This is a book written by a man with a mission: to improve clinicians' awareness of extrapyramidal side-effects and their relevance in routine clinical practice, and encourage systematic classification and descriptive terminology. He may also be hoping to disabuse anyone holding the distorted notion that while tardive dyskinesia is a malignant complication of anti-psychotic drugs, the acute extrapyramidal side-effects (Parkinsonism, acute dystonia and acute akathisia) tend to be transient and relatively benign. This is a worthy mission, as acute extrapyramidal symptoms are commonly unrecognised or misdiagnosed in routine clinical practice, to the detriment of patient care. A recurring theme is the relative neglect of the subjective aspects of drug-related movement disorders and their adverse clinical consequences. Despite the increasing use of atypical antipsychotic drugs with a lower liability for motor disturbance, the author argues convincingly that such problems should remain a core concern of psychiatrists.

Each of the extrapyramidal side-effects (the acute problems as well as tardive dyskinesia and tardive dystonia) is covered in detail, with sections on epidemiology, risk factors, course, pathophysiology and treatment. The clinical features of the conditions are considered in detail, and illustrated with case vignettes. In these sections particularly, the author's thoughtful approach and clinical knowledge in this area are most apparent. Perhaps most fascinating are the scholarly, historical accounts, which include early descriptions of the conditions. These allow the author the opportunity to try and rectify common misconceptions about these disorders, and point out how some descriptive terms have been misused. Overall, the chapters on acute and tardive dystonia and Parkinsonism are probably the most authoritative, whereas the akathisia chapter, particularly the comments on pseudoakathisia, are less so. One disappointment is that there is not more in the book about the relationships between the extrapyramidal side-effects.

One of the author's key aims is to promote the careful assessment of extrapyramidal side-effects. To this end he provides an invaluable, step-by-step description of a systematic, clinical examination, doubtless honed by his own clinical experience. Further, he usefully reviews the principles relevant to the evaluation of the extrapyramidal side-effects, and addresses the limitations and advantages of some of the standardised rating scales available.

This book is resolutely clinical in focus, for example, spending more time on treatment approaches than pathophysiological theories. It is written in an informal, readable style, although some might find the liberal use of exclamation marks and quotation marks (to denote some ironic connotation, slang word or inappropriate use of a term by another author) a little tiresome. Nevertheless, it is an essential volume for anyone considering research in the area of extrapyramidal side-effects. It is also to be recommended to anyone involved in the care of people receiving antipsychotic medication. If the author fails in his mission it will not be because of the excellent book he has written but rather because not enough psychiatrists and other mental health professionals have read it.