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Neuropsychopharmacology
  1. M Lader

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    W W Fleischhacker, D J Brooks, eds. Wien and New York: Springer Verlag 2003, pp 114, €89. ISBN 3-211-83903-8

    The European Institute of Healthcare devoted its 5th Neuropsychiatry Symposium to neuropsychopharmacology. Topics were chosen by the organisers and editors, Professors Fleischhacker and Brooks, to bridge the gap between basic neuroscience and the clinical fields of neurology, but mostly psychiatry. The slim volume comprises seven chapters that cover a wide range of topics from histamine receptors to developments in substance dependence research and the pharmacotherapy of schizophrenia. The chapters are uniformly up to date and written in a challenging and interesting way. Some of the chapters are extremely compendious, for example that on migraine contains 199 references.

    Various advances in the therapeutics of neuropsychiatric conditions are reviewed. As a psychiatrist/psychopharmacologist, I must admit to finding the three last chapters the most fascinating. Professor Deakin reviews serotonin function in relation to antisocial personality disorder and depression. He adduces interesting arguments that serotonin abnormalities are related to both conditions, the difference being an anatomical selection in the dorsal raphe nucleus. This hypothesis gives rise directly to therapeutic suggestions for treating depression. These are of course largely in place. However, the treatment of antisocial personality disorder opens up Orwellian prospects and will need carefully monitoring.

    It was particularly interesting to see a chapter devoted to future directions and substance misuse from Professor Nutt’s group in Bristol. My only criticism of this chapter was that it was too short and only whetted one’s appetite for further information concerning receptors, brain pathways, and promising avenues of drug development.

    The final chapter by one of the editors deals with new developments in the pharmacotherapy of schizophrenia. The immense clinical experience of Professor Fleischhacker is shown by his acknowledgement that improved formulations, such as rapidly dissolving tablets and syrups, have an important part to play, in view of the poor adherence to treatment of patients with schozphrenia. He also reviews polypharmacy that is the norm in many practices and points the way to further developments with new classes of compounds.

    Some curmudgeonly remark the English is often not carefully sub-edited and there are numerous typos (for example, see page 65). Some of the articles contain very long paragraphs that make the content difficult to follow. There is also no uniformity of reference style. One would expect Springer-Verlag to be able to afford the services of an experienced native English speaking sub-editor.

    The very last page states that the paper in the book was acid free in conformance with international standards for paper permanency. I suspect that the paper itself will outlive the content of these chapters, but that is no bad thing.

    Overall, the book provides a rapid updating of knowledge across the field in neuropsychiatry. Inevitably, it will be out of date fairly quickly, but in the meantime it is important reading even for the cognoscenti.

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