappointing considering their relative importance for those students not going into psychiatry. Contributing to the section's disjointedness is the odd insertion of a description of culture-bound syndromes following a brief introduction to the anxiety disorders and a random description of benzodiazepines, without clear discussion of other medication options.
Notably missing from the book is a separate chapter or adequate explanation of the psychotherapies. CBT and psychodynamic therapy are sparsely covered in the middle of a review of the anxiety disorders. In the personality chapter, the ego defenses are listed without explanation as to how they might be helpful in treating patients with personality disorders. Even if they will not be providing the service themselves, all students must be aware of the range of non-pharmacologic treatments for a variety of mental disorders, some of which already have good evidence as effective stand-alone treatments or adjunctive to medication.
Most striking about the book as an American reader is how, perhaps unintentionally at times, it highlights differences in the practice of medicine and psychiatry in the UK and US, from subtle differences in the organization and content of the psychiatric history and MSE, i.e. ‘name the prime minister and the reigning monarch’, to more glaring differences between the ICD and DSM. Chapter 3 entitled ‘The delivery of mental heath care’ is in fact a fine description of the delivery of mental heath care in the UK. While it is of critical importance trainees appreciate the context in which mental illness is treated, US students will not learn this from this book. However, this chapter does make for clear reading for clinicians interested in learning more about the British mental heath system. Throughout the book Dr Burton remarkably attempts to reconcile the ICD and DSM coding systems, which is no easy task. Chapter 8 nicely integrates the two systems' personality disorder sections.
Despite specific shortcomings such as the anxiety disorder section and the psychotherapies, the book has numerous strengths and would likely be very helpful for medical students training in a British system. While it is interesting reading and provides a useful perspective on our different mental heath care systems, I would hesitate to recommend this book as a primary review text for beginning American medical students, since there are significant gaps in required information for US shelf-exams. This is in large part due to both subtle and overt international differences in terms, practices, and systems. For an American student audience it would serve primarily as an interesting supplement to another review text. Perhaps this is not so much a problem with Dr Burton's book, but instead a challenge to our collective profession to reconcile our differences in semantics for the further advancement of the field.
