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Psychogenic Movement Disorders: Neurology and Neuropsychiatry
http://www.100md.com 《新英格兰医药杂志》
     Psychogenic movement disorders are difficult to understand and treat, so writing a book about them is challenging. The topic straddles two distinct professions and traditions — neurology and psychology — which, in my experience, often clash in their interpretation of these problems. Some of this dissonance is manifest in this book's pages.

    Psychogenic Movement Disorders begins with a description of the topic's historical background. This history is richer, better described, and more germane to the subject than many other topics in medicine. In fact, Jean-Martin Charcot and other 19th-century researchers are cited throughout the book as frequently as current investigators are cited. This reliance on past research attests to the uncertainty of the subject matter rather than to any deficiency in referencing. The next section of the book delineates the phenomenology (descriptions) of the movements as well as the epidemiology of the disorders. These chapters were written by specialists in movement disorders.

    The third section describes psychiatric disorders associated with psychogenic movement disorders. The chapters in this section include discussions of depression and anxiety and narrow descriptions of somatization. The chapters in the fourth section, entitled "Pathophysiology," include concrete data on neuroimaging and observable physiology as well as highly theoretical frameworks for understanding consciousness and decision making. This section highlights the schism between empiricism and rationalism in ongoing research. The chapters in the final two sections discuss options for the diagnosis and treatment of psychogenic movement disorders. These options include the use of hypnosis and amobarbital. The final chapter of the book, on therapeutic approaches to psychogenic movement disorders, summarizes a roundtable discussion from a meeting attended by many of the book's contributors.

    Psychogenic Movement Disorders is comprehensive, well balanced, and generally well written. Much of it is based on the opinions of experts, but these opinions appear to be unbiased and are described as such. I do not agree with all of them, especially with respect to the description of latah and other, similar conditions as psychogenic, but no two persons would agree on the entire contents of this book. The evidence-oriented physician might be appalled by the lack of good data (especially from treatment studies, which do not include a single controlled trial), but this deficiency can hardly be blamed on this book. The only important omission that detracts from the book's clinical usefulness is the lack of accompanying videos that show psychogenic movement disorders as compared with organic disorders. Although these characteristic psychogenic signs are described in several chapters, a practicing neurologist or primary care physician would probably not diagnose them confidently on the basis of written descriptions.

    William G. Ondo, M.D.

    Baylor College of Medicine

    Houston, TX 77030((Neurology Reference Seri)