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Neuropsychiatry: A Renaissance

Neuropsychiatry: A Renaissance

Special Report: Neuropsychiatry

The Special Report that starts on the next page highlights some of the
important current issues in neuropsychiatry. The articles in this report
should be of particular interest to clinical psychiatrists who treat patients
with psychiatric illnesses or symptoms associated with brain injury or
dysfunction. The neuropsychiatric aspects
of several conditions are addressed in the
articles included in this section: Alzheimer
disease, traumatic brain injury (TBI), movement
disorders in sleep, and age-related
cognitive impairment. In addition, electroencephalography
(EEG) is discussed as
an important tool that may assist clinicians
in diagnosing and treating behavioral disorders
that frequently accompany brain injury
and dementia. A few comments concerning
each of the articles included in this
special section follow.

Drs Boutros and Coburn provide an
excellent overview of the usefulness of
the standard EEG (SEEG) and computeranalyzed
quantified EEG (QEEG) in evaluating
select neuropsychiatric disorders.
The authors summarize 5 clinical indications
for use of SEEG and QEEG:
acute or gradual mental status changes,
unusual or atypical clinical presentations,
recent personality changes, episodic
aggressive behavior, and attention and
learning disorders.

Because many women may report
cognitive impairment during and after
menopause, Drs Dumas and Newhouse and
Ms Salerno review a number of important
articles that discuss whether estrogen
therapy may maintain a woman's premenopausal
level of cognitive functioning
and may reduce the risk of Alzheimer disease. The authors conclude that estrogen
should not routinely be used for either purpose but that more research needs
to be conducted into the type of estrogen, method of administration, and timing
of estrogen therapy relative to menopause for preserving cognition. They also
outline a number of common and serious adverse effects of estrogen treatment.

Because people spend nearly a third of their lives asleep, an understanding
of some of the neuropsychiatric disorders associated with sleep is important.
Dr Sachdev provides a scholarly review of the various movement disorders that may occur during sleep. In some neuropsychiatric disorders, such as Parkinson
disease and Tourette syndrome, abnormal movements are present during the
day but generally absent during sleep, whereas in other disorders, such as nocturnal
epilepsy, parasomnias, restless legs syndrome, and periodic limb movements
of sleep, abnormal movements occur during
sleep but rarely during wakefulness. The
author also provides an informative
summary of the medications that may be
used to treat restless legs syndrome,
narcolepsy, and cataplexy.

With more than 2 million persons in the
United States sustaining a TBI each year,
the article by Dr Kim is especially relevant
for psychiatrists who will treat patients
for various adverse sequelae of TBIs,
including aggression, impulsivity, cognitive
deficits, and depression. Dr Kim also
outlines the neurobiology of TBI and
defines mild TBI.

Drs Reichman and Shah summarize 4
stages of Alzheimer disease progression—mild, moderate, severe, and terminal—and
provide a concise yet complete review of
the medications available to treat cognitive
impairment during disease progression.
The dosages, risks, and benefits of
the currently available cholinesterase
inhibitors—donepezil, rivastigmine, and
galantamine—and the N-methyl D-aspartate
receptor antagonist memantine are
discussed in their article.

The 5 papers included in this Special
Report section on neuropsychiatry provide
compelling evidence for the renaissance of
neuropsychiatry as a clinical discipline. We
have every reason to hope that this will lead
to a better understanding of the complex interactions between brain and behavior
and will reduce the artificial distinction between neurology and psychiatry.

Dr Hales is Joe P. Tupin Professor and chair, department of psychiatry and behavioral sciences,
University of California, Davis, School of Medicine. Dr Yudofsky is DC and Irene Ellwood
Professor and chairman, Menninger Department of Psychiatry and Behavioral Sciences, Baylor
College of Medicine, Houston.

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