Book Reviews

Psychosomatics 43:4, July-August 2002 343

DILIP RAMCHANDANI, M.D.

BOOK REVIEW EDITOR

Psychiatry Update and BoardPreparationEdited by Theodore A. Stern andJohn B. HermanNew YorkMcGraw Hill 2000679 pages $69.00ISBN 0–071–35435–2

Reviewed by Thomas N. Wise,M.D.

This textbook is an outgrowth of theMassachusetts General Hospital’s

Board Preparation course that has beenoffered for over two decades. The vol-ume is an excellent vehicle to preparefor both Part I and Part II of the Boardexams. As recertification is a reality formany, this book will also be a musthave. It is far more than a mere Boardpreparation text; it is an excellentmethod of keeping up-to-date on ad-vances in psychiatry. Written in a mod-ified outline form, it is very readable.Careful use of tables and charts makesit even more efficient. The volume isunique in that it is actually fun to read.What really adds to the fun are the 400questions that are included at the endof the book. The questions are clini-cally relevant, and the answers includea discussion of why the specific answerwas designated. All this makes for abook that has multiple uses. First, Ithink it would be an excellent text torequire for medical students. Despite itstitle, it covers a broad range of areasthat medical students must master. Fur-thermore, many medical students donot buy textbooks, but this is a seriousvolume at a reasonable price. Second,it is an excellent book to have for the

practicing psychiatrist. In an age of in-formation overload, it is difficult tonote just how to best manage keepingup with new information. This bookcould be easily utilized by having itsowner read one or two chapters a dayand go over the specific questions. Itwould be remarkable to see how muchnew information could be gleaned fromthis exercise. Finally, it is a superbmethod to prepare for the Boards.

The chapters are written by mem-bers of the Massachusetts General Hos-pital’s Department of Psychiatry. Thesubject matter covers a broad range ofclinical issues within both psychiatryand neurology. Thus, after a brief re-view of test-taking strategies, the text-book offers a comprehensive review ofthe clinical aspects of psychiatry (e.g.,psychiatric conditions, neurologic dis-orders, treatment approaches, and somespecial topics in psychiatry). Basicneuroscience is not covered in a formalmanner.

I hope the authors plan to updatethe book every 2 to 3 years. Whetherone goes to Boston to take the Updatecourse or not, this text should becomea regular addition to clinicians’ librar-ies, even if Boards or recertification ex-ams are not imminent.

The Change Before the Change:Everything You Need to Knowto Stay Healthy in the DecadeBefore MenopauseBy Laura E. Corio, M.D., andLinda G. KahnNew YorkBantam Books 2000434 pages $24.95ISBN 0–553–10876–X

Reviewed by Joan S. Zofnass,D.S.W.

In writing this book, Laura E. Corio,M.D., a board-certified obstetrician/

gynecologist for more than 20 years,has taken on the task of presenting acomprehensive account of the physicaland psychological changes women ex-perience as they approach midlife. Shenotes in the introduction that when shebegan her training, as one of only 10women in her medical school class,PMS and menopause were not part ofthe curriculum. She was inspired towrite this book after noting a pattern ofcomplaints and symptoms in her agingpatient population that culminated inmenopause. Based on this experience,she came to see the cessation of mensesas one of the last signs of this processrather than its hallmark and thus placedthe focus of her book on the perimen-opause, the entire decade leading up tothe actual menopause. Her goal in writ-ing her book was to educate the readerabout the physical and emotionalchanges that take place prior to and fol-lowing menopause and through thatknowledge to empower the femalereader to take a more active role in dis-cussing health care with her physicianand in adopting health-promoting be-haviors.

The book is divided into two parts,the first dealing specifically with thesymptoms and signs of perimenopausein a number of body systems and thesecond with the relationship betweenthese changes and long-term health,with an emphasis on preservation andprevention. The first chapter is an in-troduction to the concept of perimen-

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344 Psychosomatics 43:4, July-August 2002

opause, explaining the hormonalchanges and accompanying physicalsymptoms, with questions for thereader to ask herself to determine if sheis indeed perimenopausal. The secondchapter sets the pattern for those thatfollow. Beginning with a thorough re-view of the normal menstrual cycle, Dr.Corio then highlights one of the hall-mark symptoms of perimenopause,menstrual irregularities, including lightperiods, heavy periods, infrequent pe-riods, and frequent periods. To help thereader differentiate “normal” fromproblematic bleeding, she highlights ina gray box the symptoms that suggestthat immediate medical interventionshould be sought. Case vignettes arepresented that illustrate the symptomsdiscussed and their treatments. Thechapter ends with a review of the treat-ment options for the symptoms de-scribed. Taking a holistic treatment ap-proach, the use of herbs, foods, andphytoestrogens to alleviate the symp-toms focused on in the chapter is re-viewed before moving on to explorepossible medical and surgical treat-ments.

The next five chapters follow thesame format, with a review of symp-toms and their etiology, the highlight-ing of symptoms that require morerapid medical assessment/intervention,illustrative case vignettes, and holistictreatment recommendations. Chapter 3addresses hot flashes and insomnia,highlighting “the brain-body connec-tion,” that is, the changes in neurotrans-mitters that lead to both hot flashes andthe mood changes of perimenopause.In a few concise paragraphs, Dr. Corioelegantly reviews the neurochemicalbasis of hot flashes, the premonitoryaura that accompanies them, and peri-menopausal mood changes. Those withclinical or personal interest should readpages 45–50, as her explanation here,as elsewhere, of the biological under-

pinning of these symptoms is concisebut comprehensive. There is a caution-ary listing of over a dozen differenttypes of medications that can cause hotflashes by influencing the thermoregu-latory system of the brain. The chapterconcludes with a review of varioustreatments of perimenopausal hotflashes including, again, a range of thevitamins/herbs, phytoestrogens, andmedical treatments currently available.

Chapter 4 explores hormone-related changes in mood, memory, andthinking. Dr. Corio presents in a fewpages a good review of the biologicalrelationship between depression andthe reproductive life cycle, highlightingthe symptoms of major depression thatshould send the reader in search of“professional help.” The next sectiondeals with memory change, first re-viewing the difference between short-and long-term memory, then focusingon the various causes of memory loss,including dementia, other illnesses, andmedications. The chapter ends with adiscussion of headaches in the peri-menopause, their cause and treatment.

Chapter 5 discusses the barriers toenjoyable sexual function in the peri-menopausal period, while Chapter 6 re-views the disturbing outward changesof the aging female body, includingwrinkles, “shape-shifting,” and weightgain. Here is a scary thought, ladies:“Anovulation alone reduces energy ex-penditure by 15,000–20,000 caloriesper year.” This certainly helps explainwhy despite all those recommendationsto maintain one’s weight at high schoolgraduation level, the high school grad-uation cap and gown now fits betterthan the cheerleader outfit!

Certainly no discussion of peri-menopause would be complete withouta discussion of the biological clock,and Dr. Corio does not disappoint. InChapter 7, she reviews the reproductivelife cycle, fertility and infertility, and

birth control options as well as simplesteps to improve fertility. The processesused to assist reproduction are ex-plained. While various aspects of in-fertility are addressed, including a clearlist of questions that Dr. Corio asks herpatients in an effort to understand whatmight be contributing to the problem,there could have been more attentionpaid to the psychological issues con-fronting women who have postponedhaving a family until their mid- to late30s or early 40s, both single womendesperate to marry and have kidsquickly and those struggling to getpregnant within a relationship.

Part 2 of the book is focused onstaying healthy, starting with a detailedchapter on bones and osteoporosisrisks. The next chapter deals with car-diac disease in women, including a dis-cussion of cholesterol and the variouselements of a lipid profile. Anotherchapter reviews breast disease, ad-dressing lumps and hormones, whetherto be tested for the breast cancer gene,and breast cancer risk as well as thedifferent types of breast cancers andtreatment options. The next severalchapters cover the uterus, ovaries andcervix, the colon, and the thyroidgland. Each chapter includes a reviewof risk factors as well as self-help strat-egies and medications that might de-crease risk and improve overall health.Finally, we get Dr. Corio’s prescriptionfor a healthy perimenopause: a varietyof health-promoting behaviors, includ-ing diet and exercise. She provides adetailed explanation and heartfelt en-dorsement of the Mediterranean diet,her personal and professional favorite.Several appendices review the herbs,phytoestrogens, and hormones she hassuggested for use in perimenopause aswell as those to avoid and provide achecklist of screening tests.

Dr. Corio’s book is aimed at a layaudience and provides the reader “with

Book Reviews

Psychosomatics 43:4, July-August 2002 345

the information you need to take chargeof your perimenopause.” In the midstof typing this review, my secretaryasked if she could borrow the book, anda colleague, reading the review overher shoulder, took it home for theweekend, certainly an indication thatthere is an eager audience for it. Theirreviews are still pending. The book isclearly written and encourages healthybehavior as well as educating thereader about available medical/surgicaltreatments. Instead of being a passiveand worried patient, the reader can beinformed and take an active role, work-ing with her physicians to obtain thebest medical care possible, and can bereassured that she is not alone in herconcerns. The more knowledgeable awoman is in understanding how herbody should function, in understandingwhat is changing and why and what shecan do to feel better, the better preparedshe is to see that everything that can bedone is done. The physiological expla-nations might be more than the averagereader wants to know, but a medicalprofessional could comfortably rec-ommend it to a patient or friend strug-gling to make sense of the demands ofa changing body. For a medical audi-ence, Dr. Corio’s book is informativeand easily read, and her simple expla-nation of complex physical processescould also serve as a welcome reviewor refresher for the physician willing tooverlook the sometimes “too cute”chapter titles: “Not Tonight, Honey!”“Can Somebody Open a Window?”and “I’m Losing My Mind!” tended toset my teeth on edge. However, movingbeyond this, the book is worthwhile notjust to patients but for psychiatrists andother mental health professionals whowant to understand the etiology of thephysical complaints they are hearingabout from their patients and whowould like to know more about alter-natives that might help ease these tran-

sitions. The professional reader willfind much of value in this book but mayfind the case vignettes less helpful.Each is marked by unwavering patientcompliance and gratitude and physi-cian omniscience that may leave thereader wondering (a) Why aren’t mypatients as nice as Dr. Corio’s? (b) Whyaren’t I as smart as Dr. Corio? and(c) Maybe I should call Dr. Corio foran appointment!

Having moved into the second halfcentury of my own life, many of thetopics discussed by Dr. Corio were fa-miliar old friends to me. I can onlyspeculate on the impact of reading thisbook earlier in life, before passingthrough my perimenopausal years. De-spite the cheerful, take-charge mes-sage, the litany of complaints, compli-cations, and treatments might havebeen too disheartening, and the pano-ply of vitamins and herbs suggestedmight have overwhelmed me (or mypocketbook or even my medicine cab-inet!). While we will all certainly age,if we are lucky, not every woman willbe tormented by every symptom andsyndrome discussed. For some women,menopause will be just a blip on theirphysical and emotional radar, whileeven the most unfortunate could notpossibly be so unfortunate as to expe-rience every disturbing symptom de-scribed herein or even a majority ofthem. On the other hand, to be fore-warned is to be forearmed, and withthis book in hand, the educated readershould feel less alone and less helplessin confronting the “growing pains” ofperimenopause.

An Elementary Textbook ofAyurveda: A Six Thousand YearOld Healing TraditionBy Frank John Ninivaggi, M.D.Madison, CTInternational Universities Press

286 pages $28.75ISBN 1–887841–33–4

Reviewed by Andrew L. Stoll,M.D.

A huge proportion of our patientsare either openly or surrepti-

tiously using complementary and/or al-ternative medicine treatments. Now,Yale psychiatrist Dr. Frank J. Ninivaggihas written a concise yet surprisinglycomprehensive book for the Westernaudience on Ayurvedic medicine.Ayurveda is the traditional healing sys-tem from India that dates back manythousands of years. It has not receivedas much attention as other forms ofcomplementary and alternative medi-cine treatments, such as herbal reme-dies and traditional Chinese medicine.Ayurvedic medicine is a complex andan unambiguously Eastern system ofhealing. Many of its diagnostic andtreatment principles were later incor-porated into traditional Chinese medi-cine. An Elementary Textbook of Ayur-veda is intended for a professional andan educated lay audience. In the text,Dr. Ninivaggi discusses the relation-ship of Ayurveda to Western (Allo-pathic) medicine. He clearly respectsboth systems and is a strong proponentof the integration of Ayurvedic prac-tices and Western medicine.

Dr. Ninivaggi has an engagingwriting style and provides clear defi-nitions of sometimes confusing termsand concepts. The book has an excel-lent glossary and ample references. Inthe first two chapters, Dr. Ninivaggi de-scribes the history and philosophicalunderpinnings of Ayurveda. Laterchapters are devoted to the Ayurvedicview of the anatomy and physiologyof health and diseases, as well as theprinciples of Ayurvedic therapy, in-cluding nutritional interventions, life-