Book Review

Movement Disorders in Neurology and Neuropsychiatry,2nded. Anthony B. Joseph and Robert R. Young, eds. BlackwellScience, Inc., 1999, 726 pp. Price: $150.00 US. ISBN086542523X.

This book is not another standard text on the clinical spec-trum of movement disorders, targeted primarily at neurologistsand movement disorders specialists. As its title suggests, themajor focus is the interface between disorders of movementand psychiatric illness. As such, it provides a unique, refreshingperspective which is relevant to a wide range of clinicians.

The conceptual integration of the disciplines of psychiatryand movement disorders is reflected in both the overall plan ofthe book and the content of its individual chapters. The firstpart is devoted to disorders of movement associated with drugs.It deals largely with the manifold complications of neuroleptictherapy, but includes a comprehensive overview of dyskinesiasinduced by other drugs, as well as chapters devoted to lithium,antidepressant-induced myoclonus, and cocaine.

Parkinson’s disease, the major focus of most movement dis-orders textbooks, is dealt with in the next section on “Dementiaand Neurodegenerative Disorders” and occupies a mere 55pages, 10 of which are on depression and dementia in Parkin-son’s disease. Progressive supranuclear palsy is given a chapterof its own, whereas multiple system atrophy is dealt withbriefly in a broader chapter on other parkinsonian syndromes,again reflecting the book’s emphasis on the psychiatric mani-festations of these neurologic disorders. A discussion of themotor manifestations of Alzheimer’s disease and other primarydementing disorders would have been a useful addition to thissection, and should, I think, have taken precedence over rarerentities such as parkinsonism–dementia complex of Guam andthe parkinsonian–pyramidal syndrome.

Parts three and four deal with disorders of movement inprimary psychiatric conditions such as schizophrenia and mooddisorders. The editors’ wide-ranging view of what constitutes amovement disorder, as declared in the preface, is reflected infascinating discussions of less familiar topics such as patho-logic crying and laughter. These two chapters provide an in-teresting perspective on motor patterning and emotional behav-ior which are not usually tackled in conventional movementdisorders textbooks. A chapter entitled “Neurologic Soft Signsin Psychiatric Disorders” is another example of frequently ob-served but seldom-discussed motor abnormalities.

The established phenomenologic entities of tics, myoclonus,chorea, tremor, and dystonia are dealt with next. In the finalsections, miscellaneous topics such as sleep bruxism, apraxia,

mirror movements, primitive reflexes, and frontal lobe automa-tisms again offer a novel, thought-provoking interpretation ofthe concept of abnormal movements.

As is usual with multi-authored volumes (in this case animpressive 100 chapters written by some 120 authors), theorganization and emphasis of individual chapters varies. Ingeneral, they have a strong clinical bias with the basic sciencesection frequently placed at the end. The reader is alerted topitfalls and controversies in diagnosis and management, andways of approaching these are discussed. Introductory histori-cal overviews to the chapters dealing with poorly defined en-tities, such as catatonia, akinetic mutism, coma vigil, alien handand conversion, clarify what is frequently a confusing array ofterminology. The clinically pertinent chapter on “MedicolegalIssues Regarding Tardive Dyskinesia” is interesting reading.

Although the editors state in their preface to this edition that“many chapters have been updated and freshened,” there is infact only limited evidence of this. With a few exceptions, theliterature from the 1990s is not heavily referenced, with articlesbeyond 1995 a rarity. It is not exceptional to find chapters thatreference no literature beyond the 1980s. The chapters on stiff-man syndrome, pathologic laughter, Tourette’s syndrome, andantidepressant-induced myoclonus are random examples. Thus,in a book that recognizes, as its fundamental premise, the re-lationship between psychiatric disease and disturbances ofmovement, ironically, little attention is given to modern psy-chotropic drugs. Apart from a paragraph on risperidone in theoverview on drug-induced dyskinesias, there is little mention ofthe newer atypical antipsychotics. Gabapentin gets a cursorymention as “an antiepileptic recently marketed in the UnitedKingdom.” There is only one brief (unreferenced) mention ofSSRIs in the chapters on Tourette’s syndrome and tic disorders.

For the practicing clinician confronting movement disorders,this book provides sound theoretical understanding and practi-cal guidance. Its emphasis on the border zone between neurol-ogy and psychiatry provides a unique and novel clinical per-spective, with discussions of many aspects of motor behaviornot specifically covered in conventional textbooks on move-ment disorders. As such, it is also a valuable source of refer-ence. However, those looking for a state-of-the-art reviewof recent scientific and therapeutic advances are likely to bedisappointed.

Jennifer Fine, MDToronto Western Hospital

Toronto, Canada

Movement DisordersVol. 15, No. 1, 2000, p. 182© 2000 Movement Disorder Society

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