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Essentials of Neuropsychiatry and Clinical Neurosciences

Dimitri Markov, M.D.

I am glad that I had an opportunity to review the Essentials of Neuropsychiatry and Clinical Neurosciences. For those of us who often wonder about the pathways, substrates, and neurotransmitters that underlie the varied psychiatric disorders we see every day, this book provides a guide through the human brain in a very practical and hands-on manner. This is an excellent reference book for psychiatrists.

An abbreviated version of the Textbook of Neuropsychiatry and Clinical Neurosciences, this volume is both thorough and comprehensive. The chapters are easy to read and ably synthesize complex information. The special and unique thing about this book is that every chapter focuses on connecting the psychological manifestations with corresponding brain processes, never straying from the goal of teaching us about the connection between neurological and psychiatric symptom profiles.

The book is organized from the standard clinical approach: the first part is about the assessment, the second and third parts are about disorders and diagnosis, and the fourth part is about treatment. In part one, the first chapter teaches the basics. It covers essential definitions and useful pearls of bedside examination, including identifying and localizing asymmetry, movement disorders, soft signs, and speech disorders (from dysarthria to aprosodia).

The third chapter makes structural neuroimaging incredibly understandable while providing the kinds of detailed explanations we need to understand what brain imaging is all about. The chapter includes clear pictures of normal and abnormal brains in different imaging modalities and clinically useful details such as indications for imaging, guidance for which sequence and contrast to request, and how to decode abbreviations on films. You will not find this topic covered so well in most other reference books. The fourth chapter provides a comprehensive overview of the functional neuroimaging techniques used in psychiatry and a good summary of the findings in various psychiatric disorders such as attention deficit hyperactivity disorder, schizophrenia, and mood and anxiety disorders.

The second part, titled "Neuropsychiatric Symptomatologies," provides an in-depth coverage of delirium, aphasia, memory, and amnesia. Authors of the chapter on delirium wrote original articles on the subject and perfected their ability to teach about delirium. The chapter is clear, comprehensive, and does a wonderful job of describing what exactly happens in the brain of a delirious patient.

The third part of the book, titled "Neuropsychiatric Disorders," contains 11 thorough and well-written chapters that describe neuropsychiatric aspects of strokes, seizures, traumatic brain injury, brain tumors, sleep disorders, and major axis I disorders. The chapters provide an up-to-date synthesis of research on how clinical symptoms are mapped to deficits in various brain regions. The chapter on sleep and sleep disorders gives a very nice overview, which is more than sufficient for the candidate to do well on the sleep portion of psychosomatic board examinations. Authors of the chapter on cerebrovascular disorders have previously made important contributions to our understanding of neuropsychiatric aspects of strokes. Once again, Robinson and Starkstein have written a wonderful chapter that includes comprehensive discussions of poststroke depression, mania, anxiety disorders, and psychosis. The chapter includes nice sections on emotional lability and catastrophic reaction to stroke.

Part four, "Neuropsychiatric Treatments," contains a chapter on pharmacological approaches and a chapter on cognitive rehabilitation and behavior therapy for patients with neuropsychiatric disorders. The chapter on pharmacological treatments includes a thoughtful section on how to think about and evaluate patients with neuropsychiatric deficits. The last chapter of the book, titled "Cognitive Rehabilitation and Behavior Therapy for Patients with Neuropsychiatric Disorders," provides a useful overview of how brain rehabilitation specialists approach patients who suffered acute brain insults of various types. With the exception of specialty texts, psychiatric books frequently omit information on this topic. Consultation-liaison psychiatrists often encounter patients in need of brain rehabilitation. This chapter provides a good overview of psychological modalities and their usefulness and limitations in various types of brain injuries.

The strengths of this book are its focus on the interface between neurology and psychiatry, the inclusion of chapters that are useful for the practice of consultation-liaison psychiatry but are frequently not encountered in psychiatric texts, and its clarity of discussion of the latest information on neuropsychiatry. The use of this volume lies in its ability to serve both as a resource book and a unique compilation of good chapters not found elsewhere. My suggestion to the editors is to consider including a chapter on the neuropsychiatric aspects of HIV/AIDS in the next edition.

FOOTNOTES

 
Dr. Markov is an instructor of psychiatry and human behavior in the Department of Psychiatry, Thomas Jefferson University, Philadelphia.

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