Textbook of Clinical Neuropsychiatry

This is a very good book that compares favorably with the magnificent Organic Psychiatry by W.A. Lishman, now in its third edition (1). For most neuropsychiatrists, Lishman’s is the seminal textbook in contemporary neuropsychiatry. When it first appeared in 1978 it reestablished neuropsychiatry as a field and fostered the development of this subspecialty, denied official status in spite of thriving from research and clinical perspectives. With this homage as prelude, I can state that David Moore’s Textbook of Clinical Neuropsychiatry is a very worthy and useful addition to available neuropsychiatry texts. It is eminently readable, well organized, and thorough. No psychiatrist or psychiatry resident acquiring this book should be disappointed.

The text, organized much like Harrison’s Principles of Internal Medicine(2), is divided into three sections: Diagnostic Assessment; Signs, Symptoms, and Syndromes; and Specific Disorders. Many of the chapters are followed by hundreds of references, which total more than 4,000. Tables and images enhance the text. Each topic is organized to cover its pathology and etiology, clinical features, course, differential diagnosis, and treatment. The writing style is tight and focused. Overall, this is very comprehensive coverage of neuropsychiatry. Especially appealing are the extended quotations from the pantheon of immortals in neuropsychiatry such as Alzheimer, Binswanger, Bleuler, Hughlings Jackson, Kraepelin, Lhermitte, and S.A.K. Wilson.

Part 1 includes summaries of interview techniques, the mental status examination, and the neurological examination. The fundamentals of computerized tomography and magnetic resonance imaging (MRI) are presented with very useful discussions of about a dozen conditions where obtaining an MRI is essential. An excellent, extended discussion of the EEG covers all any psychiatrist needs to know about this underused tool. These portions will help to counter the prevailing tendency to overvalue trivial “findings” on MRI and ignore incorporating EEG results into our assessments.

Part 2 is possibly the strongest section of the book. Moore provides clear descriptions of a plethora of “cortical” signs and symptoms. Included are language disturbances, apraxias, agnosias, aprosodias, and neglect phenomena with all their subtypes and subtleties. A major strength of this entire section is the discussion of differential diagnosis of each syndrome. These discussions help the reader appreciate the clinical context wherein these syndromes are found. The same format applies to movement disorders, which are also well described. Entire pages are needed to list the causes of tremor, myoclonus, tics, chorea, and parkinsonism, indicating the completeness of coverage. There is a very good section on catatonia, a relatively neglected topic in some texts. Naturally, there are extended discussions of dementia, delirium, and amnesia, again with an emphasis on the differential diagnosis.

Moore describes a large number of intriguing behaviors, such as “foreign accent syndrome,” abulia, mutism, utilization behavior (with an excerpt from Lhermitte), pseudobulbar palsy (with excerpts from S.A.K. Wilson), excerpts from Kluver and Bucy regarding their syndrome, alien hand sign (a personal favorite of mine), and le fou rire prodromique—uncontrollable fits of laughter without mirth that are a precursor of sudden death. A fascinating case of a bilingual patient who developed a motor aphasia in Spanish and a sensory one for Hebrew is included. Cogent descriptions of topographagnosia, simultanagnosia, and asomatognosia are instructive in showing how rather weird, nonunderstandable phenomena can have a neurological basis and how labeling them as psychiatric would be quite unfortunate. More applicable to most practices are the sections on the differential diagnosis of depression, mania, anxiety, psychosis, and personality change. The longest sections in this part of the book are on seizures and epilepsy. As the author of a previous book on this subject (3), Moore does a brilliant job of describing the different epilepsies and their etiologies. A good example is the discussion of amnestic seizures, which includes an extended quotation from Jackson’s famous case of Dr. Z. Moore quotes Bleuler’s 1924 description of the interictal personality syndrome, which is now more frequently known as the Geschwind syndrome in honor of the most distinguished behavioral neurologist of the past half century.

Part 3 contains 15 chapters and discusses more than 100 specific disorders. The most extensive coverage is given to neurodegenerative, congenital, vascular, nutritional, toxic, metabolic, and infectious disorders. The chapter on sleep disorders is an excellent introduction to extremely common conditions that often complicate the management of primary psychiatric disorders. The descriptions of clinical features are simply brilliant. In very clear and concise terms, Moore brings neuropsychiatry alive. This delightful writing extends to the chapter on idiopathic psychotic, mood, and anxiety disorders.

There are a few gaps in coverage that should be pointed out. There is sparse coverage of pseudodementia, psychogenic amnesia, and pseudoseizures other than the medical workup for the latter, which is quite excellent. I will now add serum levels of neuronal-specific enolase when pseudoseizures are a consideration. There is virtually no discussion of somatoform disorders, malingering, or conversion disorders, which are problems seen in a healthy percentage of patients referred to neuropsychiatrists. In essence, Moore has made the text decidedly medical and neurological. Issues concerning psychological understanding and management are deferred.

In conclusion, Textbook of Clinical Neuropsychiatry is an important addition to our psychiatric corpus. It resembles Organic Psychiatry, and potential buyers would do well to compare these two wonderful works side by side to decide which of these amazing single-authored texts most appeals to their taste. I suspect residents and relative novices to neuropsychiatry will prefer Moore’s crispness and tight organization. More seasoned clinicians are in a better position to appreciate Lishman’s lengthier expositions and the depth of thought that his writing conveys. Moore’s text is a fine indication of the growth of neuropsychiatry, including its importance, acceptance, and, at long last, burgeoning.