Neuropsychiatry: A Renaissance

April 1, 2006

The 5 papers in this Special Report on neuropsychiatry provide compelling evidence for the renaissance of neuropsychiatry as a clinical discipline. Wehave 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.

Special Report: Neuropsychiatry

The Special Report that starts on the next page highlights some of theimportant current issues in neuropsychiatry. The articles in this reportshould be of particular interest to clinical psychiatrists who treat patientswith psychiatric illnesses or symptoms associated with brain injury ordysfunction. The neuropsychiatric aspectsof several conditions are addressed in thearticles included in this section: Alzheimerdisease, traumatic brain injury (TBI), movementdisorders in sleep, and age-relatedcognitive impairment. In addition, electroencephalography(EEG) is discussed asan important tool that may assist cliniciansin diagnosing and treating behavioral disordersthat frequently accompany brain injuryand dementia. A few comments concerningeach of the articles included in thisspecial section follow.

Drs Boutros and Coburn provide anexcellent overview of the usefulness ofthe standard EEG (SEEG) and computeranalyzedquantified EEG (QEEG) in evaluatingselect neuropsychiatric disorders.The authors summarize 5 clinical indicationsfor use of SEEG and QEEG:acute or gradual mental status changes,unusual or atypical clinical presentations,recent personality changes, episodicaggressive behavior, and attention andlearning disorders.

Because many women may reportcognitive impairment during and aftermenopause, Drs Dumas and Newhouse andMs Salerno review a number of importantarticles that discuss whether estrogentherapy may maintain a woman's premenopausallevel of cognitive functioningand may reduce the risk of Alzheimer disease. The authors conclude that estrogenshould not routinely be used for either purpose but that more research needsto be conducted into the type of estrogen, method of administration, and timingof estrogen therapy relative to menopause for preserving cognition. They alsooutline a number of common and serious adverse effects of estrogen treatment.

Because people spend nearly a third of their lives asleep, an understandingof 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 Parkinsondisease and Tourette syndrome, abnormal movements are present during theday but generally absent during sleep, whereas in other disorders, such as nocturnalepilepsy, parasomnias, restless legs syndrome, and periodic limb movementsof sleep, abnormal movements occur duringsleep but rarely during wakefulness. Theauthor also provides an informativesummary of the medications that may beused to treat restless legs syndrome,narcolepsy, and cataplexy.

With more than 2 million persons in theUnited States sustaining a TBI each year,the article by Dr Kim is especially relevantfor psychiatrists who will treat patientsfor various adverse sequelae of TBIs,including aggression, impulsivity, cognitivedeficits, and depression. Dr Kim alsooutlines the neurobiology of TBI anddefines mild TBI.

Drs Reichman and Shah summarize 4stages of Alzheimer disease progression-mild, moderate, severe, and terminal-andprovide a concise yet complete review ofthe medications available to treat cognitiveimpairment during disease progression.The dosages, risks, and benefits ofthe currently available cholinesteraseinhibitors-donepezil, rivastigmine, andgalantamine-and the N-methyl D-aspartatereceptor antagonist memantine arediscussed in their article.

The 5 papers included in this SpecialReport section on neuropsychiatry providecompelling evidence for the renaissance ofneuropsychiatry as a clinical discipline. Wehave every reason to hope that this will leadto a better understanding of the complex interactions between brain and behaviorand 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 EllwoodProfessor and chairman, Menninger Department of Psychiatry and Behavioral Sciences, BaylorCollege of Medicine, Houston.

Special Report Chairpersons:
Robert E. Hales, MD, MBA
Stuart C. Yudofsky, MD