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Neuropsychiatry and behavioural neurology explained
  1. S Fleminger

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    Edited by A J Mitchell. Published by Saunders, London, 2004, £69.00 (hardback), pp 500. ISBN 0-7020-2688-3

    This is an ambitious project for a single author; the whole of neuropsychiatry explained using an up to date, evidence based review of the literature, and in a format that is designed to be attractive to read. There are numerous figures, boxes, lists with bullet points, and “clinical pointers” to break up the text.

    Although aimed particularly at liaison and old age psychiatrists, this book will have wide appeal and be of interest to neurologists. They will be able to quickly access clinically relevant discussion of the neuropsychiatric sequelae of common neurological disorders. The core sections of the book, on dementia and delirium, neuropsychiatric treatments, and the psychiatric complications of neurological diseases, are excellent. The discussion is practical and to the point. The reader is not stifled with references strewn in the text. They must therefore have confidence in the assertions of the author; I am confident that we are being offered accurate information. But at times the style feels a little pedantic; for example, those of us who dared to believe that alcohol might cause depression are put firmly in our place. Another quibble I have is the value of some of the lists/classifications which were of uncertain provenance. We are, for example, given lists suggesting difference aetiologies for chorea versus athetosis, but some would be sceptical of the value in splitting choreoathetosis. Many classifications are based on neuroanatomical models of neuropsychiatry that need to be treated with caution.

    The book strays into biological psychiatry, and a later section is devoted to understanding how neurological disorders result in neuropsychiatric symptoms, but this does cause a problem because some of the discussion of the neuropsychiatric sequelae of a particular disorder may not be found in the index chapter on that disorder, but in this later section. For example, the only discussion of suicide following head injury in the chapter on head injury is a single misleading sentence indicating that suicide accounts for 10% of head injury deaths. Yet, easily missed, 300 pages later, in the chapter on the neurological origins of suicide, is a more complete account of the relationship.

    Overall, however, this book is a significant achievement. A large amount of material has been made readily accessible. There are no lacunae and the length of discussion of each disorder is proportionate to its importance. The book is to be trusted and recommended. One interesting innovation is a list of support groups and useful websites in the appendix. Neurologists and psychiatrists and their trainees have good reason to buy this book.

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