Abstract
Edited by Harvey Max Chochinov, M.D. and William Breitbart, M.D. Oxford: Oxford University Press, 2009, 565 pp., $85.00.
In recent years, medical providers have heightened their focus on identifying and treating psychological distress in serious life-limiting illnesses. The second edition of the Handbook of Psychiatry in Palliative Medicine summarizes recent research advances and highlights opportunities for clinical collaboration between mental health and palliative care practitioners. The book is edited by Drs. Breitbart and Chochinov, who are leading international experts in the diagnosis and treatment of psychiatric conditions at the end of life and who have assembled contributions of acclaimed clinician-educators and researchers who work at the interface between psychiatry and palliative care.
This comprehensive textbook is organized into the following seven sections: (1) critical milestones in the delivery of psychiatric and psychosocial palliative care; (2) psychiatric complications of terminal illness; (3) psychosocial issues in palliative care; (4) ethical, existential, and spiritual issues in palliative care; (5) understanding and managing symptoms; (6) psychotherapeutic interventions in palliative care; and (7) life cycle considerations in palliative care. Separate chapters address depression, anxiety, delirium, suicide/desire for hastened death, serious mental illness, substance abuse/personality disorders, and bereavement. Covered psychotherapies include individual supportive–expressive, cognitive–behavioral, narrative, group, and family-focused grief therapy. Additionally, in this second edition, there are various new contributions, including several chapters focusing on the priorities and personal growth of dying people, interdisciplinary teamwork, cultural diversity, and approaches to integrating psychiatry and palliative medicine.
Useful clinical examples are frequently interspersed to demonstrate diagnostics and treatment, although using different formats in different chapters. Several authors provide enjoyable and meaningful case vignettes imbued with compassion and humor to demonstrate the art of interacting with dying patients.
Psychiatrists entering the field of hospice and palliative medicine may benefit from the detailed section on symptom management, which is sometimes a precondition for delivering other psychiatric interventions in this patient population. Particularly commendable are the brief descriptions of issues specific to advanced medical illnesses other than cancer, including acquired immune deficiency syndrome (AIDS), and end-stage heart, lung, liver, renal, and neurologic disease. In fact, I wished for further elaboration of these sections. Additional attention to psychodynamic underpinnings, as provided in articles by Gutheil and Schetky 1 and Muskin 2 would also enhance the chapter on suicide and desire for hastened death by helping readers better understand root causes including personality traits predisposing to these phenomena.
Clinical palliative medicine providers will certainly benefit from the book's broad scope. The specific descriptions of individual psychotherapeutic and cognitive–behavioral symptom management tactics have immediate practical application at the bedside, as do the primers for end-of-life issues in the pediatric and geriatric populations. The chapter on dignity, meaning, and demoralization provides practical questions to ask patients as well as therapeutic interventions. The section on staff burnout and stress coherently illuminates this important issue for clinicians and training directors. The sections on interdisciplinary team composition and recruitment are useful for administrators and team leaders. Educators in both psychosomatic and palliative medicine will appreciate the review of methods for helping trainees integrate each subspecialty's inherent strengths into their clinical practices.
Not surprisingly given the recent expansion of this multiauthored text, there is occasional overlap or repetition, as well as some variation in the readability of the contributors' prose styles. Despite these minor flaws, this textbook is an authoritative, state-of-the-art review of psychiatry in palliative medicine, and deserves a place in the library of mental health and palliative medicine practitioners alike. We can commend Drs. Breitbart and Chochinov for assembling this cogent integration of the practice's art and science.