Psychosomatics 50:181-182, March-April 2009
doi: 10.1176/appi.psy.50.2.181
© 2009 Academy of Psychosomatic Medicine
Psychiatric Aspects of Neurologic Diseases: Practical Approaches to Patient Care
Edited by Constantine G. Lyketsos, Peter V. Rabins, John R. Lipsey, et al., New York, Oxford University Press, 2008, ISBN 13: 9780195309430, 435 pages, $39.95
Jason P. Caplan, M.D.
An initial skimming of this text prompted some surprise at a relative paucity of focus on neurologic illness. This prompted a more focused reading of the preface, which clarified that this is a volume primarily intended for neurologists who "would like to treat the psychiatric manifestations of neurologic diseases." As such, the text is predominantly focused on discussion of psychiatric illness, although for some diagnoses (e.g., chronic pain, dementia) the distinction is becoming increasingly irrelevant in current practice.
The book is divided into three sections: 1) psychiatric assessments and syndromes; 2) psychiatric aspects of neurologic diseases; and 3) psychiatric treatments. The first section includes a well-written overview of the psychiatric interview and mental status exam that would be worthwhile reading for any trainee. The remainder of the initial section of the book is devoted to discussion of psychiatric syndromes broadly based on DSM–IV classifications. I was pleased to see that in addition to formal psychiatric diagnoses, the authors also chose to discuss normal reactions to stressful circumstances often seen in medically ill patients (e.g., demoralization) that are all-too-frequently misinterpreted as signifying psychopathology.
The second portion of the book is divided by neurological diagnosis, with each section featuring a review of epidemiology, presentations, and treatment of associated psychiatric manifestations. Again, with neurologists as the primary intended audience for this book, there is little discussion of the neuropathology—the predominant focus is on psychiatric presentation. Although some of this information will be quite familiar to most consultation psychiatrists, some of the chapters (particularly those on traumatic brain injury, headaches and chronic pain, and cerebellar diseases) combine clinical pearls from both neurology and psychiatry that would prove useful to practitioners of either discipline. Puzzlingly, with entire textbooks devoted to the subject, the psychiatric manifestations of HIV/AIDS are relegated to a "grab-bag" chapter closing the section that also encompasses brain tumors, systemic lupus erythematosus, and Wilson’s disease.
The final portion of the book reviews psychiatric treatment, with chapters dedicated to various classes of psychotropic medication, electroconvulsive therapy, and psychotherapy. For the medication classes, each chapter reviews the mechanism-of-action, adverse effects, and approaches to treatment for those drugs. The information is thorough enough to allow for initiation of treatment for more straightforward presentations of psychiatric illness, but draws what many would consider to be a sensible line in advising referral to a psychiatrist for more complicated cases. The discussion of psychotherapy is quite brief, but likely contains enough information for a neurologist considering referral of a patient. More directly instructive information for neurologists is found in the final chapter, titled "Nonpharmacologic Interventions Other Than Psychotherapy." Here, Dr. Lyketsos reviews the aspects of patient education, day-to-day structure, and caregiver interventions that many consultation psychiatrists know to be especially useful in the treatment of patients with chronic neurological illness.
My only concern regarding this text is that it glosses over many of the interdisciplinary frustrations involved in the psychiatric care of neurologically ill patients. Many consultation psychiatrists will have experienced direct conflict with our neurology colleagues over what we believe are manifestations of neurologic illness (e.g., multiple sclerosis presenting with mania, psychosis due to complex partial seizures), only to be told that these are separate and unrelated events that require hospitalization "on your service." Although this text explicitly underscores the manifold psychiatric concomitants of neurologic illnesses, it does not address the frequent disagreements between our two disciplines over diagnosis and (for want of a better term) "turf." With some in neurology writing about these differences in an increasingly dismissive manner,1 the absence of acknowledgement of these conflicts here seems like a missed opportunity.
As the foreword of this book acknowledges, after a lengthy period of neglect, clinical psychiatric experience is again required during residency training in neurology. Since the psychiatric care of medically ill patients provides an excellent milieu for such training, it is likely that consultation psychiatry as a discipline will become more involved in the education of neurology residents. I would suggest that this volume is an excellent practical guide and core text for the psychiatric education of the neurology trainee.
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FOOTNOTES
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Dr. Caplan, incoming Book Review Editor for Psychosomatics, is at the Dept. of Psychiatry, St. Joseph’s Hospital and Medical Center, Phoenix, AZ.
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REFERENCES
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- Benbadis SR: The problem of psychogenic symptoms: is the psychiatric community in denial? Epilepsy Behav 2005; 6:9–14[CrossRef][Medline]
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