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Psychoneuroendocrinology; the scientific basis of clinical practice
  1. G Gillies

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    Edited by Owen M Wolkowitz and Anthony J Rothschild. Published by American Psychiatric Publishing Inc, Washington DC, 2003, £69.00, pp 546. ISBN 0-88048-857-3

    In the last two decades a wealth of information has been gathered regarding the potent influences of our endocrine hormones on the brain and behaviour, giving rise to the discipline of psychoneuroendocrinology. By calling upon leading authorities in their subjects, Wolkowitz and Rothschild have produced this timely volume that explores, with great clarity and success, what might be the clinical significance of the empirical scientific findings in this emerging field and how this may underpin breakthroughs in the treatment of behavioural and affective disorders. Essentially, each contributor considers the hormonal changes observed in primary psychiatric illness, the psychiatric sequelae of hormonal dysregulation in primary endocrinological illness, and the potential for exogenously administered hormones or hormone antagonists to influence behaviour and affect.

    The main text begins with a delightful account of the historical roots of psychoneuroendocrinology, dating back to the ancient philosophers, and the recent rapid development of this discipline. There is then an exhaustive coverage of central nervous system neuropeptides and hypothalamic releasing factors, which addresses the controversial question of whether alterations in their secretion contribute secondarily to or are causative of aspects of psychiatric illness. There is also a balanced view of the potential use of melatonin and its analogues as chronobiotic drugs, and a review of the psychiatric manifestations of endocrinopathies—including diabetes mellitus and those affecting secretion of prolactin, growth hormone, and parathyroid hormone. There follows next a section each on glucocorticoid hormones, gonadal hormones, and thyroid hormones, considering conditions of over- and/or undersecretion, which can produce behavioural symptoms closely resembling signs of primary psychiatric illness. The penultimate section is devoted to the use and interpretation laboratory testing in clinical psychoneuroendocrinology to improve accuracy of diagnosis and treatment. The volume ends with an updating of Hans Selye’s original exposition of the general adaptation syndrome that occurs in response to stressors—both exogenous and endogenous. Although mounted to protect the host, the stress response itself may become harmful—both emotionally and physically—if allowed to proceed unchecked.

    This comprehensive work clearly demonstrates the importance of crossing the traditional boundaries of endocinology, neuroscience, and psychiatry, and represents an approachable and informative text that should be of value not only to clinicians from many disciplines, but also to basic scientists, teachers, and the educated public.