Casebook of Neuropsychiatry

Over the past 25 years, neuropsychiatry has evolved from an ill-defined esoteric area of interest to one that is now recognized as a subspecialty with a core body of knowledge at the intersection of psychiatry and neurology. Since 2006, the United Council for Neurologic Subspecialties has administered certification examinations in neuropsychiatry and behavioral neurology. Newly promulgated training milestones for general psychiatry residencies (1) formalize the inclusion of aspects of neuropsychiatry as required knowledge. Currently, high-quality clinical training resources in this arena are in great demand.

Casebook of Neuropsychiatry is a welcome volume and the first of its kind. It delves into the variety of complex neuropsychiatric diagnoses one might encounter while practicing general psychiatry in either an inpatient or outpatient setting. The authors present 38 real-life clinical cases grouped into 11 chapters by symptomatic presentation: disinhibition, apathy, depression, anxiety, psychosis, hyperkinetic states, somatoform disorders, alterations of consciousness, memory failure, intellectual failure, and focal neurobehavioral syndromes. Classic neuropsychiatric diseases (epilepsy, multiple sclerosis, and traumatic brain injury) are included along with more recently described diseases (anti-N-methyl-D-aspartic acid receptor encephalitis) and disorders (cogniform disorder).

Each case is presented with relevant clinical findings, neuroimaging data when available, and, in some instances, selected neuropsychological test findings. Patient presentations are laid out in a straightforward medical manner, focusing on basic neuropsychiatric history and examination elements. There is a dearth of descriptive information about the patients’ subjective experiences of their neuropsychiatric symptoms, although the book does not claim to offer such a focus.

Each case report is followed by a helpful discussion in which intertwining neurological and psychiatric elements serve as teaching points, and probable neuroanatomical and neurophysiological etiologies are described. In addition, an outline of key clinical points and lists of both further readings and references are provided.

Most of the case reports in this volume discuss patients referred for complex neuropsychiatric assessments to a tertiary care center. In many of the cases, the primary diagnosis is clear (epilepsy, brain injury from an aneurysm or surgical excision of a tumor, or accidental carbon monoxide poisoning); however, the management of the case was challenging to the referring physicians. The authors demonstrate how understanding the neurological underpinnings of the disorder helps to inform more effective treatment interventions.

In some of the clinical examples, the diagnosis was initially unclear. In these situations, the authors do not minimize how difficult it may be to make a diagnosis. Often, patients have gone for years without the true etiology of their symptoms being recognized. In other instances, there has not been a full understanding of how a crucial neurological component has contributed to the clinical presentation. In discussing these complex clinical problems, the authors share their thinking about how various aspects of the cases suggest different diagnoses and, just as in neuropsychiatric practice, they may not be able to settle on an absolute diagnostic solution.

Patients who present with what are generally thought of as “psychiatric symptoms” and with no previous neurological disease are probably the most pertinent to psychiatrists in general practice. Many of these cases, as discussed in the book, are diagnostic dilemmas, including, for example, an excellent case of difficult-to-diagnose Lyme disease, a patient with psychogenic nonepileptic seizures, and an individual with dementia syndrome of depression.

The editors of this book are to be commended for the many challenges they overcame in producing this work. Among them is dealing with the explosion of data about the brain basis of neuropsychological phenomena along with continued uncertainty about this information as our understanding of brain function evolves. The consistency of the writing throughout is exceptional and allows this edited book to read as though it was the work of one author.

The authors of Casebook of Neuropsychiatry do an excellent job at presenting and discussing the management of disorders that are clearly neurological and that manifest with behavioral or psychiatric symptoms. They pay somewhat less attention to disorders that may be perceived by patients to be of non-neurological origin, including learning disabilities, disturbances in social cognition, mild unrecognized prosopagnosia, autism spectrum disorders, mild cognitive impairment, mild cognitive difficulties associated with depression, or memory disturbances associated with sleep disorders. Patients with these disorders often first present to psychiatrists or psychotherapists. Another limitation is that some prior knowledge of neuropsychiatric principles, concepts, and terminology is needed for the readers to get the most out of this book.

Learning from cases is an excellent way to bring clinical situations to life. These cases are well chosen to represent a spectrum of neurological conditions. We highly recommend the Casebook of Neuropsychiatry to clinicians wishing to improve the sophistication of their neuropsychiatric differential diagnoses.