BOOK REVIEWS 77

The Psychiatric Mental Status Examination. P. T. TRZEPACZ and R. W. BAKER. Oxford University Press. Oxford. 1993. No of pages: 202. Price: f30.

Examining a patient whilst taking a history is a skill most British graduates learn within two weeks of starting their house jobs. For psychiatrists this is an everyday activity but also requires that specific questions be asked to elucidate or exclude phenomena at some point of the interview. This aspect of psychiatry is often difficult to grasp for students and trainees alike. The codification of the phenomena observed into the common language of psychiatrists often seems a difficult and impenetrable art. The authors aim at clarifying this process for the tyro and also to provide a reference for more experienced practitioners.

The book opens with useful chapters on interviewing the patient before embarking on detailed description of all possible phenomena under the standard headings of the mental state. As most phenomena in psychiatry are non-specific and only make sense when grouped together their individual description and likely diagnostic signifi- cance rapidly becomes a repetitive and stodgy read. The rather odd grouping of thought process, content and per- ception together is notjustified and leads to oddities such

as the description of an hallucination as a ‘perceptual disturbance occurring as a n internal thought . . .’. Do people perceive or only think they perceive? Without a discussion of the authors views of the psychology of per- ception this is unlikely to help a novice or a more exper- ienced clinician looking for clarity.

Each chapter ends with a series of definitions of terms which help clarify some issues but confuse further as some appear under more than one section with differing definitions (eg agitation is both a mood state and a behav- iour). The discussions of apathy, abulia and akinesia equally serve to confuse rather than clarify. The chapter on cognitive assessment is precise and useful for fireside assessment. The book concludes with a number of case vignettes with model mental states but without comment and no encouragement for the student to construct their own before referral to the text.

Overall the book whilst good in parts is unlikely to aid trainees charting these difficult waters for the first time or clarify more abstruse points for experienced clini- cians. Given its price it is unlikely to unseat the current ‘best sellers’ in the field.

CHRIS BALL London Hospital Medical College

VIDEO REVIEW Care to Make a Difference. Alzheimers Disease Society Open Learning Programme, 1994.

Helping care staff who work with people with dementia to develop their skills and healthy attitudes towards their work needs the commitment of managers at operational and strategic levels.

From my extensive work with care staff and managers in residential and day care settings, I have observed more positive outcomes when training staff in their teams within their particular units.

The ADS video learning programme ‘Care to Make a Difference’ is potentially an excellent video which could be used to help care staff and their managers to change their working practices. Its use as a training resource would be limited if the unit managersiteam leaders were not involved with the programme.

The video has been thoughtfully and sensitively pro- duced, but it is bound to raise organizational issues. Its

use would therefore be limited if an individual care worker used the video learning programme in isolation without the involvement of other team members and their manager.

The video learning programme could be used in staff induction as well as ongoing staff development. Unfortu- nately, staff can only become accredited ‘care workers with a difference’ if they are successful in completing a multiple-choice questionnaire. This will preclude a pro- portion of care staff who are anxious about their literacy skills. Completing the learning programme, however, will provide supplementary evidence for people working to- wards their NVQs in care.

The video is refreshing, authentic and also a poignant reminder for qualified people of the importance of one’s attitude and approach and the difficult and complex task with which care workers are charged. Managers and cli- nicians could also learn from the video, as well as care workers in a variety of work settings.

BARBARA GREY Lewisham and Guy’s Mental Health Trusr