The British Journal of Psychiatry
The Frontal Lobes and Neuropsychiatric Illness
Michael R. Trimble

This text is intended as a summary of the relationship of the frontal lobes to neuro-psychiatric illness. To some extent it is an expansion on a special issue of the Journal of Neuropsychiatry and Clinical Neurosciences (1994: vol. 6, pp. 341-477) covering a similar topic. The book begins with the anatomy and function of the fronto-subcortical circuits, which are elegantly explained with colour figures. An attempt is made at this early stage to incorporate neurochemical concepts into an overall neuroanatomical behavioural view of the frontal lobes.

The next section concentrates on the orbitofrontal cortex (again lavishly and helpfully illustrated), outlining in more complexity its role in the regulation of behaviour. In particular, studies in humans are discussed, as is the role of the orbito-frontal cortex in such conditions as drug dependency and obsessive—compulsive disorder. The area of working memory, and its dysfunction in schizophrenia, and the role of the frontal cortex is the next topic of discussion. This is followed by two chapters on the neuropsychological aspects of frontal lobe function, in particular examining laterality issues and the role of the frontal lobes for consciousness and self-awareness.



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The next main section deals with the more classically described prefrontal syndromes found in clinical practice (a dorsal convexity syndrome, an orbitofrontal syndrome and a medial frontal syndrome), with chapters devoted to description, diagnosis, assessment and management. A disappointment with the latter is the sparsity of studies, particularly of psycho-pharmacological treatments, and the lack of very effective remedies. Anger management, with targeted cognitive—behavioural therapy, unfortunately is not discussed.

The final part of the text concentrates on frontal lobe dysfunction in various psychiatric disorders, depression and schizophrenia representing the main topics. However, the important area of traumatic brain injury and more recondite disorders such as reduplicative paramnesia and the Capgras and Othello syndromes and other content-specific delusions, are also included.

The last chapter returns to an old theme, the neurosurgical treatment of refractory obsessive—compulsive disorder using interventions that interrupt fronto-subcortical connections. The chief author of this chapter is the late Per Mindus, who was actively involved in this exciting area of research before his death in 1998 and to whom the book is appropriately dedicated.

If you want a good all-round, comprehensive, readable update on the frontal lobes in relationship to neuropsychiatric disorder, then this is the text for you.