BOOK REVIEW

Review of the book entitled Manual de psicofarmacologia clínica

Maria da Graça Cantarelli

Psychiatrist and internist. Researcher, Depression Clinic, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil. Professor, Psychopharmacology, Instituto Abuchaim

^{Correspondence}

Irismar Reis de Oliveira, Eduardo Pondé de Sena

Rio de Janeiro, Guanabara Koogan, 2006, 2ª edição

The Manual de psicofarmacologia clínica [Manual of clinical psychopharmacology] is composed of 83 researchers from different parts of Brazil, many of them from Rio Grande do Sul, all with extensive experience, organized by Professors Irismar Reis de Oliveira and Eduardo Pondé de Sena, both working for Universidade Federal da Bahia. Its 37 chapters are divided into two large sections: "General aspects of psychopharmacology: main groups of psychotropics" and "Psychopharmacotherapy." Readers can thus learn or remember basic information on the pharmacology of different substances existing in the Brazilian and international market, naturally evolving to their use, with applications in different diseases, as well as adverse reactions and possible pharmacological interactions.

It employs colloquial language, different from other manuals that prefer a standardized speech. Such strategy provides a feeling of interaction with the authors and helps acquire the information. It is practical, does not include too many speculations and presents a didactical division, which also allows its use as teaching material.

In the first section, including 15 chapters, there is a review of the main groups of psychotropics, introducing knowledge about genetics and neuroimaging with applications in modern psychopharmacology. In this section, the chapters briefly bring indications and contraindications, pharmacokinetics, pharmacodynamics, mode of use, interactions and main adverse effects of each drug or group of drugs. In the second section, the main nosological entities are approached, with attention to some special situations such as childhood and adolescence, pregnancy and lactation, elderly and clinically sick patients.

In chapter 1, "Introduction to psychopharmacology," the authors take a quick tour on basic notions of pharmacology, with the aim of contributing to the understanding of the following chapters. The item 'Factors that interfere with drug effects' draws attention to aspects that are not always mentioned in this type of manual.

In chapter 2, "Ethics in research on clinical psychopharmacology," Dr. Valentim Gentil focuses on issues related to human research. He performs a fine commented review of the main works dealing with ethics in clinical research. He participates in the discussion by presenting ideas that disagree with those usually defended by CONEP, especially concerning placebo.

Chapter 3 deals with "Drug interactions in psychotropics." Dr. Douglas Sucar, an old partner and dedicated researcher, brings a light and pleasant overview of current interactions.

Chapter 4, "Heterocyclic antidepressants and monoamine oxidase inhibitors," is competent in maintaining the current indications of these drugs that have been prescribed for such a long time. Excellent tables summarize key pharmacological aspects.

Chapter 5, "Selective serotonin reuptake inhibitors," approaches the class of drugs that has been mostly used in our country. It reviews pharmacokinetic and pharmacodynamic issues very well, but is too economic when dealing with side effects. It uses the old terminology of the Cytochrome P450 System.

Chapter 6, "Dual–action antidepressants and bupropion," carries out an exempt review of the literature on these drugs.

In chapter 7, "Typical antipsychotics," the authors work on a synthetic version of Delay and Deniker's classification to group these drugs and describe their potentialities and limitations.

Chapter 8, "Atypical antipsychotics," objectively comments on available drugs in the market.

Chapter 9 is entitled "Antiparkinsonian drugs." It reviews concepts concerning Parkinson's syndrome and aspects of varied medications that might be used, with the advantage of not attaining only to those that are more widely used.

Chapter 10, "Lithium," brings a consistent overview of clinical use and cares to be taken when using lithium.

In chapter 11, "Anticonvulsants in neuropsychiatry," there is an excellent text on the use of anticonvulsants in psychiatry. Indications, pharmacological aspects and mode of use are well reported.

Chapter 12, "Benzodiazepine anxiolytics," performs a much too brief overview of a class of drugs that is widely used in medical practice. It does not report side effects and possible interactions with more details. Indications are not mentioned.

In chapter 13, "Genetics and psychopharmacology," the authors develop a text that is at the same time clear and sufficiently comprehensive. They go beyond the proposal of a manual and provide readers with an overview of what the future of psychiatric practice could be.

Chapter 14, "Perspectives of human genome studies to psychiatry and psychopharmacology," summarizes current knowledge on neuropsychiatry. In this chapter, it is possible to find essential concepts about the Cytochrome P450 Systems and P–glycoprotein, associated with the process of drug interactions. Schizophrenia and Alzheimer's disease receive special attention in this chapter.

Chapter 15, "Neuroimaging and psychopharmacology," applies the practical strategy of discussing applications of modern imaging examinations based on three basic needs: assessment of anatomical, biochemical and brain activity aspects.

The second section starts in chapter 16, "Treatment of major depression." It reviews diagnostic concepts and therapeutic possibilities, based on the level of available evidence. It also discusses other non–drug organic strategies, such as ECT and vagal stimulation.

Chapter 17, "Treatment of therapy–resistant depression," manages to clearly define its object and suggest objective measures to confront it. It uses staging of resistant depression, providing a rational sequence for therapeutic options.

Chapter 18, "Treatment of acute stages in bipolar disorder," focuses on bipolar depression, mania and mixed states. It clearly exposes and discusses the literature on how to approach such situations.

Chapter 19, "Treatment of bipolar disorder: maintenance stage," individually summarizes the drugs used at the maintenance stage of bipolar disease. It contains an item entitled 'Treatment Principles,' which could have been more developed by the authors.

Chapter 20, "Treatment of anxiety disorders," approaches generalized anxiety disorder, panic disorder and social phobia. It discusses therapeutic possibilities under those situations.

Chapter 21, "Pharmacological treatment of posttraumatic stress disorder," initially discusses the therapeutic resources for PTSD based on the study of the neurochemical systems involved in stress. It further reviews the classes of drugs that can be indicated for this pathology.

Chapter 22, "Pharmacological treatment of obsessive–compulsive disorders," deals with OCD, tic disorders, body dysmorphic disorder and trichotillomania. Despite being a short chapter, it performs an efficacious review of the literature, presenting a significant reference list. It discusses the pharmacological treatment in a less standardized and more understandable manner.

Chapter 23, "Strategies in the treatment of resistant obsessive–compulsive disorder," provides an accurate concept of resistant OCD, as well as the origins of such resistance. It is not only about drug strategies, but also about cognitive–behavioral therapy, ECT, transcranial magnetic stimulation and surgical treatment.

Chapter 24, "Pharmacological treatment of eating disorders," reviews anorexia nervosa, bulimia nervosa and binge eating. Its virtue lies in not only describing drugs that are generally used in these disorders, but also conducting a discussion on the practice of their application in the item 'General Principles.'

In chapter 25, "Pharmacological treatment of schizophrenia," the authors approach the treatment of acute episodes, maintenance and first psychotic episode. The text is exclusively focused on the use of antipsychotics and on management of their side effects, but it does not review other complementary pharmacological strategies. The item about First Psychotic Episode could be more elaborated.

Chapter 26, "Refractory schizophrenia," performs an effective review of operational criteria of refractory schizophrenia and a good exposure of therapeutic possibilities.

Chapter 27, "Psychopharmacotherapy in childhood and adolescence," fulfils its objective of showing "some peculiarities of psychopharmacotherapy in childhood and adolescence." By conducting a brief review, the authors manage to characterize the use of psychotropics in this stage of human development.

Chapter 28, "Pharmacotherapy of alcoholism and disorders related to use of psychoactive substances," presents the author's view on the concepts mentioned in the title. It is sufficiently comprehensive and has a meritorious initiative in the item 'Future Strategies.'

Chapter 29, "Psychiatric emergencies," deals with psychomotor agitation, depression and suicide, approach to varied psychiatric syndromes at an emergency room and side effects of psychotropic drugs. Especially in the latter item, it performs an extensive and practical review, complementary to the study presented in Section 1 chapters.

Chapter 30, "Use of psychotropics in the elderly," concerns depression, agitation and psychosis in the elderly. The authors, who have knowledge of this area, summarize current drug practices under those situations.

In chapter 31, "Treatment of dementias," there is a competent overview of the main neurodegenerative states: Alzheimer's disease, vascular dementia, dementia with Lewy bodies and frontotemporal dementia. Each case brings an excellent discussion on therapeutic possibilities.

Chapter 32, "Insomnia and its treatment," has a brief review on insomnias, followed by a discussion on the use of hypnotic benzodiazepines and non–benzodiazepines.

Chapter 33, "Psychopharmacology during pregnancy and lactation," presents a very good text on this issue. Although being synthetic, it deals with essential issues, and may serve as base for more in–depth studies. The item 'General Recommendations' is filled with common sense.

In chapter 34, "Psychopharmacology in patients with clinical diseases," the author provides a comprehensive overview of the treatment of patients with clinical diseases. The tables reviewing characteristics of psychotropics in renal patients are particularly significant.

Chapter 35, "Pharmacological treatment of attention–deficit/hyperactivity disorder," briefly but satisfactorily presents the pharmacological possibilities in ADHD.

Chapter 36, "Electric convulsive therapy," exposes the minimum knowledge needed to use this significant therapeutic option.

In chapter 37, "Transcranial magnetic stimulation," an excellent group of researchers extensively discusses this method that has been used by many research projects. The text is clear and comprehensive.

The Alphabetic Index is interesting, but not complete, which makes more specific surveys difficult.

In general, it can be concluded that this book has a non–homogeneous constitution. Some chapters have a modest content, standing out from the others. The colloquial tone, proposed from its very start, is practically used throughout the whole book, which makes its reading pleasant and more truthful, but not totally adequate for a quick survey. Due to its plurality, it can become a useful teaching instrument.

Recommended bibliography

1. Brunton LL, Lazo JS, Parker KL, eds. Goodman & Gilman's the pharmacological basis of therapeutics. 11th. ed.. New York: McGrawn Hill; 2006.

2. Schatzberg AF, Nemeroff CB, eds. Textbook of psychopharmacology. 3rd. ed. Washington, DC: American Psychiatric; 2004.

Publication Dates

• Publication in this collection
  06 Sept 2007
• Date of issue
  Apr 2007