(temazepam)Amore appropriate half-life

BOOK REVIEWSOne3().mg capsule. h.s.-usualadultdosage.One 15-mg capsule. h.s.-recommended initial dosagefor elderlyandlordebilitatedpatients.INDICATIONS AND USAO.: Restoril- (temaze­pam) is indicated for the relief of insomnia associatedwith complaints of difficulty in falling asleep. frequentnodurnal awakenings. and lor early morning awaken­ings. Since insomnia is often transient and intermit­tent, the prolonged administration of Restoril is gen­erally not necessary or recommended. Restoril hasbeen employed for sleep maintenance for up to 35consecutive nights of drug administration in sleep lab­oratory studies.

The possibility that the insomnia may be related to acondition for which there is more specific treaimentshould beconsidered.CONTRAINDICATIONS: Benzodiazepines maycause fetal damage when administered during preg­nancy. An increased risk of congenital malformationsassociated with the use of diazepam and chlordiaz­epoxide during the first trimester of pregnancy hasbeen suggested in several studies. Also. ingestion oftherapeutic doses of benzodiazepine hypnotics duringthe last weeks of pregnancy has resulted in neonata:CNS depression. Restoril is contraindicated in preg­nant women. Consider a possibility of pregnancywhen instituting therapy or whether patient intends tobecome pregnant.WARNINOS: Patients receiving Restoril (temaze­pam) should be cautioned about possible combinedeffectswith alcohol and other CNSdepressants.PR.CAUTIONS: In elderly and lor debilitatedpatients. it is recommended that initial dosage be lim­ited to 15 mg. The usual precautions are indicated forseverely depressed patients or those in whom there isany evidence of latent depression; it should be recog­nized that suicidal tendencies may be present and pro­tective measuresmay be necessary.

If Restoril is to be combined with other drugs hav­ing known hypnotic properties or CNS-depressanteffects. due consideration should be given to potentialadditiveeffects.Information for Patients: Patients receiving Restorilshould be cautioned about possible combined effectswith alcohol and other CNS depressants. Patientsshould be cautioned not to operate machinery or drivea motor vehicle. They should be advised of the possi­bility of disturbed nocturnal sleep for the first or sec­ond night afterdiscontinuing thedrug.Laboratory Tests: The usual precautions should beobserved in patients with impaired renal or hepaticfunction. Abnormal liver fundion tests as well as blooddyscrasias have been reported with benzodiazepines.Pregnancy: Pregnancy Category X. see Contraindica­tions.Pediatric Use: Safety and effectiveness in childrenbelow theageof 18years have not been established.ADV.RS. R.ACTIONS: The most commonadverse reactions were drowsiness. dizziness and leth­argy. Other side effects include confusion. euphoriaand relaxed feeling. Less commonly reported wereweakness. anorexia and diarrhea. Rarely reportedwere tremor. ataxia. lack of concentration. loss ofequilibrium. falling and palpitations. And rarelyreported were hallucinations. horizontal nystagmusand paradoxical reactions. including excitement, stim­ulation and hyperactivity.

Restoril is a controlled substance in Schedule IV.Caution must be exercised in addiction-prone individ­ualsorthOsewho might increasedosage.DOSAO. AND ADMINISTRATION: Adults: 30 mgusual dosage before retiring; 15 mg may suffice insome. Elderly andlor debilitated: 15 mg recommendedinitially until individual response isdetermined.SUPPLI.D: Restoril (temazepam) capsules-15 mgmaroon and pink. imprinted "ResToRIL 15 mg";30 mg. maroon and blue. imprinted "ResToRIL30 mg". Packages of 100. 500 and ControlPak- pack­ages of 25 capsules (continuous reverse-numbered rollofseaiedblisters). (RES-Z2 11/1181)

Before prescribing. see package insert for full productinformation.

Converging Themes inPsychotherapy: Trends inPsychodynamic, Humanisticand Behavioral PracticeEdited by Marvin R. Goldfried. New York.Springer. 1982.404 pp. $26.95.

• This book is a compilation of 25previously published papers thatfocus on subjects suggested by thetitle. The introductory chapter,written by the editor, summarizeskey points made by the ensuingpapers. Major sections of the vol­ume include "Common Ingredientsin Psychotherapy"; "Psychody­namic, Behavioral, and HumanisticTherapists Look at Other Ap­proaches"; "A Brief Look at Psy­chotherapy Outcome Research";and "The Interplay of Practice andResearch."

Throughollt the book the needfor rapprochement between thevarious psychological approaches isstressed. No single theoretical viewhas proven adequate to account forthe causes of psychopathology. Nodata support the overall superiorityof any single school in terms oftherapeutic efficacy. With morethan 130 types of psychotherapyavailable, it is obvious that sometype of convergence is necessary.

Another interesting perspectiveput forward is that curative factorsin psychotherapy may have little todo with one's theoretical orienta­tion. What a therapist actually doesin practice may be quite differentfrom what he says he does. Yetmembers of the various campsoften remain steadfast in their re­fusal to admit the value of differentapproaches. As Jerome Frank hasnoted, "Features which are sharedby all therapists have been rela­tively neglected, since little glory

derives from showing that the par­ticular method one has masteredwith so much effort may be indis­tinguishable from other methods inits effects."

In the final chapter the editordiscusses the idea that rapproche­ment between the various schools ismost likely to occur at the level of"clinical strategies," or by under­standing general principles ofchange. It is proposed that success­ful therapies work through similarmechanisms. Such shared mecha­nisms include the expectation thattherapy will help, enabling theclient to obtain a more objectiveperspective of self and the world,providing corrective experiences,and offering continued reality test­ing.

Many interesting ideas and in­sights are presented. As with manyvolumes that contain papers bymultiple authors, there is a certainfragmentation of purpose. Thebook focuses primarily on psycho­dynamic and behavioral schools,and the humanistic approach issomewhat neglected. Overall, it ef­fectively illustrates the need forrapprochement and illustrates thatmore clinical commonality existsbetween the different approachesthan is implied by their divergenttheories.

James Dietch, M.D.University of California, Irvine

Practical Management ofEmotional Problemsin MedicineBy Hugh James Lurie. New York. RavenPress. 1982. 272 pp. $24.

• Good readable texts are criticallyimportant for primary physicianswho care for patients with a variety

RES-1B3-2 A Pharmaceutical DivisionSANDOZ, INC.East Hanover. NJ 07936

162 PSYCHOSOMATICS

of psychiatric and psychologicalproblems. There are a number ofbooks currently available includingthe earlier edition of Dr. Lurie'sbook. The new edition is quitecomprehensive, with descriptionsof ways to make the office morepsychologically comfortable to thepatient, issues of various stages oflife, major psychiatric disorders,tests that can be used to diagnosepsychiatric illness, how to do be­havioral therapy, and a sectioncovering the mental health of thephysician. The chapters and sec­tions are clear and logically orga­nized.

The book is quite readable forsomeone without an extensive psy­chiatric background. One majorcriticism is the placement of themental status examination: insteadof including it with the interviewingstrategy at the beginning of thebook or before discussing majorpsychiatric topics, it is presentedpiecemeal over several sections.Part is covered in the section on theaging patient, suggesting that theonly time one would want to do athorough cognitive examination iswith older patients; the remainderis covered in the sections dealingwith major psychotic disorders,again strengthening the view thatmental status examination is neces­sary only for patients in whom psy­chiatric disturbance is apparent.This approach tends to obscure theusefulness of the mental status ex­amination as part of a routine ini­tial physical examination for anyhospitalized patient and also forproviding data in the initial evalu­ation of a patient in the office, al­lowing the physician to have someidea of the patient's mental capaci­ty and personality. This knowledge

FEBRUARY 1984 • VOL 25 • NO 2

could then be used to plan medicalmanagement with the patient moreeffectively.

The section on children is ratherlengthy and not very well done. Incontrast, the section devoted toacute anxiety, panic attacks, andchronic anxiety is relatively brief.Quite good are the sections onfamily and couples therapy andsexual counseling, which include alist of potential films for use ineducational settings, with couplesgroups, or with other groups.

Overall, I would recommend thisbook as a good basic text for use byprimary care physicians. It tends topresent a single approach to anygiven problem, which has advan­tages for those readers with littlepsychological training. However,the author does provide referencesat the end of each section for thosewho are interested in more in-depthmaterial.

In sum, this is one of the mostcomprehensive and yet readabletexts on the subject to be producedin the last few years.

Linda G. Peterson, M.D.University of Texas, Houston

Child Psychiatry: A Plan forthe Coming DecadesEdited by Irving Philips. Norberg Enzer.and Richard Cohen. Washington DC.American Academy of Child Psychiatry,1983. 115 pp. $5 (paperback).

• This short volume examineschild psychiatry in light of the so­cial and economic changes experi­enced by the United States over thepast decade. A paramount objec­tive was to clarify present and fu­ture roles for child psychiatry inregard to the mental health needsof our nation's youth. The descrip-

tions of child psychiatry as a pro­fession and its history are pleasant­ly concise and informative. Thepresentation of data related tocommon diagnoses and to type,duration, and length of treatmentfor 24 diagnostic categories is espe­cially useful.

Policymakers and planners in­volved with psychiatry will find thesurvey of private-practice childpsychiatrists of particular interest.It ranges over areas such as per­centage of time spent in varioustypes of work, attitudes towardtheir practice, training, and prob­lems encountered in private prac­tice. For example, 54% of the re­sponding child psychiatrists report­ed problems with lack of referrals;31 %, competition with other physi­cians; 60%, competition with non­physicians; and 73%, lack of anadequate range of community ser­vices. The last-mentioned was themost common problem encoun­tered by these private practice cli­nicians. The report also disputescommonly held beliefs about childpsychiatrists. For example, typicalchild psychiatrists work in cities ofless than 500,000, devote at leasthalf of their time to children andadolescents, and do not decreasethe percentage of their efforts withyoungsters as these practitionersget older.

The chapter on "PsychiatricNeeds of Children" depends heavi­lyon data from related studies.Much of this is openly attributed tothe inadequacy of presently avail­able incidence and prevalencedata. The findings thus generatedmust, of course, be superficial andgeneral. The two chapters both en­titled "Recommendations," al­though straightforward and unam-

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