In recent years, neuropsychology has contributed significantly to our knowledge of many psychiatric disorders. Clinicians and researchers frequently use neuropsychological evidence in their daily work to understand the diagnostic picture as well as the patients strengths and limitations in everyday functioning.
Assessment of Neuropsychological Functions in Psychiatric Disorders covers findings on all major psychiatric disorders. A result of a joint effort by over twenty experts in their field, this book looks at neuropsychological management, treatment, and rehabilitation of psychiatric patients, including A concise review of neuropsychological assessment methods and their application to psychiatric patients
Global cognitive effects with respect to duration, extent, and residual effects
Neuropsychological functions in disorders, such as schizophrenia, affective illness, non-affective disorders, personality disorders, childhood mental disorders, chronic medical illness with psychiatric manifestations, geriatric and dementing conditions, and drug and alcohol abuse
A look at the narrow margin between mental and organic dysfunctions
The interaction of phenomenological, neurobiological, and neuropsychological findings in childhood disorders
The effects of drugs and alcohol on neuropsychological functions and brain functions.
Complete with extensive references, tables, and forms, this comprehensive volume aims to provide clinicians and researchers with an overview of clinical assessment, treatment, management, and rehabilitation for neuropsychological functions in psychiatric disorders.
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Avraham Calev, Ph.D., is Director of the Assessment and Counseling Center of Long Island, in Smithtown, New York. He has held significant academic appointments at the Hebrew University of Jerusalem, Bar Ilan University, and the State University of New York at Stony Brook.From The New England Journal of Medicine:
A century ago, Emil Kraepelin described profound mental disturbances in patients with the illness he termed dementia praecox, which is known today as schizophrenia. These patients had not only the hallucinations and delusions that are commonly associated with schizophrenia but also had deficits in thinking, attention, and volition. Although these deficits were not originally the main focus of psychiatric inquiry, it has become increasingly evident that having knowledge of impaired cognitive processing is crucial to understanding and treating psychiatric disorders.
In fact, as one learns in reading Assessment of Neuropsychological Functions in Psychiatric Disorders, it is not at all uncommon for patients with many kinds of mental illness to have cognitive difficulties. In the milder forms, there may be difficulty in concentration for someone beset by anxiety. In the more severe forms, there may be a devastating disruption of the ability to learn new information and skills, to communicate with other people, to solve the problems encountered in everyday life, or to reflect on and learn from those solutions. Just how such cognitive difficulties in patients with psychiatric disorders may be manifested, how they can be measured, and what their implications are -- these are the subject of this book.
The evaluation of cognitive deficits is accomplished through neuropsychological testing, in which a patient's performance on standardized psychological tests and tasks is systematically recorded for comparison with normative data and with the performance of patients with known neurologic conditions. Combined with the patient's history and information obtained through observing the patient, the results of the evaluation are used to reach an understanding of the basis of the person's cognitive problems, to make inferences about possible disturbances in brain functioning, to plan treatment and management of the problems, and to monitor their course.
Knowing patients' strengths and weaknesses with respect to such cognitive functions as memory, attention, language, visuospatial ability, and executive functioning can provide valuable clues about the neurologic underpinnings of the psychiatric disorder and its effect on everyday functioning. The importance of understanding the neuropsychological manifestations of psychiatric disorders is underscored in the final chapter of the book, in which it is shown that the presence and severity of such cognitive deficits can have important prognostic implications for patients' future functioning.
Drawing on the body of neuropsychological research that has accumulated over the past 40 or so years, the authors of the 10 chapters detail the kinds of cognitive deficits that psychiatric patients may have not just as a result of their illnesses but also in association with the treatments they undergo. In schizophrenia, for example, accumulated research points to global cognitive impairment that is characterized particularly by deficits of memory and of executive function (i.e., the mental activity that leads to systematic, goal-directed behavior in a nonroutine situation).
Although the medications that are used to relieve the symptoms of hallucinations and delusions do not necessarily impair cognitive functions, the existing cognitive deficits are not relieved by the medications. Yet deficits such as impaired memory and executive function have been associated with poor social skills and everyday functioning. Little has been done to treat such deficits, but this situation may change in the future. In a searching final chapter, the authors describe their model of cognitive rehabilitation in psychiatric disability and outline the steps that can be taken to advance this developing field in a systematic and scientific fashion.
Assessment of Neuropsychological Functions in Psychiatric Disorders contains a wealth of information conveniently pulled together and is of great potential use to someone who works with patients with psychiatric disorders. Its very potential leaves one wishing for more, however. It could have benefited from more thorough editing. There are instances of language that is scarcely intelligible, misstated, or even erroneous, so the reader must sometimes sift through the material carefully to distill what is valuable. As is naturally the case with edited works, the chapters vary in focus and quality.
Although all the chapters are well organized, it is not always clear why some material is included and other material omitted. For instance, in the chapter on mood disorder, neuropsychological findings are discussed in relation to psychopharmacologic treatments, and in the chapter on personality disorder, they are discussed in relation to psychosocial intervention. The usefulness of each discussion leaves one wanting to know about the value of both treatment approaches in both disorders. Also, a reader who has grown accustomed to the rich diet of detailed reviews of research findings presented in the early chapters will be disappointed by the brevity of treatment of a few of the areas, such as some of the ideas put forth in the chapters on chronic medical illness and dementia. Some readers may also wish for more information about what has been learned in the past few years, for which the references are relatively sparse.
Despite these shortcomings, this book is a welcome addition to the field. It is not a book for the naive reader. For someone with sufficient knowledge of neuropsychology, however, it provides a concise review of neuropsychological aspects of psychiatric disorders, and its wealth of references can serve as a starting point for one who wishes to delve into specific areas.
Reviewed by Marian B. Patterson, Ph.D.
Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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