Brain stimulation in psychiatric treatment. Edited by S. H. Lisanby. Review of Psychiatry Series,...
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INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Int J Geriatr Psychiatry 2005; 20: 1205. BOOK REVIEW Brain Stimulation in Psychiatric Treatment. Edited by S. H. Lisanby. Review of Psychiatry Series, Volume 23. Series Editors J. M. Oldham, M. B. Riba Ameri- can Psychiatric Association, Washington DC, 2004. Pages: 153. Price. £25.95 The era of effective treatment of psychiatric disorders with a physical therapy started 70 years ago with elec- troconvulsive therapy (ECT). It is intriguing that a new generation of brain stimulation techniques are once again seen as being at the cutting edge of psy- chiatric treatment. ECT is still with us but remains problematic, something of a blunt instrument (albeit a strikingly effective one) and is declining in use. The resurgence in interest in brain stimulation is due to the rapid recent advances in neuroscience and in our understanding of the functional neuroanat- omy of the brain. In spite of this, our ability to target abnormalities in brain circuitry to relieve mental dis- orders remains an unachieved Holy Grail. This book sets out to describe progress in the Quest so far. If you are looking for answers you are likely to be disap- pointed, it is not yet clear which, if any, of the techni- ques described will pass into routine psychiatric practice, let alone revolutionise the field in the way that ECT did. This book is part of the well-known Review of Psy- chiatry series in which experts are commissioned to review and summarise areas of current interest and excitement. Surprisingly ECT itself is not reviewed in spite of ongoing research into different waveforms and methods of delivery that may allow improve- ments in adverse effects. Apart from a brief overview in the introduction, the five chapters are very much stand alone in covering their respective areas. Transcranial magnetic stimulation (TMS), the least invasive technique, is given two chapters reflecting the wide range of disorders in which it has been tried (from depression to schizophrenia). More invasive treatments are magnetic seizure therapy (MST), as a possible ‘better’ version of ECT, deep brain stimula- tion (DBS) and vagus nerve stimulation (VNS). The latter two are in use for neurological disorders such as Parkinson’s disease and epilepsy. As might be expected, the authors are enthusiasts for the treatments they describe. Nevertheless, at least for psychiatric disorders, the bottom line for all of them is caution about the lack of definitive efficacy data, problems in knowing the optimum treatment parameters and uncertain clinical utility. The techni- ques are well described and the book offers an acces- sible introduction to, and overview of, the field for those wanting to be abreast of developments and to answer the queries of ever more informed patients. However, it is very much work in progress and not directly relevant to most clinicans or their patients. It is a shame that there is no chapter on recent research into ECT. After all, this is the brain stimulation tech- nique that patients are currently exposed to routinely and which is desperately in need of good quality research. IAN ANDERSON Senior Lecturer in Psychiatry Neuroscience and Psychiatry Unit The University of Manchester Manchester, UK Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/gps.1415 Copyright # 2005 John Wiley & Sons, Ltd.
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Transcript of Brain stimulation in psychiatric treatment. Edited by S. H. Lisanby. Review of Psychiatry Series,...
INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY
Int J Geriatr Psychiatry 2005; 20: 1205.
BOOK REVIEW
Brain Stimulation in Psychiatric Treatment. Edited byS. H. Lisanby. Review of Psychiatry Series, Volume23. Series Editors J. M. Oldham, M. B. Riba Ameri-can Psychiatric Association, Washington DC, 2004.Pages: 153. Price. £25.95
The era of effective treatment of psychiatric disorderswith a physical therapy started 70 years ago with elec-troconvulsive therapy (ECT). It is intriguing that anew generation of brain stimulation techniques areonce again seen as being at the cutting edge of psy-chiatric treatment. ECT is still with us but remainsproblematic, something of a blunt instrument (albeita strikingly effective one) and is declining in use.The resurgence in interest in brain stimulation isdue to the rapid recent advances in neuroscienceand in our understanding of the functional neuroanat-omy of the brain. In spite of this, our ability to targetabnormalities in brain circuitry to relieve mental dis-orders remains an unachieved Holy Grail. This booksets out to describe progress in the Quest so far. If youare looking for answers you are likely to be disap-pointed, it is not yet clear which, if any, of the techni-ques described will pass into routine psychiatricpractice, let alone revolutionise the field in the waythat ECT did.
This book is part of the well-known Review of Psy-chiatry series in which experts are commissioned toreview and summarise areas of current interest andexcitement. Surprisingly ECT itself is not reviewedin spite of ongoing research into different waveformsand methods of delivery that may allow improve-ments in adverse effects. Apart from a brief overviewin the introduction, the five chapters are verymuch stand alone in covering their respective areas.
Transcranial magnetic stimulation (TMS), the leastinvasive technique, is given two chapters reflectingthe wide range of disorders in which it has been tried(from depression to schizophrenia). More invasivetreatments are magnetic seizure therapy (MST), as apossible ‘better’ version of ECT, deep brain stimula-tion (DBS) and vagus nerve stimulation (VNS). Thelatter two are in use for neurological disorders suchas Parkinson’s disease and epilepsy.
As might be expected, the authors are enthusiastsfor the treatments they describe. Nevertheless, at leastfor psychiatric disorders, the bottom line for all ofthem is caution about the lack of definitive efficacydata, problems in knowing the optimum treatmentparameters and uncertain clinical utility. The techni-ques are well described and the book offers an acces-sible introduction to, and overview of, the field forthose wanting to be abreast of developments and toanswer the queries of ever more informed patients.However, it is very much work in progress and notdirectly relevant to most clinicans or their patients.It is a shame that there is no chapter on recent researchinto ECT. After all, this is the brain stimulation tech-nique that patients are currently exposed to routinelyand which is desperately in need of good qualityresearch.
IAN ANDERSON
Senior Lecturer in PsychiatryNeuroscience and Psychiatry Unit
The University of ManchesterManchester, UK
Published online in Wiley InterScience(www.interscience.wiley.com).
DOI: 10.1002/gps.1415
Copyright # 2005 John Wiley & Sons, Ltd.
