The British Journal of Psychiatry (2001) 179: 278-279
© 2001 The Royal College of Psychiatrists
Psychiatric Management in Neurological Disease
Jonathan Michael Bird, Consultant Neuropsychiatrist
The Burden Centre for Neuropsychiatry, Neuropsychology and Epileptology,
Frenchay Hospital, Bristol BS16 1JB, UK
EDITED BY SIDNEY CROWN and ALAN LEE
Edited by Edward C. Lauterbach. Washington, DC: American Psychiatric Press.
2000. 346 pp. £31.50 (hb). ISBN 0 88048 786 0
The presence of a psychiatrist on a neurological ward is, of course, no
longer novel, but it remains an occurrence that is too infrequent for the full
and proper management of many patients with neurological disorders. It is to
be hoped that this book will encourage psychiatrists to become more aware of
their potential for improving the management of patients with a variety of
neurological diseases.
This volume is a useful reference of not only the psychiatric management,
but also the clinical state and psychiatric complications of selected
neurological conditions. The emphasis on the treatment of individual
psychiatric problems is welcome and the book forms a worthy introduction to
this field. This is a multi-author text, but it is clear that fairly strict
editorial control has been exercised, which makes it easy to use in everyday
liaison neuropsychiatric practice. There is a helpful initial introduction to
the neuropsychiatric presentations of neurological disorder and their possible
management, followed by eight chapters on individual syndromes. Each chapter
includes an introduction, a brief epidemiological overview, an outline of the
neurological presentation, pathology and investigation of the disorder, a
review of the psychiatric manifestations, and finally details of management of
the neurological and psychiatric problems that might arise from the condition.
The only exception to this is the chapter on stroke, in which only the
neuropsychiatric aspects are covered. There are several very helpful lists,
for instance of drug/drug interactions and of disease/drug interactions. A
number of illustrations, including magnetic resonance imaging brain scans and
a startling picture of a Kayser—Fleischer ring, augment the text.
The main weaknesses of the book are that the selection of neurological
disorders is incomplete and that the coverage of some that are included is
variable. There are, for example, 42 pages on Fahr disease but only 22 on
multiple sclerosis. Movement disorders are well covered, particularly
Parkinson's disease, Huntington's disease, Wilson's disease and dystonia.
There is a useful chapter on the management of the psychiatric manifestations
and complications of HIV. All of the chapters tend more towards the
pharmacological than the psychological or psychotherapeutic management of
psychiatric problems in people with these neurological diseases, but the book
does end with a short paper about family management issues. Perhaps the
emphasis on pharmacological matters indicates a relative paucity of worthwhile
research into other areas of psychiatric management, but it is a shame that no
attention is paid to the variety of cognitive—behavioural and allied
treatments that can be used in this area.
The book does not purport to cover the apparently neurological
presentations of psychiatric disorder and makes almost no mention of
somatoform disorders. At the outset the editor remarks that books on the
psychiatry of Alzheimer's disease and epilepsy exist, and therefore he makes
no further mention of them. However, serious omissions appear to be the
psychiatric management of migraine, motor neuron disease, infections of the
central nervous system other than HIV, normal-pressure hydrocephalus and,
possibly, some mention of the sequelae of head injury. Consequently, this
cannot by any means be regarded as a comprehensive reference book for those
interested in liaison psychiatry on neurological wards, but it can be strongly
recommended as a practical handbook for the trainee or general psychiatrist
who is consulted by a neurological colleague about a patient with one of the
eight conditions featured.
