Table Of ContentOxford Textbook of
Neuropsychiatry
OXFORD TEXTBOOKS IN PSYCHIATRY
Oxford Textbook of Neuropsychiatry
Edited by Niruj Agrawal, Rafey Faruqui, and Mayur Bodani
Oxford Textbook of Psychiatry of Intellectual Disability
Edited by Sabyasachi Bhaumik and Regi Alexander
Oxford Textbook of Inpatient Psychiatry
Edited by Alvaro Barrera, Caroline Attard, and Rob Chaplin
Oxford Textbook of Attention Deficit Hyperactivity Disorder
Edited by Tobias Banaschewski, David Coghill, and Alessandro Zuddas
Oxford Textbook of Correctional Psychiatry
Edited by Robert Trestman, Kenneth Appelbaum, and Jeffrey Metzner
Oxford Textbook of Old Age Psychiatry
Edited by Tom Dening and Alan Thomas
Oxford Textbook of Community Mental Health
Edited by Graham Thornicroft, George Szmukler, Kim T Mueser, and Robert E. Drake
Oxford Textbook of Suicidology and Suicide Prevention
Edited by Danuta Wasserman and Camilla Wasserman
Oxford Textbook of Women and Mental Health
Edited by Dora Kohen
Oxford Textbook of
Neuropsychiatry
EDITED BY
Niruj Agrawal
Department of Neuropsychiatry, St George’s Hospital, London, UK
Rafey Faruqui
University of Kent, and Kent & Medway NHS
and Social Care Partnership Trust, UK
Mayur Bodani
Department of Neuropsychiatry, Kent & Medway NHS
and Social Care Partnership Trust, UK
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Foreword
The Oxford Textbook of Neuropsychiatry is very timely. There is to bedside’. If they are to keep up with the pace of progress, the
a growing awareness among psychiatrists and neurologists that next generation of clinicians must be ‘neuroscientifically literate’. A
the traditional Cartesian mind-brain dualism which fuelled div- deeper integration of neurosciences and neuropsychiatry in psychi-
ision between their specialties is completely arbitrary and, in fact, atric and neurological training will better prepare trainees for the
contradicted by scientific research. Multidisciplinary team working developments in diagnosis and treatment that stem from increased
has highlighted the extent of the overlap between psychiatric and understanding of the brain in health and disease.
neurological symptoms and disorders, as well as the implications The practice of neuropsychiatry is driven by bringing together
for patients’ functioning and quality of life. Indeed, the many dis- different perspectives and this comprehensive textbook includes
orders that do not fall neatly within the remit of either specialty contributions from renowned international experts in the neuro-
need cross-disciplinary insights if they are to be fully understood logical, psychiatric, psychological and neuroscientific fields from
and our patients are to receive the most appropriate care. across the globe. The authors have kept in mind clinical relevance
Neuropsychiatry is a well-recognized discipline in many coun- and an evidence-based approach to ensure that the book delivers
tries, particularly those in which training in psychiatry and neur- exactly what its readers need. The different sections will be valuable
ology has traditionally been combined. Elsewhere, there has been to trainees and to established clinicians, to those who are moving
increasing interest in the subspecialty since the 1980s, witnessed by into the subspecialty of neuropsychiatry and are looking for a thor-
the establishment of national neuropsychiatric associations and the ough introduction, or for people seeking a detailed, up-to-date re-
publication of specialized texts. Meanwhile, many countries have view of current understanding across the field.
recognized the need to expand and improve upon the neuroscience This textbook is a considerable achievement and a very welcome
knowledge base of psychiatry and neurology trainees through the resource.
modernization of training programmes. Advances in neuroscience
research are appearing at an ever-faster rate and work in basic sci- Professor Wendy Burn
ence is becoming increasingly ‘translational’, as scientists work to co-Chair, The Gatsby/Wellcome Neuroscience Project
reduce the lag in transferring laboratory discoveries ‘from bench President, Royal College of Psychiatrists
Preface
Neuropsychiatry is often misunderstood as a discipline and its trainees, whilst they did not wish to specialize in neuropsychiatry,
definition and scope is interpreted differently across the world. recognized the value of an understanding of neuropsychiatry in
However one looks at the scope of neuropsychiatry, its core identity their preferred subspecialty as a career choice. There is currently
lies at the interface between neurology and psychiatry. Traditional a drive in a number of psychiatric programmes across the globe to
mind-brain dualism which fuelled division between neurology improve exposure to basic and clinical neuroscience.
and psychiatry is now considered outdated and arbitrary. We are Currently, there are a small number of recognized textbooks
now increasingly aware of the extent of the overlap between neuro- of neuropsychiatry in the world. However, most of these are a bit
logical and psychiatric symptoms and disorders, and their implica- old and are rather large reference works for specialists in this field.
tions on our patients’ functioning and quality of life. This overlap There is a dearth of neuropsychiatry textbooks which are pitched
ranges from common neurological disorders presenting with psy- at the level of trainees and clinicians who are not specialists in the
chiatric symptoms; psychiatric conditions presenting with neuro- field. Hence this textbook is written in simple language, is clin-
logical symptoms; common neurological and psychiatric disorders ically focused, is very comprehensive in its scope of topics, and
co-existing by chance; or various brain disorders and syndromes covers a global perspective. We believe that the Oxford Textbook
which present with a range of neurological and psychiatric symp- of Neuropsychiatry will help to bridge the gap between general psy-
toms concomitantly. Effective and timely management of these chiatric and neurology textbooks and neuropsychiatry reference
conditions requires specific neuropsychiatric knowledge and ex- books, and will become an essential training textbook for all psych-
perience brought together from a number of related fields including iatry and neurology trainees worldwide.
neurology, psychiatry, neuropsychology, neurophysiology and This book is written by international experts, clinicians, and
neuroradiology, along with a knowledge of basic neuroscience. leaders in their field from a very large number of countries in the
Popular psychiatric or neurological textbooks generally touch world and spanning several continents. They have taken an up-to-
upon these neuropsychiatric conditions superficially, but do not date evidence-based approach with clinical relevance in mind,
do justice to the nature and complexity of these conditions and do taking a global perspective on neuropsychiatric problems and treat-
not provide adequate information. Similar concerns are unfortu- ment. They come from primarily neurological, psychiatric, psycho-
nately also prevalent in the vast majority of neurology or psychiatry logical, neuroscience, and neuropsychiatric backgrounds. This is
training programmes across the world. There are very few places at truly a global multidisciplinary effort unlike any other neuropsych-
present with a formalized neuropsychiatry training programme glo- iatry textbook currently available.
bally. Despite this, patients with neuropsychiatric conditions com- This book is organized into four sections. The first section covers
monly present in neurological and psychiatric clinical practice. This the foundation and basic skills, including basic science knowledge
has led to an increasing recognition of the need to improve neuro- and clinical skills relevant to neuropsychiatry. The second section
psychiatric knowledge and skills of all neurology and psychiatry covers the details of a wide range of core neuropsychiatric condi-
trainees that is long overdue. There has been a substantial global tions. The third section focuses on the principles of treatment in
focus recently on more profound integration of neurosciences and various modalities and neuropsychiatry service models and path-
neuropsychiatry in psychiatric training. Neuropsychiatry forms an ways. This section also covers the relevance of neuropsychiatry in
important part of the psychiatric curriculum and is examined both criminal and civil courts. The last section is unique to this book
in theory and in clinical exams. Similarly, neuropsychiatry is also of and provides a snapshot of neuropsychiatry perspectives in various
interest to neurology trainees, and it is increasingly recognized that parts of the world. All chapters contain a number of key learning
all neurology trainees should have some knowledge and experience points at the end and key references.
in neuropsychiatry. We believe this book may also be of relevance to trainees in
The need for neuropsychiatric knowledge and skills is now rec- neurorehabilitation, allied professionals in neuroscience and
ognized by trainees too. A survey of over 900 trainees at the Royal mental health, in addition to neurology and psychiatry trainees and
College of Psychiatrists (RCPsych) in the United Kingdom showed clinicians. It covers core knowledge and skills for training in neuro-
that over three-quarters of psychiatry trainees desired some know- psychiatry but also covers the knowledge applicable to all neurology
ledge and training in the field of neuropsychiatry. Most of these and psychiatry trainees. The book meets curriculum requirements
viii Preface
for various international training programmes and examinations. We would also like to thank the Oxford University Press editorial
We hope that you will enjoy reading this book as much as we have team, Lauren Tilley, Karen Moore, Rachel Goldsworthy, and Pete
reading all the chapters. Stevenson for their help and support at all the stages of this book’s
We are most grateful to all our contributors internationally, production.
many of whom are friends and colleagues. They have worked hard Niruj Agrawal
to simplify complex knowledge and distil a lifetime of experience Rafey Faruqui
concisely. It has been an honour and privilege to work with them. Mayar Bodani
Contents
Abbreviations xi 12. Genetics of neuropsychiatric disease 127
Contributors xix Stefania Bruno and Nayana Lahiri
13. Neuropsychiatry curriculum and key clinical
competencies 141
SECTION 1 Perminder S. Sachdev and Adith Mohan
Foundations and basic skills 14. Immunology relevant to neuropsychiatry 151
Rachel Patel and Neil A. Harrison
1. The history and scope of neuropsychiatry 3
Michael Trimble 15. Neuropsychiatry of consciousness 161
David Linden
2. Introduction to the neuropsychiatric
examination 13
Jonathan Silver and Sonja Blum
SECTION 2
3. The neurological examination in
Core neuropsychiatric conditions
neuropsychiatry 23
Jan A. Coebergh and Biba R. Stanton
16. Brain injury 171
4. Philosophy and neuropsychiatry 35 Niruj Agrawal
Norman A. Poole and Derek Bolton
17. Neuropsychiatric aspects of epilepsy 181
5. Phenomenology: a neuropsychiatric Marco Mula and Mahinda Yogarajah
perspective 43
18. Neuropsychiatric aspects of movement
Michael Trimble
disorders 195
6. Basic neuroanatomy review 51 Andrea E. Cavanna and Hugh Rickards
John Hart Jr
19. Neuropsychiatry of stroke and transient
7. Neurophysiology in neuropsychiatry 67 ischaemic attack 207
Elisaveta Sokolov and Nandini Mullatti Yvonne Chun, Laura McWhirter, and Alan Carson
8. Structural imaging in neuropsychiatry 81 20. Infections of the central nervous system 217
Naga Kandasamy and Dana Niry Guleed Adan, Sam Nightingale, Christine Burness,
and Tom Solomon
9. Functional neuroimaging in neuropsychiatry 95
Robin A. Hurley, Shane C. Masters, and Katherine H. Taber 21. Neuropsychiatric aspects of CNS tumours
in adults 229
10. Proteomics and metabolomics in
Alex J. Mitchell and Audrey Hopwood
neuropsychiatry 105
Ray Suman 22. Inflammatory and autoimmune disorders in
neuropsychiatry 245
11. Neuropsychological assessment of
Thomas A. Pollak, Ester Coutinho, Emma Palmer- Cooper,
dementia 115
and Angela Vincent
James R. Burrell, John R. Hodges, and Olivier Piguet
