Biological Psychiatry (eBook)

Professor Trimble was for many years Professor ofBehavioural Neurology and Consultant Physician to the Department ofPsychological Medicine at the National Hospital Queen Square,London. He now holds emeritus status at the above institutions. Hestudied general medicine, obtaining membership of the Royal Collegeof Physicians before going to the National Hospital Queen Squareand then the Maudsley Hospital to advance his training in neurologyand psychiatry. Following an internship in psychiatry at the JohnsHopkins Hospital, Baltimore, he returned to the National Hospitalto pursue a career in neuropsychiatry. He set up a research groupwith main interests in the interface disorders between neurologyand psychiatry, reflected in the developing recognition ofneuropsychiatry and behavioural neurology as independentdisciplines. The research group (Raymond-Way Unit) explored thebehavioural consequences of neurological disorders and theirtreatment, with a major interest in epilepsy and movementdisorders. His current writing and academic interests involveteaching and lecturing on neuroanatomical concepts relevant tounderstanding behaviour and its variations, in particular with aninterest in neuroaesthetics and neurotheology, namely the cerebralbasis of artistic and religious experiences. Dr. George received his medical degree from the MedicalUniversity of South Carolina in Charleston in 1985, where hecontinued with dual residencies in neurology and psychiatry. He isboard certified in both areas. He worked for one year (1990-91) asa Visiting Research Fellow in the Raymond Way NeuropsychiatryResearch Group at the Institute of Neurology, London. He andProfessor Trimble used pharmacology and imaging to study theoverlaps between Obsessive-Compulsive Disorder and Gilles de laTourette Syndrome. During this year he also worked on newfunctional imaging techniques (SPECT and PET) at the Institute ofNuclear Medicine, University College of London and Middlesex Schoolof Medicine, London. He wrote one of the first textbooks in the newarea of brain activation and imaging. Dr George then moved toWashington, DC, working with Dr. Robert Post in the BiologicalPsychiatry Branch of the Intramural National Institute of MentalHealth. He was one of the first to use functional imaging(particularly oxygen PET) to assess brain changes associated withnormal emotions, as well as using imaging to understand brainchanges which occur in depression and mania. This imaging workdirectly led to his pioneering use of transcranial magneticstimulation (TMS) as a probe of neuronal circuits regulating mood,and to clinical trials using TMS as an antidepressant. In 2008prefrontal TMS was FDA approved as an antidepressant treatment. In1995 he moved back to Charleston and built the functionalneuroimaging division and brain stimulation laboratories. Thisimaging group has grown into the MUSC Center for Advanced ImagingResearch, which is now part of the SC Brain Imaging Center ofExcellence. He continues to use imaging and non-invasivestimulation, either separately or more recently in combination, tounderstand the brain regions involved in emotion regulation inhealth and disease. In 1998, he pioneered another new treatment forresistant depression, vagus nerve stimulation, that was recentlyFDA approved. He and his group have used MRI imaging to understandbrain stimulation brain effects. He is on several editorial reviewboards, and has published over 200 scientific articles, and haswritten or edited 5 books. He is the editor-in-chief of a newjournal, Brain Stimulation. He has received several international awards, including the WorldFederation of Societies of Biological Psychiatry LifetimeAchievement Award (2007), the NARSAD Falcone Award (2008) and hewas honored as one of 14 'Pioneers of Medical Progress' saluted inthe August 2009 edition of US News & World Report.

Acknowledgements.

Quotations.

Preface to the First Edition.

Preface to the Second Edition.

Introduction and Preface to the Third Edition.

1 Principles of Brain Function and Structure: 1 Genetics, Physiology and Chemistry.

Introduction.

Genetics.

Brain chemistry and metabolism.

The metabolism of glucose.

Proteins and fatty acids.

Cell membranes.

Synapses.

Receptors.

Neurones.

Neurotransmitters.

Interrelationships among transmitters.

Transmitter dispersal.

CNS inflammation.

2 Principles of Brain Function and Structure: 2 Anatomy.

Introduction.

The neuroanatomy of emotion.

Individual anatomical structures.

Ascending and descending limbic-system connections.

Macrosystems.

The basal ganglia and the re-entrant circuits.

The ventral striatum and 'limbic striatum'.

The ascending cholinergic systems.

Cortical regions of interest.

The cerebellum.

3 Important Brain-Behaviour Relationships.

Introduction.

Important anatomical structures for understanding behaviour.

Some specific behaviours.

Limbic lobe disorders in a clinical context.

Re-entrant circuits in a clinical context.

The frontal lobes in a clinical context.

Laterality.

4 Classifications and Clinical Investigations.

Introduction.

Signs, symptoms, syndromes and disease.

Classification in psychiatry.

Clinical investigation.

5 Personality Disorders.

General introduction.

Introduction to the concept of personality.

Genetics.

Somatic variables.

Metabolic and biochemical findings.

Neurophysiological and neurological data.

Some outstanding issues.

6 Anxiety Disorders.

Introduction.

Genetics.

Somatic variables.

Metabolic and biochemical findings.

Neurochemical investigations.

Neurophysiological and neurological data.

Imaging.

Obsessive-compulsive disorder.

Post-traumatic stress disorder.

Some outstanding issues.

7 The Schizophrenias.

Introduction.

Genetics.

Somatic variables.

Metabolic and biochemical findings.

Neurochemical investigations.

Neurophysiological and neurological data.

Some outstanding issues.

8 Affective Disorders.

Introduction.

Genetics.

Metabolic and biochemical findings.

Neurochemical investigations.

Neurophysiological and neurological data.

Some outstanding issues.

9 The Addictions and Disorders of Motivation.

Introduction.

Disorders of motivation.

Conditioning.

Genetics.

Metabolic and biochemical findings.

Neurophysiological and neurological data.

Some outstanding issues.

10 Epilepsy.

Introduction.

Prevalence and clinical characteristics.

Classification.

Genetics.

Symptomatic epilepsy.

Biochemical findings.

Investigation and differential diagnosis.

Psychiatric disorders in epilepsy.

Cognitive deterioration and epilepsy.

Some outstanding issues.

11 The Dementias.

Introduction.

Definition.

Prevalence.

Diagnosis and classification.

Alzheimer's disease.

Dementia of frontal-lobe type.

Focal cortical atrophies.

Dementia with Lewy bodies.

Vascular dementias.

Other forms of dementia.

Further causes of dementia.

Some outstanding issues.

12 Biological Treatments.

Introduction.

Pharmacology: pharmacokinetics and pharmacodynamics.

Antidepressants.

Antipsychotic drugs.

Anxiolytics and hypnotics.

Beta-Adrenergic blockers.

Lithium.

Anticonvulsants.

Drugs for the treatment of dementia.

Medications for the addictions.

Brain-stimulation therapies.

Sleep-deprivation therapy.

13 Epilogue: Progress toward a Neuroanatomically, Biological-psychiatrically Informed Classification Scheme in Psychiatry.

References.

Index.

"This book therefore may be valuable to those engaged in
clinical practice who wish to familiarize themselves with some of
the basic concepts behind modern biological psychiatric research
and the recent history of the field." (Psychological
Medicine, 2012)
"If you are going to choose where to fork out the money, it would
be here, for the most practical understanding of brain-behavior
science, and these authors I am sure will continue to be leaders in
this field, with perhaps only Lishman challenging them for the
buck." (Metapsychology, 25 June 2011)

"As in the earlier editions of the book, there are
comprehensive reviews and explanations of the latest advances in
neurochemistry, neuroanatomy, genetics and brain imaging
descriptions not only of methodologies but also of the application
of these in clinical settings." (AllVoices, 16 February 2011)

"An important contribution that should be read by
psychopharmacologists, psychiatrists, neurologists and
neuroscientists who wish to obtain an interesting and well-written
account of the subject." (Human Psychopharmacology,
2010)

"Writing for medical students and for researchers and
practitioners in fields that touch upon mental health, they begin
by exploring principles of brain function and structure from
perspectives of genetics, physiology, chemistry, and anatomy. Then
they consider important brain-behavior relationships, and
classifications and clinical investigations. Having set the stage,
they proceed to describe biological aspects of personality
disorders, anxiety disorders, the schizophrenias, affective
disorders, the addictions and disorders of motivation, epilepsy,
and the dementias." (SciTech Book News, December 2010)