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Brain Imaging in Psychiatry.

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    Brain Imaging in Psychiatry. Edited by shôn lewis and nicholas higgins. (Pp 326; £69.50). Oxford: Blackwell Science, Oxford 1996. ISBN 0632036478.

    Major books on neuroimaging have been published during the past few years, the earlier ones focusing on basic sciences and the more recent on neurology and neuropsychology. There have not been many on psychiatry. Furthermore, most have come from across the waters.

    This has been put right by this major multiauthored book, put together by Shôn Lewis, a Professor of Psychiatry and distinguished neuropsychiatrist himself, and Dr Higgins, a neuroradiologist. As far as this reviewer knows, it is the first of its nature to be produced in the United Kingdom. The first nine chapters are dedicated to the principles and basic sciences of the main techniques including EEG topographical mapping and magnetoencephalography. Particularly detailed are the chapters on structural MRI and MRI neuroanatomy that occupy about 25% of the book! The chapter on functional brain imaging by Professor Lewis is rather short but about the only one explaining SPECT and PET scanning.

    The remaining seven chapters are on clinical applications and their content is bound to reflect ongoing interest in, and preference for, some diseases. Thus, there are two chapters on schizophrenia: one on structural imaging (including bits on the affective psychosis) and the other on functional imaging. The chapter on the affective disorders includes a useful discussion of what does it mean “to map the emotions”. Chapter 13, entitled “structural brain imaging in neuropsychiatry” returns to basic principles and then deals with Alzheimer’s disease, vascular dementias and Huntington’s disease. Then follows a useful chapter on the functional neuroimaging of the aging brain and dementia. The last two chapters cover functional neuroimaging in the neuroses and in child psychiatry.

    All books have shortcomings and the one under review is not an exception. Contributors may not deliver on time or cover well their commissioned topic, and this causes the unavoidable lack of balance, repetitiousness and sense of inconclusiveness characteristic of most multiauthored books. Then there is the rate of progress, which in the case of neuroimaging is high, and tends to render books out of date even before their publication. More serious, however, are two omissions which I am sure can be put right in the second edition.

    One concerns the need to include a chapter dealing with the conceptual demands that neuroimaging is imposing on psychiatry. Central to this challenge is the fact that most mental symptoms are described at a level of resolution which is incommensurate with the quantitative requirements of functional neuroimaging. It is often forgotten that current psychopathological descriptions were constructed to meet the needs of 19th century gross anatomy and microscopy and hence are categorical and with fussy spatiotemporal boundaries. Because of the high cost involved in neuroimaging, wastage and nonsensical research (as occasionally published in the literature) can only be avoided by preparing mental symptoms for their new correlational duties. Such preparation should include rethinking their boundaries in time and space, developing multidimensional models, and creating criteria that can separate symptoms whose ontology is likely to depend on biological signals from those which are patently interactional, social, and whose definition depends upon pragmatics and communication. For reasons which escape me, psychopathologists do not yet seem to have cottoned on to this need. A second omission concerns the need for a chapter on neuropsychological paradigms and task-related functional neuroimaging, and the relevance of this approach to the study of mental symptoms.

    In spite of the above, this book deserves a wide readership. It is very good at explaining what these techniques are about and their limitations, and has brought together well known researchers to summarise what is currently credible and safe knowledge; some have even looked at their crystal ball to tell what is to come. Whether trainee or consultant, the psychiatrist should consult this book as it is becoming difficult meaningfully to talk about mental disorders or their treatment without knowing something about neuroimaging.

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