Abstract
The first edition of this book influenced a whole generation of psychiatrists and established Professor Lishman as a leading scholar in the field of neuropsychiatry. It was, in fact, the book that had the greatest influence on my own development in psychiatry, and later neuropsychiatry. The second edition could justifiably ride on the success of its predecessor. The field in the meantime, not a little due to the influence of this book, had continued to progress inexorably. The third edition was therefore keenly awaited, and my expectations were understandably high. These were accompanied by a faint feeling of dread. Was it possible in the late 1990s for a sole author, be it Professor Lishman, to keep up with the explosion of knowledge that had occurred in our field? Had this landmark book not been surpassed by some of the multi-authored texts that had been published in the last few years? Was it now only of historical interest?
The praise that I am about to shower on the third edition may seem to be a bit faint. It continues to be an encyclopaedic tome that one can usefully refer to when one encounters a psychiatric patient with a rare metabolic disorder or an exotic neurotoxin. It continues in its tradition of breath-taking range of coverage. It still retains the touch of a master clinician. When I recently saw a patient with Behcet's Syndrome and another with Whipple's disease, this was the book that provided a succinct neuropsychiatric perspective. It is still the book that offers a quick overview of the controversies that have bedevilled the relationship between epilepsy and psychosis.
But the book looks tired and the opportunity to build on the second edition to carry it into the 21st century may have been lost. One can begin by arguing with the title. Professor Lishman has previously defended ‘organic’ as an appropriate descriptor of neuropsychiatric syndromes, but the term has been vigorously attacked recently, and can no longer be considered to be appropriate. The need for historical continuity may yet justify its continuing usage for a classic such as this, but this anomaly should be discussed in the text. It is also important to ensure that it does not hinder the modernisation of the descriptions. The approach in the book is strongly clinical, and this has been its major strength in the past. Twenty years after the publication of the first edition, this exclusive approach appears dated. Modern neuropsychiatry is underpinned by the developments in neuroscience. Part I of the book fails to take us through this explosion of knowledge and persists with the old style of symptom description. The book does make an attempt to introduce neuroimaging but falls far short of assimilating the knowledge that has been acquired in various disorders. The illustrations, having all been presented at the beginning of the book, are no more than cosmetic.
This edition, therefore, persists in the old school of descriptive psychiatry. Its emphasis on some disorders has also not changed to keep up with modern clinical practice. As an example, cerebral syphilis still occupies 10 pages of the text. In contrast, tardive dyskinesia, which comprises a large part of neuropsychiatric practice, gets less than two pages. For the latter, the publications in the 1990s are not cited. Many excellent studies of the prevalence and incidence of tardive dyskinesia are largely ignored, and new insights into risk factors (e.g. diabetes, alcohol, smoking, many drug-related factors) do not get a mention. The concept of vascular dementia, which has been debated and reanalysed recently, receives little attention, and multi-infarct dementia as a term is persisted with. These are only some examples of how the book has failed to keep up with the times. An examination of the 129 pages of references reinforces this view, a quick count revealing that less than 10% of references are dated 1993 or later.
The first edition of this book was a superhuman effort. Its second revision (leading to the third edition) looks quite human. It still claims its rightful place on the library shelf, but individuals who possess the second edition may not find the third to offer additional value. They, like me, will now set their eyes on the fourth edition, hoping that a team of authors will be invited to improve upon what a master neuropsychiatrist started single-handed.