Abstract
This is a refreshingly simple text. Simple as in straightforward, not simple as in dumbed-down though, because its tone assumes that the reader has more than just a basic understanding of endocrinology and metabolism. As the editors state clearly in the Introduction, there are many more comprehensive and detailed textbooks on the subject of hormonal interactions with the human psyche than this one.
Wolkowitz and Rothschild have instead collected an array of practising clinicians to set out the most common endocrinological disorders – diabetes, thyroid disorders, sex-steroid dysfunctions – and then indicate how these hormone disturbances or their treatments influence behaviour, mood, appetite, sleep, cognition and general functioning.
This not a textbook in the classroom sense either, but it could be used as one if tutorials on sets of endocrine disturbances are being planned. It has few illustrations for the complex topics covered, but the few that are sprinkled throughout the book are also simple and apt. References for sections follow the chapter immediately, are numerous and range from classic papers to recent basic science and review articles. For the casual reader, checking out the bibliography on a particular topic covered – say, ‘Endogenous gonadal hormones in postpartum psychiatric disorders’ – will certainly give a reader or researcher a spread of topics and authors to follow in further search strategies.
The contents pages and well cross-referenced index both reflect the commonly encountered clinical issues discussed, while the organization of the tome is neatly divided into arenas of interest. In the Introduction, the editors state that this book takes a different approach to clinical psychoneuroendocrinology, this time from the hormones' ‘point of view’. The following chapter provides visual and verbal historical timelines from the humours of Hippocrates – black bile and melancholia – to the increasing relevance of the hypothalamic-pituitary axis (HPA) in understanding certain mood disorders.
The individual chapters are arranged into Parts entitled: ‘Peptides hormones’, ‘Adrenocortical hormones’, ‘Gonadal hormones’ and ‘Thyroid hormones’ with comprehensive sections on key topics. Such topics as the HPA and psychiatric illness, psychotropic effects of hormone replacement in women and the pros and cons of using DHEA and DHEA-S, and psychiatric effects of exogenous anabolic-androgenic steroids, have certainly been covered in specialist journals on clinical endocrinology before, but this collection of pithy reviews makes revising much more straightforward.
Hormonal balance and imbalance are common in general medicine and this book succeeds well in this alternate niche position of honing in on endocrine issues at hand and then detailing psychiatric consequences and causes.
Examples: Does jet lag improve with melatonin? Is sexual dysfunction a problem in diabetic disorders? Can androgenic steroid supplements cause sadness as well as ‘roid rage’? Will moods improve or worsen with HRT? Does DHEA provoke certain types of tumour? Of what real value is the Dexamethasone Suppression Test? Can thyroid hormones be used in conjunction with lithium? Which neuropeptides are known to be really important (so far)?
The section on thyroid hormone abnormalities, disorders, exogenous treatments and interactions with psychotropic medications is a good example of the way this book is formatted. The basic physiology is covered well, while the various disorders are outlined and sometimes detailed. The direct behavioural and psychological impact of insufficiency, dysregulation and excess are noted alongside major psychiatric conditions and the current clinical uses of thyroid hormones in psychiatry.
Part IV of this book has two sections which are ‘mini’ clinical texts and their titles speak for themselves: laboratory assessment of neuroendocrine status and endocrine imaging in depression. The final Part is simply titled ‘Stress’, and consists of Bruce McEwen's thoughtful and engaging exposition. It is provocative in that it moves well beyond the classical portrayal of stress causing illness. McEwen considers both the impact of internal secretions on the body and the mind while introducing the concept of ‘allostatic load’.
This book is a primer for clinicians and students. It is also a handy revision text for examination candidates in both endocrinology (‘Which disorders cause what psychiatric conditions?’) and psychiatry (‘What physiological illnesses should I look for when there are psychiatric signs?’), though the student of psychiatry will have to work a bit harder as this text is written from the endocrine-first, point of view.
If a specialist is looking for the answers, say, to endocrine problems brought on by psychotropic medication, this is probably not the right text for them. Nor is the interplay between hormonal and immunological physiology given much prominence. But once information for these hormonal consequences or interactions are found in any number of other texts, the specialist or even a well-informed layperson can return to this simple and engaging book for a well referenced overview of the physiology, dysfunctions and management plans provided for most of the relevant endocrine systems.