Reviewer: Michael Schrift, DO (University of Washington School of Medicine)
Description: The available modalities for neuromodulation in the treatment of psychiatric disorders have grown over the last several decades. Part of the impetus to develop these techniques grew from the perceived cognitive side effects of electroconvulsive therapy, which are generally short lived. These include repeated transcranial magnetic stimulation (rTMS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS), and neurosurgical ablative techniques. The latter two require surgical intervention to implant devices or electrodes or to induce lesions. Because these modalities do not elicit grand mal seizures, they have been suggested as replacements for ECT on the assumption that the treatments will achieve equivalent reductions in depression and lesser effects on memory. Electroconvulsive therapy remains the gold standard with which other treatments need to be compared. It still remains to be seen whether nonseizure neurostimulation methods are effective in relieving the severely psychiatrically ill. This book, by leading clinicians-researchers, surveys this burgeoning field with up-to-date reviews of each of these technologies, outlining the methods, benefits, and side effects of each treatment.
Purpose: The purpose of the book, according to the editors, is to "offer the reader an overview of the state of the art of therapeutic neuromodulation in psychiatry, discussing the techniques and biophysical principles, the mechanisms of action, animal and human research, clinical indications, clinical practice, safety considerations, and future directions." Indeed, the editors and chapter authors have produced an information-filled, well-written, and concise review of these techniques.
Audience: Their intended audience is "psychiatrists, neurosurgeons, neurologists, researchers, and all other medical professionals interested in surgical and device-based treatments of psychiatric disorders."
Features: The first two chapters focus on depression and obsessive-compulsive disorder, respectively, followed by an interesting chapter on neuroimaging and neurocircuitry of obsessive-compulsive disorder and major depressive disorder. The remaining chapters cover in detail each of the technologies, including electroconvulsive therapy, vagus nerve stimulation, neurosurgical ablative procedures for psychiatric disorders, deep brain stimulation for obsessive-compulsive disorder and major depressive disorder, transcranial magnetic stimulation, ablative therapeutics, and deep brain stimulation animal models of psychiatric disorders. The final chapter discusses the future of neurosurgery for psychiatric disorders. Each chapter concludes with timely and pertinent references of the scientific literature. The index section is very helpful, particularly for a book like this.
Assessment: This is an excellent, concise book on psychiatric neurotherapeutics. It's an outstanding review of the literature and is required reading for any psychiatrists involved in the treatment of patients with severe psychiatric disorders.
