Reviewer: Michael Joel Schrift, DO, MA (Northwestern University Feinberg School of Medicine)
Description: The recent controversy triggered by the publication of DSM-5 highlights the problems regarding the lack of validity inherent in a diagnostic scheme that is primarily based on description. However, the DSM-5 is just one aspect of a much broader problem in psychiatry. The basis of psychiatric training in the U.S. and, presumably, elsewhere is not neuroscience and brain-behavior relationships. You would think that since modern neuroscience has shown that the organ of the mind is the brain, brain science ought to be the core model that psychiatrists in training are taught. Unfortunately, it is not! Most psychiatrists are not trained to, and are incapable of, making a differential diagnosis (listing the multiple possible causes) of psychopathology. Most psychiatrists and trainees have only learned DSM differential diagnoses ("DSMology"). They do not make differential neurological and medical diagnoses. It is correct that psychiatric diagnosis is imprecise because we don't know enough yet about the brain, but what we already do know about the psychiatric, cognitive, and behavioral manifestation of neurological and medical illness is not incorporated in psychiatric training, nor is it modeled by practicing psychiatrists. Most psychiatry residency training programs do not teach brain imaging, EEG, neuropathology, or cognitive neuroscience. Molecular genetics is hardly mentioned. Most psychiatrists do not perform physical or neurological examinations of their patients. This outstanding book, now in its second edition, is an effort to relate the knowledge about the brain to the practice of psychiatry by covering the neuroscientific basis of behavior and psychopathology. Written and edited by nationally recognized clinician-researchers, it remains a welcome contribution to the psychiatric literature and is quite helpful in the training of psychiatrists as well as medical students.
Purpose: The purpose, according to the authors, "is to provide a way for residents and the practicing clinicians to gain knowledge thorough an appreciation for the mechanisms within the brain that are stimulating (or failing to stimulate) their patients." What the authors mean is that the brain is composed of a number of large scale neuronal networks with each network performing specific computational functions, such as language, spatial attention, executive functions, mood and memory, etc., and psychopathology such as depression, anxiety, etc., represents, in this view, disturbed information processing of a specific network or interaction of networks.
Audience: The intended audience includes trainees in psychiatry, psychologists, counselors, and allied physicians as well as psychiatry residents seeking to review the topics in preparation for board examinations.
Features: The first two of the book's four sections cover basic neuroanatomy, neurophysiology, and neurodevelopment, as well as neuromodulators. Section 3 focuses on the neurobiological bases of behavior, covering pain, pleasure, appetite, anger and aggression, sleep, sex, social attachment, memory, intelligence, and attention. Section 4 relates the knowledge of the basic neurosciences, as reviewed in the first two sections, to disorders such as schizophrenia and depression. Each chapter ends with a series of multiple choice questions with the answers at the end of the book. A bibliography for each chapter is included at the end as well.
Assessment: This is an outstanding introduction to neuroscience for psychiatry residents and clinicians trained prior to the paradigm shift. I have been using this book for my first-year medical school course, "Brain & Behavior," which helps the integration with neuroanatomy and neurophysiology courses, and the students overwhelmingly have enjoyed the book. The body of knowledge that it attempts to convey should be the minimum requirement for every psychiatrist!