Whenever another tome entitled ‘textbook’ or ‘manual’ of Geriatric Psychiatry is produced, the author or authors almost feel compelled to justify the compilation of yet another text, with aspirations to stand above or alongside other definitive guides, to this most wide range of subjects. Thakur, Blazer and Steffens highlight the need for a text written expressly for generalists in primary care and mental health, who represent the majority of practitioners providing care for older Americans with mental illness. With the increasing proportion of older adults in the population, future general care of people with mental illness will undoubtedly take on more of the attributes of the care of older people. It is suggested that busy clinicians from a range of disciplines may also rely on a practical field guide such as Clinical Manual of Geriatric Psychiatry to augment their care of older patients. The collective hopes and aspirations of the editors and the 21 other contributors to this work, are that their contributions to the field of mental healthcare of older adults come together as a volume that will be utilised regularly by busy professionals, and not be deposited on bookshelves or referred to only infrequently like other reference texts.

The Clinical Manual of Geriatric Psychiatry is organised into 11 chapters covering a broad span of topics ranging from delirium to psychopharmacology to the very welcome chapter entitled ‘Clinical psychiatry in the nursing home’ – a hitherto often neglected topic in other comparable guides. These under-served care sites (in respect of a lack of dedicated mental healthcare services) that are nursing homes deserve particular attention, owing to their relatively high prevalence of untreated and undiagnosed psychological morbidity. The initial chapter ‘The psychiatric interview of older adults’ sets the scene for the clinical underpinnings of the entire book with its emphasis on aetiological understanding and accurate assessment and diagnosis before treatment. The scope of the extensive chapter on psychopharmacology applicable to older adults, renders the text a valuable resource for practising and seasoned old age psychiatrists and geriatricians. This chapter summarises succinctly much of the evidence, albeit contradictory at times, in relation to published randomised controlled trials of antidepressants especially, and signposts the relative dearth of evidence for many other agents (particularly in respect of mood stabilisers), whose use and benefit may have been extrapolated from trials and clinical practices more applicable to younger adults.

Chapter 10 reviews the evidence for psychotherapy in older adults, giving consideration to both individual and group-based therapies and usefully evaluating this evidence in respect of the quality of data, its generalisability and the long-term effects of treatment. This chapter gives a glimpse into the complexity of the range of factors associated with older people’s mental health and the multiple determinants of well-being, as well as highlighting the therapeutic pessimism that underpins the failure to more fully utilise psychological therapies in older adults. The ‘invisible epidemic’ of alcohol and illicit drug use is fully fleshed out in a dedicated chapter in this book, made more pertinent by the growth of the heterogeneous ‘baby boom’ generation, which has reported higher rates of illicit drug and alcohol use and addiction than earlier ageing cohorts.

The referencing throughout the text is detailed and extensive and additional suggested reading is highlighted for topics that present themselves as worthy of further exploration.

The clarity and ‘readability’ of Clinical Manual of Geriatric Psychiatry reinforces any claim the editors may have for their text to be regarded as truly an interdisciplinary educational resource. Although the chapters do not adhere to a uniform structure and variation in the authors writing style is apparent, the key elements of each refer to aetiology, assessment and management in respect of each clinical issue under discussion, which will undoubtedly appeal to a medical audience. This is not to diminish the relevance of the text to a diverse range of disciplines who will find the succinct and concise accounts of the main syndromes to be illuminating and informative, assisting their therapeutic partnership with patients and participation in multidisciplinary teams.

The authors could be forgiven for omitting case histories in a text that aspires to be a manual rather than a definitive textbook, yet such illustrations of the heterogeneity of the presentation and narrative of mental illness can help the reader generally to understand the experience and impact of serious mental health difficulties. Any second edition of this book, which will undoubtedly be needed, might focus more on the many ethical and legal issues applicable to the psychiatry of later life. Ethical debate is at the heart of everyday clinical work, and while the many legislative frameworks underpinning good ethical practice could not be readily distilled into a text, especially one to be circulated beyond the United States, the particular experience of US-based clinicians would still be of interest to a more global readership. A chapter explicitly focused on a framework for recovery-oriented practice and the maintenance of positive mental health for older people could also be a useful inclusion for a second edition. This is of increasing importance for a specialty that has in the past been beset by widespread therapeutic pessimism and professional ignorance leading to under-treatment of patients, reducing their quality of life, and the maintenance of stigma and prejudice. Some readers in jurisdictions other than the United States may also take ongoing issue with the term ‘Geriatric’ in the title of this book and other manuals, where this term referring to the healthcare of older people may have pejorative connotations and thus terminology with less ageist or offensive overtones is often preferred. This is certain to reflect cultural and linguistic differences rather than any ageist bias by the authors, but illustrates a healthy debate and ongoing effort by many professionals working with older patients, to use language that is value free, precise and accurate and is not just politically correct or petty semantics.

In summary, this text is a comprehensive, practically relevant and user-friendly guide to the field of mental healthcare of older people. It is a condensed volume of less than 300 pages that, nonetheless, represents a formidable piece of scholarship and achieves the status of being a valuable field guide for practising clinicians that will avoid the dust accumulation and shelf residence that has befallen similar titles.