Neuropsychiatry and Behavioral Neuroscience
1
For personal use. Only reproduce with permission from The Lancet. THE LANCET Neurology Vol 2 August 2003 http://neurology.thelancet.com 514 Media watch Borna Disease Virus and its role in Neurobehavioral Diseases Edited by Kathryn M Carbone ASM Press, 2002 US$99, 300 pp ISBN 1 55581 235 X Viruses that have jumped the species barrier to establish themselves as human scourges are numerous. HIV and the coronavirus underlying the recently emerged SARS syndrome have made headlines worldwide. The Borna Disease Virus (BDV), by comparision, is practically unknown. The neurological disease it causes in mammals, such as horses, has been known for at least two centuries, long before viruses were recognised as causal agents of infectious illnesses. Only recently has this little-known virus been connected with fatal neurological diseases in human beings. Due to its low profile, the true effect of BDV on human health may have been significantly underestimated. The six chapters of this book provide a comprehensive account of our present knowledge (and the significant gaps in it) about BDV and the disease it causes. Fully referenced review-style chapters by expert authors discuss the history the virus, the role BDV has in animal diseases, and diagnosis of BDV infection. Although the association with neurological diseases in animals has been established, the virus’s role in human neurobehavioural disorders is much debated. For the neurologist the concluding chapter on human diseases that are suspected to be caused or influenced by BDV will be of most interest. Contributing or even causative roles for the virus in neuropsychiatric disorders, such as depression and schizophrenia, are an interesting speculation. The final verdict has not been cast and much more research is needed to shed light on the “BDV connection”. All the authors point out the degree of our current ignorance and which gaps must be filled to get the full picture. Although BDV has not entered the neurological mainstream, increased awareness of its existence is needed. The BDV research community is not large and many unanswered questions remain. Newcomers to research into BDV could yet make seminal contributions to our understanding of the pathogenetic effects of this enigmatic virus. This book may well be the impetus for a wave of insight that substantially affects neurological practice. Borna Disease Virus and its role in Neurobehavioral Diseases is an interesting addition to the neurological literature. Although the authors caution against hasty conclusions and implications that may not be borne out in the clinical setting, the book brings to our attention a truly hot topic that warrants the continued interest and research efforts of the neuropsychiatric community. Thomas Lazar Neuropsychiatry and Behavioral Neuroscience Cummings JL, Mega MS Oxford University Press, 2003 £69·50, 428 pp ISBN 0 19 513858 9 There have been few books that I have so eagerly anticipated; for this volume Jeff Cummings, neurologist and author of over 800 publications and 18 textbooks, has been joined by his colleague Michael Mega, an expert in neuroradiology. The book is lavishly presented with numerous tables and radiological images. Indeed this is one of only two current books on neuropsychiatry that is produced in full colour and, as the author of the rival publication, it is hard not to admire this text. Interestingly, we have taken very different approaches to the essentially same topic area. Cummings and Mega adopt the enthusiastic road highlighting many exciting areas of research and few of the pitfalls, whereas I have taken a sceptic’s approach and discussed only the robust findings together with most of the controversies! Similarly to several American publications, Cummings and Mega have set themselves the gargantuan task of covering the psychiatric complications of neurological disease (neuro- psychiatry), the biological basis of primary psychiatric disorders (biological psychiatry), and the neurobiological basis of behaviour (behavioural neuroscience). Given that there are large multi-volume reference books on each of these subjects, the authors clearly had to filter what was included. However, only a few topics—such as neuropsychological testing, problems relating to irritability (short of violence), and the increasingly popular concept of mild cognitive impairment— are not covered in sufficient detail. Perhaps the single biggest omission is the lack of any detailed discussion of the many randomised controlled treatment trials in neuropsychiatry. Despite these shortcomings, in the space of just 400 pages Cummings and Mega have crammed in an impressive amount of data including chapters on core topics such as memory disorder, delirium, and hallucinations as well as rarer topics such as tics, startle syndromes and myoclonus, dissociated states, multiple personality, and hysteria. The quality of the information that is included is good and most categorical statements are appropriately referenced. The main criticism concerns the organisation of chapters, which follows both a syndrome-driven structure (eg, mood, memory, apathy) and a disease-drive structure (eg, movement disorders, epilepsy) at the same time. The result is a degree of repetition; for example, a near identical discussion about the link between seizures and anxiety disorder appears in three separate chapters. Probably on account of space, the authors occasionally fall into the trap of making the subject matter too simple. Is it always the case that amyloid- peptide is viewed as the central pathophysiological event in Alzheimer’s disease? Or is clozapine the most efficacious treatment for Parkinson’s psychosis? And do clinical criteria accurately reflect the pathological diagnosis in most cases of Lewy-body dementia? Clearly some readers will agree with the authors and others will disagree but the point is that these are by no means the straight forward statements presented in this book. In summary, Neuropsychiatry and Behavioral Neuroscience is a beautifully presented summary of a very complicated subject that does much to enlighten the reader. It covers most topics so well that only a few of its readers will realise that other areas have received less benevolent attention from two undisputed authorities. Alex Mitchell
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Transcript of Neuropsychiatry and Behavioral Neuroscience
For personal use. Only reproduce with permission from The Lancet.
THE LANCET Neurology Vol 2 August 2003 http://neurology.thelancet.com514
Media watch
Borna Disease Virus and its rolein Neurobehavioral Diseases Edited by Kathryn M Carbone ASM Press, 2002US$99, 300 ppISBN 1 55581 235 X
Viruses that have jumped the species barrier to establishthemselves as human scourges are numerous. HIV and thecoronavirus underlying the recently emerged SARSsyndrome have made headlines worldwide. The BornaDisease Virus (BDV), by comparision, is practicallyunknown. The neurological disease it causes in mammals,such as horses, has been known for at least two centuries,long before viruses were recognised as causal agents ofinfectious illnesses. Only recently has this little-known virusbeen connected with fatal neurological diseases in humanbeings. Due to its low profile, the true effect of BDV onhuman health may have been significantly underestimated.
The six chapters of this book provide a comprehensiveaccount of our present knowledge (and the significant gaps init) about BDV and the disease it causes. Fully referencedreview-style chapters by expert authors discuss the history thevirus, the role BDV has in animal diseases, and diagnosis ofBDV infection. Although the association with neurologicaldiseases in animals has been established, the virus’s role in
human neurobehavioural disorders is much debated. For theneurologist the concluding chapter on human diseases thatare suspected to be caused or influenced by BDV will be ofmost interest. Contributing or even causative roles for thevirus in neuropsychiatric disorders, such as depression andschizophrenia, are an interesting speculation. The finalverdict has not been cast and much more research is neededto shed light on the “BDV connection”. All the authors pointout the degree of our current ignorance and which gaps mustbe filled to get the full picture.
Although BDV has not entered the neurologicalmainstream, increased awareness of its existence is needed.The BDV research community is not large and manyunanswered questions remain. Newcomers to research intoBDV could yet make seminal contributions to ourunderstanding of the pathogenetic effects of this enigmaticvirus. This book may well be the impetus for a wave ofinsight that substantially affects neurological practice. BornaDisease Virus and its role in Neurobehavioral Diseases is aninteresting addition to the neurological literature. Althoughthe authors caution against hasty conclusions andimplications that may not be borne out in the clinicalsetting, the book brings to our attention a truly hot topicthat warrants the continued interest and research efforts ofthe neuropsychiatric community.Thomas Lazar
Neuropsychiatry and BehavioralNeuroscienceCummings JL, Mega MSOxford University Press, 2003£69·50, 428 ppISBN 0 19 513858 9
There have been few books that I have so eagerly anticipated;for this volume Jeff Cummings, neurologist and author ofover 800 publications and 18 textbooks, has been joined by hiscolleague Michael Mega, an expert in neuroradiology. Thebook is lavishly presented with numerous tables andradiological images. Indeed this is one of only two currentbooks on neuropsychiatry that is produced in full colour and,as the author of the rival publication, it is hard not to admirethis text. Interestingly, we have taken very differentapproaches to the essentially same topic area. Cummings andMega adopt the enthusiastic road highlighting many excitingareas of research and few of the pitfalls, whereas I have taken asceptic’s approach and discussed only the robust findingstogether with most of the controversies!
Similarly to several American publications, Cummingsand Mega have set themselves the gargantuan task of coveringthe psychiatric complications of neurological disease (neuro-psychiatry), the biological basis of primary psychiatricdisorders (biological psychiatry), and the neurobiological basisof behaviour (behavioural neuroscience). Given that there arelarge multi-volume reference books on each of these subjects,the authors clearly had to filter what was included. However,only a few topics—such as neuropsychological testing,problems relating to irritability (short of violence), and theincreasingly popular concept of mild cognitive impairment—are not covered in sufficient detail. Perhaps the single biggest
omission is the lack of any detailed discussion of the manyrandomised controlled treatment trials in neuropsychiatry.Despite these shortcomings, in the space of just 400 pagesCummings and Mega have crammed in an impressive amountof data including chapters on core topics such as memorydisorder, delirium, and hallucinations as well as rarer topicssuch as tics, startle syndromes and myoclonus, dissociatedstates, multiple personality, and hysteria.
The quality of the information that is included is good andmost categorical statements are appropriately referenced. Themain criticism concerns the organisation of chapters, whichfollows both a syndrome-driven structure (eg, mood,memory, apathy) and a disease-drive structure (eg, movementdisorders, epilepsy) at the same time. The result is a degree ofrepetition; for example, a near identical discussion about thelink between seizures and anxiety disorder appears in threeseparate chapters. Probably on account of space, the authorsoccasionally fall into the trap of making the subject matter toosimple. Is it always the case that amyloid-� peptide is viewed asthe central pathophysiological event in Alzheimer’s disease?Or is clozapine the most efficacious treatment for Parkinson’spsychosis? And do clinical criteria accurately reflect thepathological diagnosis in most cases of Lewy-body dementia?Clearly some readers will agree with the authors and otherswill disagree but the point is that these are by no means thestraight forward statements presented in this book.
In summary, Neuropsychiatry and Behavioral Neuroscienceis a beautifully presented summary of a very complicatedsubject that does much to enlighten the reader. It covers mosttopics so well that only a few of its readers will realise thatother areas have received less benevolent attention from twoundisputed authorities.Alex Mitchell
