As a neuropsychologist who functions in a general psychological and psychiatric practice, The Neuropsychology of Psychopathology peaked my interest. I have long believed that neuropsychology is not only pertinent in a purely medical or neurological facility, but has a lot to say for the effective care of mental health patients in general. And even effective psychotherapy.
The book begins with a chapter by one of the Editors, Noggle, that provides a succinct and helpful historical view of the topic at hand. At the end of the chapter, he tells us his hope for the book: “This knowledge can be used to expand one's clinical skills and knowledge to better serve the patient populations discussed within this text because a neuropsychological formulation offers the most comprehensive view of the impact of these disorders on everyday functioning.” This would indeed be a very helpful accomplishment for neuropsychologists, clinical psychologists, and other mental health practitioners.
Section I, Principles of Psychopathology, lays out general information helpful in understanding the neuropsychology of psychopathology. Chapters include The Neuropsychology of Psychopathology: Historical Shifts; Pediatric Versus Adult Psychopathology: Differences in Neurological and Clinical Presentations; and Neuroanatomy of Pleasure and Emotion. This is a fairly brief but appropriate historical review, followed by a helpful and often overlooked discussion about the differences between adult and child pathology, and a very complete discussion of the neuropsychology of hedonistic functioning. I found the third chapter to be particularly helpful in understanding the orbital-frontal cortex (“best thought of as an important nexus for sensory integration, emotional processing, and hedonic experience”) and deep brain hedonic functioning and deep brain stimulation.
Section II, Forms of Psychopathology, takes a topical approach to the psychopathologies most often found in clinical practice. Each chapter includes a description and history of the subject disorder, a solid review of relevant neuroscience, discussion of the neuroanatomy involved, and perhaps most helpful to the practicing neuropsychologist, the cognitive correlates to the condition and its treatment. Chapters in this section include: Attention Deficit Hyperactivity Disorder; The Enigma of Learning Disabilities: Examination via a Neuropsychological Framework; Autism Spectrum Disorders; Conduct and Oppositional Defiant Disorders; Tic Disorders; Depressive Disorders; Bipolar Disorders; Generalized Anxiety Disorders and Panic Disorder; Obsessive-Compulsive Disorder; Posttraumatic Stress Disorder; Somatoform Disorder; Schizophrenia; Personality Disorders; Alzheimer's Disease; Frontal-Subcortical Dementias; Delirium; and Eating Disorders.
The book ends with Section III, entitled Interventions and Treatment. Specific chapters are Neuropsychological Assessment Within the Psychiatric Setting; Psychological Assessment: From Interviewing to Objective and Projective Measurement; and The Psychopathology and Functional Neuroanatomy of Psychotherapy.
I found the chapters in the Forms of Psychopathology section to be consistently solid discussions of each subject. I particularly appreciated the chapter on Autism Spectrum Disorders, which provided an inclusive discussion of a very diverse and difficult topic, including very helpful information about assessment. Level I evaluations (screening), Level II evaluations (comprehensive), and follow-up evaluations were discussed. A thorough discussion of neuropsychological assessment by cognitive domain is provided.
Chapters on depressive disorders and bipolar disorders were also very complete and helpful. Rigorous discussions of neurotransmitters, neuroanatomical substrates, and neuropsychological sequelae were provided. Advanced diagnostic procedures and treatment outcomes were discussed. The authors challenge the assumption that depression causes neurocognitive deficits: “Many medical professionals assume that depression causes neurocognitive deficits. This assumption is not always supported by research findings”. Their review suggests “strikingly conflicting results” about this issue. A discussion of the neurocognitive deficits in euthymic, depressive, and manic states proved interesting. For example, sustained attention may be impaired in euthymic patients, patients with Bipolar II disorder (BD II) may perform worse than those with Major Depressive Disorder (MDD), nonverbal memory tasks may help differentiate BD II from MDD, and manic patients may exhibit more pronounced deficits in executive functions and sustained attention. The difference between neurocognitive deficits in Bipolar I and Bipolar II is also discussed.
The chapter on Somatoform disorders proved to be a competent description of the condition, although it left this reviewer somewhat wanting. This is likely an accurate response to the real state of knowledge about somatoform disorders, rather than any failing by the author. I would have liked more thorough discussions of current medical diagnostic trends and their overlap with somatoform disorders: non-neurologic seizures, postconcussive disorders, environmental or global allergies, chronic pain, and chronic fatigue syndrome, for example. The discussions of psychological and pharmacological treatment for somatoform disorders were adequate.
The chapter on personality disorders was interesting, with a description of each specific disorder and their biological correlates. The chapters on dementia and delirium were helpful and concise sources of information. Throughout this section, I would have been happy to see more specific discussions of performance validity testing for specific conditions, and suggestions about evidence based practice by condition.
Given my interests, I was excited to read the final section of the book: Interventions and Treatment. The first two chapters in Section III were competent enough, but the third chapter took on a very ambitious topic. “The neurophysiological paradigm” states that “psychopathology arises primarily from two factors: (1) reduced capacity for learning and flexibility (plasticity) and (2) homeostatic dysregulation and dissociation between systems in the brain.” To say it the other way around, “Adaptability, and consequently mental health, is based on the degree of mental flexibility or neuroplasticity of the brain, that is, the brain's ability to change in response to experiences.” Through learning experiences, psychotherapy changes the brain at the synaptic level and makes certain neural networks more likely to be activated. Stimulus-response associations can be broken, and automatic thoughts changed. “…the primary mechanism of action of most therapy approaches appears to be associated with stimulating growth and restructuring of neural networks…in essence, psychotherapy results in an enhancement of neural plasticity.” Specific therapies and disorders are then discussed. While only an introduction to a very new field of study, this is an interesting essay nonetheless.
The Neuropsychology of Psychopathology is a helpful and competent book which will sit on my bookshelf right above my desk, to be easily grabbed and used as a reference as I face different conditions in my clinical practice. It should be helpful to all neuropsychologists, but especially for those in a more traditional mental health environment. It should also be helpful for clinical psychologists interested in better aligning their work with current neuroscience, although some of the discussions may be a bit dense for the general clinical psychologist. This book may be helpful for psychiatrists and neurologists, and also, if not a bit of a stretch, for other mental health professionals.
