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Friday, 28.04.2017

Diagnosis and Drug Treatment of Psychiatric Disorders

Donald F. Klein and John M. Davis: Diagnosis and Drug Treatment of Psychiatric Disorders. Williams & Wilkins, Baltimore, 1969. (480 pages.)

INFORMATION ON CONTENTS:

Foreword: Jonothan O Cole.

Introduction: Brief historical summary of somatic psychiatric care; I. Diagnosis and the diagnostic process; II. Psychotropic drug management; III.Diagnosis of schizophrenia; IV.Review of antipsychotic drug literature; V. Treatment of Schizophrenia; VI.Diagnosis of affective disorders; VII.Review of mood-stabilizing drug literature; VII.Treatment of affective disorders; VIII.Diagnosis of neuroses and personality disorders; IX.Review of minor tranquilizer literature; X. Treatment of neuroses and personality disorders; XI.Critique of treatment studies; XII.Theoretical inferences on clinical groupings of psychotropic drugs; Author Index;  Subject Index;. 36 tables detailing the treatment reviews; 10 figures.

About 1964 John Davis suggested this book to me as a collaboration of clinical trials expertise with a depth of literature review and theoretical concerns.

The initial material included an unusually detailed discussion of the theory of diagnosis and the importance of syndromes. The belief that psychiatric diagnosis could arise from the multivariate study of scales was criticized.

There was a general chapter on psychotropic drug management followed by a series of three layer cakes regarding schizophrenia, affective disorders, and neuroses and personality disorders. Each first section was a critical statement about the development of this diagnosis and its substantiation.  A critical review of the drug literaturefollowed documenting each trial. Such reviews have been effectivelysuperseded by meta-analyses. However, a detailed comparison of trial designs, analyses and outcome measures is a necessary precursor for fleshing out anonymous effect sizes.  An attempt to integrate clinical trials data, clinical experience and practical matters follows, providing detailed treatment guidance.

Following these data rich chapters was acritique of the design of treatment studies . A scheme for large clinical research facilities to facilitate psychopharmacological development was outlined. Unfortunately this proved Utopian. The last chapter emphasized the utility of psychopharmacological dissection. It emphasized the existence of syndromes and the fact of remission was critical to nosology.  This material shrinks the current over emphasis on endophenotypes and dimensions. That current psychopathological theory emphasizes either an excess or deficiency of some neurotransmitter --in rheostat fashion-- was also criticized as incompatible with known clinical data. A theory of cybernetic deficiencies of control feedback mechanisms was suggested that is still largely unremarked

AUTHOR’S STATEMENT:

Published in 1969, it was the first clinical textbook of psychopharmacology. The title of the book was unique in that it emphasized drug treatment. It was upsetting when we were told by the eminent publisher that due to some incomprehensible technical difficulty that the word “Drug” had been omitted from the book’s cover .They hoped that I would agree that this was of little consequence. However,myreaction led to a re-embossed cover. A corrected stick-on was provided for the spine, which promptly peeled off.

The book sold well as academic texts go. We were frequently told by residents that it served as an indispensable solitary, resource.

Over the next decade the exponential psychopharmacologic development warranted a second edition. In particular the entire field of childhood psychopharmacology had blossomed.

Donald F. Klein
November 28, 2013

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