2
Chapters follow on ICH, CRF design, data capture, planning, data validation, QA, performance metrics, data presentation, data coding including MedDRA an ICH standard), database design for central labora- tories, computer systems, software validation, re- engineering the CDM process, working with CROs, and data management in epidemiology and pharma- coeconomics. Not much dust is allowed to settle there, and the ®nal chapter on the future revisited breathlessly ushers in the electronic age as it all but leaps over the threshold. Already the world of clinical data management is moving the book towards a third edition, as the electronic data revolution, with and without the Inter- net, takes hold. There is plenty of reference to and advice on electronic data capture and transfer, electro- nic signatures, electronic document management and the like, but as yet little practical evidence of their successful implementation for the management of clinical research data, of their conversion to success- ful global product registration packages, or even of a reduction in the paper mountain. The digital age may be here, but utopia perhaps takes a little longer! The book is one of very few such publications and the authors are masters of their craft. It is written with all clinical researchers in mind, be they in academia, industry or government, and regardless of where in the world they are practising or which professional group in the clinical research team they represent. As a work of principle and practice, this book should be made available to all of them ± a de®nite buy. P. D. Stonier 5 Branstone Road Kew, Richmond Surrey, UK DOI: 10.1002/hup.285 Nicotine in Psychiatry: Pathology and Emerging Therapies. Edited by M. Piasecki and P. A. New- house. American Psychiatric Press, 2000. Pages 279. ISBN: 0-88048-797-6. The self-medication model for nicotine emerged around 12±15 years ago, and most chapters within this text re¯ect its in¯uence. The model is based upon the notion that nicotine can be used by disadvantaged individuals to relieve their psychiatric symptoms and other psychological problems. Over the years I have failed to ®nd solid evidence to support the self-medication model, so I read this book with con- siderable interest, hoping to uncover some empirical data which might answer my sctepticism. But this book fails to provide solid supportive evidence, and instead con®rmed my belief that nicotine dependency causes problems rather than solves them. The authors' belief in the utility of nicotine is stated in the fore- word, where Hughes calls nicotine a `renaissance drug ... able to do many things'. Piasecki's chapter continues in this positivistic frame, starting with two quotations about its supposed mood-enhancing quali- ties, including one from a commercial cigarette adver- tisement: `Alive with pleasure!' p 131). Piasecki reviews some of the extensive literature on the rela- tionship between smoking and mood control. The increased rates of smoking in depressed adolescents and adults are summarized, and possible reasons for these links explored. Three models are debated: that depressed smokers bene®t from using nicotine; that the link between smoking and depression re¯ects the common association with a superordinate factor socio-economic deprivation, low self-esteem, genetic linkage); and that nicotine dependency heightens depression. Piasecki tends to focus mainly on the ®rst two models, which is unfortunate because a large number of recently published prospective stu- dies support the third explanation. Thus although depressed adolescents are over represented amongst young smokers, many longitudinal studies show that taking up smoking lead to heightened stress and depression see McGhee et al., 2000, Addiction, 95: 491±504; Wu and Anthony, 1999 Am J Public Health, 89: 1837±40; Patton et al., 1998, Am J Public Health, 88: 1518±22; Goodman and Capitman, 2000, Pedia- trics, 196: 748±55). The reason for the adverse mood effects of smoking is that nicotine dependency causes mood lability and increases daily feelings of stress and depression. Regular smokers suffer poor moods without their nicotine, and the feelings of `relief' on smoke inhalation only re¯ect the restoration of nor- mal moods for a brief period Parrott, 1998, Addiction 93: 27±39; Parrott, 1999, Am Pyschologist, 54: 817±820; Parrott, 2000, JAMA, 283: 1959). There are, however, some areas where nicotine might be having useful or bene®cial effects. In parti- cular, its pharmacological pro®le would suggest a potential for cognitive enhancement. This book has sections on Alzheimer's disease, Parkinson's disease book reviews 361 Copyright # 2001 John Wiley & Sons, Ltd. Hum Psychopharmacol Clin Exp 2001; 16: 357±362.

Nicotine in psychiatry: pathology and emerging therapies

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