Organic Psychiatry: The Psychological Consequences of Cerebral Disorders

Behavioural Neurology, Jul 2018

A. R. Mayes, D. Montaldi

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Organic Psychiatry: The Psychological Consequences of Cerebral Disorders

0953-4180 This is the third edition of Lishman's classic textbook of organic psychiatry. The first edition appeared in 1978, the second in 1987, and this one appeared in 1998 so there has been about ten years between each edition. Each edition has been substantially updated and rewritten and the changes made have accurately reflected the marked developments that have occurred in this field of science over the past two decades. It is a pleasure to see how truly Lishman's writing has reflected these advances in our knowledge. The book is not a text about biological psychiatry in that it is not focally concerned with describing what possible biological mechanisms may underlie psychiatric disturbances nor does Lishman want to use the term 'neuropsychiatry' for two reasons. The first is he wishes to consider not only neurological and therefore direct disturbances of brain function that cause psychological impairments, but also endocrinal, toxic and metabolic disorders which are normally the concern of general medicine and cause psychological impairments because they indirectly lead to disturbed brain function. Second, he wishes to avoid the negative connotation which 'neuropsychiatry' sometimes conveys of being a weak amalgam of the interfacing regions of neurology and psychiatry. The term 'organic psychiatry' is intended instead to include all those disorders where, following detailed investigation, it is very likely that a cerebral or systemic pathology will be found to be playing a central role. This definition is clearly met by the disorders and themes covered by the chapters in this third edition. Disorders discussed include head injury, tumours, epilepsy, intracranial infections, cerebrovascular disorders, the dementias, endocrine and metabolic disorders, vitamin deficiencies, toxic disorders, movement disorders, as well as some rare or exotic disorders such as myasthenia gravis, amyotrophic lateral sclerosis, and Kuru. Themes incorporated in the discussions include differential diagnosis, functional and structural neuroimaging, and molecular genetics. The structure of the latest edition is the same as the previous edition and the broad topics covered are basi- - Book review cally the same although the second edition had little to say about neuroimaging, which has expanded explosively in the past decade, and there was little coverage of molecular genetics of which the same can be said. In contrast, the present edition has a great deal to say about these topics as well as about exciting new developments in differential diagnosis and the clarification of disease mechanisms. The expanded coverage of the new edition is well illustrated by the chapter on the dementias, which apart from having an updated review of Alzheimer’s disease, now has additional sections on more recently identified disorders which include Lewy body dementia, frontal lobe dementia, and an extended range of prionrelated disorders. The review of Alzheimer’s disease reflects improved knowledge of histological features such as beta amyloid. As beta amyloid development has been related to the presence of genetic factors that lead to Alzheimer’s disease, it is good to see that there is also coverage of recent advances in molecular genetics. Reference is made to variants of the APP gene, to ApoE4, and there is even a brief reference to the work that has led to the confident identification of presenilin1 and presenilin-2, which have been linked to certain early onset forms of the disease. In another ten years no doubt there will be an extended list of genetic culprits not only for this form of dementia, but for many other organic brain disorders the molecular genetics of which are currently being vigorously investigated. A particularly helpful feature of the chapter on the dementias is the focus on the operational criteria used to differentiate between the different dementias. Once again, one would suspect that by the end of the next ten years, many more kinds of dementing condition will have been identified. It will also be possible to make the critical differentiations in vivo more confidently than at present when post mortem analysis is so often vital. Neuroimaging work is also well covered in the latest edition. This coverage includes SPECT, PET, and ERPs, as well as both structural and functional MRI (which it is good to see now takes the more recent name of MRI rather than the NMR of the previous edition). Among the examples of functional MRI included is the work of David and his colleagues at the Institute of Psychiatry which pioneered the functional exploration of hallucination in schizophrenia. This work suggested that the occurrence of verbal auditory hallucinations specifically inhibited the regions that are normally activated by auditory inputs. There is a beautiful illustration of this study in one of the plates that appears in the volume. The nineteen plates (largely coloured), which can be found in the present edition is another welcome addition to the textbook. The results of functional neuroimaging studies are also described in many other areas which include epilepsy, head injury, dementia, alcoholism, migraine, Gilles de la Tourette’s syndrome, panic disorder, and Parkinson’s disease. In summary, we recommend the latest edition to anyone with an interest in the effects of direct and indirect brain disorders on psychological functions. It provides a superb text which can be dipped into to update one’s knowledge on an extraordinarily wide range of conditions. Furthermore, the coverage is very upto-date although inevitably this will be considerably less true by 2008 when we hope we can see a fourth edition from Professor Lishman’s retirement years. A.R. Mayes and D. 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A. R. Mayes, D. Montaldi. Organic Psychiatry: The Psychological Consequences of Cerebral Disorders, Behavioural Neurology, DOI: 10.1155/1999/989647