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Book Review   |    
The Neuropsychiatry of Limbic and Subcortical Disorders
Joseph M. Tonkonogy, M.D.
Psychiatric Services 1999; doi:
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edited by Stephen Salloway, M.D., M.S., Paul Malloy, Ph.D., and Jeffrey L. Cummings, M.D.; Washington, D.C., American Psychiatric Press, 1997, 217 pages, $49.50

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This book represents an important attempt to bring together the rapidly growing body of knowledge in neuropsychiatry and neuroscience related to the understanding of mental illnesses as brain diseases. In 14 chapters, it incorporates review articles and recent research findings on the anatomy and neurochemistry of the limbic-subcortical system and limbic-related syndromes that include a wide range of psychiatric manifestations. The editors and contributors include Jeffrey Cummings, Michael Trimble, Lennart Heimer, and other leading investigators with research and clinical experience in the field of the limbic-subcortical system structure and function and related neuropsychiatric syndromes.

The book first takes the reader through the phylogenetic development, anatomy, and neurochemistry of the limbic-subcortical system, stressing its role as a border zone between neocortical structures and the brain stem. This chapter, both intriguing and encyclopedic, includes a broad range of basic anatomical-functional data about the main structures of the limbic system and their interconnections within the system and with the cortical and brain-stem structures.

Based on a review of human research and nonhuman tracer studies, two divisions of the limbic system, the amygdala-orbitofrontal and hippocampal-cingulate, are described. Both divisions share common phylogenetic and architectonic features. It is suggested that the amygdala-orbitofrontal division supports emotional associations and appetitive drives while the hippocampal-cingulate division supports memory-encoding and attentional processes.

Also in the first chapter, psychiatric syndromes of limbic system dysfunction are divided in three groups: hypolimbic, hyperlimbic, and dysfunctional limbic syndromes. According to this scheme, primary and secondary depressive symptoms are associated with hypofunctioning of the orbitofrontal division, while lesions of the anterior cingulate above the corpus callosum produce profound apathy and akinesia. Amnesia is considered as hypofunctioning of the hippocampal-cingulate division. Similar associations for hyperlimbic syndromes are also discussed; they include mania, obsessive-compulsive symptomatology, interictal personality changes known as the Gastaut-Geschwind syndrome, and episodic explosive behavior. Dysfunction in the lateral orbitofrontal interactions is considered to be responsible for socially inappropriate behavior, while anxiety and panic disorders are related to dysfunction in integration of the visceral-amygdalar functions with the internal state of the organism.

Several chapters in the book discuss psychiatric syndromes resulting from temporolimbic dysfunction, including paroxysmal neuropsychiatric disorders, auras with fears, amnestic disorders, delusions, and hallucinations. Special attention is given to the roles of the temporolimbic systems in religious experience and religious delusions.

A chapter by Stuart Zola, one of the leading experts on the controversial and compelling topic of recovered memory, analyzes the neurobiology of amnestic disorders with special emphasis on the dynamic organization of memory in the brain and its role in the re-creation of the past. Discussion of the neurobiology of substance abuse is concentrated on the role of the mesocortical limbic system in the reinforcement of addiction, especially in relation to the role of the extended amygdala complex that includes the dopamine-rich nucleus accumbens. The book highlights in special chapters the neurobiological theories of emotions and a model of the neurobiology of depression.

The contents of the book originally appeared in the summer 1997 special issue of the Journal of Neuropsychiatry and Clinical Neurosciences, and the book itself may be considered a landmark publication in the neuropsychiatry of the limbic-subcortical system. Certainly, further studies are needed to advance the ideas and approaches put forward here, and future editions of the book may gain from inclusion of chapters discussing the treatment of limbic-subcortical psychiatric disorders. Meanwhile, The Neuropsychiatry of Limbic and Subcortical Disorders may help readers navigate through the maze of complex research and clinical findings on this topic. It can be an asset to mental health professionals, whether they are reading it from cover to cover or using it as a reference text.

Dr. Tonkonogy is professor of psychiatry and neurology at the University of Massachusetts Medical School in Worcester.

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