Clinical Reasoning and Decision-Making in Psychiatry

'In this book, Drs Joseph Goldberg and Stephen Stahl, two well-respected psychiatrists with expertise in mood disorders and psychopharmacology, clarify the thinking that goes into the provision of personalized medicine. They cogently illustrate the many dilemmas psychiatrists face in their everyday practices: how to weigh clinical observations with the scientific literature guiding expert treatment without losing sight of individual patients' histories, objectives, and preferences. Clinical vignettes bring to life the shared physician/patient decision-making that is key to successful personalized treatment. The reader comes away knowing what a seasoned clinician would do under the complex situations that often appear in practice but are not always discussed in treatment guidelines. This is a must-read for new or experienced clinicians who seek to improve their practices by collaborating with and meeting the needs of their individual patients.' David J. Miklowitz,, Ph.D., Distinguished Professor of Psychiatry and Behavior Sciences, UCLA School of Medicine, Los Angeles
'Clinical decision making is an art that depends on effective translation of prior scientific evidence and experience to the care of an individual patient. This volume is designed to help both experienced clinicians and those earlier in their careers navigate that process. The authors bring to this challenging task the valuable perspectives of researchers with a deep knowledge of the clinical studies that underlie our diagnostic formulations and those that yield the medications and other treatments that are available for use. They couple this knowledge with extensive clinical experience in addressing the treatment of patients. Their goal is to develop a model that views clinical decisions about diagnosis or treatment as a test of a hypothesis that will be confirmed or rejected based on an observable outcome for the patient. Following that model will reward clinicians and their patients.' Nina R. Schooler, Ph.D., Professor of Psychiatry and Behavioral Sciences SUNY Downstate Health Sciences Center
'This terrific book is an indispensable resource for mental health clinicians. Drs. Goldberg and Stahl, both luminaries in the field, provide nuanced, practical, and person-centered recommendations for addressing the needs of patients, especially those with diagnostic complexity or treatment resistance. The authors engage readers in useful consideration of common clinical concerns such as optimal use of diagnostic categories, off-label treatment options, and management of complex clinical dilemmas. Humorous tips, informative vignettes, and easy-to-reference summaries bring the material to life. Readers will appreciate the authors' encyclopedic knowledge of psychopharmacology, sage clinical wisdom, and thoughtful approach to shared decision making. If you want to take better care of your psychiatric patients, this book is for you.' Holly A. Swartz, M.D., Professor of Psychiatry, University of Pittsburgh, Editor-in-Chief, American Journal of Psychotherapy
'Psychiatry, at best, is both a science and an art. Lacking formal tools like x rays and pathology tests in the main, generating a valid diagnosis and then determining the optimal treatment requires both domains to be brought into play by the psychiatrist. Some learn criteria lists and weight guidelines documents, a process that risks a 'painting by numbers' approach. Some 'hear the music' and meld (or iterate) left brain and right brain thinking to operate to a pattern analytic approach. Malcolm Gladwell has argued that any skill requires ten thousand hours to obtain expertise. This book by two skilled clinicians and educators can be guaranteed to reduce that period, being jam packed with clinical wisdom. Their focus on a non-patriarchal shared decision-making model is illuminating. Will Rogers once astutely observed that 'Common sense ain't that common.' This book is redolent with common sense and at level rarely observed in medicine let alone psychiatry.' Gordon Parker, Scientia Professor of Psychiatry, University of New South Wales, Sydney
'This is a comprehensive and indispensable resource for mental health professionals seeking to master two essential psychiatric skill sets. They delve deep and offer a profound exploration of the intricate processes that guide clinical decision-making in this field. Drs. Goldberg and Stahl provide a well-balanced blend of theoretical insights and practical wisdom. Readers will benefit from guidance on navigating the nuanced landscape of psychiatric diagnoses, refining relevant skills, and formulating evidence-based treatment plans. The authors emphasize the importance of considering both the biological and psychosocial aspects of mental health, ensuring a holistic approach to patient care. With its clear, accessible language and evidence-based approach, 'Clinical Reasoning and Decision Making in Psychiatry' is an essential companion for psychiatric clinicians, residents, and all students, offering a robust foundation for delivering compassionate and effective care in the field of psychiatry.' Allan Young, Chair of Mood Disorders and Director, Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London
'Psychiatrists perform one of the most difficult tasks in medicine. In our training we must acquire knowledge and understanding of all the determinants of behavior and how to address symptomatic behavior. As clinicians we have one tool in which to assess and determine how to treat our patients, our minds. Drs. Goldberg and Stahl provide a conceptual guide as to how to address and order the information that we attain in our clinical interactions. They apply this guide to initial patient assessments where we develop diagnoses and therapeutic treatment plans and then to all the complex elements that affect our work throughout a course of patient treatment. This is not a volume that tells us what to do. Instead, it teaches how to engage in essential clinical thinking and hypothesis formation in all areas of practice. This volume provides the critical foundation as to how to be a modern psychiatrist.' Sidney Weissman, M.D., Clinical Professor of Psychiatry and Behavioral Science, Northwestern University/Feinberg School of Medicine; Emeritus Faculty, Chicago Psycho Analytic Institute; Past President, American Association of Directors of Psychiatric Residency Training
'A psychiatrist has to master a great deal of information – signs, symptoms, diagnoses, treatments and much more. However, information is not enough. The clinical process involves how to think, not only what to think about. This volume, by two expert clinical psychopharmacologists, shifts attention to this broader clinical process: coping with diagnostic ambiguity, determining the appropriate level of care, when and how to start, stop, change or end a course of treatment, how to construct a strategic plan that recognizes that treatment often doesn't work, how to evaluate whether it is working (including a primer on what a clinician can learn from research statistical methods), and finally, most important, how to include the patient in every step along the way. This book belongs on the shelf of every psychiatrist who has mastered the basics and is ready to become a seasoned expert, a consultant to others and, most of all, to his or her own work.' Robert Michels, M.D., Walsh McDermott University Professor of Medicine, University Professor of Psychiatry, Weill Medical College, Cornell University