Book reviews

Book reviews

Mania-An Evolving Concept. Edited by
Robert H Belmaker, HM van Praag.
(Pp 393; £18-95.) Lancaster: MTP Press
Ltd. 1981.

The aim of this book, according to the
forthright statement with which it opens,
is "to be a 23-chapter comprehensive
textbook on manic illness". How well
does it achieve these avowed objectives?
There is no problem with the first: 23
chapters are indeed listed in the table of
contents, and duly appear in sequence
within the book itself. There is, however,
much less certainty about it being com-
prehensive. For example, it provides only
the most sketchy advice concerning
treatment, scant mention is made of recent
observations on the changes in neuro-
endocrine activity which occur during the
course of a manic illness, and there is
little on the range of rating scales available
for assessing the severity of a manic illness
in a given patient before and after treat-
ment.

Despite these shortcomings this book
has a number of very good sections. The
two reviews on the genetics of mania by
Fischer, and by Gershon and Rieder are
excellent; the chapter on biochemical
theories by Post are thoughtful and
thought-provoking, as is that on the
possible role of cholinergic mechanisms in
the pathogenesis of mania by Janowsky
and Davis. The extremely long chapter by
Robbins and Sahakian on animal models
is exhaustive, everything that needed to
be said on this topic is said. I also
enjoyed Carpenter and Stephen's chapter
on diagnosis, finding their warning against
overdiagnosing mania at the expense of
schizophrenia a timely one; the pendulum
of diagnostic fashion has possibly swung
too far in that direction. In addition to
these more weighty topics there is an
evocative anthology of self-descriptions by
patients of what it is like to be manic; a
chapter on the relationship of creativity
to cyclothymia, and a final chapter
devoted to describing the strange career of
a seventeenth-century manic-depressive
rabbinical scholar.

In summary, I consider this book to be
excellent in parts, but wanting in others;
it can be recommended as a most useful
source book in the fields of genetics,
biochemistry and animal models of
mania.

TREVOR SILVERSTONE

Essentials of Neurosurgery. Robert R
Smith. (Pp 321; £17-95.) London: Harper
and Row. 1980.

As the Preface informs us, this book is
written primarily for medical students in
response to their repeated requests for a
textbook ofrecent vintage, dealing with the
fundamentals of the surgery of the nervous
system. Not so long ago such a venture for
undergraduates would have been frowned
upon, neurosurgery being considered an
inappropriate study for impressionable
students. Even neurology, if it were taught
at all, seldom had a specialist instructor to
explain its mysteries. Now that the general
physician and the general surgeon have all
but departed from the teaching scene,
their place taken by individual organ
specialists, there seems no longer any
reason why the interests of the nervous
system should not be promoted by its own
practitioners. The author of this work is
Professor of Neurosurgery at the Univer-
sity of Mississippi.
The volume provides a balanced and

comprehensive review of the present-day
work and concerns of the neurosurgical
specialist, albeit with some transatlantic
bias. Introductory contributions deal with
the importance of history taking and the
basic techniques of neurological examina-
tion, and outline the various specialist
examinations. The care of the critically
ill neurosurgical patient is considered in
detail. Thereafter each chapter covers the
usual subjects-trauma, infection, cerebral
haemorrhage and ischaemic disorder,
cerebral tumour, cord compression, disc
degeneration and intractable pain. The
problems of the paediatric patient and the
technique of examination of the newly
born receive special attention. Each
chapter begins with a review of relevant
anatomy and physiology, and proceeds
from symptoms and signs to diagnosis and
possibilities of treatment. Differential
diagnosis is given extended treatment,
equal emphasis being given to medical
and surgical alternatives. The possibilities
and limitations of surgical measures are
explained and considerable effort made to
present a balanced view. Details of surgical
procedures are laregly passed over, or, to
use the author's term, de-emphasized. The
only chapter to contain some surgical
detail is that on head injury, and the facts
are thQse that should not be unfamiliar to
anyone having care of the head injured.
The Glasgow coma scale is explained and
recommended for assessing level of
consciousness. The head injury instruction

959

sheet which is given to the patient or his
attendants on his discharge from hospital
or when hospital admission is not
considered essential, has much to recom-
ment it.
Not all the chapters are written with

equal conviction, but for a single author
work the content is comprehensive. The
style is clear and the text easy to follow;
the choice of illustrations and particularly
the line diagrams, is very good. The
references at the end of each chapter are
up to date.
A study of the major disorders of the

nervous system, some of which such as
stroke illness or dementia are of increasing
importance in our aging society will equip
the embryo doctor for work in many
different fields. The neurological patient,
properly surveyed, offers an unrivalled
experience in the skills of history taking
and of clinical assessment. For students
before or after qualification, this book
provides an excellent foundation for
further study of the nervous system, and
particularly of those disorders which may
have some surgical solution.

JJ MACCABE

Long-term Effects of Neuroleptics. Edited
by F Cattabeni, G Racagni, PF Spano,
E Costa. (Pp 660; $78.88.) New York:
Raven Press. 1980.

This large and expensive book is described
as "Advances in Biochemical Psycho-
pharmacology, Volume 24", but it is
actually the proceedings of yet another
symposium, held in Monte Carlo in 1979.
It contains no less than 81 papers, dealing
with the effects of long term neuroleptic
administration on dopaminergic neurons,
dopamine receptors, neurotransmitter in-
teraction, behaviour and neuroendocrine
function. There is also a section on clinical
studies. Some of the findings, already
available in scientific journals, are impor-
tant or at least interesting. Others are
trivial in the extreme and could be used
as ammunition by anyone opposed to
animal experiments. The book is beauti-
fully produced but the very variable
quality of its contents makes it hard to
recommend it.

JL GIBBONS

Disorders of the Cerebellum. By Sid
Gilman, James R Bloedel and Richard
Lechtenberg. (Pp 393; $50.00, £25-00.
Philadelphia: FA Davis Co. 1981.

The Contemporary Neurology Series al-

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