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The American Journal of Psychiatry, VOL. 160, No. 9

Book Forum: Neuropsychiatry | September 01, 2003

Neuropsychological Interventions: Clinical Research and Practice

MICHAEL R. TRIMBLE, F.R.C.P., F.R.C.Psych.

Am J Psychiatry 2003;160:1714-1714. 10.1176/appi.ajp.160.9.1714

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Edited by Paul J. Eslinger. New York, Guilford Publications, 2002, 360 pp., $50.00.

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As someone interested in neuropsychological interventions in the management of both neurological and psychiatric problems, and recognizing that their application sometimes requires a quasiphysical basis for understanding, it was certainly an intellectual jolt to open this book and to start reading a chapter on the theoretical basis of near infrared spectroscopy. Needless to say it was entirely incomprehensible to me, and the second chapter, "Instrumentation," was simply boring. How did all of this fit into neuropsychological interventions I wondered. It was not until page 18 that I then turned to page 17 (which followed it), when the book that I had been asked to review came into focus. More about that later.

Having no access to the main bulk of the introduction chapter on the theoretical basis of neuropsychological interventions, which I hope would be comprehensible and of interest and include the potential neurological and neurophysiological changes that occur with both psychological intervention and brain plasticity following injury, I proceeded with the rest of the book, unhindered by the threat of penetration of near infrared spectroscopy. Since the book possessed no contents table of relevance to my mission, getting a feel for the layout was at first difficult. The first half of this book is largely theoretical and covers neuropsychological assessments; the methods, reliability, and validity of assessing neuropsychological treatments; and the design and evaluation of rehabilitation experiments. The advice given is fairly standard, but for the neophyte the individual chapters provide a useful overview and would help outline strategies for those embarking upon research in this area.

The main bulk of the text relates to interventions themselves, essentially covering impairments of several cognitive domains. The topics chosen are attention, learning and memory, visuoperceptual impairments, language, apraxia, and so-called executive functioning. These are the most important areas of neuropsychological impairment that are impaired in patients with psychiatric disorders and particularly in patients with neurological damage. Each of these impairments forms a considerable bar not only to successful rehabilitation but also to attainment of satisfactory quality of life in those who are so affected.

The individual chapters are relatively comprehensive, although often rather light on the citation of published literature with a tendency to cite individual cases. The growing emphasis on the use of computers is an obvious trend, as is the use of what are essentially cognitive behavioral techniques in the attempt to alter aberrant behavior. A major difficulty is that there are no long-term studies in these areas; the data reported largely depend on what can be achieved between therapist and patient in the therapeutic situation as opposed to any gains when patients are back in their communities.

The whole text is rounded off by a brief summary of the current state of the art and a view of future directions. The potential for brain plasticity, particularly after damage, is a recurrent theme, but there is little discussion of the need for a multidisciplinary approach, including appropriate psychopharmacology, to these problems. Of course, psychopharmacology is not a theme of the book, and it is no criticism that alternatives take very much a backseat here. There is also hardly a mention of the other potential ways of altering CNS function and plasticity on the horizon, which, when combined with neuropsychological interventions, may prove to enhance their potential. In particular, the technique of transcranial magnetic stimulation would be considered in this context.

The book nicely summarizes an urgent area of patient care to which, perhaps, we have paid far too little attention. It may be because there is no industry supporting the technologies, or it may simply be that research design and application have been up to the present time a very difficult enterprise and demonstrating effectiveness of such interventions has been difficult. The book clarifies the difficulties and, overall, is a very useful guide to the way ahead.

My commiserations go to the editor, Paul Eslinger, who has done a nice job collecting the contributors together, avoiding much of the repetition one often finds in such a text, and generally providing chapters that are user friendly and easy to read. To go to such trouble and be let down by a negligent publisher can only be a disappointment. All those involved in producing this book should be ashamed; their production of a seriously flawed text, if it was in medical terms, would be seen as the equivalent of gross malpractice.

Reprints are not available; however, Book Forum reviews can be downloaded at http://ajp.psychiatryonline.org.

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MICHAEL R. TRIMBLE; Neuropsychological Interventions: Clinical Research and Practice. American Journal of Psychiatry. 2003 Sep;160(9):1714-1714.

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