Review of the book entitled Avanços em clínica neuropsiquiátrica
Reseña del libro Avanços em clínica neuropsiquiátrica
Bruno Mendonça Costa
Psychiatrist, PhD. Chief, Department of Psychiatry, Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, RS, Brazil
AVANÇOS EM CLÍNICA NEUROPSIQUIÁTRICA
Carlos Alberto Crespo de Souza
Porto Alegre, AGE, 2005
The second book by Dr. Crespo de Souza, launched in July 2005, addresses again the topics of studies he has already developed and his research on neuropsychiatry of cranioencephalic trauma (CET).
The book, whose preface is written by Prof. Dr. Marco Antônio Alves Brasil, ex-President of the Brazilian Association of Psychiatry (2001-2004), is a collection of the author's articles published in several national and international journals about the topic from 2002 through 2004.
The book, 237 pages, is divided into 18 chapters of which 16 are published articles and the other 2 account for comments and conclusions.
As a sample of what one may find in the book, I will briefly describe each chapter.
Chapter 1 raises the issue about what a neurological and a psychic trauma is, as if they were distinct. The case studied as an example demonstrates that psychic suffering is also registered in the brain. The author demonstrates that both the neurological and psychic lesions are similar, and there are a few reasons why they should be so separated in a dichotomist point of view.
Chapter 2 describes how difficult it is to set differences between the postconcussional and posttraumatic stress disorders resulting from traffic accidents, which have been increasing frequently. In this chapter, the author again is concerned to how long will medicine still take to provide proper value to emotional or psychic reactions present in those traumas.
In chapter 3, the author investigates history and makes a record of the evolution of knowledge about the relationship between neurology and psychiatry in different populations. Although there are recent studies on the matter, there is still much to clear up, what makes the topic open to new and necessary research.
Chapter 4 poses an intriguing question: "Who is responsible for treating psychiatric symptoms in neurological patients?" The question has a provocative nature and answers are left to readers after reflection on the topic. The "syndrome of second impact" is approached in chapter 5. It is a severe new entity that stemmed from more recent studies on repeated brain concussions. Chapter 6 brings new knowledge on the relation between CET and attention deficit hyperactivity disorder (ADHD), and demonstrates that brain traumas are frequently found as the cause of such disorders in children.
In chapter 7, entitled "Posttraumatic psychoses", the author invests in the research about the relation between CET and psychoses. Once the neurological and psychiatric services do not communicate with each other, neurologists treat CETs and psychiatrists treat psychoses. The consequence is that most of times psychiatrists do not establish a relation of cause and effect with previous traumas, thus causing damages to patients.
"CET and the Tourette syndrome" is the title of the eighth chapter, in which the author shows evidence that some CET cases present tourettism symptoms, this means that CET cases have clinical manifestations similar to those of Tourette syndrome.
Chapter 9 approaches a phenomenon that is not well known by psychiatrists, the apoptosis phenomenon. Knowing the importance of the disease is necessary to approach patients who present delusion or agitation crises immediately after trauma, which can cause cell death.
Chapter 10, under the title "CET and Alzheimer" is more speculative, because it is evident that people who undergo brain traumas are more prone to develop Alzheimer when elder, especially if there is a genetic component tassociated: the APOE-4.
Chapter 11 approaches the topic "CET and sexual dysfunction", which is not given much attention by medicine. Other studies mention that this area is not investigated by physicians when they treat their patients, which may cause some damage to them. The text is relevant because alterations in sexuality may cause severe posttraumatic consequences, which may generate a number of unpleasant circumstances, including legal matters.
Chapter 12, "Rivastigmine in the treatment of memory deficits after severe CET: literature review and case report" presents a case of a patient he managed who had an excellent recovery of his musical memory, which was totally blocked after a trauma. It is worth reading.
Chapter 13 reviews the CETs in children and adolescents and presents recent data, from 2002 through 2004. There have been considerable advances in this area, and prophylactic measures for people with birth brain trauma sequelae may result from such advances.
Chapter 14 covers another topic that is not given much attention: "Long term deleterious consequences of cranioencephalic trauma and physicians and society lack of knowledge."
Chapters 15 and 16 are different from the others because they approach brain changes promoted by factor other than external trauma.
Chapter 15 describes the case of a patient referred to the Serviço de Interconsulta da Santa Casa de Porto Alegre, RS, Brazil, with thyrotoxic psychosis symptoms. The text depicts the significant difficulties found before a diagnosis was found. The rarity of the situation is well documented and highlights the importance of the Serviço de Interconsulta, which counts o the participation of psychiatrists in an interdisciplinary follow-up.
Chapter 16, whose title is "Multiple deficits after bacteria or viral neurological lesions: clinical and psychosocial implications" showed how cognitive deficiencies derived from bacteria or viral neurological lesions, as in CETs, are not adequately taken into account by experts in general, and specially by neurologists. This is another chapter that deserves our reading and reflections, for the psychosocial repercussion that results from such a lack of attention.
Eventually, chapters 17 and 18, bring several ideas on data collected throughout the author's studies and research. He emphasizes that: "Concepts and attitudes must be renewed in face of new knowledge, which must be integrated for the benefit of brain trauma patients that have psychiatric damages."
Concluding, the book is another significant contribution to the Brazilian psychiatry and medicine for its novelty, presenting new aspects which so for have not being fully studied.
After reading and analyzing the book, I conclude it is a must reading, upon which we should reflect, absorbing the knowledge it provides.
CorrespondenceBruno Mendonça CostaE-mail:
Publication in this collection
22 Aug 2006
Date of issue