August 2009  << Back  

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The Spectrum of Psychotic Disorders: Neurobiology, Etiology, and Pathogenesis

James Allen Wilcox, DO, PhD

University of Arizona, Tucson, AZ, USA

This book is on a fascinating topic. The editors have assembled a group of leading experts who review psychotic conditions from many different angles. With this approach, the bad habit of seeing psychosis as a functional disorder is refined and the reader can clearly view this condition as a symptom complex that could arise from a variety of causes. This is the excellent premise from which the text develops.

Edited by Daryl Fujii and Iqbal Ahmed; Cambridge University Press; New York, NY; 2007; ISBN: 978-0-521-85056-8; $150.00 (hardcover), 572 pp.

The editors begin with topics in schizophrenia and mood disorders and then rapidly move to the more coarse organic causes of psychosis. This is well handled as the quality of symptoms is important to the differential, and this issue is laid out in the first 20 pages. The second portion deals with symptoms of false perception and thought disorder often seen in epilepsy, stroke, tumors, and inflammatory processes. The experience of hospital consultants demonstrates that many medical conditions ranging from urinary tract infections to massive “silent” tumors cause a variety of delirium and transient psychoses. My only criticism of this section is that it could have been longer. A bit more detail would have helped young clinicians looking for more meat on these topics. For experienced clinicians, the section was sufficient and enjoyable to read.

Midway through the text the topics change to drug-induced psychosis. This section runs about 40 pages. This is a valuable addition as this problem is very common and often poorly treated. An interesting chapter on cannabis-related mental status problems is included in this section, followed by excellent chapters on cocaine and methamphetamine abuse. We often deal with stimulant-induced syndromes of psychosis, and the authors cover this topic quite well. They discuss epidemiology, risk factors for decompensation, and treatment. The last part of this section deals with iatrogenic causes of psychosis.

Considerable media attention has been given to the misuse of prescription drugs and to physician error. The section has many useful references and would be a great help to emergency room physicians. Many medical professionals prescribe liberally and forget the intoxicating side effects of their work. I have consulted on “psychotic” patients who were simply delirious from polypharmacy. To the amazement of attending physicians, these individuals improved when their medications were decreased. With so many people on so many drugs, this is a much-needed addition to any book dealing with the spectrum of psychosis.

The last segment of the book deals with psychosis seen in neurodegenerative disorders. Problems with Alzheimer’s disease, Lewy body dementia, and Parkinson’s disease are dealt with in this portion. The last part examines psychosis associated with sensory impairment. Since the advent of brief psychotherapy and relatively benign psychotropic medications, many psychiatrists have forgotten their roots in neurology. The diseases noted above are becoming increasingly common. A good review of dementia and or neurodegenerative conditions is vital in any text on psychotic conditions. I wish this section were longer and more detailed, but it is sufficient for a book of this kind. This is generally an enjoyable and informative reading experience.

This book is an excellent addition to the clinician’s library. It is set up to contain epidemiological information on age of onset, genetics, risk factors, and ideas to consider for each case of psychosis mentioned in this review. The reading is quick and precise. Treatment options and risk reduction strategies are offered for each scenario. It is well written and contains excellent references. This book could be considered a brief textbook about the differential diagnosis of psychosis. It should be available to all teaching hospitals and consult services.