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Wednesday, 29.03.2017

Donald F. Klein, Rachel Gittelman, Frederic Quitkin and Arthur Rifkin, editors

Donald F. Klein, Rachel Gittelman, Frederic Quitkin and Arthur Rifkin, editors. Diagnosis and Drug Treatment of Psychiatric Disorders: Adults and Children. Williams & Wilkins, Baltimore, 1983. (849 pages.)


Foreword: Jonathan O. Cole.

Introduction: Brief historical summary of somatic psychiatric care “We may be fortunate to be entering a period in which rational comparative study will become the standard for therapeutic decision…”, “We are looking forward to the publication of the American Psychiatric Association Diagnostic and Statistical Manual III”.

I.Diagnosis, the Diagnostic Process, and Common Errors; II. Psychotropic Drug Management, General Principles; III. The Concept of Psychosis - This was a unique, we think still fruitful, hypothesis developing the term Psychosis as due to a flaw in inferential process yielding an unwarranted sense of certainty through the failure of innate skepticism; IV.  Diagnosis of Schizophrenia; V. Review of Nosological Schemes in Schizophrenia; V1.  Review on the Pharmacotherapy and Psychotherapy of Schizophrenia: A Review of the Literature; VII. Clinical Management of the Various Stages and Subtypes of Schizophrenia;VIII. Side Effects of Antipsychotic Drugs and their Treatment; IX. Antipsychotics in non-schizophrenic conditions;  X. Diagnosis of Affective Disorders: Clinical Considerations; XI.  Diagnosis of Affective Disorders : Review of Nosological Schemata;  XII. Review of the Literature on Mood-Stabilizing Drugs; XIII. Clinical Management of Affective Disorders; XIV.  Side Effects of Mood Stabilizing Drugs and Treatments; XV Diagnosis of Anxiety, Personality, Somatoform, and Factitious Disorders; XVI. Review of the Literature on Antianxiety Drugs; XVII. Treatment of Anxiety, Personality, Somatoform and Factitious Disorders; XVIII. Assessment and Treatment of Childhood Disorders: General Considerations; XIX.  Diagnosis and Drug Treatment of Childhood Disorders; XX. Critique of Treatment Studies; XXI. Theoretical Inferences Concerning Clinical Groupings and Psychotropic Drugs.

Author Index; Subject Index; Glossary of Drugs.

ONE OF THE EDITOR’S STATEMENT: This second edition of this book is organized somewhat differently from the first edition, which was co-authored by John M Davis MD. (First edition: Donald F. Klein and John M. Davis: Diagnosis and Drug Treatment of Psychiatric Disorders. Williams & Wilkins, Baltimore, 1969 – See, INHN “Books”, November 28, 2013). In 1969 there was still considerable doubt within the psychiatric professions concerning the scientific basis for the uses of antipsychotics. antidepressants and antianxiety agents. It was not unusual to hear the firm assertion that there were more studies proving that these drugs do not work than demonstrating that they were effective.  We felt at that time that the presentation of extensive tabulated reviews of studies of drug efficacy would be a worthwhile contribution. In fact the evidence of drug efficacy was well-nigh overwhelming .This work had been done largely through the efforts of John Davis, who has since continued to contribute brilliantly to systematic critical reviews of psychopharmacological studies.

For this edition we decided this tactical goal had been accomplished and that it didn't pay to belabor what had become the obvious, although a recent spurt of lay books have endeavored to muddy the waters. Unfortunately these efforts have been reinforced by the recent evidence concerning the deletion of important negative clinical data by industry. We believe that only release of the raw patient level data will restore the publics’ justified confidence.

Therefore, for the Second Edition, critical reviews and tabulations focused on narrower specific questions that were, circa 1983, (and still are) controversial.

Yet another change is a unique section on pediatric psychopharmacology ably managed by Rachel Gittelman. Negative feelings towards the use of psychiatric medication reach their apogee in the treatment of children.   Our review dealt systematically with realistic concerns. It should help dispel largely irrational fears. The section on affective disorders was largely the work of the late Frederick Quitkin. The section on schizophrenia was based on the efforts of Art Rifkin.

It is recognized that many of the descriptions of psychiatric syndromes are abstract and the reader might well have benefited from representative case illustrations .This proved impractical. The reader is referred to Klein DF. Psychiatric Case Studies: Treatments, Drugs and Outcomes, Williams & Wilkins, Baltimore, 1972 (see, INHN “Books”, January 2, 2014), which remains the only set of full case presentations addressing the long-term effects of the range of psychopharmacological treatments.

Donald F. Klein

February 6, 2014