Pharmacological Management of Neurological and Psychiatric Disorders

This is a useful and well-informed source for neuropsychopharmacology. Enna and Coyle have persuaded an impressive group of U.S. experts to provide 15 well-informed chapters on the pharmacological treatment, diagnosis, and pathophysiology of neurological and psychiatric disorders, following an introductory overview. The reviews span brain disease from headache to heartache (depression and anxiety, that is) and across the age spectrum, from a broad-based review of the psychopharmacology of developmental disorders and attention deficit hyperactivity disorder (ADHD) to a comprehensive assessment of the treatment of dementia and delirium. Whether or not it is on their agenda, the editors contribute valuably to blurring the boundaries between neurological and psychiatric disorders by collecting them in one volume. After all, why should schizophrenia be a “mental” disorder and epilepsy a “brain” disorder?

The editors are modest about their potential readership. They suggest the book be aimed at primary care physicians and those in training, but it is also likely to be very valuable to CNS pharmacologists and psychiatric specialists. This value is enhanced by references in each chapter to the equivalent sections of that bible of pharmacology, Goodman and Gilman’s The Pharmacological Basis of Therapeutics(1), which shares a publisher with this book. The primary care practitioner or training physician has here a “one-stop shop” for neuropsychopharmacology, while references (when provided—I came across some text citations that were not listed at the chapter’s end) provide opportunity for those with time and interest to take things farther.

Several aspects of this book reinforce a scientific approach to clinical neuropharmacology. Flow charts support logical decision making in diagnosis and pharmacotherapy. The text is supplemented by boxes with rating scales, lists of drugs, diagnostic criteria, and so on that, along with clear and unfussy figures, provide for an organized and accessible source of information.

The disappointments here are few. However, the absence of any mention of the usual formulation combining l-dopa with a dopa decarboxylase inhibitor is a surprising omission in an otherwise excellent review of the movement disorders. Some pharmacology is misleading, such as the description of the monoamine oxidase type B inhibitor selegiline as an antioxidant and differentiated from Eldepryl, its trade name. Vitamin E is essentially the same as alpha-tocopherol, but in the index they refer to different topics. Less frustrating than these editorial deficiencies are the missed opportunities: a discussion of the future in the context of pharmacogenetics would have enhanced the book.

These disappointments aside, the majority of the text by far is well written, comprehensive, and often stimulating. Topics that provoke some debate, such as ADHD, are handled carefully, albeit from a DSM-IV-based perspective. Although it is too much to hope that every reader will be thinking, “Is this how I’d want a member of my family treated?” (a question posed in the chapter on developmental disorders by D.M. Kaplan et al.), the book should contribute to improved practice by strongly supporting informed and evidence-based prescribing.