Pediatric Neuropsychiatry
http://www.100md.com
《新英格兰医药杂志》
Pediatric Neuropsychiatry is an intriguing title that conveys a sense of opportunity, but it may also cause some confusion. If, indeed, child and adolescent psychiatry is the medical subspecialty dedicated to the understanding and treatment of a broad group of cognitive, mental, developmental, and emotional disorders in youth, what is "pediatric neuropsychiatry"? According to the editors of this book, as stated in their preface, it is "an evolving clinical discipline devoted to the diagnosis and treatment of psychiatric or behavioral disorders in children and adolescents who have disturbances of brain function."
We know that during the past 50 years, there have been dramatic changes in our understanding of psychiatric disorders. These include an awareness of the prevalence and impact of the onset of psychiatric disorders in childhood, with perhaps as many as 50 to 75% of all psychiatric disorders arising before adulthood. Furthermore, the complex manner in which biologic and environmental factors interact to affect brain function and, ultimately, create the symptoms of psychiatric disorders has been the focus of intense study that has led to a new understanding of psychopathology. Where, then, does "pediatric neuropsychiatry" fit in? If this book is a measure of neuropsychiatry as an evolving discipline, much evolution has yet to occur. If, however, "pediatric neuropsychiatry" is a euphemism for "child and adolescent psychiatry," the book fails to capture the breadth and depth of the discipline and misses an opportunity to bring together the seemingly disparate languages and constructs used to define similar brain–behavior interactions.
The book has four sections, the first of which, "Neuropsychiatric Assessment of the Child and Adolescent," provides uneven coverage of the topic of assessment but does include strong chapters on neuropsychological testing, neuroimaging, and electrophysiology (including a very nice review of event-related potentials). But there are gaps: there is no discussion of the assessment of sleep electrophysiology, and genetics is left to a discussion in a later section on treatment. In addition, there are only limited discussions of assessment strategies for nonverbal or intellectually impaired children and measures of adaptive functioning (mixed in with outmoded assessments such as the Denver model) and academic performance.
The second and third sections, "Neuropsychiatric Aspects of Psychiatric and Behavioral Disorders of Children and Adolescents" and "Neuropsychiatric Aspects of Neurologic Disorders of Children and Adolescents," represent a distinction without an obvious difference. It is not clear why, for example, mental retardation and schizophrenia are considered psychiatric disorders, whereas movement disorders and dyslexia are classified as neurologic disorders. Aren't dysfunctions in neural systems involved in all these conditions? Equally puzzling, childhood schizophrenia and autism spectrum disorders share a chapter, despite having been separated long ago for the purposes of diagnosis and treatment. The reason they are linked is not evident, and the discussion of these examples of "neuropsychiatric" disorders is limited. In addition, the chapter on anxiety disorders, which does provide an excellent discussion of threat response, remains overall a weak presentation that fails to make critical distinctions among these widely disparate disorders. For example, obsessive–compulsive disorder, an established neurobiologic condition, is mentioned in only three paragraphs and is not linked to other stereotyped disorders, such as Tourette's syndrome (which is, alas, now labeled a neurologic disorder). These two sections offer limited discussion of "genetic syndromes," despite the recognition that at least autism and probably attention deficit–hyperactivity disorder, obsessive–compulsive disorder, dyslexia, seizure disorders, and other conditions also have strong genetic components. Still, some chapters are of good quality, including chapter 12, "Conduct Disorder and Sociopathy"; chapter 13, "Pediatric Mood Disorders"; and chapter 16, "Substance Use Disorders."
The section on treatment has some strengths, but there is considerable redundancy. Since virtually every earlier section includes a discussion of pharmacotherapy, there is duplication in the chapter on psychopharmacology; still, Daniel Geller and colleagues provide an excellent review. The chapter by Carol Anderson on genetic evaluation, counseling, and treatment is quite useful, as is the unique and excellent chapter by C. Edward Coffey on electroconvulsive therapy in children.
In the final analysis, Pediatric Neuropsychiatry is a missed opportunity, but it does contain a few pearls. Rather than creating a dichotomy between neurologic and psychiatric disorders, the editors could have better served the field by producing a book that took a fresh look at neurobiology as a fundamental part of psychiatry. Perhaps we will see this merger more clearly in future books. Meanwhile, this one is useful for occasional reference, especially the few strong chapters.
Bennett L. Leventhal, M.D.
University of Illinois College of Medicine
Chicago, IL 60608(Edited by C. Edward Coffe)
We know that during the past 50 years, there have been dramatic changes in our understanding of psychiatric disorders. These include an awareness of the prevalence and impact of the onset of psychiatric disorders in childhood, with perhaps as many as 50 to 75% of all psychiatric disorders arising before adulthood. Furthermore, the complex manner in which biologic and environmental factors interact to affect brain function and, ultimately, create the symptoms of psychiatric disorders has been the focus of intense study that has led to a new understanding of psychopathology. Where, then, does "pediatric neuropsychiatry" fit in? If this book is a measure of neuropsychiatry as an evolving discipline, much evolution has yet to occur. If, however, "pediatric neuropsychiatry" is a euphemism for "child and adolescent psychiatry," the book fails to capture the breadth and depth of the discipline and misses an opportunity to bring together the seemingly disparate languages and constructs used to define similar brain–behavior interactions.
The book has four sections, the first of which, "Neuropsychiatric Assessment of the Child and Adolescent," provides uneven coverage of the topic of assessment but does include strong chapters on neuropsychological testing, neuroimaging, and electrophysiology (including a very nice review of event-related potentials). But there are gaps: there is no discussion of the assessment of sleep electrophysiology, and genetics is left to a discussion in a later section on treatment. In addition, there are only limited discussions of assessment strategies for nonverbal or intellectually impaired children and measures of adaptive functioning (mixed in with outmoded assessments such as the Denver model) and academic performance.
The second and third sections, "Neuropsychiatric Aspects of Psychiatric and Behavioral Disorders of Children and Adolescents" and "Neuropsychiatric Aspects of Neurologic Disorders of Children and Adolescents," represent a distinction without an obvious difference. It is not clear why, for example, mental retardation and schizophrenia are considered psychiatric disorders, whereas movement disorders and dyslexia are classified as neurologic disorders. Aren't dysfunctions in neural systems involved in all these conditions? Equally puzzling, childhood schizophrenia and autism spectrum disorders share a chapter, despite having been separated long ago for the purposes of diagnosis and treatment. The reason they are linked is not evident, and the discussion of these examples of "neuropsychiatric" disorders is limited. In addition, the chapter on anxiety disorders, which does provide an excellent discussion of threat response, remains overall a weak presentation that fails to make critical distinctions among these widely disparate disorders. For example, obsessive–compulsive disorder, an established neurobiologic condition, is mentioned in only three paragraphs and is not linked to other stereotyped disorders, such as Tourette's syndrome (which is, alas, now labeled a neurologic disorder). These two sections offer limited discussion of "genetic syndromes," despite the recognition that at least autism and probably attention deficit–hyperactivity disorder, obsessive–compulsive disorder, dyslexia, seizure disorders, and other conditions also have strong genetic components. Still, some chapters are of good quality, including chapter 12, "Conduct Disorder and Sociopathy"; chapter 13, "Pediatric Mood Disorders"; and chapter 16, "Substance Use Disorders."
The section on treatment has some strengths, but there is considerable redundancy. Since virtually every earlier section includes a discussion of pharmacotherapy, there is duplication in the chapter on psychopharmacology; still, Daniel Geller and colleagues provide an excellent review. The chapter by Carol Anderson on genetic evaluation, counseling, and treatment is quite useful, as is the unique and excellent chapter by C. Edward Coffey on electroconvulsive therapy in children.
In the final analysis, Pediatric Neuropsychiatry is a missed opportunity, but it does contain a few pearls. Rather than creating a dichotomy between neurologic and psychiatric disorders, the editors could have better served the field by producing a book that took a fresh look at neurobiology as a fundamental part of psychiatry. Perhaps we will see this merger more clearly in future books. Meanwhile, this one is useful for occasional reference, especially the few strong chapters.
Bennett L. Leventhal, M.D.
University of Illinois College of Medicine
Chicago, IL 60608(Edited by C. Edward Coffe)