Psychiatry and Clinical Neuroscience: A Primer

ISBN : 9780199360567

Charles F. Zorumski; Eugene H. Rubin
320 ページ
156 x 234 mm

Research in neuroscience is revolutionizing how we think about psychiatric diagnosis and treatment. Psychiatric disorders reflect dysfunction of the human mind and involve changes in cognition, emotion, and motivation. Understanding how the neural networks that underlie these mental functions become dysfunctional holds great promise for devising innovative approaches to diagnosis and treatment. Scientific progress is being driven, in part, by advances in human functional neuroimaging, which is being used to characterize the activity of specific brain circuits at rest and during the performance of specific tasks. Moreover, advances in clinical neuroscience are being coupled with expanding knowledge about genetics and cellular and synaptic neuroscience. Taken together, these advancements offer the hope of much more mechanism-based approaches to treatment in the future. Better understanding of neural circuits also can provide the basis for innovative psychotherapeutic strategies that take advantage of brain plasticity for purposes of neurorehabilitation. In this book, we examine recent developments in the field of network neuroscience and their potential impact on clinical psychiatry, including the way that psychiatrists are trained and interact with other medical specialties and mental health professionals.


1. Psychopathology 101
a. Mental status examination
b. The nature of psychiatric symptoms: insights from behavioral neurology
c. Cognitive symptoms: psychotic and non-psychotic thinking
d. Disturbances in the form of thought
e. Disturbances in emotions
f. Disturbances in motivation: the role of salience and personality
g. Disturbances in memory
h. Points to remember
2. Depression and Dementia: An Introduction to Systems Neuroscience and Psychiatry
a. Some basic concepts about systems neuroscience & psychiatry
b. Depression
c. Dementias
i. Dementia of the Alzheimer's type (DAT)
ii. Behavioral variant frontotemporal dementia (bvFTD)
d. Points to remember
3. Systems Neuroscience & Psychiatry: Basic Principles
a. The brain is complex but not hopeless
b. Network theory and brain systems
c. Organization of the brain
d. "Big picture" principles of brain function
e. Basic principles of ICNs
f. Points to remember
4. Brain Networks and the Human Mind
a. Cognition (Thinking)
i. Working memory & prefrontal cortex (PFC)
ii. How does the brain select thought content?
iii. PFC does more than working memory
iv. PFC and neuropsychiatric disorders
v. Perception is cognitively complex
vi. Lateralized brain function & cognition
vii. Intelligence and cognitive flexibility
b. Emotions: computing values & meaning
i. What values, what meaning?
ii. How are emotions processed?
iii. Other emotions & other brain regions
iv. What triggers emotional responses in the brain?
c. Motivation: the importance of having goals
i. How does motivation work?
ii. What determines our expectations?
d. Summary: a simplified overview of brain systems and mind
e. Points to remember
5. Psychiatric Disorders and Brain Networks
a. Psychiatric disorders and defects in mental error correction
b. Why do individuals with psychiatric disorders fail to correct mental errors?
c. Rethinking psychiatric classification and endophenotypes
d. What do we know about ICNs and psychiatric disorders?
i. Cognitive disorders: psychosis
ii. Obsessive-compulsive disorder (OCD): cognitive or emotional disorder?
iii. Anxiety disorders as primary emotional disorders
iv. Emotional disorders: primary major depression
v. Motivational disorders: substance abuse
vi. Other abused drugs: hallucinogens
e. Summary: recurring themes
f. Points to remember
6. The Hippocampus: Synapses, Circuits, and Networks
a. Why is the hippocampus important?
b. What is the hippocampus?
c. How does information flow within the hippocampal system?
d. What do hippocampal subregions do?
e. Synaptic plasticity: how the hippocampus learns
f. The hippocampus does not act alone
g. Sleep and the hippocampus
h. Neurogenesis (new neurons) and the hippocampus
i. Information flow: a reprise
j. Points to remember
7. Network Dysfunction: Stress, Psychiatric Disorders and the Hippocampus
a. Psychiatric disorders and structural changes in the hippocampus
b. Causes of hippocampal changes in psychiatric illnesses
c. The stressed hippocampus: lessons from animal models
d. Recent human studies in mood and psychotic disorders
e. Can defects in connectivity be corrected? Potential therapeutic targets
f. What about other brain regions and networks?
g. Points to remember
8. Genetics, Epigenetics, and Plasticity
a. Genetics and psychiatry
b. Epigenetics, the environment, and psychiatry
c. Stress, allostasis, and psychiatry
d. Molecules, networks, and treatments
e. Points to remember
9. Conceptualizing causes of psychiatric disorders
a. Developmental abnormalities
b. Abnormalities of ICN connectivity that develop later in life
c. Abnormalities resulting from exogenous or endogenous substances
i. Exogenous substances
ii. Endogenous substances
d. Abnormalities resulting from traumatic brain injury
e. Abnormalities resulting from defects in brain metabolism
f. Abnormalities due to aging
g. Points to remember
10. Neurotransmitters and Receptors
a. Neurotransmitters and receptors
i. The brain uses a variety of neurotransmitters
ii. Transmitters use a variety of receptors
b. Neurotransmitters and synapses: complex signaling devices
c. Transmitters, synapses, and brain rhythms
d. Why antidepressants take time to work while benzodiazepine anxiolytics act quickly
e. Points to remember
11. Methods of Determining Diagnosis and Cause
a. Current methods of diagnosis
b. Current use of laboratory and imaging procedures
c. Current use of psychological testing
d. Future approaches to diagnosis
e. Future trends related to psychiatric diagnoses
f. Points to remember
12. Why Do Some Psychiatric Disorders Become Chronic Problems?
a. Problems with current treatments and practice
b. Brain mechanisms contributing to refractory illnesses
c. Connectivity networks, brain mechanisms and refractory disorders
i. Anosognosia
ii. Anergia
iii. Amotivation
iv. Aplasticity
v. Asociality
d. How can psychiatry take advantage of synaptic plasticity?
i. The brain needs to learn
ii. The brain needs novelty
iii. Social interactions are important
iv. Lifestyle can have huge and non-linear effects on outcomes
e. Points to remember
13. Approaches to Treatment
a. Psychopharmacology
i. Mechanisms of action
ii. Antidepressants
iii. Anxiolytics
iv. Antipsychotics
v. Mood stabilizers
vi. Anti-dementia agents
vii. Stimulants
viii. Drugs of abuse
b. Brain stimulation methods
i. Electroconvulsive therapy (ECT)
ii. Vagus nerve stimulation (VNS)
iii. Transcranial magnetic stimulation (TMS)
iv. Deep brain stimulation (DBS)
c. Psychotherapies
d. Lifestyle interventions
e. Rehabilitative versus etiologic therapies
f. The role of the patient and others in treatment
g. Points to remember
14. The Future of Psychiatry
a. Psychiatry and clinical neuroscience
b. Psychiatric diagnosis and treatment
c. Psychiatry and rehabilitative medicine
d. Psychiatry and primary care
e. Psychiatry and public health
f. Training future psychiatrists
15. Appendix


Dr. Zorumski is the Samuel B. Guze Professor and Head of the Department of Psychiatry and Professor of Neurobiology at Washington University in St. Louis - School of Medicine, where he is also Psychiatrist-in-Chief at Barnes-Jewish Hospital and Director of the McDonnell Center for Cellular and Molecular Neurobiology. His research focuses on synaptic transmission in the hippocampus, and on the use of brain stimulation methods to treat psychiatric disorders. Dr. Rubin is Vice-Chair for Education and Professor in the Department of Psychiatry at Washington University in St. Louis - School of Medicine. He is also Professor of Psychology at Washington University in St. Louis. His research interests include Alzheimer's disease and depression in the presence of comorbid medical illness. He directed the psychiatry residency training program at Washington University School of Medicine for 20 years.