Biological Psychiatry

Professor Trimble was for many years Professor of Behavioural Neurology and Consultant Physician to the Department of Psychological Medicine at the National Hospital Queen Square, London. He now holds emeritus status at the above institutions. He studied general medicine, obtaining membership of the Royal College of Physicians before going to the National Hospital Queen Square and then the Maudsley Hospital to advance his training in neurology and psychiatry. Following an internship in psychiatry at the Johns Hopkins Hospital, Baltimore, he returned to the National Hospital to pursue a career in neuropsychiatry. He set up a research group with main interests in the interface disorders between neurology and psychiatry, reflected in the developing recognition of neuropsychiatry and behavioural neurology as independent disciplines. The research group (Raymond-Way Unit) explored the behavioural consequences of neurological disorders and their treatment, with a major interest in epilepsy and movement disorders. His current writing and academic interests involve teaching and lecturing on neuroanatomical concepts relevant to understanding behaviour and its variations, in particular with an interest in neuroaesthetics and neurotheology, namely the cerebral basis of artistic and religious experiences. Dr. George received his medical degree from the Medical University of South Carolina in Charleston in 1985, where he continued with dual residencies in neurology and psychiatry. He is board certified in both areas. He worked for one year (1990-91) as a Visiting Research Fellow in the Raymond Way Neuropsychiatry Research Group at the Institute of Neurology, London. He and Professor Trimble used pharmacology and imaging to study the overlaps between Obsessive-Compulsive Disorder and Gilles de la Tourette Syndrome. During this year he also worked on new functional imaging techniques (SPECT and PET) at the Institute of Nuclear Medicine, University College of London and Middlesex School of Medicine, London. He wrote one of the first textbooks in the new area of brain activation and imaging. Dr George then moved to Washington, DC, working with Dr. Robert Post in the Biological Psychiatry Branch of the Intramural National Institute of Mental Health. He was one of the first to use functional imaging (particularly oxygen PET) to assess brain changes associated with normal emotions, as well as using imaging to understand brain changes which occur in depression and mania. This imaging work directly led to his pioneering use of transcranial magnetic stimulation (TMS) as a probe of neuronal circuits regulating mood, and to clinical trials using TMS as an antidepressant. In 2008 prefrontal TMS was FDA approved as an antidepressant treatment. In 1995 he moved back to Charleston and built the functional neuroimaging division and brain stimulation laboratories. This imaging group has grown into the MUSC Center for Advanced Imaging Research, which is now part of the SC Brain Imaging Center of Excellence. He continues to use imaging and non-invasive stimulation, either separately or more recently in combination, to understand the brain regions involved in emotion regulation in health and disease. In 1998, he pioneered another new treatment for resistant depression, vagus nerve stimulation, that was recently FDA approved. He and his group have used MRI imaging to understand brain stimulation brain effects. He is on several editorial review boards, and has published over 200 scientific articles, and has written or edited 5 books. He is the editor-in-chief of a new journal, Brain Stimulation. He has received several international awards, including the World Federation of Societies of Biological Psychiatry Lifetime Achievement Award (2007), the NARSAD Falcone Award (2008) and he was honored as one of 14 'Pioneers of Medical Progress' saluted in the August 2009 edition of US News & World Report.

• Acknowledgements xiQuotations xiiiPreface to the First Edition xvPreface to the Second Edition xixIntroduction and Preface to the Third Edition xxi1 Principles of Brain Function and Structure: 1 Genetics, Physiology and Chemistry 1Introduction 1Genetics 1Brain chemistry and metabolism 8The metabolism of glucose 9Proteins and fatty acids 9Cell membranes 10Synapses 12Receptors 14Neurones 21Neurotransmitters 24Interrelationships among transmitters 29Transmitter dispersal 29CNS inflammation 292 Principles of Brain Function and Structure: 2 Anatomy 31Introduction 31The neuroanatomy of emotion 32Individual anatomical structures 41Ascending and descending limbic-system connections 53Macrosystems 55The basal ganglia and the re-entrant circuits 57The ventral striatum and ‘limbic striatum’ 58The ascending cholinergic systems 60Cortical regions of interest 60The cerebellum 633 Important Brain–Behaviour Relationships 65Introduction 65Important anatomical structures for understanding behaviour 68Some specific behaviours 74Limbic lobe disorders in a clinical context 77Re-entrant circuits in a clinical context 78The frontal lobes in a clinical context 79Laterality 814 Classifications and Clinical Investigations 83Introduction 83Signs, symptoms, syndromes and disease 84Classification in psychiatry 84Clinical investigation 875 Personality Disorders 113General introduction 113Introduction to the concept of personality 113Genetics 118Somatic variables 121Metabolic and biochemical findings 121Neurophysiological and neurological data 123Some outstanding issues 1276 Anxiety Disorders 131Introduction 131Genetics 134Somatic variables 135Metabolic and biochemical findings 135Neurochemical investigations 137Neurophysiological and neurological data 140Imaging 140Obsessive–compulsive disorder 142Post-traumatic stress disorder 143Some outstanding issues 1447 The Schizophrenias 147Introduction 147Genetics 150Somatic variables 153Metabolic and biochemical findings 154Neurochemical investigations 159Neurophysiological and neurological data 164Some outstanding issues 1768 Affective Disorders 183Introduction 183Genetics 184Metabolic and biochemical findings 186Neurochemical investigations 198Neurophysiological and neurological data 200Some outstanding issues 2099 The Addictions and Disorders of Motivation 215Introduction 215Disorders of motivation 216Conditioning 217Genetics 219Metabolic and biochemical findings 221Neurophysiological and neurological data 223Some outstanding issues 22810 Epilepsy 231Introduction 231Prevalence and clinical characteristics 231Classification 231Genetics 235Symptomatic epilepsy 235Biochemical findings 236Investigation and differential diagnosis 237Psychiatric disorders in epilepsy 237Cognitive deterioration and epilepsy 254Some outstanding issues 25511 The Dementias 257Introduction 257Definition 257Prevalence 258Diagnosis and classification 258Alzheimer’s disease 259Dementia of frontal-lobe type 267Focal cortical atrophies 268Dementia with Lewy bodies 268Vascular dementias 269Other forms of dementia 271Further causes of dementia 275Some outstanding issues 27512 Biological Treatments 281Introduction 281Pharmacology: pharmacokinetics and pharmacodynamics 281Antidepressants 284Antipsychotic drugs 296Anxiolytics and hypnotics 304Beta-Adrenergic blockers 308Lithium 308Anticonvulsants 310Drugs for the treatment of dementia 316Medications for the addictions 317Brain-stimulation therapies 318Sleep-deprivation therapy 32913 Epilogue: Progress toward a Neuroanatomically, Biological-psychiatrically Informed Classification Scheme in Psychiatry 331References 335Index 395

“This book therefore may be valuable to those engaged in clinical practice who wish to familiarize themselves with some of the basic concepts behind modern biological psychiatric research and the recent history of the field.”  (Psychological Medicine, 2012)"If you are going to choose where to fork out the money, it would be here, for the most practical understanding of brain-behavior science, and these authors I am sure will continue to be leaders in this field, with perhaps only Lishman challenging them for the buck." (Metapsychology, 25 June 2011)  "As in the earlier editions of the book, there are comprehensive reviews and explanations of the latest advances in neurochemistry, neuroanatomy, genetics and brain imaging descriptions not only of methodologies but also of the application of these in clinical settings." (AllVoices, 16 February 2011)"An important contribution that should be read by psychopharmacologists, psychiatrists, neurologists and neuroscientists who wish to obtain an interesting and well-written account of the subject." (Human Psychopharmacology, 2010)"Writing for medical students and for researchers and practitioners in fields that touch upon mental health, they begin by exploring principles of brain function and structure from perspectives of genetics, physiology, chemistry, and anatomy. Then they consider important brain-behavior relationships, and classifications and clinical investigations. Having set the stage, they proceed to describe biological aspects of personality disorders, anxiety disorders, the schizophrenias, affective disorders, the addictions and disorders of motivation, epilepsy, and the dementias." (SciTech Book News, December 2010)