Emily Gavett, MD

In this short, easy-to-read book, authors Michael Casher and Joshua Bess delineate the major issues psychiatrists face on inpatient units. Throughout the book, they include factual data, case scenarios, tables about specific medications, treatment algorithms, and a large number of references at the end of each chapter, as well as their personal treatment philosophies.

In her foreword, Dr Laura Hirshbein writes about the history of inpatient psychiatry. The first 9 chapters are mainly divided by diagnosis (eg, schizophrenia, depression, mania, borderline personality disorder, dementia, traumatic brain injury, dual diagnosis). The final 2 chapters focus on young adult inpatients and clinical documentation.

Written in a question-and-answer format, the book describes common experiences of residents on inpatient units, as though the reader were asking the attending physician specific questions. The format is reader-friendly, but it also allows one to search quickly through the bolded questions when seeking information on a particular topic. Each chapter begins with basic questions, such as why might a patient with a specific diagnosis be admitted to the psychiatric unit? Gradually, topics build in complexity and include specific treatment recommendations (eg, how to approach an agitated, psychotic patient).

While the authors acknowledge that it is impossible for a brief review to include all scenarios in inpatient psychiatry, they do a good job of covering a variety of topics succinctly. The book covers fairly basic terms (eg, the definition of a hallucination) as well as some complex information (eg, specific medication recommendations and treatment algorithms). Upper-level psychiatry residents or attending physicians should already know much of the material covered in this book.

Each chapter includes clinical pearls gleaned from the authors’ experiences and philosophies and not from a textbook. For example, the authors give tips for dealing with patients who have borderline personality disorder (“do not try to fix all the patient’s problems during a brief stay . . . work on the most pressing current issues . . . avoid the search for the ‘perfect’ medication regimen.”

The book is an ideal guide for medical students and first-year residents beginning to train in inpatient unit psychiatry. Readers will find the answers to questions they are afraid to ask for fear of looking incompetent or ignorant. This book will fit easily into the pocket of a white coat and serve as a quick reference on the unit when learning how to deal with specific diagnoses or about a particular medication.

While an excellent resource for those in early training or beginning their careers, seasoned clinicians may find the book too basic. That said, it is an easy read and contains a fair amount of useful information and clinical tips. I would recommend it for medical students, new or returning residents, new attending physicians who have been thrust into the role of primary decision maker for their patients, and clinicians who would appreciate a pocket supervisor to help them make treatment decisions.

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 I would recommend it for medical students who have been thrust into the role of primary decision maker for their patients, and clinicians who would appreciate a pocket supervisor to help them make treatment decisions. 

Author | Emily Gavett, MD

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Manual of Inpatient Psychiatry