textbook was not available at the time I textbook was not available at the time I took my exams. took my exams. Robert Chaplin Robert Chaplin Consultant Psychiatrist, South Consultant Psychiatrist, South West London and St George's Mental HealthTrust, West London and St George's Mental HealthTrust, London SW17 7DJ London SW17 7DJ Atlas of Psychiatric Atlas of Psychiatric Pharmacotherapy Pharmacotherapy By R. Shiloh, D. Nutt & A.Weizman. London: By R. Shiloh, D. Nutt & A.Weizman. London: Martin Dunitz.1999. 235 pp. »49.95 hb). Martin Dunitz.1999. 235 pp. »49.95 hb). ISBN1-85317-630-3 ISBN1-85317-630-3 Some people usually males) have superior Some people usually males) have superior visuo-spatial abilities. Such men excel at visuo-spatial abilities. Such men excel at map-reading, a skill at which women are map-reading, a skill at which women are allegedly abysmal. Those of either gender allegedly abysmal. Those of either gender who delight in maps will enjoy this book. who delight in maps will enjoy this book. Those with predominantly linguistic ten- Those with predominantly linguistic ten- dencies may feel like a hippocampamised dencies may feel like a hippocampamised rat lost in a maze. rat lost in a maze. The book, by title and aim, is an atlas The book, by title and aim, is an atlas ``written ``written ... for the clinician required to for the clinician required to know, understand, and decide efficiently know, understand, and decide efficiently about options for biological treatments''. It about options for biological treatments''. It contains a series of intracellular road maps contains a series of intracellular road maps depicting not only the main highways depicting not only the main highways travelled by psychotropic drugs but also travelled by psychotropic drugs but also the smaller roads and footpaths, some of the smaller roads and footpaths, some of which peter out, ending in ``unknown which peter out, ending in ``unknown cellular mechanisms''. These maps are cellular mechanisms''. These maps are ingenious, intricate but difficult. They ingenious, intricate but difficult. They follow the route, for example, of an follow the route, for example, of an antidepressant drug from a serotonin antidepressant drug from a serotonin receptor through many stages to its effect receptor through many stages to its effect on ``cAMP response element binding on ``cAMP response element binding protein CREB) and the `proper produc- protein CREB) and the `proper produc- tion' tion' of `brain-derived neurotropic factor of `brain-derived neurotropic factor BDNF)' '', leading finally to resolution of BDNF)' '', leading finally to resolution of the depressive state. It is doubtful whether the depressive state. It is doubtful whether many psychiatrists will penetrate this far many psychiatrists will penetrate this far into the jungle. However, the maps, with into the jungle. However, the maps, with their densely written texts, could be valu- their densely written texts, could be valu- able for research workers requiring detailed able for research workers requiring detailed information, and may serve as a reference information, and may serve as a reference for clinicians to absorb at leisure. Students for clinicians to absorb at leisure. Students and trainees would do better to start with and trainees would do better to start with something simpler. something simpler. Other maps, more easily followed, Other maps, more easily followed, include flow charts of treatment strategies include flow charts of treatment strategies and grids of adverse drug effects. The and grids of adverse drug effects. The former are available from other sources, former are available from other sources, but this book has the merit of stating how but this book has the merit of stating how firmly evidence-based are the strategies firmly evidence-based are the strategies suggested. Nevertheless, the text requires suggested. Nevertheless, the text requires close searching for important clinical close searching for important clinical information such as dosage titration, information such as dosage titration, dosage in the elderly and individual meta- dosage in the elderly and individual meta- bolic differences. Withdrawal reactions bolic differences. Withdrawal reactions from antidepressants or antipsychotics are from antidepressants or antipsychotics are not mentioned among adverse effects, not mentioned among adverse effects, although the flow charts advise slow taper- although the flow charts advise slow taper- ing of dosage on withdrawal no reason ing of dosage on withdrawal no reason given). Readers may disagree with various given). Readers may disagree with various items such as the statements that with- items such as the statements that with- drawal reactions occur ``only if stopped drawal reactions occur ``only if stopped quickly'' for several short half-life benzo- quickly'' for several short half-life benzo- diazepines and are ``relatively insignificant'' diazepines and are ``relatively insignificant'' with zopiclone. with zopiclone. These are perhaps minor criticisms These are perhaps minor criticisms considering the wealth of information the considering the wealth of information the book contains, and its wide coverage book contains, and its wide coverage spanning basic pharmacodynamics and spanning basic pharmacodynamics and pharmacokinetics, drug interactions, drugs pharmacokinetics, drug interactions, drugs of misuse, sexual dysfunction, personality of misuse, sexual dysfunction, personality and eating disorders and attention±deficit and eating disorders and attention±deficit hyperactivity disorder. The authors deserve hyperactivity disorder. The authors deserve congratulations for their originality and congratulations for their originality and courage in presenting in black and white courage in presenting in black and white and colour) their micro- and macroscopic and colour) their micro- and macroscopic perspectives on an extremely complicated perspectives on an extremely complicated subject. This book is a must for the library. subject. This book is a must for the library. C. Heather Ashton C. Heather Ashton School of Neurosciences, School of Neurosciences, Division of Psychiatry, University of Newcastle, Division of Psychiatry, University of Newcastle, The Royal Victoria Infirmary, Queen Victoria Road, The Royal Victoria Infirmary, Queen Victoria Road, Newcastle uponTyne NE1 4LP Newcastle uponTyne NE1 4LP Prenatal Exposures Prenatal Exposures in Schizophrenia in Schizophrenia Edited by Ezra S. Susser, Alan S.Brown & Edited by Ezra S. Susser, Alan S.Brown & Jack M.Gorman.Washington,DC: American Jack M.Gorman.Washington,DC: American Psychiatric Press.1999.261 pp.US$36.50 hb). Psychiatric Press.1999. 261 pp.US$36.50 hb). ISBN0-88048-499-3 ISBN0-88048-499-3 If you attend an annual meeting of the If you attend an annual meeting of the American Psychiatric Association APA), American Psychiatric Association APA), you are faced every day with a bewildering you are faced every day with a bewildering array of symposia, plenary sessions, work- array of symposia, plenary sessions, work- shops, posters and so on. More often than shops, posters and so on. More often than not you make the wrong choice and that not you make the wrong choice and that evening at some social function you are told evening at some social function you are told about the session you `really should have about the session you `really should have attended'. The APA must be aware of this attended'. The APA must be aware of this because it now produces the `Progress in because it now produces the `Progress in Psychiatry Series' which publishes `the best Psychiatry Series' which publishes `the best of the symposia'. This book is number of the symposia'. This book is number 56 ± clearly the APA is on to a good thing 56 ± clearly the APA is on to a good thing Royal College please note). Royal College please note). Although it is not clear in the intro- Although it is not clear in the intro- duction, I presume this symposium was duction, I presume this symposium was organised by Dr Ezra Susser of Columbia organised by Dr Ezra Susser of Columbia University in New York. There are only University in New York. There are only nine chapters, but six come from his nine chapters, but six come from his department. The book is really an extension department. The book is really an extension of his already published work, which of his already published work, which argues forcefully for the role of prenatal argues forcefully for the role of prenatal factors in the aetiology of schizophrenia. factors in the aetiology of schizophrenia. Nowakowski from New Jersey sets the Nowakowski from New Jersey sets the scene with a useful description of normal scene with a useful description of normal prenatal brain development but why is this prenatal brain development but why is this Chapter 3?). Waddington Chapter 3?). Waddington et al et al from Ireland from Ireland review especially their own work that review especially their own work that suggests a `cascade process' in which suggests a `cascade process' in which intrauterine events are associated in child- intrauterine events are associated in child- hood with neuromotor and psychological hood with neuromotor and psychological abnormalities and in adulthood with the abnormalities and in adulthood with the appearance of psychosis. But the core of the appearance of psychosis. But the core of the book is a description and expansion of book is a description and expansion of Susser Susser et al et al's finding that in the Dutch 's finding that in the Dutch famine at the end of the Second World famine at the end of the Second World War, those who were exposed as foetuses in War, those who were exposed as foetuses in the first trimester of pregnancy to the the first trimester of pregnancy to the height of the famine, had a greater than height of the famine, had a greater than expected chance of developing schizo- expected chance of developing schizo- phrenia in adult life. Susser believes that phrenia in adult life. Susser believes that prenatal nutrition may be an important risk prenatal nutrition may be an important risk factor in schizophrenia; his current work is factor in schizophrenia; his current work is taking this further by looking at specific taking this further by looking at specific micronutrients. micronutrients. This is an intriguing finding. However, to This is an intriguing finding. However, to the best of my knowledge it has not been the best of my knowledge it has not been replicated. There must be many other specific replicated. There must be many other specific situations in which pregnant mothers are situations in which pregnant mothers are exposed to famine. Also, what exposed to famine. Also, what about chronic about chronic severe malnutrition in a country such as severe malnutrition in a country such as India? If Susser is right, then why is the India? If Susser is right, then why is the incidence of schizo incidence of schizophrenia not demonstra- phrenia not demonstra- bly higher in that country; or is it that such bly higher in that country; or is it that such children die before reaching adulthood? children die before reaching adulthood? What I am really trying to say, I What I am really trying to say, I suspect, is that in this book there is no suspect, is that in this book there is no chapter chapter providing a counterbalance to the providing a counterbalance to the undoubted undoubted enthusiasm of Susser's group. If enthusiasm of Susser's group. If Professor Tim Crow had been invited to Professor Tim Crow had been invited to speak at the symposium, there might have speak at the symposium, there might have been a real debate. been a real debate. For me, interested in clinical research in For me, interested in clinical research in schizophrenia, this book will provide a schizophrenia, this book will provide a useful source of references; I suspect it is useful source of references; I suspect it is not for the general psychiatrist. not for the general psychiatrist. Robin G. McCreadie Robin G. McCreadie Director of Clinical Director of Clinical Research, Crichton Royal Hospital, Dumfries Research, Crichton Royal Hospital, Dumfries DG1 4TG DG1 4TG Psychiatric and Behavioural Psychiatric and Behavioural Disorders in Developmental Disorders in Developmental Disabilities and Mental Disabilities and Mental Retardation Retardation Edited by Nick Bouras.1999.Cambridge: Edited by Nick Bouras.1999.Cambridge: Cambridge University Press. Cambridge University Press. 464 pp. »35.00.ISBN 0-521-64395-3 464 pp. »35.00.ISBN 0-521-64395-3 This excellent postgraduate textbook pro- This excellent postgraduate textbook pro- vides a broad critical appraisal of psychi- vides a broad critical appraisal of psychi- atric and behaviour disorders in individuals atric and behaviour disorders in individuals 603 603 BOOK REVIEWS BOOK REVIEWS