"Neuropsychiatry” has become a popular term that has been appropriated by large numbers of psychiatrists who have in common the belief that the brain is the organ of behavior. Neuropsychiatrists share the theory that biological processes, including cognition, mood, memory, speech, and language, underlie consciousness. This is distinct from behavioral neurology, which appeared historically as a lesion-oriented field, distinct from psychiatry.
Psychiatry and psychology have been heavily influenced by Freud, focusing on unconscious psychological mechanisms (not being accessible to scientific testing by the physiological methods of their time), which have proved inadequate either to advance the science of consciousness, or to effectively treat serious mental illnesses. Neuropsychiatry, according to Mitchell in this new textbook, deals with the question: “What are the psychiatric and behavioral consequences of neurological conditions that affect the brain, and how can these consequences be explained?” The book begins with a foreword by W.A. Lishman, author of the classic work Organic Psychiatry, now in its 3rd edition.1 Lishman’s groundbreaking work is now a classic compendium of mind/brain relationship, incorporating the fields of neurochemistry, neuroendocrinology, neuropharmacology, neuropsychology, neuroimaging, and neuropathology.
In the period since Lishman’s epic work first appeared, fiber tracking and functional imaging, genomics, and histology in the realm of DNA, RNA, and mitochondria, have revolutionized the thinking about psychiatry. Clearly, this enormous burgeoning of complex detail could not even be surveyed, much less mastered, by a busy practicing psychiatrist. Even with an index of the thousands of articles that appear regularly in the world literature of neurology, psychiatry, psychology, and incorporated areas of study, including every branch of medicine, a study guide is essential. This excellent new text by Alex J. Mitchell, formerly Lecturer in Psychiatry, University of Leeds, and now a consultant in Liaison Psychiatry at Leicester General Hospital in the U.K., provides a remarkably concise and useful review of current knowledge in neuropsychiatry. Not an encyclopedic work like Lishman’s text, Organic Psychiatry, it is, rather, a book for those of us who are still trying to learn those essential facts that are necessary for the proper diagnosis and treatment of patients with brain malfunctions, whether they are labeled psychiatric or neurological.
The book is easy to read, with practical information, colorful and clear tables and diagrams, as well as full-color illustrations where nothing else will do, as in SPECT with overlay MRI, or such illustrations as microscopic slides of negri bodies in a rabies-infected neuron. I have always admired the prose style of British medical writers, and Dr. Mitchell is a prime example of that great scientific tradition going back to Thomas Willis and Joseph Lister.
This book is composed in a style that is designed to be read, not simply referred to. It is, therefore, ideal for students at any level. There are many useful references to supporting literature, without attempting to be over-inclusive in scope. The practical aspects include flow-charts for differential diagnosis, and lists and tables that appear throughout the book in a format that should be most appealing to those studying for their board exams or those who in practice every day and need a convenient source to help find material for a differential diagnosis.
The book is divided into five sections. The first section discusses the foundations of neuropsychiatry and the tools of clinical assessment. These include epidemiology, mental state examination, physical examination, and other investigations; the assessment of cognition, including consciousness, intelligence, orientation, attention, memory, speech, and language, followed by the regional cerebral syndromes of the frontal lobe, temporal lobe, parietal lobe, occipital lobe, and basal ganglia and subcortical areas. Section 2 discusses the core neuropsychiatric disorders: multi-focal, basal ganglia, CNS infections, miscellaneous CNS disorders, and CNS toxins. The third section discusses delirium and dementia. The fourth section contains evidence-based review of treatments in neuropsychiatry, and, where controversy exists, it is identified. It discusses, for example, in Chapter 48, “Treatment of Patients With Epilepsy,” which begins with a discussion of the neurological management of epilepsy, broken down into partial seizures, generalized seizures, epilepsy and learning disability, adverse effects on the CNS of anti-epileptic drugs, refractory epilepsy, and emergency treatment. This is followed by a discussion of the treatment of the neuropsychiatric complications of epilepsy, including mood disorders, with antidepressants and mood stabilizers; and psychosis, with antipsychotics. Very useful is the section on the effect of psychotropics on seizure threshold, followed by a summary of management of the neuropsychiatric complications of epilepsy, broken down into 10 useful suggestions. Chapter 69, “The Origin of Cognitive Impairment,” discusses mechanisms of memory, and delirium and its treatment. Other chapters include discussions of obsessive-compulsive symptoms, the neurobiology of appetite and weight, stress biology, and somatoform disorder. Malingering and pseudoseizures are among the many areas covered.
I particularly appreciate Appendix 1: “Historical Landmarks in Neuropsychiatry,” a seven-page list of the great scientists on whose shoulders we stand as we peer into the future. I did not know that, in 1825, Jean E. Esquirol distinguished between delusions and hallucinations, or that, in 1855, Bartolomeo Panizza showed that the occipital lobe is essential for vision. Of course, Broca, in 1878, and Kraepelin, in 1883, are listed in this chronology. Likewise, we learn that Heinrich Irenaeus Quincke, in 1891, introduced the lumbar puncture. The chapter ending the book, “Maxims of Neuropsychiatry, Revisited,” provides evidence for many of those rules-of-thumb that we learned in medical school and residency, such as: “Any significant brain lesion can cause diverse neuropsychiatric complication,” or “Psychological symptoms may manifest before neurological symptoms of neurological disease,” or that “Neuropsychiatric complications arise from a combination of organic and non-organic factors.” It is difficult for me to restrain my enthusiasm about this text, having for years struggled with books that are no more than catalogs of disease, or, conversely, philosophical treatises. In this age of the Worldwide Web, no bibliography would be complete without the appendix of databases, web addresses, and electronic sources presented by Dr. Mitchell. I would place this book on my shelf next to Lishman’s Organic Psychiatry and my two-volume Comprehensive Textbook of Psychiatry.
Psychosomatics 48:181-182, April 2007
doi: 10.1176/appi.psy.48.2.181
© 2007 Academy of Psychosomatic Medicine
