520 Book reviews

two chapters : one which outlines approaches to in- of assessment techniques, interventions, and
vestigation and assessment, including reference to professional issues in the field of clinical adult psy-
appropriate assessment measures ; and another which chology, organized into accessible sections written by
outlines current evidence in relation to best practice experts. The use of tables, diagrams, and figures also
treatment, including case examples and models for further improve accessibility and provide useful re-
formulation. This makes the handbook extremely sources. I can imagine that it will provide an initial
accessible and easy to use, as well as reinforcing the ‘ port of call ’ for many clinical psychology trainees
importance of assessment in formulation and treat- and, as with previous editions, I am sure it will feature
ment. The book has a large emphasis on CBT inter- on the bookshelves of many students, researchers, and
ventions, with the majority of evidence for treatment mental health practitioners alike.
approaches being drawn from the findings of recent JO HODGEKINS
randomized controlled trial studies. However, other (Email : [email protected])
psychotherapeutic approaches are referred to, as well
as non-psychological interventions such as psycho-
pharmacology. Modern approaches are also discussed, Psychological Medicine, 39 (2009).
such as the computerized delivery of CBT in anxiety doi:10.1017/S0033291708005060
disorders. First published online 5 January 2009
The most notable differences from the previous Stahl’s Essential Psychopharmacology : Neuroscientific
edition of this handbook are the addition of chapters Basis and Practical Applications, Third Edition. By
specifically devoted to bipolar disorder (authored by S. M. Stahl. (Pp. 1096 ; $85.00 ; ISBN 978-0-521-6736-1
Dominic Lam and Warren Mansell), post-traumatic pb.) Cambridge University Press : New York. 2008.
stress disorder (authored by Nick Grey), and per-
sonality disorder (authored by Peter Hayward and This third edition of Stahl’s Essential Psychopharmaco-
Julian Walker). In addition, the section on anxiety logy is greatly expanded from the second edition. In
disorders has been separated into chapters on social this comprehensive single-author text, Dr Stephen
phobia (authored by Freda McManus and Colette Stahl elucidates and expands the understanding of
Hirsch) and panic (authored by Stan Lindsay). More- current neuroscience developments, which represent a
over, the section on schizophrenia has been replaced paradigm shift in our understanding of brain function,
with a more inclusive section on the assessment and neuronal mechanisms, and neurocircuits.
treatment of psychosis (authored by Elizabeth Kui- Chapter 1 presents the unique structures of neurons
pers, Emmanuelle Peters, Louise Johns, and Yvonne and their specialized functions. Chapter 2 highlights
Linney). These changes are perhaps reflective of the the anatomy of synaptic transmission and how
progress that has been made since the 1990s in terms neurons evolve and form synapses. The next chapter
of the development of specific psychological inter- describes the chemical aspects of brain and nervous
ventions for a range of clinical problems. system communication and the molecular basis of
In addition to the above, several sections of the neurotransmission. Chapters 4 and 5 delineate the
handbook are devoted to areas of clinical psychology new neuroscience, which underlies our current under-
other than the direct treatment of mental health prob- standing of psychopharmacological drug action.
lems. These include chapters on clinical health psy- In Chapter 6, Dr Stahl describes how genes exercise
chology, and the provision of psychological evidence a role in causing subtle molecular abnormalities that
in court. Two chapters also focus on the use of single- create increased risk of mental illness under specific
case methodology in evaluating psychological inter- environmental strain. Environmental stress may in-
ventions. Chapter 41 on ‘ Professional issues in the teract with the subtle abnormalities associated with
new century ’ by Catherine Dooley is particularly in- complex genetic risk to produce a behavioral syn-
teresting, documenting the continuing evolution of drome, consistent with psychiatric illness.
clinical psychology as a profession since her previous Chapter 7 leads the reader to an increased compre-
chapter on professional issues in the Second Edition of hension of relevant neurocircuits, which are critically
the handbook. Dooley considers the impact of public important in regulating mood and emotions and in
issues and government policy on the changing role of organizing thoughts. Chapter 8 depicts how psychi-
clinical psychology over the last 10 years, as well as atric symptoms and syndromes may be linked to
implications for the future in terms of the skill base alterations in neuronal circuits.
required from psychologists, from both a clinical and The subsequent chapters in this impressive text ad-
research perspective. dress most of the syndromes in psychiatry and the
As a researcher, I feel that this handbook provides a role of medication action and treatment. Chapter 9
comprehensive and thoroughly up-to-date overview focuses on the syndrome of psychosis including new

https://doi.org/10.1017/S0033291708005060 Published online by Cambridge University Press

hypotheses involving the glutamate system and its mechanisms involved in the pharmacologic action of
relation to the symptoms of schizophrenia. Chapter 10 benzodiazepines and all other non-benzodiazepine
focuses on the treatment of schizophrenia with anti- anti-anxiety treatments, including the serotonin re-
psychotic medication, in particular. Dr Stahl outlines uptake inhibitors. Additional chapters in this im-
elegantly the benefits and limitations of conventional pressive text cover the medication treatments used in
and atypical antipsychotic medications as well as po- pain syndromes, fibromyalgia, disorders of sleep and
tential new targets for drug treatment of the syn- wakefulness, dementia, drug abuse, and all other
dromal features of schizophrenia. substance dependence.
Chapter 11 addresses mood disorders and generates In summary, Stahl’s Essential Psychopharmacology
hypotheses about how neurotransmitter regulation now stands alone as the most recently updated and
abnormalities lead to malfunctions in brain circuits, most comprehensive psychopharmacology textbook,
and are associated with specific symptom patterns. written by a single author. His illustrations are ex-
This chapter highlights important clinical distinctions tremely well-conceived, educational, and informative.
between recurrent depression and depressed phases of Dr Stahl is consistent in his approach to teaching and
bipolar disorder. writing. I find his work to be extremely valuable to the
Chapter 12 reviews the use of all available anti- practicing clinician. He fosters an academic, research-
depressant medications and putative mechanisms based understanding of modern pharmacology and
of action of these drugs. In this detailed presentation, psychopharmacologic drug action. Medical students,
Dr Stahl also alerts the reader to antidepressants in psychiatry residents and fellows, and experienced
development, the use of antidepressant combinations, clinicians will find the style and content refreshing.
and potential novel targets for antidepressant treat- Neuroscientists will assert that Dr Stahl is too sim-
ment in the future. plistic in his explanations of neuronal system interac-
Chapter 13 explains in detail the controversies tion and the functioning of neurocircuits in the brain.
about the term mood stabilizer and then thoroughly Nevertheless, I recommend this text as an extremely
explores all available medications and medication useful reference work as we enter the next decade of
combinations used to treat bipolar disorder. discovery in brain neurosciences and its role in clinical
Chapter 14 provides clear descriptions of the sym- psychiatry.
ptom patterns which are part of the anxiety disorders.
The author then includes all relevant biological treat- A L A N M. G R U E N B E R G
ment approaches to anxiety, and outlines the different (Email : [email protected])

https://doi.org/10.1017/S0033291708005060 Published online by Cambridge University Press