Managing Manic Depressive DisordersBMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7098.1916 (Published 28 June 1997) Cite this as: BMJ 1997;314:1916
Ed Ved Varma: Jessica Kingsley, £16.95, pp 188 ISBN 1 85302 347 7
Manic depressive (bipolar affective) disorders are serious mental illnesses that have a remitting and relapsing course. Unipolar depressions are the commonest disorders seen by psychiatrists, and bipolar disorder is the commonest diagnosis after schizophrenia among “new long stay” patients in British psychiatric facilities. Since the 1960s lithium prophylaxis has revolutionised the treatment of bipolar disorders, but the long term management of conditions that, in the acute phase, impair insight requires far more than regular prescribing. A text which offered a synthesis of useful management approaches from a multidisciplinary perspective would be a helpful addition to the literature.
Unfortunately, the individual chapters of this book do not form a unified whole. There seems no clear consensus as to whether the text should be limited to discussing bipolar disorders or whether the enormous topic of unipolar depression should be covered too. Most of the authors of the 12 chapters–describing what various professionals and treatments (such as drugs, psychodynamic therapy, friends and relatives) have to offer–are active in the caring professions, and their writing reflects the strengths, weaknesses, and prejudices of their own discipline.
If the book is aimed at those who experience mania or depression, and their families and friends, then some chapters will be too technical (for example, the chapter about drugs does not explain terms such as polyuria and tardive dyskinesia). On the other hand, if professionals are the target audience, it is unlikely to be news to them that “nurses have long known that talking with patients can be helpful.” Whoever reads the book is likely to regret that there is no introductory chapter on the nature, definitions, aetiology, epidemiology, course, and outcome of manic depressive disorders.
Instead, the book opens with a two page appreciation of Professor Hugh Freeman, former editor of the British Journal of Psychiatry. Quite why Dennis Friedman's embarrassing eulogy has been included is nowhere made plain. Freeman has contributed no chapter and has not published extensively on manic depressive disorder. The foreword by the director of the Manic Depression Fellowship UK is rightly critical of the tendency of some of the authors to use the pejorative label “manic depressives.”
Although it contains some useful information, this is a disappointing volume.
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