Sei sulla pagina 1di 2

The

n e w e ng l a n d j o u r na l

of

m e dic i n e

b o ok r e v ie w s

psychiatric aspects of hiv/aids


Edited by Francisco Fernandez and Pedro Ruiz. 440 pp. Philadelphia, Lippincott Williams & Wilkins, 2006. $59.95. ISBN 978-1-5825-5713-7.

quarter of a century from the beginning of the epidemic of the human immunodeficiency virus (HIV) and AIDS, in a world where 40 million people are estimated to be living with the virus and where, in 2005, 5 million new infections occurred, this book is a welcome addition to our understanding of the manifestations and challenges of HIV. The psychiatrists, psychologists, epidemiologists, neurologists, and other contributors provide a thoughtful, evidencebased, practical resource for those working in the field. The book moves effortlessly from basic science and clinical research, through the epidemiology of HIV (incidence and risk factors for mental disease), to a compilation of practical tools to measure, monitor, and treat the psychiatric aspects of HIV and AIDS. The specifics of HIV science, the epidemiology of HIV infection in the United States, and the psychiatric disorders, predispositions, and diseases associated with various stages of HIV in different populations are clearly outlined. The populations discussed, including women, children, homosexual men, the homeless, and prisoners, are specific to the United States, but the information the chapters contain is applicable in many parts of the world. Of practical use to psychiatrists and others in HIV care will be the section on coexisting conditions, including the stressdistress spectrum and adjustment disorders, anxiety disorders, mood disorders, psychotic disorders, sleep disorders, and the difficult areas of cognitive and substance-abuse disorders. Accurate and accessible information on psychotropic drug interactions with antiretroviral medications, and on detailed management of coexisting psychiatric conditions in medically ill patients, will provide a valuable reference in many settings. Diagnostic tools, including psychiatric assessment, psychological and neuropsychological testing, and the use of electrophysiology and brain
532

mapping, are also covered. All readers will appreciate the excellent reviews of the literature on the epidemiology of coexisting psychiatric conditions, postulated pathophysiological processes, and the available data on evidence for diagnosis and treatment. Since the beginning, the HIV epidemic has challenged scientists and clinicians to look beyond a narrow specialty; to broaden their horizons into new communities; to face multiple personal, community, and societal challenges; and to overcome personal biases and assumptions. This book offers essays on legal, health care provider, and policy issues, covering topics such as complementary holistic medicine, suicide, and end-of-life care. It also presents challenging and diverse views on biosocial, psychiatric, and psychological aspects of care and prevention and on individual and community responses. Themes running through many chapters are the need for multidisciplinary approaches and for the early recognition of psychiatric and psychological factors in HIV medicine. Many authors stress the evidence that appropriate and timely consideration of psychiatric, psychological, and social needs is required to achieve adherence to combination antiretroviral therapy and to facilitate better outcomes for patients with HIV. Throughout the book, the integration of assessment and an early response to psychiatric and psychological disorders is identified as a key criterion for success in care models. Another innovative and consistent theme is the incorporation of psychological and psychiatric responses in the prevention of HIV infection. Many authors argue for combination prevention programs that include biological, educational, and behavioral interventions adapted for individuals, partnerships, and communities. There are some disappointments in this book. As always, epidemiologic data that were accurate at the time of writing were rapidly overcome by the speed of this epidemic. Some areas of basic science are overlooked, such as the new understandings of the early loss of gut-associated lymphoid tissue in the pathogenesis of immune dysfunction. Refer-

n engl j med 356;5 www.nejm.org february 1, 2007

Downloaded from www.nejm.org on May 11, 2009 . Copyright 2007 Massachusetts Medical Society. All rights reserved.

book reviews

ences to evidence-based interventions for prevention, including motivational interviewing, are followed by comments with details that go beyond the scope of the text. However, these and other small disappointments including minor repetitions and inconsistencies and a U.S.-centric perspective do not detract from the usefulness of this book. Would I purchase it? Definitely. Will I read it? Yes, frequently. Would I recommend it? Absolutely. Anne M. Mijch, M.B., B.S.
Alfred Hospital 3181 Melbourne, Australia anne.mijch@med.monash.edu.au

The clinical neuropsychiatry of stroke: cognitive, behavioral, and emotional disorders following vascular brain injury
Second edition. By Robert G. Robinson. 470 pp., illustrated. New York, Cambridge University Press, 2006. $150. ISBN 978-0-521-84007-1.

he usual care of patients affected by stroke is focused on limiting or remediating impairments in sensorimotor function and on facilitating improvements in the performance of activities of daily living. This focus, however, affords too limited a view of the clinically important sequelae of stroke. Cognitive, emotional, and behavioral disorders complicate sensorimotor and functional recovery and are themselves substantial sources of further complication and suffering for stroke survivors and their families. Nonetheless, the neuropsychiatric consequences of stroke remain uncommon subjects of evaluation and treatment in most general medical settings. In this second edition of The Clinical Neuropsychiatry of Stroke, Robert G. Robinson discusses in detail the phenomenology, neurobiology, and treatment of post-stroke neuropsychiatric disorders, particularly depression. Psychological theories of post-stroke depression are considered in historical context as well as in response to published debates generated by Robinsons own work. He thoughtfully acknowledges that psychosocial factors are involved in the development of post-stroke depression and other stroke-related emotional and behavioral problems. However, he also makes a strong argument with volumes of supporting data for the view that neurobiologic distur-

bances are primary contributors to post-stroke neuropsychiatric disorders. Working from a review of his own work as well as the world literature, Robinson makes several important and clinically relevant observations. Post-stroke depressions are phenomenologically similar to idiopathic depressive disorders and can be identified using standard psychiatric diagnostic criteria. Depression, particularly in the period shortly after a stroke, is a major contributor to cognitive and functional impairments, rather than a purely psychological response to such problems. Although the issue of the association between lesion location and post-stroke depression is contentious, anterior left-hemisphere stroke is identified as a clear risk factor for episodes of post-stroke major depression. Serotoninergic depression and noradrenergic dysfunction resulting from such lesions are further identified as contributors to post-stroke emotional disturbances and as targets for pharmacotherapy. Finally, the treatment of post-stroke depression not only improves recovery from this condition but also improves stroke outcome more generally. Conversely, failure to treat post-stroke depression not only impedes recovery from stroke but also increases long-term post-stroke mortality. Robinson concludes that depression is a neurobiologically understandable consequence of stroke, one for which treatments are both available and necessary. The evidence presented in this book

Topography of Focal Cerebral Reperfusion after Ischemia Associated with Obstruction of a Major Cerebral Artery. Color-coded blood flow images and double-label autoradiography are used in a model of endothelin-induced experimental stroke. Highest to lowest flows are indicated by white, red, and yellow to green; very low flows are blue or purple; black indicates no flow or almost no flow.

Dr. I.M. Macrae/Wellcome Trust Photo Library.

n engl j med 356;5 www.nejm.org february 1, 2007

533

Downloaded from www.nejm.org on May 11, 2009 . Copyright 2007 Massachusetts Medical Society. All rights reserved.

Potrebbero piacerti anche