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Textbook of Clinical Neuropsychiatry
  1. Simon Fleminger

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    Edited by D P Moore (Pp 747, £69.50). Arnold, London, 2001. ISBN 0340806249

    There is a certain logic to the system Moore uses in his textbook of clinical neuropsychiatry. The first half of the book essentially consists of numerous lists of causes of different symptoms, signs, and syndromes. For example lists are provided for causes of dementia lacking distinctive features, dementia associated with strokes, and dementia with frontal lobe syndrome or with parkinsonism. Confronted with a patient with dementia plus parkinsonism the reader has quick access to conditions that need to be considered. Or if the reader is looking for a list of causes of catatonia he need look no further than table 3.8. Having identified the potential causes of the patient's symptoms the reader then goes to the second half of the book where he will find up to date descriptions of the relevant neuropsychiatric diagnoses.

    The problem with such an approach is that it leads to duplication. In the first half any single diagnosis has to appear as many times as there are symptoms, signs, or syndromes that it can produce. The approach depends heavily on the validity of the classification of symptoms and syndromes; conditions with different names often seem to share more in common than sets them apart. For example it is asserted that stupor can be distinguished from akinetic mutism partly on the basis of eye movements: in the former they are generally roving or dysconjugate, whereas in akinetic mutism lively conjugate tracking eye movements are to be seen. I am not so sure and would have preferred a critical discussion of the nosological status of akinetic mutism alongside abulia, stupor, and catatonia. Frontal lobe syndrome is given syndrome status, but I could find no mention in the book on the dysexecutive syndrome.

    What is lacking in this book is a sense of proportion. Three of the biggest suppliers of referrals to a neuropsychiatric service—stroke, head injury, and conversion disorders—hardly get a mention. Given the huge range of conditions that are covered it is not surprising that the book sometimes gives a sense of having been written in the library rather than from clinical experience. But there are some excellent sections; I was particularly impressed by the chapters on epilepsy and the introduction to EEG.

    It is a very comprehensive textbook. This is its strength. The complete range of neuropsychiatric conditions is described in a consistent, easy to read, format. Large numbers of up to date references are provided.

    Overall Dr Moore is to be congratulated on producing a useful textbook. Two neuropsychiatric colleagues gave this book the thumbs up because Moore has achieved his aim of offering this book as a ready reference for established practitioners. It will be of interest to both neurologists and psychiatrists.

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