Psychiatric Bulletin (2000) 24: 400. doi: 10.1192/pb.24.10.400
© 2000 The Royal College of Psychiatrists
Psychiatric Bulletin (2000) 24: 400
© 2000 The Royal College of Psychiatrists
The Bethlem & Maudsley NHS Trust Prescribing Guidelines 5th Edition
Femi Oyebode, Professor of Psychiatry
Queen Elizabeth Psychiatric Hospital, Mindelsohn Way, Edgbaston,
Birmingham B15 2QZ
Edited by David Taylor et al. London: Martin Dunitz Ltd. 1999. 190
pp. £ 14.95 (pb) ISBN: 1-85317-835-7
This new edition of The Bethlem & Maudsley Prescribing
Guidelines is the case of an acorn growing into a medium-sized oak, and
an admirable oak too. The fifth edition is now a formally
published book. In other words, it is no longer published with the
assistance of grants from pharmaceutical companies. This development reassures
the reader that the guidelines are independent of any direct or indirect
influence from the pharmaceutical industry. Not that there was ever any reason
to doubt the independence of the previous editions.
As the editors say, the Guidelines have become an institution in
the UK. It is a worthy compendium of information. From clearly laid out
algorithms for the drug treatment of schizophrenia or depression to advice on
the swapping or stopping of antidepressants, to advice on the use of
psychotropic agents in special populations such as children and pregnant or
lactating mothers to advice on rapid tranquillisation, the Guidelines
manage to integrate new knowledge with an understanding of the dilemmas and
preoccupations of practitioners. The common sense and pragmatic approach of
the Guidelines will continue to endear it to clinicians. This
characteristic of the Guidelines is particularly welcome at a time
when some are looking to guidelines to reduce the wide variation in the
practice of medicine and in the outcomes of treatment in the UK. The anxiety
is that guidelines may narrow or severely limit clinical freedom and that
patients will ultimately lose out. Furthermore, there is anxiety that
guidelines prepared by special interest groups will not speak to the interests
of the vast body of clinicians, but will only serve to promote particular
clinical approaches. The Bethlem & Maudsley Prescribing
Guidelines belie these anxieties.
The Guidelines started life as a reference source for clinicians
at the Bethlem & Maudsley Hospitals. Deservedly, they have become
established as a resource for clinicians in the UK and it is likely that they
will go on to have an international status. The contribution of the graphics
and text design to the success of the 5th edition must be emphasised. All
readers look forward to an electronic version, available on CD-ROM as well as
on-line in the near future.