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Brain Circuitry and Signaling in PsychiatryReview - Brain Circuitry and Signaling in Psychiatry
Basic Science and Clinical Implications
by Gary B. Kaplan and Ronald P. Hammer, Jr. (Editors)
American Psychiatric Publishing, 2002
Review by Roy Sugarman, Ph.D.
Oct 8th 2003 (Volume 7, Issue 41)

So much has been published in recent years, and so much of it in the mental health professions. Not all of it has been exemplary, most of it entry level, much of it still tainted with a century of blind speculation, and driven by hypotheses that would drive Scott Lilienfeld to drink, or worse, publish another book slamming the pseudosciences and their apologists.

Not so this slim book from Kaplan and Hammer. It may start off with a basic chapter, but that is where it stops being for entry level practitioners in medicine and psychology.

The joke here is that when you are tired of medicine, and want to leave the profession, you become a psychiatrist. My registrars in their postgraduate years are overwhelmed when we give them the Kandel, Schwartz and Jessell tome Principles of Neural Science, or worse, Gazzaniga's magnificent doorstopper The New Cognitive Neurosciences, with 24 sub-editors and 98 chapters in cognitive neuroscience.

I can't wait to show them this one.

Not that it is without flaws: after all, the science presented here is only a few years old, so that any such book is unlikely to be perfect, and as soon as the chapters are ready for print, taking some years, then at publishing date, they are likely to be ancient history.

But as Heraclites said, you cannot put your foot in the same river twice. So there are bound to be limitations.

In the brain behavior sciences, we must examine why a particular patient presents with a particular behavior, at a particular time in their lives.

This book sets out to map, for the psychiatrist and other mental health professional with a biological streak in them, how brain becomes mind, and what is wrong with the bad brain in various presentations.

After an introduction to functional neural circuitry written by Salloway and Blitz, the book introduces the reader to neural signaling pathways, written by Kaplan and Leite-Morris. The book then covers schizophrenia (I would have preferred the term psychotic illnesses) and then addiction, anxiety, depression, bipolar disorders, and then finally Alzheimer's and dementia in general.

The first chapter is a nice one, with really great diagrams that beg to be scanned and power-pointed, and I beg the authors to CD Rom and sell them, they are so good for teaching purposes.

The authors examine visual signaling (that was predictable) but then go on to the meat and vegetables of mental health, namely the functional organization of the limbic system, prefrontal cortex, frontal-subcortical-thalamic circuits, and finally the brainstem systems, all focusing on how information is processed and behaviour regulated. Add to this volume things from Russ Barkley on the evolution of self-regulation, use Miller and Cummings' work on subcortical frontal conditions, and the students are gearing up for Kandel and Gazzaniga. A touch of Damasio, and the first year registrars will begin to see the DSM-IV-TR in stark focus. Each section of this first chapter contains some reference to where the structures are, how they connect to other areas, what their primary role in the brain must therefore be, and how they do this via neurochemical pathways and how pathology emerges from disruption or dysfunction. As the author's caution at the end of the chapter, if the brain were that simple that we could understand it, then our observing brains would lack the capacity to understand these concepts, a nice tautology, I think first pointed out by Emerson Pugh.

The conclusions to chapter two likewise come with caveats. Much research is needed to determine which molecular changes in mesocorticolimbic pathways are responsible for the effects of drugs, and again, the pathways are part of a dynamic homeostatic second order cybernetic system that cannot easily be illuminated on with regard to the linear intervention of medication. The chapter nevertheless charts, in simple terms, the physical highways in the brain and the chemical messenger systems that enable such homeostasis, by elucidating the signal transduction mechanism as far as we know them. A nice side to this book is that this chapter, like others, is kept short and tight, only 30 pages, and reader exhaustion is avoided. Length is not strength after all, and this does nicely.

And of course, while this book does all that, it refers to everyone present and gone in the literature from Kandel, to the luckless Goldman-Rakic.

Heckers and Goff bravely take on the review of schizophrenia, and waste a few pages on history and subtypes which probably is unnecessary: anyone using this book would know all that, and the subtypes are not neurologically helpful anyway. But the rest is sheer bliss to read, with detailed explanations of every possible sort, including all the neurotransmitters that are necessarily connected, and not just the monoamines, but the glutamates of the world are also here, with easily 200 references packed into the few pages allowed for this chapter, a monumental, but tiny work. Again, there is so much more now in 2003, just a year later than publication date, but this is good stuff to read and absorb. It is all made so easier by crisp and clear prose, and tight editing.

Speaking of the editor, Hammer himself takes on the task of explaining neural circuitry and signaling in addiction, addressing the paradigm shift that forced the entry of the book's focused topics into addiction studies. No longer seen as voluntary self-administration behavior, addiction is now seen as an understandable offshoot of normal reward seeking behavior become brain disease, with its focus on the dopamine systems of the subcortex. Predictably the words nucleus and accumbens are paired, and early on emerge in the discussion of neural circuitry. This fourth chapter is complex and dense, and takes some reading for the implications to sink in. At face value, this is about reward seeking behavior, but its implications go much wider afield, and relate easily to social competition and learning theories in anthropology.

Kent, Sullivan and Rauch embark on anxiety, and again, tight writing style and clear but intricate diagrams make it accessible, if not simple. For instance, a really useful diagram on page 137 embarks on the task of making the homeostatic feedback loops of the cortico-thalamo-cortical circuits understandable, and relating this to OCD, and by implication, if you read Scandanavian Nobel Prize laureate's work for fun, related conditions such as ADHD as well. Again, the fingers itch for the scanner and a bit of diagram plagiarism… sigh.

Marek and Duman cope with depression in the same way, again with tight prose and good diagrams. Despite the age of the book, now out for a year, the work on brain-derived neurotrophic factor is up to date, as is the information on the neurodegeneration of frontal and limbic areas.

Sassi and Soares take on bipolar disorder. In 13 pages. Either little is known, or they write as tightly as the others. Nine pages of references suggest the latter.

Nixon works on Alzheimer's and dementia, and certainly concentrates on the former, since much more is known, but the later comments on the Chromosome 17 taupathies is a little thin, and summarizes what one will find in other tomes, such as Burns and Levy.

A noticeable and only failure of the book is the absence of a collated index of authors, although of course each chapter has its own. The subject index is comprehensive.

The only thing to do is buy this book, prescribe it to students, and honor it for what it is: good.

 

 

2003 Roy Sugarman

 

Roy Sugarman PhD, Clinical Lecturer in Psychiatry, Adelaide University, Senior Cinical Neuropsychologist, Royal Adelaide Hospital Glenside Campus Extended Care.


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