The Bethlem & Maudsley NHS Trust Prescribing Guidelines 5th Edition 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.