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Psychiatric Aspects of Neurologic Diseases: Practical Approaches to Patient Care
Reviewed by THOMAS M. WISE
Am J Psychiatry 2009;166:1194-1194. doi:10.1176/appi.ajp.2009.09030401
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edited by Constantine G. Lyketsos, Peter V. Rabins, John R. Lipsey, Philip Slavney. New York, Oxford University Press, 2008, 464 pp., $42.95.

This excellent clinical resource opens with the statement that psychiatry and neurology had their origins together and were linked by a “fascination with behavior in the broadest meaning.” Today these two disciplines overlap: many patients with neurologic diseases suffer from cognitive deficits, abnormal mood states, and difficult behaviors that are fundamental to their disease states or reaction to the illness, and psychiatrists are increasingly asked to help manage such patients. This book from the psychiatry faculty at Johns Hopkins should be in the library of both psychiatrists and neurologists.

The first section, “Psychiatric Assessments and Syndromes,” reviews the psychiatric examination and describes various psychiatric symptoms and syndromes. Demoralization, a common yet often misunderstood reaction to adversity, is increasingly recognized as a unique category in itself and is comprehensively described. This is a section that should be used by medical students during their psychiatric clerkships and by psychiatrists preparing for their general psychiatric boards.

The second section, “Psychiatric Aspects of Neurologic Diseases,” reviews elements of mind, mood, and behavior of a variety of neurologic disorders including stroke, traumatic brain injury, headaches and chronic pain, multiple sclerosis, and other disorders commonly seen by physicians. Each chapter is outstanding and outlines both the common psychiatric disorders that co-occur with a neurologic disorder and helpful treatment interventions. The chapter on pain reviews headaches but also chronic pain and provides excellent tables for analgesics. The chapter on traumatic brain injury reviews common problems in this syndrome, such as apathy, irritability, behavioral disorders, and depression, with an excellent table on various medications for each symptom complex. The caregivers of individuals with neurologic diseases are not forgotten and are briefly discussed within each chapter. The chapter on Tourette’s syndrome includes important information about children and adolescents who are often diagnosed with this troubling syndrome. Chapters on other disorders, whether common, such as Parkinson’s, epilepsy, and stroke, or less common, such as Huntington’s, allow the reader to easily obtain necessary information on presentation, course, and treatment.

The final section, on psychiatric treatments, covers in detail contemporary psychotropic medications and their uses and side effects. The chapter on the use of stimulants and dopamine augmenters is particularly helpful. Neuroleptics, anxiolytics, and mood stabilizers are included in this section.

Chapters on psychotherapy and other nonpharmacological interventions, which include the rationale for structured day treatment centers and psychoeducation, complete the volume. A glossary at the end of the book is useful. For example, “catastrophic reaction” is defined and a clinical example is provided. The book is issued in paperback and can fit into a lab coat pocket. All the chapters are carefully edited and presented in a clear and consistent writing style with judicious use of tables. Whatever the reader’s level of training, this book offers an up-to-date means of mastering a body of knowledge that is mandatory for any competent psychiatrist or neurologist.

+The author reports having served on the speakers bureaus for Eli Lilly and Pfizer.

+Book review accepted for publication June 2009 (doi: 10.1176/appi.ajp.2009.09030401).

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