This is an important and useful book. One of the major
facets of university hospitals is that they most often
end up caring for treatment failures. "Our practices
are atypical in that most of the patients are either
diagnostic prob-lems or refractory to the usual treatments.
Consequently, physicians work-ing in university settings
have built up vast clinical experience with diag-nostic
and treatment puzzles." This is probably the converse
of the experience of most practitioners, where the majority
of their patients re-spond quite nicely to the standard
treatment regimens. in this volume, Dr. Neppe and his
colleagues have put together their vast clinical experience
with difficult treatment situations. This is a book
that experienced clinicians will turn to when patients
do not respond to the usual forms of treatment. It is
a work that attempts to chart a course in an uncharted
land where there are very few scientific studies. Numerous
studies are quoted, but much of the book is based on
the clinical impressions of experienced clinicians.
However, the import and uniqueness of this book rests
on the fact that the authors attempt to provide a theoretical
framework with which to approach patients who have not
responded adequately to treatment. Much of this theoretical
framework is based on information from the most current
biologic data about the functioning of the central nervous
system. As such, while speculative, this volume should
provide the basis for many future studies. I know clinicians
will find that they frequently refer to this book, not
only for its utility but also for its review of the
literature, which will save many hours of library work.
it is a most useful compendium and framework for experienced
clinicians and should provoke much discussion and thought
in the field.
Gary J. Tucker, M.D.
Department of Psychiatry and Behavioral Sciences
University of Washington