edited by Stuart C. Yudofsky, M.D., and H. Florence Kim, M.D.; Arlington, Virginia, American Psychiatric Press, Inc., 2004, 228 pages, $36.95 softcover
Dr. Benjamin is associate professor of psychiatry and neurology, and Dr. Eisenstock is a resident in the Combined Neurology and Psychiatry Program, University of Massachusetts Medical School, Worcester.
Stuart Yudofsky has produced some of the most clinically useful texts in neuropsychiatry, including the American Psychiatric Publishing Textbook of Neuropsychiatry and Clinical Neurosciences. In Neuropsychiatric Assessment, Dr. Yudofsky and Dr. Kim offer the reader the basic tools needed for neuropsychiatric evaluation: bedside neuropsychiatric examination and neuropsychological, electrophysiological, laboratory, and neuroimaging assessment.
In Chapter 1, Fred Ovsiew presents a comprehensive version of his guide to the bedside neuropsychiatric and physical examination. The pearl-laden neurological examination he presents has been adapted for psychiatric patients with extensive coverage of neurobehaviorally relevant cognitive and neurological findings.
Chapter 2 is an introduction to neuropsychological testing by Glen Getz and Mark Lowell. The authors have done a thoughtful job of explaining to the psychiatric audience the definition of each domain of cognitive function, with examples of the most common tests relevant to that domain. Rather than offering a long and comprehensive list of possible neuropsychological instruments, the authors have carefully selected the most important tests to understand in each area.
Nashaat Boutros and Frederick Struve's chapter on neurophysiologic testing follows. In just a few pages they manage to explain the techniques of electroencephalography (EEG), evoked potentials, quantitative EEG brainmapping, and polysomnography. The bulk of the chapter is dedicated to a unique description of the electrophysiologic findings in seven key neuropsychiatric problems: impulsive aggression, cognitive decline, advanced dementia, acute confusion, attention dysfunction, rapid-cycling bipolar disorder, and panic attacks.
Chapter 4, written by the editors of the text, reviews the use of the hospital laboratory in neuropsychiatry. The chapter's core is an extensive table of lab tests and their relevance to neuropsychiatric conditions, one of the features that makes this text a useful "pocket guide" for trainees. A guide to useful laboratory tests is also included for seven common clinical problems: new-onset psychosis, mood disturbance, anxiety, altered mental status, cognitive decline and dementia, mild cognitive impairment, and substance abuse. The final chapter by Thomas Nordahl and Ruth Salo reviews current research on neuroimaging.
Unfortunately, for a book intended as a basic guide to neuropsychiatric assessment, the topics selected are reviews of neuroimaging research in schizophrenia, mood disorders, and obsessive-compulsive disorder rather than a basic guide to neuroimaging techniques used clinically. Excellent summaries of research into axis I disorders using MRI structural imaging, magnetic resonance spectroscopy, diffusion tensor imaging, and positron emission tomography (PET) are included. Although the chapter gives an excellent research overview, the reader will have to look elsewhere to determine which type of MRI to order in clinical evaluations or how and when to order clinical PET and single-photon emission computed tomography studies.
This book is not an exhaustive reference and doesn't claim to be. Intended to be an update for practicing psychiatrists, it can also be a valuable guide for residents, primary care physicians, nurse practitioners, or others who routinely assess psychiatric patients. In the text's introduction, the editors conclude that the mind-brain dichotomy is no longer applicable. This book makes it clear that we now have the tools to transcend it. It's time to put the dichotomy behind us and become more proficient at neuropsychiatric assessment.