BOOK REVIEWS: Textbook of Neuropsychiatry and Clinical Neurosciences. Sixth Edition
The scientific specialty of clinical neuroscience has developed into the rational branch of psychiatry. It represents the intersection of neurology and psychiatry that is based at the level of molecular and anatomical models. This is an area that too many clinicians are complacent about and glad to ignore. The editors of this book are knowledgeable experts in the fields of neuropsychiatry and behavioral neurology. They have gathered more than 30 leading authors in the arena of neurobehavioral medicine to assemble a book worthy of publication by the American Psychiatric Association.
The text begins with a chapter on cognition, emotion, and behavior based on sound biological principles. This is largely a review of neuroanatomy and functional connections. This early portion of the text is well illustrated and clearly written by David B. Arciniegas, MD, C. Edward Coffey, MD, and Jeffrey L. Cummings, MD, ScD, in a straightforward, easy-to-read manner, and they review the topic well enough to form the introduction of the subsequent clinical material. I found this chapter to be much less “circuitoriented” and more of a general guide to the clinical basics of neuropathology and behavior than some of Dr. Arciniegas’s previous writings.
After the initial reviews of anatomy and function, the next 100 pages or so discuss assessment. This is broken down into the arenas of neuropsychiatric evaluation and psychological and medical testing in the forms of neuroimaging and diagnostic neurophysiology. The utilization of CT, MRI, and positron emission tomography are briefly described. These chapters are well written, but may be too brief for some specialists and too dense in detail for the novice student. The portions on imaging carry numerous illustrations. The presentation of these illustrations comprises more than 20 pages worth of diagrams and images. Although this large grouping of illustrations is awkwardly sandwiched into the book, it contains enough quality material to make up for the location.
The neuropsychiatric exam is described in fine detail. It contains references to its origins and the diagnostic significance of various signs, symptoms, and terminology. The correlation of clinical signs to symptoms and anatomical aberrations is well done and constitutes a reasonable reference guide for teaching and clinical use.
The effects of various cortical insults upon behavior are well covered. The explanation about the effects of injuries to subcortical locations and afferent pathways is also quite good. I found the material covering infectious disease in the nervous system to be both historically and clinically interesting. In this area, topics of infectious neuropathology ranging from the psychiatric syndromes associated with syphilis to those found with human immunodeficiency virus are well described. The neuropathology, clinical presentations, and treatment of underlying disease entities are all appropriately described. This methodology reflects the organizational style of the textbook. The division of psychiatric symptoms into syndromic descriptions is valuable, as are the reviews of the organic causes of psychosis, mood disorders, and anxiety.
This text brings rational medicine back to the field of psychiatry. It is a much-needed reference for all clinicians and medical educators. I enjoyed this book and found it a refreshing break from the softer genres of behavioral theories and self-help books that one could find in any bookstore. I highly recommend it.
DISCLOSURE: The author reports no financial relationships with any companies whose products are mentioned in this article, or with manufacturers of competing products.
James Allen Wilcox, MD, PhD
University of Washington
Seattle, Washington, USA
Edited by David B. Arciniegas, Stuart C. Yudofsky, and Robert E. Hales; Washington, DC; American Psychiatric Association Publishing; 2018; ISBN 978-1-58562-487-4; pp 653; $259 (hardcover).