Cambridge Textbook of Effective Treatments in Psychiatry

Preface summary

By: Peter Tyrer and Kenneth R. Silk

All professionals in mental health want to give the best treatments for their patients, but how do we judge what is really best in a specific instance?

The decisions about treatment are individual ones and yet the evidence in the literature is necessarily derived from groups, the larger the better.

We realize that evidence-based medicine (EBM), although it now trips easily off the tongue, is not nearly as straightforward as it may first appear. Real patients are seldom the same as those who are described in textbooks. Even at best, they only approximate to the sort of people who are described in good trials of evidence.

We also have to remind ourselves that there must be hundreds of effective treatments that have not yet been shown to be effective, but this does not mean that clinicians should be deprived of their value because no one has done the hard work necessary to show that they are effective.

We are also fully aware that most of the evidence of efficacy comes from simple treatments such as drugs, which are much easier to evaluate than complex treatments, including most of the psychological therapies. The resources of the pharmaceutical companies are also quite naturally devoted to establishing good evidence as there is a strong commercial reason for doing so.

As psychological therapies become more widely used and standardised, evaluation of these treatments may become methodologically less complicated, so we must be careful not to allege bias to one type of treatment only.

At the heart, we are hoping to answer five questions that we as clinicians ask ourselves when faced with the choice
of treatment for a problem:

(1) What treatments are available for the condition that I think this patient has?

(2) What is the relative value of each of these treatments?

(3) Are there any other treatments that I should be considering now that my first approach has failed?

(4) Is there any value in combinations of treatment for this condition, and if so, which are likely to be most effective?

(5) Can I be reassured that the evidence and recommendations I read are free from bias?

Because there are so many treatments available in psychiatry, we have to group them by diagnosis. Because we, and indeed all independent thinkers, regard the diagnostic conditions in psychiatry as a weak approximation to the truth, and we make this clear, in advance of discussing individual treatments.

Because diagnosis is inexact, most treatments have a wide spectrum across several disorders, and so we feel it important to discuss the main modalities of treatment and their principles, recognising that there is some significant overlap, both between diagnosis and between treatments at different stages of the lifespan.

However, we feel that this volume, (Cambridge Textbook of Effective Treatments in Psychiatry), whatever its deficiencies, is the first attempt to bring together all treatments, both standard and complementary, into the evidence ring where they can compete openly with one another.

There are often few head-to head comparisons between all these treatments but we hope that their exposure, however brief, may help the practitioner in deciding on that critical set of decisions that will point the way to the solution of an individual problem.

References

Peter Tyrer and Kenneth R. Silk, Cambridge Textbook of Effective Treatments in Psychiatry, Cambridge University Press 2008.

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