Late-Life Depression
http://www.100md.com
《新英格兰医药杂志》
This book is "state of the art," an observation that is both a compliment and a caution. The editors have brought together many of the leading researchers in the field to assemble an authoritative reference that will be useful for students, residents, practicing physicians, and mental health professionals in related fields. For a multiauthored textbook, Late-Life Depression is well organized, appropriately succinct, and clear. Those qualities in themselves are accomplishments.
An Artist's Interpretation of a Person with Depression.
Nanette Hoogslag/Wellcome Photo Library.
The great strength of the book is its medical and biologic orientation. Indeed, it might have been more specifically titled Medical and Biologic Perspectives of Late-Life Depression. It will serve as an excellent resource for those seeking to understand the clinical varieties of the condition, relevant pathobiologic theories and correlates, and approaches to treatment. With the exception of one chapter, entitled "Psychotherapy in Old-Age Depression," however, the therapies that are discussed are solely biologically driven — both pharmacologic and electroconvulsive.
It is ironic that the book's medical and biologic orientation is also its great weakness. Reading it, I might have thought that psychological and socially oriented theories of depression in later life had disappeared altogether. Although the book's contributors give deep obeisance to the "vascular hypothesis," or neuroendocrinologic and neuroanatomical correlates of depression, it is mystifying to me that they omit comparable consideration of developmental psychology, late-life social and functional changes and losses, and the potential role of vulnerabilities of personality in the genesis of depressive conditions. An argument could certainly be made that the supporting data for such perspectives are just as robust (or as weak) as those presented here.
There are other important gaps in the book. Although there is an important introductory chapter on the epidemiology and treatment of depression in residential care settings, virtually nothing is said about the challenges of treating depressed elderly patients in primary care venues. That is where most of the action takes place, not in psychiatrists' offices or on any inpatient psychiatric service. Physicians who are treating depressed elderly persons often work as much with family members as with the patients themselves, but I could find no mention of this reality in the book. Except for a relatively brief mention of approaches to suicide prevention, there is nothing of what I call "public health and preventive psychiatry," a perspective that invites consideration of how we might undertake to prevent the onset of late-life depressive conditions. I cannot imagine a book on vascular diseases without a consideration of risk factors that might be addressed (e.g., elevated blood lipids, smoking, overweight, or lack of exercise) to preclude the onset of more serious, function-robbing conditions.
In summary, this book well represents what has become the state of the art of geriatric psychiatry early in the 21st century. It is excellent in those elements of biomedicine that it emphasizes and almost devoid of a serious consideration of psychological, social, cultural, and public health perspectives.
Eric D. Caine, M.D.
University of Rochester Medical Center
Rochester, NY 14642
eric_caine@urmc.rochester.edu(Steven P. Roose and Harol)
An Artist's Interpretation of a Person with Depression.
Nanette Hoogslag/Wellcome Photo Library.
The great strength of the book is its medical and biologic orientation. Indeed, it might have been more specifically titled Medical and Biologic Perspectives of Late-Life Depression. It will serve as an excellent resource for those seeking to understand the clinical varieties of the condition, relevant pathobiologic theories and correlates, and approaches to treatment. With the exception of one chapter, entitled "Psychotherapy in Old-Age Depression," however, the therapies that are discussed are solely biologically driven — both pharmacologic and electroconvulsive.
It is ironic that the book's medical and biologic orientation is also its great weakness. Reading it, I might have thought that psychological and socially oriented theories of depression in later life had disappeared altogether. Although the book's contributors give deep obeisance to the "vascular hypothesis," or neuroendocrinologic and neuroanatomical correlates of depression, it is mystifying to me that they omit comparable consideration of developmental psychology, late-life social and functional changes and losses, and the potential role of vulnerabilities of personality in the genesis of depressive conditions. An argument could certainly be made that the supporting data for such perspectives are just as robust (or as weak) as those presented here.
There are other important gaps in the book. Although there is an important introductory chapter on the epidemiology and treatment of depression in residential care settings, virtually nothing is said about the challenges of treating depressed elderly patients in primary care venues. That is where most of the action takes place, not in psychiatrists' offices or on any inpatient psychiatric service. Physicians who are treating depressed elderly persons often work as much with family members as with the patients themselves, but I could find no mention of this reality in the book. Except for a relatively brief mention of approaches to suicide prevention, there is nothing of what I call "public health and preventive psychiatry," a perspective that invites consideration of how we might undertake to prevent the onset of late-life depressive conditions. I cannot imagine a book on vascular diseases without a consideration of risk factors that might be addressed (e.g., elevated blood lipids, smoking, overweight, or lack of exercise) to preclude the onset of more serious, function-robbing conditions.
In summary, this book well represents what has become the state of the art of geriatric psychiatry early in the 21st century. It is excellent in those elements of biomedicine that it emphasizes and almost devoid of a serious consideration of psychological, social, cultural, and public health perspectives.
Eric D. Caine, M.D.
University of Rochester Medical Center
Rochester, NY 14642
eric_caine@urmc.rochester.edu(Steven P. Roose and Harol)