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Biological Psychiatry, 3rd Edition

ISBN: 978-0-470-68894-6
432 pages
October 2010
Biological Psychiatry, 3rd Edition (0470688947) cover image
Biological psychiatry has dominated psychiatric thinking for the past 40 years, but the knowledge base of the discipline has increased substantially more recently, particularly with advances in genetics and neuroimaging. The third edition of Biological Psychiatry has been thoroughly updated taking into account these developments. As in the earlier editions of the book, there are comprehensive reviews and explanations of the latest advances in neurochemistry, neuroanatomy, genetics and brain imaging— descriptions not only of methodologies but also of the application of these in clinical settings. It is within this context that there is a considerable emphasis in the book on brain–behaviour relationships both within and without the clinical setting.

This edition has been enhanced by the inclusion of new chapters, one on anxiety and another on motivation and the addictions. The chapter that relates to treatments has been extended to include the latest information on brain stimulation techniques. The overall book is well illustrated in order to help with an understanding of the text.

For the third edition, Professor Michael Trimble has been joined by Professor Mark George as co-author. These are two of the world's leading biological psychiatrists who both have considerable clinical as well as research experience which they have brought to the book. Unlike multiauthored texts, it has a continuity running through it which aids understanding and prevents repetition.

This book is strongly recommended for all practising psychiatrists and trainees wishing for an up-to-date, authoritative, easy to digest and acessible review of the latest advances and conceptualizations in the field. It will also appeal to neurologists interested in neuropsychiatry and biological psychiatry or the psychiatric aspects of neurological disorders, as well as other practising clinicians (psychologists, social workers, nurses) in the mental health field.

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Acknowledgements.

Quotations.

Preface to the First Edition.

Preface to the Second Edition.

Introduction and Preface to the Third Edition.

1 Principles of Brain Function and Structure: 1 Genetics, Physiology and Chemistry.

Introduction.

Genetics.

Brain chemistry and metabolism.

The metabolism of glucose.

Proteins and fatty acids.

Cell membranes.

Synapses.

Receptors.

Neurones.

Neurotransmitters.

Interrelationships among transmitters.

Transmitter dispersal.

CNS inflammation.

2 Principles of Brain Function and Structure: 2 Anatomy.

Introduction.

The neuroanatomy of emotion.

Individual anatomical structures.

Ascending and descending limbic-system connections.

Macrosystems.

The basal ganglia and the re-entrant circuits.

The ventral striatum and ‘limbic striatum'.

The ascending cholinergic systems.

Cortical regions of interest.

The cerebellum.

3 Important Brain–Behaviour Relationships.

Introduction.

Important anatomical structures for understanding behaviour.

Some specific behaviours.

Limbic lobe disorders in a clinical context.

Re-entrant circuits in a clinical context.

The frontal lobes in a clinical context.

Laterality.

4 Classifications and Clinical Investigations.

Introduction.

Signs, symptoms, syndromes and disease.

Classification in psychiatry.

Clinical investigation.

5 Personality Disorders.

General introduction.

Introduction to the concept of personality.

Genetics.

Somatic variables.

Metabolic and biochemical findings.

Neurophysiological and neurological data.

Some outstanding issues.

6 Anxiety Disorders.

Introduction.

Genetics.

Somatic variables.

Metabolic and biochemical findings.

Neurochemical investigations.

Neurophysiological and neurological data.

Imaging.

Obsessive–compulsive disorder.

Post-traumatic stress disorder.

Some outstanding issues.

7 The Schizophrenias.

Introduction.

Genetics.

Somatic variables.

Metabolic and biochemical findings.

Neurochemical investigations.

Neurophysiological and neurological data.

Some outstanding issues.

8 Affective Disorders.

Introduction.

Genetics.

Metabolic and biochemical findings.

Neurochemical investigations.

Neurophysiological and neurological data.

Some outstanding issues.

9 The Addictions and Disorders of Motivation.

Introduction.

Disorders of motivation.

Conditioning.

Genetics.

Metabolic and biochemical findings.

Neurophysiological and neurological data.

Some outstanding issues.

10 Epilepsy.

Introduction.

Prevalence and clinical characteristics.

Classification.

Genetics.

Symptomatic epilepsy.

Biochemical findings.

Investigation and differential diagnosis.

Psychiatric disorders in epilepsy.

Cognitive deterioration and epilepsy.

Some outstanding issues.

11 The Dementias.

Introduction.

Definition.

Prevalence.

Diagnosis and classification.

Alzheimer’s disease.

Dementia of frontal-lobe type.

Focal cortical atrophies.

Dementia with Lewy bodies.

Vascular dementias.

Other forms of dementia.

Further causes of dementia.

Some outstanding issues.

12 Biological Treatments.

Introduction.

Pharmacology: pharmacokinetics and pharmacodynamics.

Antidepressants.

Antipsychotic drugs.

Anxiolytics and hypnotics.

Beta-Adrenergic blockers.

Lithium.

Anticonvulsants.

Drugs for the treatment of dementia.

Medications for the addictions.

Brain-stimulation therapies.

Sleep-deprivation therapy.

13 Epilogue: Progress toward a Neuroanatomically, Biological-psychiatrically Informed Classification Scheme in Psychiatry.

References.

Index.

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Professor Trimble was for many years Professor of Behavioural Neurology and Consultant Physician to the Department of Psychological Medicine at the National Hospital Queen Square, London. He now holds emeritus status at the above institutions. He studied general medicine, obtaining membership of the Royal College of Physicians before going to the National Hospital Queen Square and then the Maudsley Hospital to advance his training in neurology and psychiatry. Following an internship in psychiatry at the Johns Hopkins Hospital, Baltimore, he returned to the National Hospital to pursue a career in neuropsychiatry. He set up a research group with main interests in the interface disorders between neurology and psychiatry, reflected in the developing recognition of neuropsychiatry and behavioural neurology as independent disciplines. The research group (Raymond-Way Unit) explored the behavioural consequences of neurological disorders and their treatment, with a major interest in epilepsy and movement disorders. His current writing and academic interests involve teaching and lecturing on neuroanatomical concepts relevant to understanding behaviour and its variations, in particular with an interest in neuroaesthetics and neurotheology, namely the cerebral basis of artistic and religious experiences.

Dr. George received his medical degree from the Medical University of South Carolina in Charleston in 1985, where he continued with dual residencies in neurology and psychiatry. He is board certified in both areas. He worked for one year (1990-91) as a Visiting Research Fellow in the Raymond Way Neuropsychiatry Research Group at the Institute of Neurology, London. He and Professor Trimble used pharmacology and imaging to study the overlaps between Obsessive-Compulsive Disorder and Gilles de la Tourette Syndrome. During this year he also worked on new functional imaging techniques (SPECT and PET) at the Institute of Nuclear Medicine, University College of London and Middlesex School of Medicine, London. He wrote one of the first textbooks in the new area of brain activation and imaging. Dr George then moved to Washington, DC, working with Dr. Robert Post in the Biological Psychiatry Branch of the Intramural National Institute of Mental Health.  He was one of the first to use functional imaging (particularly oxygen PET) to assess brain changes associated with normal emotions, as well as using imaging to understand brain changes which occur in depression and mania. This imaging work directly led to his pioneering use of transcranial magnetic stimulation (TMS) as a probe of neuronal circuits regulating mood, and to clinical trials using TMS as an antidepressant. In 2008 prefrontal TMS was FDA approved as an antidepressant treatment. In 1995 he moved back to Charleston and built the functional neuroimaging division and brain stimulation laboratories. This imaging group has grown into the MUSC Center for Advanced Imaging Research, which is now part of the SC Brain Imaging Center of Excellence. He continues to use imaging and non-invasive stimulation, either separately or more recently in combination, to understand the brain regions involved in emotion regulation in health and disease. In 1998, he pioneered another new treatment for resistant depression, vagus nerve stimulation, that was recently FDA approved. He and his group have used MRI imaging to understand brain stimulation brain effects. He is on several editorial review boards, and has published over 200 scientific articles, and has written or edited 5 books. He is the editor-in-chief of a new journal, Brain Stimulation.
He has received several international awards, including the World Federation of Societies of Biological Psychiatry Lifetime Achievement Award (2007), the NARSAD Falcone Award (2008) and he was honored as one of 14 'Pioneers of Medical Progress' saluted in the August 2009 edition of US News & World Report.

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“This book therefore may be valuable to those engaged in clinical practice who wish to familiarize themselves with some of the basic concepts behind modern biological psychiatric research and the recent history of the field.”  (Psychological Medicine, 2012)

"If you are going to choose where to fork out the money, it would be here, for the most practical understanding of brain-behavior science, and these authors I am sure will continue to be leaders in this field, with perhaps only Lishman challenging them for the buck." (Metapsychology, 25 June 2011)

 "As in the earlier editions of the book, there are comprehensive reviews and explanations of the latest advances in neurochemistry, neuroanatomy, genetics and brain imaging descriptions not only of methodologies but also of the application of these in clinical settings." (AllVoices, 16 February 2011)

"An important contribution that should be read by psychopharmacologists, psychiatrists, neurologists and neuroscientists who wish to obtain an interesting and well-written account of the subject." (Human Psychopharmacology, 2010)

"Writing for medical students and for researchers and practitioners in fields that touch upon mental health, they begin by exploring principles of brain function and structure from perspectives of genetics, physiology, chemistry, and anatomy. Then they consider important brain-behavior relationships, and classifications and clinical investigations. Having set the stage, they proceed to describe biological aspects of personality disorders, anxiety disorders, the schizophrenias, affective disorders, the addictions and disorders of motivation, epilepsy, and the dementias." (SciTech Book News, December 2010)

 

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