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Prof. Hanwella

The 'Handbook of Clinical Psychiatry' by Varuni de Silva and Raveen Hanwella serves as a practical guide for medical students and clinicians, emphasizing structured patient management and the use of diagnostic tools. It covers 17 psychiatric conditions in a clear format, facilitating comprehension and learning, though it has minor editing issues and could benefit from clearer presentation. Overall, the handbook meets a significant need for both students and practicing clinicians in the field of psychiatry.

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Ganashiam Nadarasa
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18 views

Prof. Hanwella

The 'Handbook of Clinical Psychiatry' by Varuni de Silva and Raveen Hanwella serves as a practical guide for medical students and clinicians, emphasizing structured patient management and the use of diagnostic tools. It covers 17 psychiatric conditions in a clear format, facilitating comprehension and learning, though it has minor editing issues and could benefit from clearer presentation. Overall, the handbook meets a significant need for both students and practicing clinicians in the field of psychiatry.

Uploaded by

Ganashiam Nadarasa
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Book review

Handbook of Clinical Psychiatry: A Practical Guide


By Varuni de Silva and Raveen Hanwella. Kumaran Book House, Colombo; Chennai. 2012. Rs 1000. Pages 170

A handbook is generally described as a written or causes of jaundice that you know, and start taking the
printed work giving information such as basic facts or history from there. The next patient has bilateral ankle
instructions, a guidebook, an instruction manual, or a vade oedema. Write down the causes of ankle oedema and
mecum, in contrast to a standard textbook or a monograph. proceed from the there”. He did not actually use the phrase
The authors of this handbook on clinical psychiatry 'hypotheses generation', but I intuitively grasped what he
are two senior academic professionals with nearly two meant and that was all I needed for whatever success I
decades of experience teaching medical students in the may have achieved thereafter in the domain of diagnosis
Faculty of Medicine of the University of Colombo. The and management.
purpose of the handbook, as succinctly stated in the preface,
The other aspects stressed in the first chapter that
is to help undergraduates and clinicians to develop a
are in my opinion crucial to patient management in
structure they can use in psychiatric patient management.
psychiatry include emphasis given to the DSM multiaxial
A significant stimulus for writing the handbook apparently
diagnoses, use of scales as tools wherever appropriate,
was their finding that textbooks in psychiatry were, to use
the idea of risk assessment, and the use of ICD-10 and
their dainty phrase, “rather thin on management”.
DSM-IV coding to indicate severity of the illness.
The handbook is arranged in the form of 20 discrete
Diagnosis and management of the 17 psychiatric
chapters on selected topics. The first chapter is on assess-
conditions in chapters 2-18 are handled competently
ment of the patient, and the last two are on electrocon-
and by and large in similar fashion, comprising a brief
vulsive therapy and psychopharmacology. Chapters 2-18
introduction, followed by sections on establishing the
deal with specific problems in psychological medicine,
diagnosis, identifying the aetiology, assessing severity
ranging from delirium and dementia, to sleep disorders and
of the illness, risk assessment, developing a management
problems with sexuality and gender, which cover the gamut
plan, and a summary of the assessment. The distinctive
of clinical situations that a general practitioner or a specialist
features of the illnesses receive appropriate emphasis.
physician is likely to encounter in an entire lifetime.
Diagnostic dilemmas and disagreements, which I venture
All chapters follow a structured format that, along to presume are commoner in psychiatric clinical practice
with clear signposting within each chapter, conduces to than in most (if not in all) other branches of medicine,
easy comprehension, and mental classification and because of the very nature of the variations in clinical
grouping of the information gathered. A large number of features of psychiatric syndromes, are lucidly explained
tables (unfortunately, printed against a very dark indigo in all the chapters. The structured presentation, several
background that markedly reduces clear visibility), provide explanatory figures and numerous tables facilitate learning.
aides-memoire that help learning as well as recapitulation
for professional examinations. Each chapter ends with an I do have a few minor reservations about this hand-
extremely useful summary of its content that encourages book. For example, the large number of lists (of causes,
both contemplation and revision. items of a management plan or as structures for assess-
ment, etc), may sometimes cause confusion among
The first chapter on assessment of the patient is students and the younger postgraduates, because of
comprehensive. I found satisfying the initial emphasis variations in the lists. The book deserves more careful
placed on hypotheses generation, that starts immediately editing. For example again, there are several acronyms,
as the clinician first meets with the patient and the ensuing common though they may be, that require expansion when
process of confirmation or refutation of these hypotheses first used in a book; GABA, ACE, and NSAID are examples.
in an orderly sequence, as the key to diagnosis and manage- Shiny paper is harder to read than the matt varieties,
ment. My mind went back to our student days when one especially under artificial ‘white’ lighting.
of my major problems was to work out how to use the
detailed bits of information in the marvellous little book, Considered as a whole, the handbook is an enter-
Hutchison's Clinical Methods, for actual diagnosis and prising endeavour that fulfils a felt need of students of
developing a management plan, until a Senior Registrar at psychiatry. But its usefulness is certainly not limited to
the time, Dr Oliver Peiris, tossed a lifeline to me, the single students. Young clinicians will surely widen their clinical
most important thing I have ever learnt in clinical medicine. repertoire, acumen and awareness by reading it carefully.
He saw me struggling with the usual bits and pieces of And the more senior clinicians who read it will be given
history-taking and said, “I say, start with the diagnosis. and uncommon opportunity for introspection, construc-
See, this patient has mild jaundice. Write down about five tive self-criticism and perchance, remediation of their ways.

C Goonaratna, Founder Chairman, Sri Lanka Clinical Trials Registry.


E-mail: <[email protected]> Competing interests: None declared.

Vol. 58, No. 1, March 2013 45

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