Biological Psychiatry, 3rd Edition

Acknowledgements xi

Quotations xiii

Preface to the First Edition xv

Preface to the Second Edition xix

Introduction and Preface to the Third Edition xxi

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

Introduction 1

Genetics 1

Brain chemistry and metabolism 8

The metabolism of glucose 9

Proteins and fatty acids 9

Cell membranes 10

Synapses 12

Receptors 14

Neurones 21

Neurotransmitters 24

Interrelationships among transmitters 29

Transmitter dispersal 29

CNS inflammation 29

2 Principles of Brain Function and Structure: 2 Anatomy 31

Introduction 31

The neuroanatomy of emotion 32

Individual anatomical structures 41

Ascending and descending limbic-system connections 53

Macrosystems 55

The basal ganglia and the re-entrant circuits 57

The ventral striatum and ‘limbic striatum’ 58

The ascending cholinergic systems 60

Cortical regions of interest 60

The cerebellum 63

3 Important Brain–Behaviour Relationships 65

Introduction 65

Important anatomical structures for understanding behaviour 68

Some specific behaviours 74

Limbic lobe disorders in a clinical context 77

Re-entrant circuits in a clinical context 78

The frontal lobes in a clinical context 79

Laterality 81

4 Classifications and Clinical Investigations 83

Introduction 83

Signs, symptoms, syndromes and disease 84

Classification in psychiatry 84

Clinical investigation 87

5 Personality Disorders 113

General introduction 113

Introduction to the concept of personality 113

Genetics 118

Somatic variables 121

Metabolic and biochemical findings 121

Neurophysiological and neurological data 123

Some outstanding issues 127

6 Anxiety Disorders 131

Introduction 131

Genetics 134

Somatic variables 135

Metabolic and biochemical findings 135

Neurochemical investigations 137

Neurophysiological and neurological data 140

Imaging 140

Obsessive–compulsive disorder 142

Post-traumatic stress disorder 143

Some outstanding issues 144

7 The Schizophrenias 147

Introduction 147

Genetics 150

Somatic variables 153

Metabolic and biochemical findings 154

Neurochemical investigations 159

Neurophysiological and neurological data 164

Some outstanding issues 176

8 Affective Disorders 183

Introduction 183

Genetics 184

Metabolic and biochemical findings 186

Neurochemical investigations 198

Neurophysiological and neurological data 200

Some outstanding issues 209

9 The Addictions and Disorders of Motivation 215

Introduction 215

Disorders of motivation 216

Conditioning 217

Genetics 219

Metabolic and biochemical findings 221

Neurophysiological and neurological data 223

Some outstanding issues 228

10 Epilepsy 231

Introduction 231

Prevalence and clinical characteristics 231

Classification 231

Genetics 235

Symptomatic epilepsy 235

Biochemical findings 236

Investigation and differential diagnosis 237

Psychiatric disorders in epilepsy 237

Cognitive deterioration and epilepsy 254

Some outstanding issues 255

11 The Dementias 257

Introduction 257

Definition 257

Prevalence 258

Diagnosis and classification 258

Alzheimer’s disease 259

Dementia of frontal-lobe type 267

Focal cortical atrophies 268

Dementia with Lewy bodies 268

Vascular dementias 269

Other forms of dementia 271

Further causes of dementia 275

Some outstanding issues 275

12 Biological Treatments 281

Introduction 281

Pharmacology: pharmacokinetics and pharmacodynamics 281

Antidepressants 284

Antipsychotic drugs 296

Anxiolytics and hypnotics 304

Beta-Adrenergic blockers 308

Lithium 308

Anticonvulsants 310

Drugs for the treatment of dementia 316

Medications for the addictions 317

Brain-stimulation therapies 318

Sleep-deprivation therapy 329

13 Epilogue: Progress toward a Neuroanatomically, Biological-psychiatrically Informed Classification Scheme in Psychiatry 331

References 335

Index 395