Books, like people, are born, and, if they survive the trauma of birth, mature in response to a changing environment. This volume is no exception. It imme­ diately proved its usefulness to psychiatric clinicians upon its publication six years ago, and it is not surprising to find it now entering a new phase of life in a second edition. The many and significant changes that the reader will find herein reflect not only the rapid growth of knowledge in the field of psy­ chopharmacology but also the editors' wise awareness of the need to incorpo­ rate that knowledge into clinical practice. Important new sections have been added on the management of elderly patients, on the pharmacological approach to those with temporal lobe epilepsy, and on the use of psychoactive medications during pregnancy. The existing clinical sections have been expanded, and the format has been altered to make the volume more practi­ cally useful for the harried clinician. Most important of all, the discussions of individual drugs have been carefully revised to update information about those medications that have stood the test of time and to include those newer pharmacological agents that have appeared on the clinical scene since the publication of the first edition. This last task has been significantly aided by the addition of Dr. Alan J. Gelenberg to the family of editors; his clinical and scientific knowledge nicely complements that of Drs. Bassuk and Schoonover, and its influence is evident throughout.

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1. Introduction: The Practice of Pharmacotherapy.- I. Historical Perspective.- II. Current Trends in Psychopharmacology.- A. Definition of Clinical Syndromes.- B. Development of Brain Chemistry Models and New Pharmacological Agents.- C. Pharmacokinetics.- D. Design of Drug Studies.- III. Perspectives on Clinical Practice.- A. Matching Medications with Drug-Responsive Syndromes.- B. Properties of Medication.- C. Attributes of the Clinician.- D. Attributes of the Patient.- E. Pharmacotherapy and Psychotherapy.- IV. General Clinical Guidelines.- A. Patient Evaluation.- B. Principles of Drug Use.- 1. Use Nonbiological Treatments When They Are as Effective as Pharmacotherapy.- 2. Do Not Deny a Patient Appropriate Medication.- 3. Choose the Drug with the Best Risk/Benefit Ratio.- 4. Understand the Pharmacokinetics of Psychotropic Agents.- 5. Learn the Differences between Preparations.- 6. Minimize Drug Use.- 7. Prescribe the Simplest Drug Regimen to Increase Compliance.- 8. Avoid Polypharmacy.- 9. Provide the Most Cost-Effective Treatment.- 10. Exercise Special Care with Medically Ill Patients.- 11. Establish an Ongoing Therapeutic Relationship.- 12. Complete Each Drug Trial.- V. Conclusion.- References.- 2. Depression.- I. Introduction.- A. Psychological Models.- B. Biological Models.- C. Integrative Model.- II. Diagnostic Considerations.- A. Clinical Presentations.- B. Classifications.- C. Biological Diagnosis.- 1. Amine Metabolites.- 2. Cortisol Metabolism.- D. Symptom Profiles and Drug Responsiveness.- III. General Therapeutic Measures.- A. Milieu and Crisis Techniques.- B. Psychotherapy.- C. Electroconvulsive Therapy.- 1. Introduction.- 2. Mechanism of Action.- 3. Indications.- 4. Contraindications and Adverse Reactions.- 5. Technique.- IV. Pharmacotherapy.- A. Heterocyclic Antidepressants.- 1. Chemistry.- 2. Mechanism of Action.- 3. Adverse Reactions.- a. Gastric.- b. Hematological.- i. Leukocytic Effects and Purpura.- ii. Agranulocytosis.- c. Hepatic.- d. Endocrine.- e. Ocular.- f. Cardiovascular.- g. Neurological.- h. Cutaneous.- i. Autonomic.- j. Drug Interactions.- k. Miscellaneous Adverse Reactions.- 4. Precautions for Administration during Pregnancy.- 5. Acute Toxicity.- a. Intoxication Syndromes.- b. Anticholinergic Syndromes.- i. Description.- ii. Anticholinesterase Therapy.- 6. Pharmacokinetics.- 7. Therapeutic Plasma Levels.- 8. Preparations and Dosage.- B. Monoamine Oxidase Inhibitors.- 1. Chemistry.- 2. Mechanism of Action.- 3. Adverse Reactions.- a. Cardiovascular.- b. Autonomic.- c. Gastrointestinal.- d. Neurological.- e. Hepatic.- f. Drug Interactions.- g. Miscellaneous Adverse Reactions.- 4. Contraindications.- 5. Use during Pregnancy.- 6. Toxicity.- 7. Pharmacokinetics.- 8. Preparations and Dosage.- C. Evaluation of the Depressed Patient.- D. Drug Therapy for the Depressed Patient.- 1. Initiating Treatment.- 2. Completing a Medication Trial.- 3. Discontinuing Medication.- 4. Maintenance Therapy for Chronic or Recurrent Depressions.- 5. Depressive Episodes in Bipolar Affective Disorders.- 6. Agitated, Anxious, or Hostile Depressions of Moderate Severity.- 7. Mild Depressions.- 8. Psychotic Depressions.- 9. Depression in Schizophrenic Patients.- 10. "Atypical" Depressions.- 11. Resistant Depressions.- 12. Use of Stimulants for Depression.- V. Conclusion.- References.- 3. Bipolar Affective Disorder and Recurrent Unipolar Depression.- I. Introduction.- II. Manic-Depressive Disorder (Bipolar Affective Disorder).- A. Clinical Presentation.- B. Course of the Illness.- III. General Measures for Treating Manic-Depressive Illness and Recurrent Depressions.- A. Electroconvulsive Therapy.- B. Milieu Therapy.- C. Group Therapy.- D. Psychotherapy and the Therapeutic Relationship.- IV. Pharmacotherapy.- A. General Clinical Considerations.- B. Pharmacokinetics.- C. Adverse Reactions.- 1. Endocrine.- a. Thyroid.- b. Diabetes Mellitus.- 2. Renal.- a. Polydipsia and Polyuria.- b. Diabetes Insipidus.- c. Structural Kidney Damage.- d. Other Kidney Effects.- 3. Hematological.- 4. Cardiovascular.- 5. Cutaneous.- 6. Gastrointestinal.- 7. Central Nervous System and Neuromuscular.- 8. Ocular.- 9. Weight Gain.- 10. Other Adverse Reactions.- 11. Pregnancy.- D. Drug Interactions.- E. Toxicity.- F. Preparations and Dosage.- V. Clinical Applications.- A. Diagnostic Evaluation.- B. Medical Evaluation.- C. Initiating Treatment.- D. Bipolar Affective Disorder.- 1. Acute Manic Episode.- 2. Hypomania.- 3. Maintenance Therapy.- E. Acute Depressive Episode.- F. Recurrent Depression.- G. Schizoaffective Disorder.- H. Other Possible Applications.- 1. Emotionally Unstable Character Disorders.- 2. Premenstrual Tension.- VI. Conclusion.- References.- 4. Psychoses.- I. Introduction.- II. Other Treatments.- A. Nonbiological.- B. Nondrug, Biological.- 1. Electroconvulsive Therapy.- 2. Psychosurgery.- 3. Megavitamin Therapy.- III. Antipsychotic Drugs.- A. Introduction and Terms.- B. Effects on Behavior and the Nervous System.- C. Mechanism of Action.- D. Classes and Chemistry.- E. General Principles of Use.- F. Pharmacokinetics.- G. Adverse Effects and Toxicity.- 1. Neurological.- a. Extrapyramidal Syndromes.- i. Acute Dystonic Reactions.- ii. Akathisia.- iii. Parkinson's Syndrome.- iv. Tardive Dyskinesia.- b. Sedation.- c. Seizures.- d. Neuroleptic Malignant Syndrome.- 2. Anticholinergic.- a. Peripheral.- b. Central.- c. Serious Toxicity.- 3. Cardiovascular and Respiratory.- a. Hypotension.- b. Cardiac.- 4. Ocular.- 5. Cutaneous.- 6. Hormonal, Sexual, and Hypothalamic Reactions.- 7. Hepatic.- 8. Hematological.- 9. Pregnancy and Lactation.- 10. Withdrawal Reactions.- 11. Overdose.- H. Drug Interactions and Combinations.- I. Laboratory Tests and Monitoring.- J. Clinical Uses of the Antipsychotic Drugs.- 1. Acute Treatment.- 2. Transition and Continuation Therapy.- 3. Maintenance Therapy.- a. Definition.- b. Chronic Schizophrenia.- c. Other Diagnostic Groups.- K. New Drugs.- IV. Conclusion.- References.- 5. Anxiety.- I. Introduction.- A. Anxiety: A Symptom.- B. Symptoms.- 1. Psychological.- 2. Physical.- C. What Anxiety Is Not.- II. Models.- A. Psychoanalytic.- B. Behavioral.- C. Separation Anxiety.- D. Biological.- III. Differential Diagnosis.- A. Medical.- B. Psychiatric.- IV. Primary Anxiety Disorders and Their Treatment.- A. Phobic Disorders.- 1. Agoraphobia.- 2. Social Phobia.- 3. Simple Phobia.- B. Anxiety States.- 1. Panic Disorder.- 2. Generalized Anxiety Disorder.- 3. Obsess…