Textbook of Biological Psychiatry / Edition 1

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Biological psychiatry brings together information from multiple disciplines, including psychiatry, neuropsychology, neurology, neuroendocrinology, pharmacology, physiology, and biochemistry. A Textbook of Biological Psychiatry will be the only modern text to integrate the basic science concerning brain mechanisms of psychiatric disorders alongside surveys of present standard clinical treatment. Organized in a coherent and easy to follow structure, chapters expand across different levels of analysis, from basic mechanisms to clinical practice.
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Editorial Reviews

From The Critics
Reviewer: Michael Joel Schrift, D.O., M.A.(University of Illinois at Chicago College of Medicine)
Description: This is a new book covering "biological" (is there nonbiological psychiatry?) psychiatry. Although the book is edited by an internationally recognized neuroscientist and many of the chapters are written by well-known clinician/researchers in psychiatry, I believe that the book has significant shortcomings that would not allow me to recommend it.
Purpose: The purpose of the book, according to the editor, "... was to seek the middle ground - a balance of facts and theories, as well as consideration of both clinical and preclinical perspectives." Unfortunately, several of the chapters tend to be weighted toward the theory side. It appears that the critical, evidenced-based approach that permeates much of the book was suspended for chapters that cover psychoanalysis and "depth psychological consequences of brain damage." Also, glaringly missing was virtually any discussion of cognitive neuroscience in relationship to psychopathology. Cognitive neuroscience, neuropsychology, hallucinations, or delusions are not even listed in the index of a textbook of biological psychiatry!
Audience: The intended audience, according to the editor, is students, teachers, and practitioners, as well as "... scientists who harvest the basic knowledge from which future understanding must emerge."
Features: The book is divided into three parts and 21 chapters and includes an appendix and index section. Part I contains chapters covering the history of biological psychiatry, an excellent chapter on the neuroimaging of emotion and affect, and interesting chapters on the neural substrates of consciousness, stress, sleep, sexuality, psychobiology of personality disorders, and functional neuroimaging. Part II covers specific syndromes and includes some excellent chapters on depression, treatment of mood disorders, neuroscience of schizophrenia, PTSD, panic disorder, OCD, childhood neuropsychiatric disorders, and aging/dementia. Part III has also some outstanding chapters on fear and anxiety, somatic treatments, evolutionary aspects of psychiatry, and neuropeptides. There is also a useful appendix on pharmacodynamics and pharmacokinetics. The index is generally helpful.
Assessment: Psychoanalysis continues to be the nonscientific "elephant in the room" of psychiatry. To continue to attempt the resurrection of psychoanalysis and the bootstrapping of it to modern neuroscience, in my opinion, is a waste of intellectual effort, given advances in elucidating the relationships between brain function and behavior through such disciplines as behavioral/molecular genetics, cognitive neuroscience, neuropsychology, neuropharmacology, and evolutionary psychology. If Freud were alive today, I believe he would be a cognitive neuroscientist. This book, although it has some excellent sections, does not compare to other books of this genre.

2 Stars from Doody
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Product Details

  • ISBN-13: 9780471434788
  • Publisher: Wiley, John & Sons, Incorporated
  • Publication date: 11/10/2003
  • Edition number: 1
  • Pages: 736
  • Product dimensions: 7.22 (w) x 10.10 (h) x 1.52 (d)

Table of Contents

Pt. I Foundational Concepts 1
1 Biological Psychiatry Sketched - Past, Present, and Future 3
2 Imaging Human Emotions and Affective Feelings: Implications for Biological Psychiatry 33
3 Neural Substrates of Consciousness: Implications for Clinical Psychiatry 75
4 Stress, Sleep, and Sexuality in Psychiatric Disorders 111
5 Psychobiology of Personality Disorders 145
6 Functional Neuroimaging in Psychiatry 167
Pt. II Core Psychiatric Challenges 195
7 Depression: A Neuropsychiatric Perspective 197
8 Treatment of Mood Disorders 231
9 Neuroscience of Schizophrenia 267
10 Pharmacological Treatment of Schizophrenia 299
11 Psychobiology of Posttraumatic Stress Disorder 319
12 Nature and Treatment of Panic Disorder 345
13 Nature and Treatment of Obsessive-Compulsive Disorder 367
14 Biological Basis of Childhood Neuropsychiatric Disorders 393
15 Aging and Dementia 437
Pt. III Future Prospects 487
16 Emerging Neuroscience of Fear and Anxiety: Therapeutic Practice and Clinical Implications 489
17 Somatic Treatments in Psychiatry 521
18 Psychoanalysis and Psychopharmacology: Art and Science of Combining Paradigms 549
19 Depth Psychological Consequences of Brain Damage 571
20 Sociophysiology and Evolutionary Aspects of Psychiatry 597
21 Future of Neuropeptides in Biological Psychiatry and Emotional Psychopharmacology: Goals and Strategies 627
App. A Pharmacodynamics and Pharmacokinetics 661
Index 683
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First Chapter

Textbook of Biological Psychiatry

John Wiley & Sons

Copyright © 2004 John Wiley & Sons, Inc.
All right reserved.

ISBN: 0-471-43478-7

Chapter One


J.P. Scott Center for Neuroscience Mind & Behavior, Department of Psychology, Bowling Green State University, Bowling Green, Ohio


It is a difficult task to capture the history of biological psychiatry in a brief essay. Let me frame this modest effort in a timeless humanistic perspective.

Psychiatry is the study and treatment of troubled mental lives. Its ultimate goal is to heal broken spirits. At its core, it is an attempt to better understand human thoughts and emotions and to allow this understanding to inform the healing arts. Despite our modern scientific hubris, we know rather little about how brains truly construct our minds and passions. Partly, this is because few scholars have come to terms with the need to understand the evolutionary neural dynamics that affective experiences are ultimately made of. It is all too easy to accept emotions as primitive "givens" and proceed toward a superficial understanding based on words, arbitrary definitions, and the quiddities of logic rather than biology. But the greater and more significant depths of this mystery have to be plumbed by an integrative neuroscience that has barely emerged.

It is surely not off the mark to claim that the single mostimportant scientific question for biological psychiatry is the accurate decoding of the basic neural nature of affective values and related cognitive experiences. Emotions and moods guide most of our thinking processes and behavioral choices, whether well-arranged or deranged. Many psychopathologies arise from imbalances in these feeling systems that motivate us to think and act in certain ways. At a deep psychological level, that often goes unspoken, emotionally disturbed people have some insight into the weaknesses of their minds. They simply don't know how to manage their persistent psychic dis-equilibrium. They are certainly no more accustomed to thinking about these psychic forces in neural terms than are the counselors and psychotherapists from whom they seek assistance.

Taxonomic schemes that do not directly acknowledge the underlying emotional faculties of the human mind and brain must be deemed provisional approximations of the goals to which we should aspire. Brain sciences that do not acknowledge or attempt to explore how such processes motivate and guide thinking do no great service to psychiatric thought. Mind sciences that do not dwell on the complexity of the internal world, replete with all manner of feelings and cognitions, do not serve our understanding well. The cognitive, behavioral, and affective sciences must devote equal effort to understanding the embeddedness of mind in brain, body, environment, and culture; otherwise essential components will be overlooked. Only by blending these perspectives judiciously, without inflaming simple-minded polarities such as nurture versus nature, is psychiatric practice well served.

By the end of the 20th century neuroscience had advanced to a point where we now understand the brain rather well. Unfortunately, the discussion of equally important, but more slippery, mind matters continues to lag far behind. Credibly linking facts about the brain to mental functions is maddeningly difficult. There are few incentives in our current system for integrating the abundant peppercorns of brain data into an integrated psychobiological understanding. A prevailing positivistic hope has been that knowledge will emerge automatically from the raw facts like cream rising from freshly expelled milk. To an undesirable degree, theoretical views have been demoted to second-class citizenship. Accordingly, rich discussions of many key functional issues almost disappeared in neuroscience as it mastered how to milk our neural nature during the last third of the 20th century. Indeed, the very concept of productive hypothesizing came to be termed, scornfully, as "mere speculation," perhaps because too many students of the mind (and certainly too many science popularizers) forgot the difference between a "working hypothesis" and a "provisional conclusion." Major textbooks of biological psychiatry and neuropsychiatry no longer discuss emotions prominently. Some consider them needless frills that intervene between reliable diagnostic categories and descriptions of related brain changes. Often, there is little tolerance for such "middle-level" theorizing that seeks to meaningfully link brain functions with mind. One aim of this text is to reverse this trend.

Thus, I proceeded to this historical sketch with several common but oft-neglected preoccupations that continue to trouble modern psychiatric thought. How are the passions of the mind truly created? How do they become overwhelming? How can mere words help heal minds? What is the healing touch? Why are character traits so important in healers as well as patients? What is the proper role of placebos in the therapeutic enterprise? Are our diagnostic categories as sound as they could be? Such concerns led me to encourage all contributors to this book to consider the central role of thought and emotions in psychiatrically significant disturbances of the psyche. My own bias is that the next great frontier in biological psychiatry is the topic that has been most neglected by modern neuroscience-the deep neurobiological nature of affective experiences. Even though our understanding of such key issues remains woefully incomplete, we must continue to share the harvest of knowledge we already have, and thereby fertilize the field, once more, so that those who come after us are better prepared to contend with the perennial joys and difficulties of mental existence.


Although human interest in the nature of the mind and its passions surely goes back to a time long before the beginning of recorded history, the systematic scientific search for the causes of psychological disorders did not begin in earnest until the latter part of the 19th century. Prior to that, the practice of psychiatry was characterized more by superstition and punishment, punctuated by occasional humane concerns. Although there were several sustained periods of enlightened care of the emotionally distraught, as in the ritual purification (i.e., "incubation" or rest therapy) approaches of the Grecian period, it is likely that one of the main functions of those whole-body, whole-mind efforts-which included athletics, baths, music, dance, and ritualized sexual encounters -was the alleviation of everyday stress and sexual inadequacy. The holistic cures of those healing temples, organized symbolically under the aegis of Asclepius, the god of health, thrived for well over a millennium, but surely the stigmatization and brutalization of serious mental ailments also remained abundant yet uncelebrated. While a humanistic tradition was sustained in many middle eastern countries, Europe succumbed to the flea-ridden plagues and narrow-mindedness of the Dark Ages for an extended period, in which harsh punishments and the demonizing of nonstandard human souls prevailed [for a more detailed historical coverage, see Andreasen (2001), Mora (1985) and Stone (1997)].

Most biological approaches to treating mental ailments during the past several thousand years have been based on unsubstantiated beliefs and wild logic rather than scientific substance. Beatings, bleedings, starvation, hot and cold water shock treatments, and restraints have all been time-tested therapeutic failures, at least in the long-term. However, various socially sustained and often effective placebo approaches have often flourished, including witch-doctoring, shamanism, and occasional trepanations of skulls to release evil spirits. Apparently our social brains respond quite well to the sympathetic concerns of others, which may be the foundation of all pervasive placebo effects in psychiatry (Harrington 1999; Moerman 2002; Shapiro and Shapiro 2001). Of course, we now know that placebo effects have real effects on the brain (Mayberg et al., 2002), perhaps brain opioid mediated (Petrovic et al., 2002), and the intervening prosocial feelings may be mediated, in part, by endogenous opioids (Panksepp, 1998).

A few revolutionaries also made substantive biomedical advances. Paracelsus (1493-1541) enthusiastically promoted one of the few effective medicines available in his time (e.g., opioids), and in Diseases Which Deprive Man of His Reason (1567), he described many alchemical concoctions, some of which contained heavy metals such as mercury. We now know that some of these toxic agents can help purge the body of certain psychopathological vectors, one of which was recognized as Treponema pallidum in 1906-the agent responsible for causing syphilis and its resulting schizophreniform mental deteriorations. Unfortunately, the safety margin between the effective doses and lethal doses was not auspicious. The eventual discovery that induction of fevers could sometimes halt syphilis-induced mental deterioration was honored with Nobel recognition (Laureate Julius Wagner-Jauregg, 1927) for the "discovery of the therapeutic value of malaria inoculation in the treatment of dementia paralytica" (Jasper, 1983).

With the emergence of the scientific tradition in the physical sciences, enlightened thinkers sought to approach human psychological problems with a new sensitivity. Benjamin Rush (1745-1813) in America, along with Phillipe Pinel (1745-1826) in France, and Vincenzo Chiarugi (1759-1820) in Italy, set in motion the "moral treatment" of the insane, even though some also advocated somatic treatments: Benjamin Rush promoted bloodletting, emetics, purges, special diets, and his agitation-constraining, straight-jacket "tranquilizing chair," while Benjamin Franklin promoted electrical therapy for various ailments. These revolutionaries helped establish havens for the mentally ill in small humanistic hospitals where they sought to create therapeutic environments that aimed to facilitate the reestablishment of emotional homeostasis. The movement was sustained and amplified by social activists such as Dorothea Dix (1802-1887). Sadly, by the end of the 19th century this model had devolved in America into the massive warehousing of cognitively and emotionally impaired individuals in large state-run institutions.

Meanwhile, with the growth of scientific physiology and biochemistry throughout the latter half of the 19th century, especially in German universities, neuropsychiatry became integrated into the standard biologically oriented medical curriculum. Indeed, modern psychiatry emerged from the successes of neurology, and the hybrid subdiscipline of neuropsychiatry still thrives (Yudofsky and Hales, 1997). However, a clear division of duties also developed-classical neurologists came to focus on standard brain abilities (i.e., sensations, perceptions, actions, and only more recently cognitive activities) while psychiatrists occupied themselves more with how people feel and how they impulsively react and choose to behave on the basis of their internal passions and other affectively experienced value systems.

Thus, the two sister disciplines, neurology and psychiatry, also commonly deal with different parts of the nervous system, the former with the somatic components and the other more with the visceral components. Theodore Meynert's 1884 textbook Psychiatry: A Clinical Treatise on the Diseases of the Forebrain was prescient in this regard. Since then, it has become increasingly clear that emotional regulation and psychiatric diseases are related more to frontal-limbic executive functions than to posterior cortico-thalamic, sensory-intellectual functions. Parenthetically, Meynert was one of Freud's esteemed teachers, and even after he abandoned brain approaches, Freud continued to acknowledge that his wide-ranging psychoanalytic theories eventually needed to be linked to neuroscience. He recognized that what might eventually grow from that potentially fertile hybridization could be spectacular. As Freud noted in Beyond the Pleasure Principle (1920, p. 60): "Biology is truly a land of unlimited possibilities. We may expect it to give us the most surprising information, and we cannot guess what answers it will return in a few dozen years.... They may be of a kind which will blow away the whole of our artificial structure of hypotheses." And by the end of the 20th century, his premonitions had come true to such a degree that his own conceptual ideas also seemed to be blown away, or so it seemed to many who had become disenchanted with the possibility of scientifically understanding the "mental apparatus." However, there are recent indications of resurgent interest in the relations between brain and depth psychological issues in the newly emerging neuropsychoanalytic movement (Solms and Turnbull, 2002), which seeks to build substantively on past and present discoveries.


The three pioneers who set the stage for thinking throughout the modern phase of 20th-century psychiatry were Emil Kraepelin (1855-1926) in Germany, Sigmund Freud (1856-1939) in Austria, and Adolph Meyer (1866-1950) in America. The influence of Kraepelin's perspective, derived from the successes of German neurology, has been most pervasive, yielding a lasting influence on our conceptualization of what a comprehensive psychiatry should look like. Kraepelin, now widely regarded as the titular father of biological psychiatry, started his academic work at Dorpat University at the edge of the German empire of medical science (now the University of Tartu, Estonia), where he wrote the first edition of his seminal Textbook of Psychiatry, which went through nine editions between 1883 and 1927. That contribution propelled him to Heidelberg and ultimately to Munich as the implicit leader of German psychiatry. Recognition of his seminal diagnostic and pathophysiological thinking remained widespread from the latter half of the 19th century until World War I shattered the vigorous beginnings of biological psychiatry.

Still, Kraepelin had laid the essential foundations, and his approach continues to symbolically represent how scientific psychiatry should proceed [his influence is still especially clear in Axis I diagnostics of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV)]. He recognized that progress had to be based on systematic cross-sectional and longitudinal clinical observations, leading to diagnostic systematics.


Excerpted from Textbook of Biological Psychiatry Copyright © 2004 by John Wiley & Sons, Inc.. 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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