Neuroscience for the Mental Health Clinician / Edition 1

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Overview

As scientific knowledge grows about the role of the brain in mental disorder, no clinician can afford to be uninformed about neurobiology. This accessible primer provides the basic grounding in neuroscience that all contemporary mental health professionals need. Readers are first guided through the fundamentals of neuroanatomy, neurochemistry, and psychiatric genetics. Chapters then illuminate the neurobiological underpinnings of a range of frequently encountered disorders--including ADHD, substance abuse, mood and anxiety disorders, schizophrenia, and learning and cognitive problems--giving particular attention to the impact of psychosocial risk factors on the brain. Also examined are ways that both pharmacological and psychological interventions have been shown to alter brain chemistry as they bring about a reduction in symptoms.
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Editorial Reviews

From the Publisher

"Neuroscience for the Mental Health Clinician is a unique book. In it, Pliszka expertly explains complex concepts from laboratory-based neurosciences in a cogent and readily accessible fashion. What is particularly noteworthy about this work is its adroit descriptions of ideas that are often difficult to grasp. Although it covers a wide array of topics from the basic neurosciences, the book never loses its clinical focus. Deftly bridging the gap between clinical and laboratory science, this book should be a welcome read for experienced and novice clinicians alike."--Robert L. Findling, MD, Division of Child and Adolescent Psychiatry, University Hospitals of Cleveland

"This volume will be invaluable to clinicians who work with patients with a range of different psychiatric disorders. Readers will benefit from the clear organization of the text and Pliszka's ability to explain very complex neurochemical issues to the non-MD practitioner. This much-needed book will be well used over time as both a reference and teaching tool. This book will work well as a text in graduate-level psychopathology courses."--Margaret Semrud-Clikeman, PhD, Department of Educational Psychology, University of Texas at Austin

"I have read and struggled with a number of books on brain functions and mental health. This is the first such in-depth book I've read that is user-friendly to mental health professionals who do not have formal medical training. It includes what is often missing in other technical publications--interesting, attention-getting descriptions of the relationships of brain functions to real-life experiences. The reader gets a coherent, progressively unified picture rather than being left with a multitude of details. Dr. Pliszka makes it easy to understand the neurological underpinnings of anxiety, ADHD, and depression, and the epilogue offers one of the best summaries of the state-of-the-art in mental disorders I have read. The book also ties current scientific knowledge to other theoretical interpretations of human behavior, such as Freud's structural theory. Written in a straightforward, conversational style, this book has given me a deeper appreciation of how truly marvelous the brain is. It is ideal for graduate-level psychology courses as well as for medical school education and psychiatric residencies."--Michael J. Manos, PhD, Director, ADHD Center, Children's Hospital at the Cleveland Clinic

Bulletin of the Menninger Clinic

"...this is an excellent book....the author ties his presentation of neurobiology and of genetics directly to topics of enormous clinical interest--topics such as memory, fear, pleasure, and aggression. And more than that, he explains the neurobiological bases of both the symptomatic presentation and the successful treatment of disorders ranging from depression and mania through personality disorders."--Bulletin of the Menninger Clinic
Community Mental Health Journal

"Strengths of the book include Dr. Pliszka's extensive use of the literature in a laudable synthesis of research, presenting each topic concisely and clearly. He does not short-change any area he addresses and has highlighted the role of important scientists with summaries of key findings where relevant....Dr. Pliszka has made an important contribution in helping mental health clinicians to orient themselves to the imperatives of neuroscience and the possibilities for future advancement."--Community Mental Health Journal
Psychological Medicine

"An excellent introductory guide to neuroscience and its relationship to mental illness. The author has done a commendable job."--Psychological Medicine
Archives of Psychiatry and Psychotherapy

"This book is well written and crafted in an engaging style that captures the reader's attention....Highly recommended for all mental health professionals. It is also a great introductory text for teaching in psychiatric residency programs, particularly for residents who are interested in the study of genetics and mental illness."--Archives of Psychiatry and Psychotherapy
Doody's Review Service
Reviewer: Michael Joel Schrift, D.O., M.A.(University of Illinois at Chicago College of Medicine)
Description: This is an excellent introductory book covering the fundamentals of neuroscience in relation to psychiatric disorders. Written and edited by an academician/researcher in the field, this book is a valuable beginner's guide to the neurosciences.
Purpose: The purpose, according to the author, is to provide a book outlining and integrating the recent research in neurobiology of the disorders that psychiatrists see every day. The author has produced an accessible and readable book.
Audience: The intended audience is practicing mental health clinicians including psychiatrists, psychologists, and social workers. It would also be useful for trainees in psychiatry, neurology, and behavioral pediatrics.
Features: The book's 14 chapters are grouped into two parts. Part I covers fundamental concepts and contains chapters on neuroanatomy, the neuron, neurotransmitters, action and emotion, memory, and cortical function. Part II covers clinical issues with reviews of the neuroscientific aspects of the major psychiatric disorders. At the end of each chapter there are relevant and up-to-date references. There is a helpful index at the end of the book.
Assessment: This is a valuable introductory book covering the neurobiology of psychiatric disorders. I highly recommend it to anyone interested in understanding psychiatric disorders.

3 Stars from Doody
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Product Details

  • ISBN-13: 9781593850784
  • Publisher: Guilford Publications, Inc.
  • Publication date: 11/1/2004
  • Edition description: New Edition
  • Edition number: 1
  • Pages: 280
  • Sales rank: 633,431
  • Product dimensions: 5.90 (w) x 8.90 (h) x 0.60 (d)

Meet the Author


Steven R. Pliszka, MD, is Associate Professor and Chief of the Division of Child and Adolescent Psychiatry at the University of Texas Health Science Center at San Antonio.
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Read an Excerpt

Neuroscience for the Mental Health Clinician


By Steven R. Pliszka

The Guilford Press

Copyright © 2004 The Guilford Press
All right reserved.

ISBN: 1-59385-078-6


Chapter One

Introduction

WHY ANOTHER BOOK ON NEUROSCIENCE?

There are literally hundreds of books on the brain, so why should a mental health clinician read this one? Current books in the field of neuroscience fall into a number of areas, usually directed at specific audiences. There are textbooks of neuroanatomy that describe the physical structure of the brain. Neurochemistry or pharmacology texts give the chemical structures of the many neurotransmitters in the brain and describe the multitude of drugs that affect these transmitters. Psychopharmacology books give physicians "nuts-and-bolts" information about marketed pharmaceuticals in terms of their indications, dosages, and side effects. Physiological psychology textbooks aimed at graduate students focus on laboratory techniques and animal research. What appears to be missing is a book that can integrate the recent research on neurobiology for the practicing mental health clinician. This is true even for psychiatrists, despite their exposure to neuroscience and neuroanatomy in medical school. By the time psychiatrists finish residency, they often find that what they learned in neurology does not transfer well to the treatment of mental disorders. Clinical neurology focuses on strokes,epilepsy, and degenerative diseases of the brain that can have psychiatric sequelae, but even most psychiatrists do not encounter these disorders in their daily practice. What is of more interest to psychiatrists, and, I suggest, to the broader group of mental health practitioners is a book outlining the neurobiology of the disorders we see every day: depression, mania, anxiety, personality disorder, and attention-deficit/hyperactivity disorder (ADHD).

Take, for example, the fact that medications such as fluoxetine (Prozac) or sertraline (Zoloft) are effective in the treatment of major depressive disorder (MDD). These drugs are selective serotonin reuptake inhibitors (SSRIs), meaning that, at least acutely, they increase the amount of serotonin available to the neurons. But in this sentence are embedded a whole series of questions. Where exactly in the brain does serotonin reside? What role does it play in normal mood and behavior? What role, if any, does it play in the development of affective disorder? How does perturbing serotonin with medication improve depression? Finally, if serotonin is a critical link in treatment of depression, why are other agents that have no effect on serotonin also effective treatments for affective disorder? These are the sorts of questions this book seeks to answer about the many brain systems involved in mental disorders.

WHO SHOULD READ THIS BOOK?

This book is aimed primarily at practicing mental health clinicians (psychiatrists, psychologists, social workers, counselors, neurologists, developmental pediatricians) who are interested in how advances in neurobiology will ultimately lead to new treatments and social policies. This audience would include residents and interns in all these professions, as well as medical students in clinical psychiatry courses or rotations. It also should be highly useful as an introductory textbook for graduate students or upper-division undergraduates who seek a more clinically focused treatment of neurobiology. Many advanced neuroscience textbooks can be quite daunting in terms of their size and complexity. I think many students will find that this book can help them get their bearings before they move on to more advanced material. I assume knowledge of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) classification of mental disorders, as well as college-level biology.

NEUROSCIENCE ISSUES FOR MENTAL HEALTH CLINICIANS

The role of neuroscience in mental health goes well beyond the prescription of medication for specific mental disorders. The development of new techniques in genetics and brain imaging have the potential to significantly change our views of mental illnesses and, indeed, our view of the human condition itself. For some, this is a worrisome prospect: They are concerned that emphasizing the role of biology in mental illness will lead to a "reductionistic" view of mental illness, that complex mental disorders will be attributed to a single cause with medication as the only treatment. As this book shows, this reductionism is not the goal of clinical neuroscience. To place these issues in perspective, I give an overview of the history of the study of mental disorders germane to this issue.

EARLY DEVELOPMENTS

For hundreds of years, the severely mentally ill were cared for in asylums, where many were brutally treated. At the St. Mary of Bethlehem Hospital in London, patients were often displayed for the entertainment of the public. It is from this institution that the word "bedlam" acquired its popular meaning as a "place of uproar." Most modern people would profess to be horrified by the thought of going to see mental patients for entertainment, but let us not be too smug. Recently in a major city I noticed a man on the street, wearing a billboard that said, "America awake, Vice President Gore's body has been taken over by aliens." The man carried a bullhorn, with which he broadcast his warnings to all who passed by. The man probably suffered from bipolar disorder, but as people walked past they laughed and pointed. Admittedly, the man's behavior was funny-until you reflected that he was someone's son or spouse. That day, the people on the street of 21st century America were little different from the crowds at "Bedlam" in the 1400s.

Throughout the 17th and 18th centuries, however, there were movements to provide more humane care for persons in hospitals. The most notable of these was the "moral therapy" movement began by Philippe Pinel, who in 1795 ordered mentally ill inmates at the Paris hospital Salpêtrière released from chains. "Moral treatment" dominated psychiatry in the early part of the 19th century. In 1830 the British physician John Conolly started a movement to abolish mechanical restraints of patients; in 1841 limiting the use of restraint became the official policy of the Association of Medical Officers of Hospitals for the Insane (now the Royal College of Psychiatrists). Debates about how to deal with violent behavior in mental patients remain intense in our own time. During the 1800s the first debates began as to whether the causes of mental illness were primarily biological or psychological. In Germany, Johann Reil published Rhapsodies about the Application of Psychotherapy to Mental Disturbances (1803), which emphasized psychological factors, whereas in 1845 Wilhelm Griesinger wrote that mental diseases were brain diseases. As professor of psychiatry and neurology in Berlin, he had wide influence on European psychiatry. The discovery by Paul Broca and Carl Wernicke of specific brain lesions that caused speech and language deficits reinforced the view that disturbed behavior could be related to brain dysfunction. At this point, biological psychiatry entered a phase that led to great advancements on the one hand and tragedy on the other.

At the turn of the 20th century, Emil Kraepelin divided "insanity" into manic-depressive illness and "dementia praecox" (schizophrenia). In 1906 Alois Alzheimer discovered the relationship between early-onset dementia and a pathological lesion in the brain; this disorder now bears his name. At the turn of the 20th century, Ladislas von Meduna noted that convulsions reduced symptoms in schizophrenia; two Italian psychiatrists, Ugo Cerletti and Lucio Bini, developed a means of inducing convulsions by electroshock. Electroconvulsive therapy (ECT) proved highly effective for psychosis, particularly for affective disorder. Before antidepressants and antipsychotics were developed, ECT was the mainstay for treating these disorders. It remains a highly effective option for some patients today, despite the negative views that some lay people hold of it. At the turn of the 20th century, there was great optimism that the brain mechanisms underlying mental disorders would soon be unraveled.

THE PROBLEM OF EUGENICS

There were, however, other trends in biological psychiatry that were not so positive. In the late 19th century the French psychiatrists Bénédict-Augustin Morel and Valentin Magnan proposed the "theory of degeneration." This theory held that all mental illnesses were genetic and that mental illness often worsened from one generation to the next. The same was felt to be true for many neurological illnesses, such as epilepsy. The theory took on an ominous note, as degeneration was thought to cluster among the "lower classes" who often belonged to racial or ethnic minorities. This theory was the justification for the widespread sterilization of mentally ill and retarded patients in the late 19th and early 20th centuries. The Italian psychiatrist Cesare Lombroso proposed that criminal behavior was also the result of "degeneracy" and could be predicted by the physical features of an individual. Lombroso is viewed as the father of criminology, but his views led to much pessimism about the possibility of rehabilitating criminals. Again, this debate is with us today. The theory of degeneration spawned the "eugenics" movement in the early 20th century. Kraepelin had noted that many cases of manic-depressive illness ran in families, and in 1917 he established a Genealogical and Demographic Department at the Kaiser Wilhelm Institute of Psychiatry in Munich to study how mental illnesses were transmitted in families. The head of this department, Ernst Rüdin, took over the Institute on Kraepelin's death in 1926. Rüdin became infamous as the author of the "Law to Prevent Hereditarily Sick Offspring," enacted by the Nazis in 1933. Hundreds of thousands of people with physical handicaps or mental illnesses were forcibly sterilized and later murdered in the Holocaust. In the United States, eugenics gained some ground, with forced sterilization often being practiced in facilities for the mentally ill or retarded. After World War II, particularly when the crimes of the Nazis were exposed, the eugenics movement was rightly abandoned. Today, some critics of modern psychiatry point to these horrors as reasons that the study of genetic or brain-based mechanisms of mental illness should not go forward. The implication is that any study of the brain with regard to human behavior will inevitably place society on a "slippery slope" that leads to genocide. It is important to bear in mind, however, that the Holocaust was not the result of the Nazis "slipping" into mass murder. Hitler's intent to eradicate the Jews and others he deemed inferior was a deliberate policy for which the pseudoscience of eugenics was not a necessary prerequisite. Moreover, "eugenics" and the "theory of degeneration" were not supportable even by the science of the time-it was the departure from the scientific method that allowed the eugenics movement to spread. There is no parallel between the modern study of neurobiological factors in mental illness and the pseudoscientific views of Morel, Lombroso, and Rüdin; this becomes clear as the reader progresses through the chapters on specific mental disorders. It is critical for the sophisticated clinician to be able to articulate how our modern studies differ fundamentally from the pseudoscience of the past.

PSYCHOANALYSIS AND THE DECLINE OF BIOLOGICAL PSYCHIATRY

As pointed out by Samuel Barondes in his book Mood Genes, it was not just the excesses of the eugenics movement that led to the decline of the study of biological factors in mental illnesses. Biological factors became viewed as irrelevant to mental illness when psychoanalysis began to grow. At the end of the 19th century, neurologists used their expanding knowledge of the nervous system to associate specific neurological symptoms (e.g., paralysis) to lesions in the brain. Certain disturbances in behavior, however, could not be explained by neuroanatomy. Many people of the time suffered from what was called "neurasthenia"-a syndrome of tiredness, weakness, and somatic complaints (i.e., nonspecific aches and pains). The description of the disorder was quite similar to the modern disorders of chronic fatigue syndrome or fibromyalgia-conditions that today also defy medical understanding. Other patients, particularly women, suffered from hysteria-for instance, paralysis of a limb not related to a neurological lesion. The neurologist Jean-Martin Charcot found that these symptoms could be relieved by hypnosis. At this same time, Sigmund Freud was also using hypnosis to treat hysteria, but he developed a different technique, free association, that seemed just as effective in removing the symptoms. As patients talked in open-ended manner, they often reported dreams and memories of a sexual nature. Freud developed the theory that unconscious thoughts, particularly sexual ones about which the patient felt guilty, caused the hysteria. There is controversy among historians as to how Freud arrived at this conclusion. Freud had first developed a "theory of seduction," which stated that hysteria arose as a sequelae of sexual abuse during childhood. He presented this hypothesis to the Society for Psychiatry and Neurology in 1896. He presented 18 cases, but the audience rejected his reasoning; his lecture, Freud said, "had an icy reception from the donkeys." Critics of Freud suggested that he abandoned this seduction theory because it was poorly received by the medical community of the time. Allegedly, he then revised his theory to state that, between the ages of 3 and 5, all children had sexual feelings toward the parent of the opposite sex and that fixation in this "oedipal" stage led to neurosis. An alternative view has it that he encountered sexual fantasies of this sort in so many of his patients that he came to view actual sexual abuse as an improbable mechanism of neurosis. Thus he revised his theory, and neuroses were viewed as stemming from unconscious conflicts. Psychoanalysis was born.

The impact of Freud on 20th-century culture was profound. In the repressive atmosphere of the Victorian time, people were not expected to have any sexual feelings-this was especially true of women. Children were regularly beaten for masturbation or even wetting the bed. (See George Orwell's "Such, Such Were the Joys" for a chilling look at a childhood in the early 1900s). Hysteria was more common among women. It is reasonable to speculate that the highly restricted lifestyle women led-corsets, hours of domestic labor, lack of access to careers, complete domination by husbands or fathers-led to the high rates of hysteria noted at the time.

Continues...


Excerpted from Neuroscience for the Mental Health Clinician by Steven R. Pliszka Copyright © 2004 by The Guilford Press. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents


1. Introduction
I. Basic Principles of Neuroscience
2. Draw the Brain: Introduction to Clinical Neuroanatomy
3. The Neuron
4. Neurotransmitters
5. Fear, Reward, and Action
6. Memory
7. An Overview of Cortical Function
II. Neuroscience of Mental Disorders
8. Introduction to Clinical Issues
9. Attention-Deficit/Hyperactivity Disorder
10. Aggression, Antisocial Behavior, and Substance Abuse
11. Mood and Anxiety Disorders
12. Schizophrenia and Pervasive Developmental Disorders
13. Cognitive Disorders
14. Epilogue
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