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(Drug information on rivastigmine), and galantamine—and the N-methyl D-aspartate receptor antagonist memantine(Drug information on 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.