Post-Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care: National Collaborating Centre for Mental Health

Post-traumatic stress disorder (PTSD) has its believers and non-believers, but the balance appears to be moving in favour of the former. Despite numerous descriptions of the disorder since the First World War (and before), it was not a formally recognised clinical diagnosis until fairly recently.

psychological issues. Supervision and management of clinical teams are also important clinical tasks.
The important teaching role is discussed in relation to both undergraduate and postgraduate medical education and the education of professions allied to medicine. Strategic advisory and clinical governance responsibilities are discussed and the particular remit to bring a psychologically minded approach to these discussions is highlighted.
Finally, the report highlights the future development of the role in relation to the changing role of medical consultants within he health service. It stresses the importance of developing a capacity for flexible ways of working, employing a range of therapeutic modalities, learning new evidence-based therapies and participating in the research base for and development of new treatments. In addition, the changing structure of adult psychiatry is discussed in relation to developing therapeutic roles for consultant psychiatrists in psychotherapy more generally, including involvement in developments such as assertive outreach, crisis intervention and home treatment teams. As a child it was often said to me that 'Good things come in little parcels'. This sentiment applies to this book, which although being slender contains invaluable information to guide clinicians faced with the task of managing adults with learning disability who have additional mental health problems, behavioural problems and/or epilepsy.
Compared with the general population, individuals with learning disability often respond differently to standard psychiatric (and other) medication and may be exquisitely sensitive to such medication and its side-effects. Many clinicians are justifiably cautious when prescribing for these patients and are often obliged to seek the advice of their more experienced colleagues; advice that may be more anecdotal than evidence based. Thus it was with a sense of professional delight, mingled with relief, that I received this book.
The book covers all the major psychiatric disorders and challenging behaviours that most professionals working with people with learning disability are likely to come across in their daily practice. Each chapter has a clear, logical format and benefits from being succinct with a pleasing absence of verbosity. The authors use sub-headings to full effect and bullet points draw attention to important facts. Chapters that are particularly strong are those on the management of epilepsy in people with learning disability and the management of affective disorders.
The authors clarify treatment options/ pathways by the liberal use of treatment algorithms in most chapters. Although this strategy is helpful, some of the algorithms are difficult to follow (particularly that for the treatment of aggression (pages 59-61)).
Having read this text several times I am convinced that it will become an invaluable aide, not only to my psychiatric colleagues but also to other mental health professionals and general practitioners, all of whom regularly treat people with learning disability. For the future, the publication of guidelines for prescribing for children and adolescents with learning disability and co-morbid mental health problems, epilepsy and/or challenging behaviours would be very welcome . . . please? Post-traumatic stress disorder (PTSD) has its believers and non-believers, but the balance appears to be moving in favour of the former. Despite numerous descriptions of the disorder since the First World War (and before), it was not a formally recognised clinical diagnosis until fairly recently.

Angie Stevens Specialist Registrar in Child and
The increased number of victims of violence within our society, including political refugees and the victims of the recent bomb attacks in London, places PTSD at the centre of the current health and political agendas. All of this makes this book more than welcome, as it responds to the clear need for understanding, training and clinical guidelines.
This book introduces the reader to the concept of PTSD, mainly from the medical/clinical point of view and includes some observations about the psychosocial dimensions. We are offered a summary of the majority of well-conducted randomised clinical trials of its treatment modalities, both psychotherapeutic and pharmacological, both in adults and children, in whom its presentation is less well described. It covers disaster planning (very topical) and early intervention, and makes recommendations for future research. Furthermore, there is a very moving and enlightening chapter dedicated to the views and experiences of sufferers and carers from different backgrounds.
It is important to note, however, that anyone looking to gain a thorough understanding of more complex and severe cases of PTSD will not find it here. The main research trials select populations of the more simple cases of trauma -this might be owing to the costs, length and complexity of including studies of the more complicated and severe clinical cases. This book also misses the opportunity to satisfy the reader's curiosity in relation to newer treatments for PTSD such as eye movement desensitisation and reprocessing (EMDR), which is briefly described but only from the perspective of cognitive-behavioural therapy, which predominates in this book.
As a summary of current trends and practices, however, this book is invaluable. It will be useful to a range of health and non-health workers, including general practitioners, psychiatric services, children's services, psychotherapists, and others within the National Health Service and non-statutory services. Essentially a factual report upon an international programme to reduce stigma, this book develops many interesting ideas beyond those which might be expected from the title. It gives a detailed account columns Columns The College