In medical school, we become adept at memorizing diagnostic criteria, able to spout off, at a moment’s notice, the definitions for everything from autism to schizophrenia. For some diagnoses, we are aided by mnemonics — SIG E CAPS for depression, DIG FAST for mania — while other disorders require simple brute-force memorization. All of this is, we are told, to help us divide those with mental illness into neat little boxes, each with its own implications for prognosis and treatment.
Textbooks traditionally have supported this simplified view of the world, providing brief case studies that serve to illustrate diagnoses and adding restricted color to the paint-by-number portraits of illness we create in our mind’s eye. Then we meet actual people with mental illness and learn that no one is coloring inside the lines. Our clear-cut diagnoses — you have it or you don’t — are replaced with nuance. Details of our patients’ lives and symptomatology blur the demarcations we have made between pathologies.
It is in this space that Essential Psychopathology Casebook works to bridge the gap between textbook simplicity and the gray areas of real clinical cases.
Edited by psychiatrists Mark Kilgus and William Rea, the book is divided into chapters, written by experts in the field, that each focus on a different clinical condition. It is not just the level of expertise that makes this resource stand out, however. What students and junior clinicians will most appreciate is all the highly nuanced case descriptions based on real, complex patients.
The book includes 38 cases in total that reflect the diversity of mental illness; in addition to the more bread-and-butter depression and anxiety, the book includes cases dealing with pain, competency to stand trial, malingering, and perfectionism.
Each chapter begins with a multi-page presentation of a clinical case, including chief complaint and history of present illness and on through mental status exam. Reading feels as though you are sitting in the room with the patient — an experienced clinician asking all the right questions and making observations.
What helps is that the cases themselves are not the classical examples we have come to expect from textbooks. For example, in the chapter on autism, instead of the typical two-year-old who refuses to make eye contact, sitting alone and continually spinning the wheels of his toy trucks, we are introduced to a 28-year-old man whose chief complaint is listed as “Depression…. He argues with people.”
Although Steve is referred by his primary care provider for his depression, his history, we find out, reveals marital issues, difficulties with interpersonal relationships at work, trouble interacting with his young daughter, fixations with the “correct” way of doing things, and persistent feelings of anxiety. With more information about his developmental and educational history, the eventual diagnosis is high-functioning autism.
The author of that chapter, Felicity Adams, goes on to discuss various aspects of the history that point to this diagnosis. For example, she notes that “the tendency to argue with others or persist in defending a point of view without integrating the point of view of others suggests that Steve may have deficits in the ability to see or imagine other people’s perspectives and potential reactions.”
In addition to the rich case histories, each chapter addresses a number of different issues surrounding the case in question. These include what one might expect in a text about mental illness with differential diagnosis, epidemiology, etiology and pathogenesis, and evidence-based treatment options.
However, we also find here important details you might not see in every textbook, such as the course of the disorder with and without treatment; systems-based factors that influence diagnosis, treatment, and outcomes; and legal, ethical, and cultural challenges that patients with this disorder, their family, and treating clinicians may face.
Overall, this is a user-friendly book, perfect for the student or junior clinician who wants a thorough overview of a number of different pathologies presented in an engaging case-based manner.
But, given that this is a companion resource to the authors’ Essential Psychopathology and Its Treatment, for some topics the reader might be better suited referring to the primary text. While each chapter includes a section covering the evidence-based biopsychosocial treatment options, for details like how much Risperidone you should prescribe for your patient suffering from her first psychotic break, you will need to look elsewhere.
Similarly, although the text provides a concise look at our current understanding of the neuroscience behind each disorder, the reader will need to consult the other reference for more in-depth coverage.
Regardless, this is a worthwhile text on its own. It will have a prominent place on my bookshelf.
Essential Psychopathology Casebook
W. W. Norton & Company, April, 2014
Paperback, 648 pages