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The Clinical Neuropsychiatry of Multiple Sclerosis

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    The Clinical Neuropsychiatry of Multiple Sclerosis. By a feinstein. (Pp 204, £40.00). Cambridge: Cambridge University Press, 1999. ISBN 0 521 57274 6.

    This is a clear, basic textbook outlining the main neuropsychiatric syndromes prevalent in patients with multiple sclerosis. It can be divided into three main sections. (1) an introductory chapter summarising briefly the pathogenesis, pathology, and clinical features of multiple sclerosis and concentrating on some useful definitions and guidelines for diagnosis, (2) four chapters on the psychiatry of multiple sclerosis—namely, depression, bipolar affective disorder, pathological laughing, and crying and psychosis, and (3) five chapters on cognitive changes in multiple sclerosis, specifically examining their nature, detection, course, and neuroimaging correlates. The emphasis of the book is thus predominantly on the cognitive dysfunction associated with multiple sclerosis. This is a well presented section with a clear and comprehensive review of research in this area. By contrast, it is somewhat disappointing that the section on psychiatry of multiple sclerosis is so small, particularly as depression in multiple sclerosis is, according to the author, more prevalent than cognitive dysfunction. Again, this psychiatry section is clear and structured (with summary points at the end of each chapter) detailing DSM-IV definitions of the above disorders, providing some treatment guidelines, and incorporating illustrative case vignettes. However, the focus on DSM-IV categories as well as the perspective that is taken mainly from the multiple sclerosis rather than from the psychiatry aspect, results in some limitations to the given account.

    There is also a regrettable disregard for the non-English literature, particularly on the association between depression and multiple sclerosis (for example, the great book by Ombredane). The range of psychiatric symptoms and syndromes seen in patients with multiple sclerosis (for example, anxiety symptoms, fatigue, irritability syndromes, adjustment reactions, personality effects, etc) is not covered and there is little on the description of such psychopathology. Similarly, discussion on the nature of the association between psychiatry and multiple sclerosis is restricted and superficial (despite excellent papers in English where this is treated in depth). Explanations for a lack of clear association between multiple sclerosis and psychiatric problems, are focused on the variability inherent in multiple sclerosis and the diversity of its course. Other possible explanations—for example, relating to the nature of the psychopathology itself, or the way in which it is elicited—are not explored.

    Overall, the main contribution of this book is in the chapters on cognitive changes in multiple sclerosis which are clearly and concisely presented. It will be useful for anyone involved in the management of patients with multiple sclerosis.

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