Abstract
The title of Alex Mitchell's text might raise a few eyebrows: Explained sets the bar at a high level, and the double-header billing of both neuropsychiatry and behavioural neurology sounds ambitious. My initial suspicion that I was going to be disappointed quickly dissolved. Mitchell's book is highly rewarding, and just the scope and depth of description of its subject matter would be altogether adequate for such a text (particularly for a single-authored piece of work). The explicit attempts to explain neuropsychiatric phenomena add extra value.
The book is clearly about neuropsychiatry though, and behavioural neurology's headline status in the title is initially puzzling, as the discipline per se is hardly mentioned again. There are a few chapters describing regional cerebral syndromes, but the content blends with preceding chapters describing (non-regional) cognitive domains such as attention and memory, and in all of these chapters the treatment of cognition is explicitly neuropsychological in nature.
Mitchell acknowledges being encouraged by neuropsychiatric ‘authorities’ in German Berrios, Alwyn Lishman, and Richard Mindham; indeed, Lishman, whose Organic psychiatry I would consider the landmark text in the area, contributes a glowing Foreword. Mitchell defines his remit by posing the question: ‘What are the psychiatric and behavioural consequences of neurological conditions that affect the brain, and how can these consequences be explained?’ The ensuing 500-odd pages provide answers to these questions very satisfactorily indeed, and provide even more in terms of invaluable reference tables, visually appealing figures and fullcolour images, bullet-pointed summary boxes, discursive clinical pointers, and appendices which reference a variety of resources (e.g. tests, support organizations). A good test of a book which is most likely to used as a reference text is how well it is indexed. The index is richly subcategorized and cross-referenced, and I happily whiled away half an hour or so just following links suggested by looking up a few (likely, as well as unlikely) terms. Mitchell states that he has limited information to ‘data collected from robust primary research’, and backs this claim up by declaring the evidence bases in an appendix. One might look for signs of fraying at the margins of an author's expertise, and I can vouch that there are no problems to speak of with coverage of neuropsychological matters, at the least.
The only negative comment I could make about the way he poses the defining question is that conditions such as schizophrenia, major depression, and anxiety disorders (e.g. OCD) are not addressed. As the biological bases of these conditions become understood, they must be considered fundamentally neuropsychiatric. Their omission is striking when Mitchell states the book ‘looks beyond the old dichotomy of functional and organic and attempts to integrate the two components into part of a bigger picture’; their omission is also highlighted by the discussion in the final ‘explanatory’ chapter about topics such as ‘the origin of depression’ and ‘the origin of psychosis’, to name a few (that is, they are only discussed as features of neurological illness).
The book is divided into five sections, viewing the various topics from different perspectives. In Section I Mitchell reviews the foundations of neuropsychiatry, and the tools of clinical assessment. Section II provides a summary of psychiatric phenomena in neurological conditions, and Section III is reserved for a discussion of delirium and the dementias (though why there should be a distinction between Sections II and III was not clear to me). Section IV deals with treatment, and includes detailed reviews of treatment trials. Section V brings together aspects of the preceding material in discussing the mechanisms of neuropsychiatric phenomena (the ‘explanatory’ section). I found the division of content quite user-friendly, and it allowed for free-standing chapters such as ‘Management of Carer Stress’ and ‘Driving and Neuropsychiatric Conditions’ in Section IV, and overarching synthetic accounts of, for example, the origin of mania in Section V.
There is a clear clinical focus maintained throughout all sections of the book, with emphasis on diagnosis, treatment, broader management, and education of the patient and carers. Mitchell himself suggests that the book will be particularly useful for liaison psychiatrists and old age psychiatrists. I would certainly add neuropsychologists to this prime target audience, with clinical neuropsychology figuring more and more in the interface between psychiatry and neurology; clinical psychologists, and allied health professionals such as occupational therapists and speech pathologists would find the text extremely useful as an encyclopaedic resource.