Clinical Evidence Mental Health
Editor: Stuart Barton
This book is a spin off from Clinical Evidence Issue 6 and contains the review of the evidence for the treatment of mental illness. This evidence has been derived from international randomised controlled trials (RCTs) or systematic reviews.
Faced with a bewildering array of antidepressants, which does the GP choose for his patients? The answer, it seems, is that there is no clinically significant difference in benefit from the various antidepressants available. Choice then, becomes a matter of matching up the preferred side effect profile to the patient, because tolerability and not effectiveness is the deciding factor. So next time the consultant psychiatrist flips the patient from one antidepressant to another, point him in the direction of page 61 of this book.
Rather more worryingly, what do you think has been proven to be effective in the treatment of anorexia nervosa? Nothing... zilch, - I kid you not. This leads one to the unwelcome conclusion that patients either die from it (and 5% do) or recover in spite of our treatment. Next time you are face to face with an anorexic and wondering what to do for the best, remember even the great and the good don’t know. Thankfully, the picture is less pessimistic for bulimia with various psychological treatments and antidepressant medication on the list of therapies likely to be beneficial.
The evidence for each intervention is graded by degrees, for instance: beneficial, likely beneficial, trade off between benefits and harms, unknown effectiveness etc. so one can see at a glance which are worth pursuing. This is followed by key messages from the search for the evidence and then a textbook-like account of the topic in question. Finally there is a detailed discussion of each intervention followed by the references employed. A very useful glossary at the front of the book explains the numerous statistical terms used, although happily a detailed knowledge of statistics proves to be unnecessary. All in all a very handy book but surprisingly no mention has been made of bipolar disorder.....why?
| Publisher: | BMJ Publishing Group
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| ISBN: 0-7279-1745-5
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| BMA House, Tavistock Square, London. WC1H 9JR
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| Tel: | 020 7387 4499
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| Fax: | 020 7383 6662
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| Reviewer: | Dr Jeremy M Sager
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