response to neuroleptic drug treatment as a response to neuroleptic drug treatment as a validator of the diagnosis. validator of the diagnosis. The second major theme of the book The second major theme of the book concerns paraphrenia, where Munro nails concerns paraphrenia, where Munro nails his colours to the mast at the outset: like his colours to the mast at the outset: like paranoia, it should be separated from paranoia, it should be separated from schizophrenia and resurrected as a separate schizophrenia and resurrected as a separate category of illness. Here, however, the category of illness. Here, however, the ground is very slippery. Because of the lack ground is very slippery. Because of the lack of studies, he leans heavily on clinical of studies, he leans heavily on clinical authority, some of which unfortunately authority, some of which unfortunately turns out merely to be the pontifications turns out merely to be the pontifications of old American analysts and worse, old of old American analysts and worse, old eclectic British psychiatrists) writing in eclectic British psychiatrists) writing in textbooks of the 1960s and 1970s. He has textbooks of the 1960s and 1970s. He has to consider whether there are differences to consider whether there are differences between late-onset schizophrenia and late between late-onset schizophrenia and late paraphrenia ± a case of hair-splitting if ever paraphrenia ± a case of hair-splitting if ever there was one. He even ends up invoking there was one. He even ends up invoking the concept of the paranoia spectrum which the concept of the paranoia spectrum which he regards with veneration, but which this he regards with veneration, but which this reviewer at least feels should have been reviewer at least feels should have been taken round the back and shot a long time taken round the back and shot a long time ago. Ultimately, even British psychiatrists, ago. Ultimately, even British psychiatrists, who have a soft spot for paraphrenia, will who have a soft spot for paraphrenia, will probably fail to be convinced by his case. probably fail to be convinced by his case. Leaving aside these points of contention, Leaving aside these points of contention, which might legitimately be regarded as which might legitimately be regarded as merely the kind of tedious and ultimately merely the kind of tedious and ultimately futile disputes that the topic of paranoia futile disputes that the topic of paranoia always generates, this is a valuable account always generates, this is a valuable account of an area of psychiatry in which the of an area of psychiatry in which the patients are in steady supply. It is clearly patients are in steady supply. It is clearly and unusually well-written and makes an and unusually well-written and makes an easy, even enjoyable read, something that easy, even enjoyable read, something that cannot be said for most psychiatric text- cannot be said for most psychiatric text- books. At the end of the day, the reader books. At the end of the day, the reader may agree to disagree with Munro's con- may agree to disagree with Munro's con- clusions about paranoia, but will certainly clusions about paranoia, but will certainly go away with a deeper appreciation of the go away with a deeper appreciation of the questions it raises. questions it raises. P. J. McKenna P. J. McKenna Consultant Psychiatrist,Fulbourn Consultant Psychiatrist,Fulbourn Hospital,Cambridge CB15EF Hospital,Cambridge CB1 5EF CognitiveTherapy for Bipolar CognitiveTherapy for Bipolar Disorder: ATherapist's Guide to Disorder: ATherapist's Guide to Concepts,Methodsand Practice Concepts,Methods and Practice By Dominic H.Lam,Steven H.Jones,Peter By Dominic H.Lam,Steven H.Jones,Peter Hayward & Jenifer A.Bright.Chichester: Hayward & Jenifer A.Bright.Chichester: JohnWiley & Sons.1999.306 pp. »19.95 pb). JohnWiley&Sons.1999.306 pp.»19.95pb). ISBN0-471-97945-7 ISBN0-471-97945-7 Dominic Lam Dominic Lam et al et al have put together an have put together an excellent book as part of the Wiley series in excellent book as part of the Wiley series in clinical psychology. The text falls into two clinical psychology. The text falls into two broad categories. First, the authors offer a broad categories. First, the authors offer a comprehensive review of our current comprehensive review of our current knowledge and understanding of psychoso- knowledge and understanding of psychoso- cial problems confronting people with cial problems confronting people with bipolar disorders. Then they look at the bipolar disorders. Then they look at the cognitive therapy treatment package and cognitive therapy treatment package and the interventions that may be used to deal the interventions that may be used to deal with typical symptoms of manic or depres- with typical symptoms of manic or depres- sive episodes. They include detailed scripts sive episodes. They include detailed scripts from clinical sessions to guide the reader from clinical sessions to guide the reader through the introduction and implementa- through the introduction and implementa- tion of different therapy strategies. tion of different therapy strategies. The book is well written and, despite its The book is well written and, despite its multi-authorship, the style of writing is multi-authorship, the style of writing is consistent. It also covers the key elements consistent. It also covers the key elements of traditional cognitive therapy approaches of traditional cognitive therapy approaches and outlines how to undertake an assess- and outlines how to undertake an assess- ment interview for cognitive therapy based ment interview for cognitive therapy based on our current understanding of the psy- on our current understanding of the psy- chosocial problems of people with bipolar chosocial problems of people with bipolar disorders. disorders. The text has been written at an early The text has been written at an early stage in our understanding of the applica- stage in our understanding of the applica- tion of cognitive therapy to this new patient tion of cognitive therapy to this new patient population. For this reason, the approach population. For this reason, the approach tends to be pragmatic and many of the tends to be pragmatic and many of the interventions appear to be symptom- interventions appear to be symptom- focused, rather than driven by a well- focused, rather than driven by a well- developed formulation. However, this is developed formulation. However, this is not the fault of the authors, as we currently not the fault of the authors, as we currently lack a clear theoretical model for under- lack a clear theoretical model for under- standing all the cognitive and behavioural standing all the cognitive and behavioural aspects of bipolar disorders. Likewise, there aspects of bipolar disorders. Likewise, there are as yet no major outcome studies to are as yet no major outcome studies to review: the authors themselves are among review: the authors themselves are among the first to have published the results of a the first to have published the results of a trial of cognitive therapy for bipolar dis- trial of cognitive therapy for bipolar dis- orders. orders. The clinical section is generally of a The clinical section is generally of a high standard, but does not perhaps give as high standard, but does not perhaps give as much detail as it might. For example, it much detail as it might. For example, it does not deal with drug and alcohol misuse does not deal with drug and alcohol misuse in this population, nor how to cope with in this population, nor how to cope with fluctuating mood states, rapid cycling or fluctuating mood states, rapid cycling or mixed states. mixed states. This book is unlikely to be the final This book is unlikely to be the final word on the subject, as a number of other word on the subject, as a number of other authors, including Beck himself, have pro- authors, including Beck himself, have pro- duced or are about to produce manuals on duced or are about to produce manuals on the role of cognitive therapy in treating the role of cognitive therapy in treating bipolar disorders. However, it will be a bipolar disorders. However, it will be a welcome addition to the bookshelves of welcome addition to the bookshelves of most practising cognitive therapists. Many most practising cognitive therapists. Many junior doctors and mental health profes- junior doctors and mental health profes- sionals will also value the up-to-date review sionals will also value the up-to-date review of psychosocial aspects of bipolar disorders of psychosocial aspects of bipolar disorders and the strategies described for intervening and the strategies described for intervening in medication non-adherence or identifying in medication non-adherence or identifying and managing early warning signs of mania and managing early warning signs of mania or depression. The authors have tackled a or depression. The authors have tackled a complex subject in a coherent manner and complex subject in a coherent manner and have produced a readable and informative have produced a readable and informative text. text. Jan Scott Jan Scott Professor of Psychiatry,University Professor of Psychiatry,University Department of Psychological Medicine,Gartnavel Department of Psychological Medicine,Gartnavel Royal Hospital,Glasgow G12 0XH Royal Hospital,Glasgow G12 0XH The Handbookof Childand The Handbookof Childand Adolescent Psychotherapy: Adolescent Psychotherapy: Psychoanalytical Approaches PsychoanalyticalApproaches Editedby Monica Lanyado & Ann Horne. Editedby Monica Lanyado & Ann Horne. London:Routledge.1999.475pp.»16.99pb). London:Routledge.1999.475pp.»16.99pb). ISBN0-415-17259-4 ISBN0-415-17259-4 601 601 BOOK REVIEWS BOOK REVIEWS