Antipsychotics and their Side Effects Edited by David M. Gardner and Michael D. Teehan Cambridge University Press, 2010, £35.00, pb, 228 pp. ISBN: 9780521132084

The first section of this book comprises 20 chapters reviewing specific side-effects of antipsychotics. In addition to well-known side-effects such as hyperprolactinaemia, extrapyramidal symptoms, weight gain and diabetes there are chapters on relatively ignored side-effects including urinary incontinence, ocular effects and hepatic effects. Information is clearly laid out and the Extrapyramidal Symptom Rating Scale included as an appendix is a useful addition. Data from several recent and important randomised controlled trials are discussed; this includes the CATIE study in chronic schizophrenia and the CAFE study in patients with first-episode psychosis. However, there is little mention of side-effect data from recent meta-analyses, which could have informed the discussion on relative risk. In addition, there are no data on the side-effect profile of amisulpride.

The second section provides side-effect monitoring schedules for 22 antipsychotic drugs. The schedules only differ in the suggested frequency of monitoring of certain side-effects. With a few notable exceptions, the most obvious being clozapine, I felt it was unnecessarily complicated and unrealistic to suggest different monitoring schedules for each drug.

The final section of the book presents a general antipsychotic monitoring form that allows clinicians to record side-effects on a regular basis during treatment. This may act as a prompt and also to facilitate the tracking of side-effects over time.

Unfortunately, the book has a major weakness: there is no information on the management of side-effects. Once an apparent side-effect is detected, a clinician must try to determine whether it is a true side-effect or has causation independent of the suspected antipsychotic drug. The impact on the patient needs to be assessed and various management options considered, with the patient being fully involved. These issues are not taken into account. In addition, the practical challenges of side-effect monitoring, including integrating the role of primary and secondary care, are only discussed briefly.

Antipsychotic side-effects can impair quality of life, contribute to poor adherence and in some case lead to secondary physical health problems. Audits have repeatedly shown that the monitoring of antipsychotic side-effects in clinical practice is poor. This book will certainly help address that by raising the profile of antipsychotic side-effects and systematic monitoring, yet the lack of guidance on management reduces its clinical utility.