Front Matter

List of Figures ix

List of Tables xi

Contributors xv

Preface xix

Acknowledgment xx

Lauren Drag, Ph.D.

Juliana Lockman, M.D.

Michael Zeineh, M.D.

Michel Medina, M.D.

Kieran C.R. Fox, Ph.D.

Sheldon Benjamin, M.D.

Delia Bakeman, D.O.

Sepideh N. Bajestan, M.D., Ph.D.

Gaston Baslet, M.D.

Simon Ducharme, M.D.

Lisa Koski, Ph.D.

Jeffrey L. Cummings, M.D., Sc.D.

Michael R. Trimble, M.D., FRCP, FRCPsych

Lauren Drag, Ph.D.

Jagan Pillai, M.D., Ph.D.

Juliana Lockman, M.D.

John J. Barry, M.D.

Yelizaveta Sher, M.D.

Jeffrey L. Cummings, M.D., Sc.D.

Alex Eischeid, M.D.

Hokuto Morita, M.D.

Michel Medina, M.D.

Kathleen L. Poston, M.D., M.S.

Gregory W. Albers, M.D.

John J. Barry, M.D.

Reena P. Thomas, M.D., Ph.D

John J. Barry, M.D.

Les Dorfman, M.D.

John J. Barry, M.D.

Aryandokht Fotros, M.D.

Sepideh N. Bajestan, M.D., Ph.D.

Amer Raheemullah, M.D.

Ori-Michael Benhamou, M.D.

Jesse Adams, M.D.

Manal Khan, M.D.

Katherine E. Williams, M.D.

Scheherazade Le, M.D.

Peter H. Marcus, Psy.D.

Lawrence M. McGlynn, M.D., M.S.

John J. Barry, M.D.

John P. Coetzee, Ph.D.

Ian H. Kratter, M.D., Ph.D.

Mahendra T. Bhati, M.D.

Nolan Williams, M.D.

Index 371

Typical electroencephalogram waveforms

Major limbic system structures in medial view

Frontal-subcortical circuits

Anatomical areas as depicted by Brodmann

Default network of the human brain

Sensory homunculus in the human brain

Differential diagnosis of psychogenic nonepileptic seizures (PNES)

Examples of a normal performance (A) and an abnormal performance (B) on the design fluency test

Example of abnormal performance on alternating programs

Examples of abnormal performance on the multiple loop test

Rey-Osterreith Complex Figure (top) and a copy of the figure made by a patient with a right parietal lobe lesion (bottom)

Taylor Complex Figure (top) and a copy of the figure made by a patient with a dementia syndrome and visuospatial dysfunction (bottom)

Classification of memory tasks relating to clinical phenomenology

Locations of ischemic strokes

Locations of hemorrhagic strokes

Proposed evaluation of thyroid-stimulating hormone (TSH) levels

Categories of HIV-associated neurocognitive disorder

A structured approach to assessing for neurocognitive impairment in HIV based on the European AIDS Clinical Society

Bedside mental state testing

Brief neurological screening examination

Examples of common neuropsychological tests

Clinical indications for structural brain imaging in psychiatric patients

Comparison of CT and MRI

Neuroreceptors of clinical relevance

Some neurotransmitters

Limbic system

Some brain-behavior associations

Frequency of depression in neurological disorders

Neurological disorders associated with mania or hypomania

Neurological disorders associated with mood and affective lability

Causes of pseudobulbar palsy

Types of delusions

Neuropsychiatric disorders associated with delusions

Neurological disorders associated with visual hallucinations

Neurological disorders associated with OCD or compulsions

Repetitive behaviors observed in patients with brain dysfunction

Personality alterations in neurological disorders

Causes of Klüver-Bucy syndrome

Neurodevelopmental disorders associated with self-injurious behavior

Semiological signs suggestive of psychogenic nonepileptic seizures (PNES)

Neurological examination findings that help confirm the diagnosis of functional neurological symptoms disorder

Example of biopsychosocial neuropsychiatric case formulation with predisposing, precipitating, and perpetuating (PPP) factors

Frontal lobe syndromes and their assessment

Disorders of the frontal lobes

Skills and abilities mediated asymmetrically by the two hemispheres of the brain

Characteristics of the aphasia syndromes

Differential diagnosis of mutism

Characteristics of ideomotor apraxias

Visuoperceptual disorders

Characteristics of blindness of different etiologies

Visual recognition disorders

Disturbances of visuospatial attention

Body-spatial disorientation

Constructional disorders

Neuropsychiatric syndromes reported in patients with right-brain lesions

Neuropsychiatric syndromes associated with left-brain lesions

Memory tasks

Some causes of the amnestic syndrome

Varieties of psychogenic amnesia

Memory tests

Classification of seizures

Epilepsy syndromes

Principal etiologies of epilepsy

Prevalence of psychiatric diagnoses among patients with epilepsy

Classification of psychiatric symptoms in people with epilepsy

The Neurological Disorders Depression Inventory for Epilepsy

Potential psychiatric effects of epilepsy management

Indications for anterior temporal lobectomy

Causes of delirium/Precipitating factors

I WATCH DEATH mnemonic for diagnosis of delirium causes

Contrasting features of dementia and delirium

Assessment of patients with dementia

Differential diagnosis of dementia

Major pathological and neurochemical changes of the neurodegenerative disorders

Brain imaging findings in patients with major dementia syndromes

Treatments for Alzheimer’s disease (AD)

Psychotropic drugs for neuropsychiatric syndromes in dementia

White matter disorders with dementia

Parkinson’s disease medications

Differential diagnosis of chorea

Classification of tic syndromes

Common inherited ataxias

Causes of symptomatic myoclonus

Characteristics of tremors

Clinical features of catatonia

Etiologies of catatonia

Neuroleptic-induced movement disorders

Relative frequency of types of stroke syndromes

Etiologies of stroke in young individuals

Principal behavioral alterations occurring after a stroke

Relative frequency of major types of primary brain and CNS tumors

Differential diagnosis of brain mass

Major categories of CNS white-matter diseases and representative examples

Laboratory tests used in the diagnosis of multiple sclerosis

McDonald criteria in multiple sclerosis

Common long-term problems in patients with multiple sclerosis, and some management strategies

Scales used to assess head injury

Classification of traumatic brain injury severity

DSM-5 criteria for substance use disorder

Stages of change

FDA-approved alcohol use disorder medications

DSM-5 diagnostic criteria for autism spectrum disorder

Diagnostic tools for assessment of autism spectrum disorder

Causes and risk factors for hypothyroidism

Physical and neuropsychiatric symptoms of hypothyroidism

Common causes and risk factors for hyperthyroidism

Physical and neuropsychiatric signs/symptoms of hyperthyroidism

Physical and neuropsychiatric signs/symptoms of adrenal insufficiency

Physical and neuropsychiatric signs/symptoms of hypercortisolemia

Key features of autoimmune limbic encephalitis

Clinical approach to limbic encephalitis (LE)

Differential diagnosis for limbic encephalitis

Differential diagnosis: HIV-related components to be aware of

Tests and procedures

Classification system for psychotropic drugs

Disorders most likely to respond to monoamine oxidase (MAO) inhibitors

Side effects of non–monoamine oxidase inhibitor antidepressants

Select antipsychotics

Pharmacological differences among benzodiazepines

Some clinical properties of select anticonvulsant drugs

Significant anticonvulsant interactions

Neuropsychiatric illnesses and electroconvulsive therapy (ECT)

Director of Child and Adolescent Psychiatry, Seattle Neuropsychiatric Treatment Center, Seattle, Washington

Professor, Department of Neurology, Stanford University, Stanford, California

Chief, Neuropsychiatry Services; Associate Director, Neuropsychiatry and Behavioral Neurology Fellowship; Co-Director, Individual Psychotherapy Clinic; and Clinical Associate Professor, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California

Assistant Professor, Department of Neurology, University of Colorado Anschutz Medical Campus, Denver, Colorado

Fellowship Director, Neuropsychiatry and Behavioral Neurology; Director, Neuropsychiatry Clinic; Co-Director, Individual Psychiatry Clinic; Professor of Psychiatry and Behavioral Sciences, Department of Psychiatry and Behavioral Sciences; School of Medicine, Stanford University Hospital, Stanford, California

Director, Division of Neuropsychiatry; Co-Director, Center for Brain/Mind Medicine and Neuropsychiatry and Behavioral Neurology Fellowship Program; and Director, Medical Student Education in Psychiatry, Brigham and Women’s Hospital; Assistant Professor of Psychiatry, Harvard Medical School, Boston, Massachusetts

Clinical Assistant Professor, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California

Professor of Psychiatry and Neurology, University of Massachusetts T. H. Chan School of Medicine, Worcester, Massachusetts

Clinical Professor, Chief of Interventional Psychiatry, Director of Electroconvulsive Therapy, Departments of Psychiatry and Behavioral Sciences and Neurosurgery, Stanford University, Stanford, California

Advanced Health Fellow, Polytrauma Division, VA Palo Alto Health Care System, Palo Alto; Postdoctoral Scholar, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California

Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, Nevada

Professor Emeritus, active, Department of Neurology and Neurological Sciences, School of Medicine, Stanford University, Stanford, California

Clinical Assistant Professor (Affiliated), Department of Neurology and Neurological Sciences, School of Medicine, Stanford University, Stanford, California

Douglas Mental Health University Institute, Montreal, Quebec, Canada

Neurologist, Department of Neurology and Neurological Sciences, Stanford University, Stanford, California; Ruan Neurology and Research Center, MercyOne, Des Moines, Iowa

Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island

School of Medicine, Stanford University, Stanford, California

University of California, Los Angeles, Los Angeles, California

Scientist, Brain Repair and Integrative Neuroscience Program, Research Institute of McGill University Health Centre; Associate Professor, Departments of Neurology and Neurosurgery and Psychology, McGill University, Montreal, Quebec, Canada

Clinical Assistant Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California

Clinical Associate Professor, Department of Neurology and Neurological Sciences, Stanford Comprehensive Epilepsy Center, Palo Alto, California

Clinical Associate Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California

Department of Psychiatry, Harvard Medical School, Boston, Massachusetts

Clinical Professor, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California

Department of Psychiatry and Neurology, Kaiser Permanente Northern California, Sacramento, California

Assistant Professor, Department of Neurology and Neurological Sciences, Stanford University, Stanford, California; Department of Neurology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

Lou Ruvo Center for Brain Health, Cleveland Clinic, Case Western Reserve University, Cleveland, Ohio

Professor, Department of Neurology and Neurological Sciences, and (by courtesy) Neurosurgery, Stanford University, Stanford, California

Clinical Assistant Professor of Addiction Medicine, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California

Clinical Associate Professor of Psychiatry, School of Medicine, Stanford University, Stanford, California

Clinical Associate Professor, Division of Neuro-Oncology; Vice Chair of Diversity and Inclusion, Department of Neurology; and Associate Dean, Office of Diversity in Medical Education, School of Medicine, Stanford University, Stanford, California

Emeritus Professor in Behavioural Neurology, Faculty of Brain Sciences, Queen Square Institute of Neurology, University College London, London, United Kingdom

Clinical Professor of Psychiatry, and Director, Women’s Wellness Clinic, School of Medicine, Stanford University, Stanford, California

Assistant Professor; Director, Interventional Psychiatry Clinical Research; and Director, Brain Stimulation Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California

Associate Professor or Radiology (Neuroimaging and Neurointervention), Department of Radiology, The Richard M. Lucas Center for Imaging, Stanford University, Stanford, California

The Concise Guide to Neuropsychiatry and Behavioral Neurology was first published in 1995 and has since helped hundreds of clinicians provide excellent care to thousands of patients with neuropsychiatric and neurobehavioral syndromes. The book originated from our shared passion for clinical phenomenology, neurological and psychiatric diagnoses, excellence in patient care, and teaching of these related disciplines to students at all levels of learning. The complexity of the brain is reflected in the diagnostic conundrums that patients present to clinicians. Substantial expertise in understanding how to examine an individual experiencing delusions, hallucinations or aphasia combined with a deep understanding of brain structure and function in health and disorder is required of the neuropsychiatrist/behavioral neurologist. Our goal in the Concise Guide was to distill this information into a brief format and to produce a volume that would fit in a pocket virtually or physically and be available when needed to assist in diagnosis and treatment of patients with neuropsychiatric and neurobehavioral disorders. The enduring popularity of this volume suggests that we succeeded.

There has been tremendous progress in neuropsychiatry and behavioral neurology since the Concise Guide was last published. The development of new techniques of brain imaging with amyloid and tau PET; the advances in MRI allowing examination of brain structure, function, composition, and perfusion; the improvement in electrophysiological methods to better detect and characterize epilepsy and sleep disorders; and the evolution of an ever-growing list of blood and spinal fluid biomarkers have revolutionized the diagnostic capability of the neuropsychiatrist/behavioral neurologist. Treatment alternatives have advanced markedly since the last edition. Improved therapies for psychosis, depression, mania, OCD, anxiety, and sleep disorders have materialized from innovative programs, as have treatments for epilepsy, movement disorders, stroke, multiple sclerosis, brain tumors and degenerative brain disorders. Awareness of these advances is necessary to provide neuropsychiatrists and behavioral neurologists with skills not only to achieve accurate diagnoses but also to manage patients with complex neuropsychiatric and neurobehavioral disorders once the well-prepared clinician has examined the patient thoroughly, with insight and kindness. We have endeavored to preserve this precious vision of patient care while integrating the many advances that have enriched the field.

We are very grateful to John Barry and Sepideh Bajestan for their willingness and enthusiasm in reviving the Concise Guide. They have done a terrific job of preserving much of the original content and intent while integrating the new approaches, technologies, and therapies. Additional chapters have been added addressing autism, substance use, endocrine and HIV neurocognitive disorders, limbic encephalities, and interventional neuropsychiatry. We are pleased to know that more generations of neuropsychiatrists and behavioral neurologists will have this companion in their pocket. Our goals remain teaching, excellent patient care, growth of individual expertise, and expansion of our understanding of mind/brain relationships. This new edition of the Concise Guide captures these ideals.

We offer since gratitude to Dr. Cummings and Dr. Trimble for the privilege and opportunity to update this third edition of the Concise Guide to Neuropsychiatry and Behavioral Neurology. We hope that this new edition will be as clinically useful as its predecessors.