Neuroscience of clinical psychiatry : the pathophysiology of behavior and mental illness

334 Pages·2013·76.25 MB·English

by  Edmund S. Higgins MD

The Neuroscience
of Clinical Psychiatry
The Pathophysiology of Behavior
and Mental Illness
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The Neuroscience
of Clinical Psychiatry
The Pathophysiology of Behavior
and Mental Illness
Second Edition
Edmund S. Higgins, MD
Clinical Associate Professor of Psychiatry and Family Medicine
Medical University of South Carolina
Charleston, South Carolina
Mark S. George, MD
Distinguished Professor of Psychiatry, Radiology, and Neurosciences
Director, MUSC Center for Advanced Imaging Research
Medical University of South Carolina
Charleston, South Carolina
Illustrations by Edmund S. Higgins, MD
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Library of Congress Cataloging-in-Publication Data
Higgins, Edmund S.
Neuroscience of clinical psychiatry: the pathophysiology of behavior and mental illness/Edmund S. Higgins, MD,
clinical associate professor of family medicine and psychiatry, Medical University of South Carolina, Charleston,
South Carolina, Mark S. George, MD, distinguished professor of psychiatry, radiology, and neurosciences, director,
MUSC Center for Advanced Imaging Research, Medical University of South Carolina, Charleston, South Carolina;
illustrations by Edmund S. Higgins, MD.—Second edition.
pages cm
Includes bibliographical references and index.
ISBN 978-1-4511-0154-6 (hardback)
1. Mental illness—Pathophysiology. 2. Psychiatry. I. George, Mark S. (Mark Stork), 1958- II. Title.
RC483.H54 2013
616.89—dc23
2012043162
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10 9 8 7 6 5 4 3 2 1
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To my eldest son Fess, for his assistance with
the artwork on Tuesday mornings at local
coffee shops while waiting for school to open.
—ESH
To Eloise, my dance partner for 27 years now,
who has acetylated large portions of my DNA
through wonderful shared life experiences.
—MSG
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Preface
Neuroscience is the basic science of psychiatry. Neuroscience describes the brain mechanisms that
• gather information from the external and internal world,
• analyze the information, and
• execute the best response.
Psychiatric disorders are the result of problems with these mechanisms.
The increased accessibility to the workings of the brain in the last 25 years has resulted in an
explosion of information about neuroscience. Different lines of research such as brain imaging and
animal studies along with more traditional postmortem analysis, medication effects, and genetic
studies have transformed the way we conceptualize normal and abnormal behavior.
Bits and pieces of the neuroscience literature have filtered up to the practicing clinician, but a
comprehensive understanding of the field is almost inaccessible to all but the most dedicated self-
educators. The jargon is foreign and difficult to navigate. The standard textbooks are thick with
contributions from multiple authors and almost impossible to read cover to cover. The relevance to
the practice of psychiatry can sometimes be hard to appreciate.
We hope this book will provide a way for residents and practicing clinicians to gain a thor-
ough appreciation for the mechanisms within the brain that are stimulating (or failing to stimulate)
their patients. We also hope that the reader will have more accurate answers for the patient who
asks, “What’s causing my problem?” Likewise, we hope the reader will be better prepared for the
increasingly difficult neuroscience questions that appear on board certification tests.
If we’ve learned anything from our studies of the brain, it is that LEARNING IS WORK! The
brain increases its metabolism when conducting academic assignments. The process of focusing
one’s attention, understanding the concepts, and storing the new information requires energy. There
is no passive learning.
Consequently, when learning is interesting and relevant it requires less energy. We have made
every effort to make this material appealing and easy to consume. Pictures, drawings, and graphs
have been liberally incorporated to allow the reader to learn the concepts quickly and efficiently.
Every effort has been made to keep the material short and concise, but not too simple. Finally, we
think information that is relevant to the reader is easier to retain, so we have tried to keep bringing
the focus back to the practice of psychiatry.
We intend our book to be for three populations. First, it is for those in training: psychiatrists,
psychologists, counselors, and allied physicians. Second, it is for psychiatric residents seeking to
review the topics in preparation for their board examinations. And last, it is for the practicing clini-
cian who was trained before the revolution in neuroscience and who would like to become more
up-to-date and familiar with the field.
We hope that the reader will have a thorough—soup to nuts—understanding of the important
topics in neuroscience and will henceforth be able to read and comprehend the future research in
this field.
Edmund S. Higgins, MD
Mark S. George, MD
vi
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Acknowledgments
The authors wish to thank the following people for their assistance with this manuscript: Sherri A.
Brown for her assistance with the artwork; Pamela J. Wright-Etter, MD, and Robert J. Malcolm Jr,
MD, who reviewed individual chapters; and Laura G. Hancock, DO, and L. William Mulbry, MD,
residents, who reviewed the entire book. We also wish to thank all those readers who pointed out
the typos in the first edition.
Figures 3.5, 3.6, 3.7 and 22.1 and the dolphin in the sleep chapter were drawn by Fess Higgins.
vii
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About the Authors
Edmund S. Higgins, MD Mark S. George, MD
Edmund S. Higgins, MD, is a clinical associate professor of psychiatry and family medicine at the
Medical University of South Carolina (MUSC). He received his medical degree from Case Western
Reserve University School of Medicine. He completed residencies in family practice and psychia-
try at MUSC. He provides psychiatric services at several jails and prisons in South Carolina and has
a private psychiatric practice. He has written one other book with Mark George: Brain Stimulation
Therapies for Clinicians. He lives on Sullivan’s Island, South Carolina.
Mark S. George, MD, is a distinguished professor of psychiatry, radiology, and neuroscience as
well as director of the Brain Stimulation Laboratory, Psychiatry, at the Medical University of South
Carolina, Charleston. He received his medical degree and completed dual residencies at MUSC in
both neurology and psychiatry and is board certified in both areas. After a fellowship in London
and 4 years at NIMH, he returned to Charleston where he has conducted pioneering work with
functional imaging of the brain, transcranial magnetic stimulation, and vagus nerve stimulation.
He is the editor in chief of the journal Brain Stimulation, is on several editorial review boards,
has published over 400 scientific articles or book chapters, has 2 patents, and has written or edited
5 books. He too resides on Sullivan’s Island, South Carolina.
viii
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Contents
Preface vi
Acknowledgments vii
About the Authors viii
SEcTioN i The Neuroscience Model
1 Historical Perspective and Neuroscience Methods 2
2 Neuroanatomy 13
3 circuits and cells 26
4 Neurotransmitters 37
5 Receptors and Signaling the Nucleus 48
6 Genetics and Epigenetics 59
SEcTioN ii Modulators
7 Hormones and the Brain 73
8 Adult Development and Plasticity 86
9 inflammation and immunity 101
10 The Electrical Brain 114
SEcTioN iii Behaviors
11 Pain 123
12 Pleasure 136
13 Appetite 150
14 Anger and Aggression 162
15 Sleep and circadian Rhythms 174
ix
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x contents
16 Sex and the Brain 188
17 Attachment 203
18 Memory 217
19 intelligence 229
20 Attention 240
SEcTioN iV Disorders
21 Depression 252
22 Anxiety 263
23 Schizophrenia 275
24 Alzheimer’s Disease 287
Bibliography 298
Answers to End-of-chapter Questions 313
index 315
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