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.

Biological Psychiatry 3
Contents 9
Acknowledgements 13
Quotations 15
Preface to the First Edition 17
Preface to the Second Edition 21
Introduction and Preface to the Third Edition 23
1 Principles of Brain Function and Structure: 1 Genetics, Physiology and Chemistry 29
Introduction 29
Genetics 29
Brain chemistry and metabolism 36
The metabolism of glucose 37
Proteins and fatty acids 37
Cell membranes 38
Synapses 40
Receptors 42
Neurones 49
Neurotransmitters 52
Interrelationships among transmitters 57
Transmitter dispersal 57
CNS inflammation 57
2 Principles of Brain Function and Structure: 2 Anatomy 59
Introduction 59
The neuroanatomy of emotion 60
Individual anatomical structures 69
Ascending and descending limbic-system connections 81
Macrosystems 83
The basal ganglia and the re-entrant circuits 85
The ventral striatum and ‘limbic striatum’ 86
The ascending cholinergic systems 88
Cortical regions of interest 88
The cerebellum 91
3 Important Brain–Behaviour Relationships 93
Introduction 93
Important anatomical structures for understanding behaviour 96
Some specific behaviours 102
Limbic lobe disorders in a clinical context 105
Re-entrant circuits in a clinical context 106
The frontal lobes in a clinical context 107
Laterality 109
4 Classifications and Clinical Investigations 111
Introduction 111
Signs, symptoms, syndromes and disease 112
Classification in psychiatry 112
Clinical investigation 115
5 Personality Disorders 141
General introduction 141
Introduction to the concept of personality 141
Genetics 146
Somatic variables 149
Metabolic and biochemical findings 149
Neurophysiological and neurological data 151
Some outstanding issues 154
6 Anxiety Disorders 159
Introduction 159
Genetics 162
Somatic variables 163
Metabolic and biochemical findings 163
Neurochemical investigations 165
Neurophysiological and neurological data 169
Imaging 169
Obsessive–compulsive disorder 170
Post-traumatic stress disorder 171
Some outstanding issues 172
7 The Schizophrenias 175
Introduction 175
Genetics 178
Somatic variables 180
Metabolic and biochemical findings 182
Neurochemical investigations 187
Neurophysiological and neurological data 192
Some outstanding issues 204
8 Affective Disorders 211
Introduction 211
Genetics 213
Metabolic and biochemical findings 214
Neurochemical investigations 226
Neurophysiological and neurological data 228
Some outstanding issues 237
9 The Addictions and Disorders of Motivation 243
Introduction 243
Disorders of motivation 244
Conditioning 245
Genetics 247
Metabolic and biochemical findings 249
Neurophysiological and neurological data 251
Some outstanding issues 256
10 Epilepsy 259
Introduction 259
Prevalence and clinical characteristics 260
Classification 259
Genetics 262
Symptomatic epilepsy 263
Biochemical findings 264
Investigation and differential diagnosis 265
Psychiatric disorders in epilepsy 265
Cognitive deterioration and epilepsy 282
Some outstanding issues 283
11 The Dementias 285
Introduction 285
Definition 285
Prevalence 286
Diagnosis and classification 286
Alzheimer’s disease 287
Dementia of frontal-lobe type 295
Focal cortical atrophies 296
Dementia with Lewy bodies 296
Vascular dementias 297
Other forms of dementia 299
Further causes of dementia 303
Some outstanding issues 303
12 Biological Treatments 309
Introduction 309
Pharmacology: pharmacokinetics and pharmacodynamics 310
Antidepressants 312
Antipsychotic drugs 325
Anxiolytics and hypnotics 332
Beta-Adrenergic blockers 336
Lithium 336
Anticonvulsants 338
Drugs for the treatment of dementia 344
Medications for the addictions 345
Brain-stimulation therapies 346
Sleep-deprivation therapy 357
13 Epilogue: Progress toward a Neuroanatomically, Biological-psychiatrically Informed Classification Scheme in Psychiatry 359
References 363
Index 423

"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)