Assessment of Neuropsychological Functions in Psychiatric Disorders
The intent of this edited volume is to present “neuropsychological effects of psychiatric disorders,” focusing on clinical assessment of neurocognitive deficits in psychiatric disorders and their attempted treatment, management, and rehabilitation.
To this end, the editor first presents a brief overview of neuropsychological assessment techniques. Chapters by contributing authors then address the neuropsychology of various psychiatric disorders, including schizophrenia; mood disorders; several nonpsychotic, nonaffective psychiatric disorders such as posttraumatic stress disorder; childhood mental disorders; personality disorders; chronic medical illness; dementing conditions; and alcohol and other substance abuse. Finally, there is a chapter on management, treatment, and rehabilitation of psychiatric patients. (Q-JMS: Are depression and PTSD nonaffective??)
In several chapters the authors deal with clinical assessment, but their apparent purpose is to provide converging evidence from neuropsychology, neuroradiology, and imaging techniques to develop a coherent picture of the neurocognitive deficits and preserved functions evident in particular psychiatric disorders. This approach, of course, works better with some disorders than others for a host of reasons. For some disorders, the paucity of findings makes one wonder why the disorder was included in the chapter. Even with considerable research on a particular disorder, the limitations of the findings are quite evident, not the least of which is an attempt to “localize” the disorder to some area of the brain. Some of the authors appear quite convinced of the consistency in the findings with regard to localization of dysfunction, while others are appropriately cautious in their speculations. Despite the burgeoning application of neuropsychology to psychiatric disorders, one has to recognize that accuracy of localization is limited by the reliability and validity of the neuropsychological instruments for such a purpose and by the heterogeneity in cognitive functioning among individuals with the same psychiatric diagnosis.
Some chapters stand out for their sophisticated and thorough treatments of the findings from research studies. Among these are O'Donnell and Calev on nonpsychotic, nonaffective psychiatric disorders; Gorton et al. on personality disorders; and Harvey and Dahlman on dementing conditions. The best chapters are by Bates and Convit, who give an excellent review and critique of the neuropsychological and neuroimaging studies of alcohol and substance abuse and by Jaeger and Berns on neuropsychological management, treatment, and rehabilitation of psychiatric patients. This latter chapter presents a historical context for the role of neuropsychology in assessment of psychiatric disorders that ought to be read by anyone interested in the interface of neuropsychology and psychiatric disorders. The authors make a well conceived and novel argument for giving neuropsychology a central role in the diagnosis, treatment, and rehabilitation of patients with various psychiatric disorders.
Other, well-intended chapters are compendiums of findings but lack the application of a critical eye to reviewing the significance of the research. These include the chapters on schizophrenia, mood disorders, childhood disorders, and chronic medical illness. Particularly disappointing was the first chapter, by the book's editor, which summarizes clinical neuropsychology in a superficial, overly simplistic manner but also lapses into levels of complexity that might baffle the reader.
This book, as a source for secondary readings, is slightly dated (the last references are from 1997) and uneven in its quality. The good chapters stand on their own and inform the reader; the lesser chapters serve as acceptable sources of references to other works to be read independently.
Dr. Rosen is Associate Clinical Professor of Medical Psychology in the Department of Psychiatry, Columbia University, New York, NY.
