Pharmacy & Therapeutics - February 2009 - (Page 104)

BOOK REVIEW Third Edition of a Classic Psychopharmacology Text Reviewed by David A. Casey, MD ing current medications used for other indications, various antiamyloid therapies, and other psychopharmacological targets. While it is difficult to find fault with the text, which succeeds brilliantly in its mission, it is possible to add a sobering note. In recent years, the field of academic psychopharmacology has been troubled by allegations of a “too cozy” relationship with the pharmaceutical industry, suggesting a loss of objectivity in assessing the value and risks of medication therapies in psychiatry. Controversies including suicide risk and antidepressants in children and adolescents, metabolic syndrome and atypical antipsychotics, heightened mortality and antipsychotics in dementia, and the problems of off-label prescribing are just a few of these vexing issues. The increasing reliance on polypharmacy, despite a lack of much scientific evidence, also might soon be added to this list. Throughout the text, it is implied that a better understanding of drug mechanisms might be able to guide clinical therapy. The use of such mechanisms to plan treatment, especially multiple drug therapies, may be supportable when there is a dearth of actual empirical outcome data, but this application is limited by the extreme heterogeneity of psychiatric illness. The history of clinical medicine is replete with examples of therapies that seemed to be mechanistically sound but proved to be ineffective or to have hidden risks when these treatments are studied empirically. The optimistic tone of the text might leave the reader unaware of these cautionary notes. That concern aside, however, Stahl’s Essential Psychopharmacology is highly recommended. Dr. Casey is Associate Professor in the Department of Psychiatry and Behavioral Sciences at the University of Louisville School of Medicine in Louisville, Kentucky. I Title: Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications, 3rd edition (Essential Psychopharmacology Series) Author: Stephen M. Stahl, MD, PhD Publisher: Cambridge University Press, 2008 Price: U.S., $85 paper and online; U.K., £90.00 hardback and £45.00 paper Stephen M. Stahl, MD, PhD Stephen Stahl, MD, is Adjunct Professor of Psychiatry at the University of California, San Diego. In recent years, his name has become synonymous with psychopharmacology through his many publications and presentations, including previous editions of this text. The third edition of Stahl’s Essential Psychopharmacology is likely to further burnish his reputation. At more than 1,100 pages, this single-author work is unique in its inclusiveness, evenness, and readability. The author has a knack for rendering complex neurochemistry, pharmacology, and cell biology in a way that clinicians can quickly grasp and relate to clinical applications. Voluminous illustrations by Nancy Muntner help greatly in this regard. The book is divided into 19 chapters, moving generally from basic science to specific classes of drugs and clinical disorders. A book of this scope may serve as a reference, but its logical organization and straightforward, largely jargon-free language render it suitable as a textbook for basic psychopharmacology courses. The intended audience seems to be psychiatrists and others interested in a sophisticated approach to clinical psychopharmacology. Topics include neuron structure, genetics, symptoms, schizophrenia, mood disorders, bipolar disorder, anxiety, attention-deficit disorder, chronic pain, David A. Casey, MD somatic syndromes, sleep disorders, cognition, obesity, and disorders of impulse control. As a geriatric psychiatrist, I particularly appreciated the chapter on dementia and its treatment. A brief review of basic science in dementia logically leads to current treatments (modest though they may be) and future directions, such as repurpos- COMMENTARY continued from page 79 The Pharmaceutical Care Management Association preferred the Waxman bill because it conferred no market exclusivity on innovator biologic drugs. The Biologics Price bill gave innovator companies 12 years plus the possibility of additional time through minor changes to its preferred product. Henry Waxman’s increased prominence and Barack Obama’s presence—he had made wider use of generics a major plank in his platform to assist the uninsured—means not only the likely passage of a biopharmaceuticals bill but also the passage of legislation allowing re-importation of brand-name drugs from other Western countries, a proposal the Pharmaceutical Research and Manufacturers of America (PhRMA) has hotly opposed. But President Obama and his allies in Congress will be shoving a quite bit down the throat of PhRMA in 2009. Fortunately, pharmacists face a more promising fate in spite of the inevitable challenges for organizations such as PhRMA. I 104 P&T® • February 2009 • Vol. 34 No. 2

Table of Contents Feed for the Digital Edition of Pharmacy & Therapeutics - February 2009

Pharmacy & Therapeutics - February 2009 Contents Editorial Medication Errors Prescription: Washington New Drugs/Drug News/New Medical Devices Drug Forecast Pushing an Expanded Role for Pharmacists Better Asthma Management with Advanced Technology Pharmaceutical Approval Update 58th Annual Meeting, American Society of Human Genetics, 2008 American Society of Hematology, 50th Annual Meeting and Exposition 2008 San Antonio Breast Cancer Symposium Stahl’s Essential Psychopharmacology, 3rd Edition Author Guidelines

Pharmacy & Therapeutics - February 2009

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