Concise Guide to Neuropsychiatry and Behavioral Neurology

Concise Guide to Neuropsychiatry and Behavioral Neurology

JL Cummings and MR Trimble

Washington DC: American Psychiatry Press Inc; 1995.275 p

Psychiatry is heading, willy-nilly, down the subspecialty route. Child, geriatric and forensic psychiatry are already recognized as subspecialties, and others such as psychotherapy and consultation-liaison psychiatry are following closely. Unfortunately, subspecialization is progressing in a disorganized manner, and this leads related subdisciplines such as neuropsychiatry and consultation-liaison psychiatry to evolve in parallel. Often, little effort is made to cohere or even to collaborate.

The authors of this small volume define neuropsychiatry and behavioral neurology as “clinical disciplines devoted to understanding and treating behavioral disturbances associated with brain dysfunction” (p 1). This definition seems restrictive and appears to rule out, by definition, the psychosocial aspects of neurological practice. Therefore, neuropsychiatry, according to these authors, does not follow the biopsychosocial model. The first author is a professor of psychiatry and neurology at the University of California at Los Angeles (UCLA) School of Medicine, and the second is a professor of behavioral neurology at the Institute of Neurology, London, England.

Initial chapters are devoted to assessment, neurobiology and psychiatric syndromes. The rest of the book is devoted to neurological syndromes such as epilepsy, dementia, stroke and head injury. Each chapter is concise, and frequent tables list and summarize relevant points. The text is clear, readable and nonrepetitive. No references are given in the text, but there is a useful reading list at the end of each chapter.

Despite the authors’ restrictive definition, I was surprised by the total absence of any reference to somatoform disorders or to the psychosocial aspects of neurology. Somatoform disorders form at least 14% of a neurologist’s practice (Mai 1995). One would have thought that any clinical textbook that included the word “behavior” in its title would also cover the field of illness behavior. However, one looks in vain in this book for any recognition of the existence of illness behavior, conversion or somatization. Even the brief description of pseudoseizures fails to mention that they may have a conversion basis. The authors do not explain the reasons for this omission, but it is likely the result of their chosen focus on neurological disease.

This approach reminds me of the old story about the drunk who returns home late at night to find he has lost the key to his front door. He then confines his search to the area around the street light, because “that’s where the light is”. The authors of this volume have similarly chosen to ignore the darker areas of neurology which, inspite of themselves, affect the clinical practice of this discipline.

In other respects, the book provides a useful and concise description of the field within die confines set by the authors. It could be of value to residents, psychiatrists and neurologists with an interest in this field. It is expensive for a soft-cover book.