The Neurobiology of Mental Illness

This is the second edition of the text first published in 1999 and has been expanded considerably and rewritten. I read and greatly valued my copy of the first edition which was immensely useful as a reference for the state of the literature in neurobiology. I believe that this second edition shall continue to be of immense value to a wide readership.

The book is divided into nine sections. The first two sections include an introduction to basic neuroscientific concepts and a section that discusses different methods of inquiry in basic and clinical neuroscience. Sections three through seven deal in some detail with neuropsychiatric syndromes including psychoses, mood disorders, anxiety, substance abuse and dementia. A further section deals with childhood and adolescent onset psychiatric disorders and a final section debates some topics of special interest.

Psychiatry has been extensively influenced by the explosive developments in neurobiology in the last couple of decades and even in the five years since the first edition of this book was published there has been an impressive addition to the available base of knowledge. Given the already heavy demands of a psychiatric educational curriculum, and the schedule of a busy practitioner, it is increasingly difficult to keep up with this burgeoning knowledge base. There is a need for a basic neurobiological grounding in psychiatric neuroscience and I think the first two sections of this book that cover an introduction to neuroscience and a primer on the methods of neurobiological research do this in an admirable and clear fashion. As an example, Tollefson’s chapter on drug discovery in mental illness, a chapter that concludes section two is instructive in its detailed discussion of the pitfalls and complexities involved in psychopharmacological drug discovery. It should be of interest to readers outside of the pharmaceutical industry as well as those actively involved in it.

The psychoses are covered in eight sections which follow the general breakdown of each section. Breier discusses the historical context of the diagnostic classification of the psychoses and the implications for our understanding of its neurobiology. Ken Kendler and Brien Riley discuss the molecular genetics of schizophrenia. I especially liked Trevor Robbins’ discussion of the animal models of psychosis for both its detail as well as its comprehensiveness in discussing the different cognitive models that have become important as we search for therapies that would benefit the cognitive deficit in schizophrenia. John Krystal’s discussion of pharmacological models is excellent and touches upon the important aspects of NMDA receptor function and the pharmacology of ketamine. The next three chapters describe in high level detail the neurobiology of schizophrenia, a summary of current imaging in the disorder and finally information processing in the disorder. Tamminga rounds off this excellent section by discussing drug treatments of psychoses and the contrast between typical and atypical antipsychotic compounds.

Parts 4 and 5 of the text concentrate on mood disorders and anxiety disorders and are edited by Charles Nemeroff and Dennis Charney respectively. The layout of each section follows the general layout for each of the “syndrome” sections, i.e. it starts of with diagnostic classifications, discusses animal models (new for anxiety disorders in this edition) and then develops the themes of neurochemistry, neuroimaging and finally a chapter on treatments. I found Swedo’s chapter on the treatment of OCD to be very helpful and informative with a discussion not just of the basal ganglia dysfunction that probably underlies this disease but also of potential neurotransmitter dysfunction that may contribute to symptoms. In the mood disorders section, I was also impressed by the comprehensiveness of the chapter on neuroimaging of affective disorders. Drevets and Ramakrishnan have been involved in some of the important research on the imaging of mood disorders and their expertise feeds well into the layout, discussion and comprehensiveness of this review. In addition, the chapter on animal models of mood disorders is also well written as is Dennis Charney’s chapter on the drug treatment of depression.

My knowledge of substance abuse disorders is largely based on my recollections from classes during my residency and so the chapter on molecular mechanisms of addiction was a revelation to me on how far the field has come in these past few years. In addition, I found Nora Volkow’s essay on neuroimaging in substance abuse disorders to be well written and informative to someone with my limited knowledge of this literature.

Dementia has its own section (seven), and although weighted as usual toward Alzheimer disease with detailed descriptions of its molecular biology, neuroimaging and animal models, is distinctly different from the first edition in that there are additional chapters discussing the cognitive deficits in multiple sclerosis, Lewy body dementia and the dementia of Parkinson’s disease. I think the expansion of focus serves this section well. In future editions, I would like to see further broadening of the discussion to include tauopathies, Huntington’s disease and other neurodegenerative diseases that are associated with dementia.

Pediatric and adolescent psychiatric disorders are discussed in section 8. Overall the section is well written and comprehensive with chapters on childhood psychoses, mood and anxiety disorders as well as tic disorders and ADHD. What was of considerably more interest to me were the chapters on autism and the Fragile X syndrome (not discussed in the earlier edition), both of which discuss the current state of the literature and brought me up to speed on what is a fast moving area of knowledge in pediatric psychiatry.

Section 9 is the “special topics section” and begins with a superb essay on neuropsychiatry. The history of neuropsychiatry from Hippocrates to Freud is described followed by a discussion of basal ganglia disease, multiple sclerosis and cerebrovascular disease. Basal ganglia disease forms the heart of quintessentially neuropsychiatric illness whereby every single movement disorder has a major “psychiatric” component. The psychopathologic morbidity of disorders such as Huntington’s and Parkinson’s disease are discussed as well as depression post stroke and the mood changes seen with multiple sclerosis. Richard Davidson discusses the conceptual issues involved in the study of the biology of personality and the state of the literature relating to this research. RJR Blair’s chapter on the neurobiology of aggression was of great interest to me because of my unfamiliarity with the recent literature in this field. The chapter is an excellent introduction to the current state of knowledge (admittedly over two years old now). The final few chapters in this section consist of brief discussions of topics that would not fit comfortably in other portions of this book but due to the state of the research, deserve an overview. These include social attachment, sexual dysfunction, eating disorders, circadian rhythms and sleep.

In conclusion, I must say that I really liked this book. It has the potential to be a valuable resource to psychiatric residents, a primer for those entering the field of neurobiological research as well as a way to keep up with the state of the art in fields other than our own research interests. It suffers from shortcomings, some of which are intrinsic to the book format (i.e. the information is somewhat dated by the time the book is published) and others that I believe are limitations of size constraint (e.g. the relationship between Down’s and AD is not explored). All in all however, definitely recommended as a book to keep on the shelves of anyone interested in psychiatric neurobiology.