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The Biochemical Basis of Neuropharmacology, ed 3
BOOK REVIEWS described is universal, regardless of the different approaches. Since some of the ideas have been presented as mere facts, the student may feel deprived of the pleasure of understanding how the author arrived at his conclusions. The reviewer somewhat missed a criticism of the various approaches. A short reminder about the research done on treatment outcome and on difficulties of research would have been welcome. Despite the limitations, which are probably related to the author's effort to restrict the volume's size, the book will be a useful addition to the student's library. It will help dissipate the mythology of psychotherapy by confronting the reader with a well-defined clinical approach. Dan G. Herr:. M.D. Jerusalem. Israel
Psychotherapy in Chronic Ulcerative Colitis By Aaron Karu,h. George l. Daniels. ('harle, Flood. and John F. O'Connor. 148 pp. $13.75. Philadelphia. W. B. Saunders. 1977.
• This volume presents a summary of internists'. psychiatrists'. and surgeons' work over 40 years at the Col um bia-Presbyterian Medical Center with patients suffering from chronic ulcerative colitis and related ileocolonic diseases. The authors present data on the general course of chronic ulcerative colitis in the pre- and poststeroid eras and the results of three studies of the influence of psychotherapy. They discuss the role of mental processes. motivational conflict. and loss of emotional control as factors that
640
influence the four determinants of the disease-genetic endowment, constitutional vulnerability. intrapsychic processes. and the external environment. They do not maintain that in trapsychic processes are the cause of ulcerative colitis: instead. they conclude that their 40 years of experience in working with hundreds of patients shows mainly that intrapsychic processes may predispose to the development of the disease, arise as reactions to the symptoms and disability caused by the disease. or may reinforce and intensify the disability. The effects of psychotherapy in ulcerative colitis are variable. Treatment requires the combined efl'orts of the internist, the psychiatrist. and the surgeon. But j udiciously selected psychotherapeutic interventions can improve patients' chances for lasting improvement. The authors conclude. "Without sacrificing the important pharmacological and surgical contributions to treatment. a more deliberate and prolonged use of dynamic psychotherapy can only help the colitis patient and reduce the burden of disability." Although this is a short volume. it successfully summarizes a massive amount of clinical experience with chronic ulcerative colitis patients. Chapter 3 presents an excellent review of the psychosomatic literature on this subject. beginning with a short discussion of Murray's pioneering report on the psychological study of ulcerative colitis patients in 1930 and encompassing the contributions of Groen, Lindemann. Weinstock. Alexander. Engel, and others. The volume is worth buying just for the definitive
review presented in this chapter. Five case studies supplement the presentation of the data and illustrate principles of psychotherapy that are described in detail. And in Chapter 7. the authors descri be their patients' physiologic and psychological responses to removal of the colon. This brief. meaty volume is highly recommended to psychosomaticists. psychiatrists. internists. and others working with ulcerative colitis patients or interested in the topic. Although the results of 40 years of experience with these difficult patients are somewhat inconclusive, Karush and his colleagues have made a distinct contribution to psychosomatic medicine by distilling the results of their work and offering them to us in a readable. interesting volume. John J. Schwah. M.D. Vnil'enir\, LouiSl'iIIe
or
The Biochemical Basis of Neuropharmacology, ed 3 By Jack R. Cooper. Floyd E. Bloom. and Roher! H. Roth. 327 pp. S13.95 hard cover. S6.95 paperhack. New York. OXftHd Universi Iv Press. 197X.
• As with the previous editions. the third edition of The Biochemical Basis of Neuropharmacolo?.1' selectively focuses on the neurochemical and neurophysiologic aspects of neuropharmacoiogy. with particular reference to the role of neurotransmitters and neurotransmitter candidates. Two excellent new chapters have been added: a chapter on receptors and one on neuroactive peptides. The same high quality of vigorous. searching scholarship. and easy readability PSYCHOSOMATICS
that was present in the earlier editions is strikingly eviden t in this edi tion as well. Chapters from the previous editions now revised in accordance with new knowledge include: Cellular Foundations of Neuropharmacology; Metabolism in the Central Nervous System; Acetylcholine: Catecholamines; Serotonin; Neuroactive Peptides; Cyclic N udeotides. Prostaglandins. and Histamine; and Cellular Mechanisms in Memory and learning. These chapters follow essentially the format of the two previous editions. The new 13-page chapter on receptors provides a concise essay on this emergent area of biochemical neuropsychopharmacology. The concept that drugs. hormones. and neurotransmitters exert their biologic effect by interacting with receptors has flourished in recent years with the isolation of macromolecular substances that fit receptor criteria. Receptors that have been isolated and identified to date incl ude cholinergic. fi-adrenergic. gonadotropin. angiotensin II. glucagon. prolactin. and TSH. The currently most sensitive receptor assay involves the measurement of binding affinity of radiolabeled. high-affinity ligands to the receptor. Additional sections in the chapter provide a lucid discussion of receptor characterization and the kinetics and theories of drug-receptor interactions. The 23-page chapter on neuroactive pep tides includes sections on peptide-synthesizing enzymes and peptidases. TRH. the endorphins and enkephalins. angiotensin II. oxytocin and vasopressin. lH-RH. substance P and SEPTEMBER 1979· VOL 20· NO 9
neurotensin. and somatostatin release inhibiting factor (SRIF). The recen t data in this area of increasing interest provide an ever-increasing list of potentially neuroactive peptides that could function as neurotransmitters or modulators of neural transmission. The sensitive assay methods used to analyze neuronal-peptide interaction include radioimmunoassay and immunocytochemical tests. Interesting questions that are presented as currently under consideration in this area of research include: Do the peptides act presynaptically. postsynaptically. or at both sites? Can the pep tides modulate the release of the transmitters of other neurons? Can peptide chemistry provide useful antagonists for the identification of receptors? The selected references that accompany this chapter are particularly noteworthy. John L. Slil/iI'Gn. M. D. Duke Un;ven;/r
Manic-Depressive Illness: History of a Syndrome Edited by Edward A. Wolpert. 604 pp. 522.50. New York. International UniversiI ies Press. 1977.
• WolperCs plan was to present an historical account of modern-day concepts of manic-depressive illness. He does this via the original articles by the primary exponents of their theses. The book includes 3 I such articles. The first two papers are by Kraepelin (1902-1921), who created order and a unified thesis out of the inchoate mass of concepts existing in his time. The next stage in development of the psychiatric thesis in-
volved psychoanalytic concepts. These are covered in two articles by Abraham, two by Freud. two by Fromm-Reichmann, and several by other authors. The third stage in this historical progression involved neurophysiologic concepts. In the last few decades, there has been an explosion of studies in this area. I came away from the book with the sense that this aspect has been only summarily treated. There is an excellent article on the "Biogenic Amines" by Schildkraut and Kety. A current (1969) article on the genetics of mania is good. but the more comprehensive historical studies (Kallman, Slater, Stenstedt) are missing. The limbic system, which plays such an important role in current physiology of emotions. is not mentioned (Papez. Maclean. Old;; belong here). The shock therapies still universally used were a potent factor in focusing attention on the physiologic nature of the manicdepressive illness; they are discussed only incidentally in sections on other subjects. Meduna's work is of historical importance here. The whole face of therapy of the depressions has been changed with the advent of tricyclic drugs and MAO inhibitors. Here again. there is a paucity of information on the development and significance of these medications. Only lithium is given full historical coverage. in articles by Cade and Schou. The historical approach of this volume is excellent. Its defect lies not in errors of commission but in those of omission. Samuel H. Kraines. M. D. Chicago
641
Psychotherapy in Chronic Ulcerative Colitis By Aaron Karu,h. George l. Daniels. ('harle, Flood. and John F. O'Connor. 148 pp. $13.75. Philadelphia. W. B. Saunders. 1977.
• This volume presents a summary of internists'. psychiatrists'. and surgeons' work over 40 years at the Col um bia-Presbyterian Medical Center with patients suffering from chronic ulcerative colitis and related ileocolonic diseases. The authors present data on the general course of chronic ulcerative colitis in the pre- and poststeroid eras and the results of three studies of the influence of psychotherapy. They discuss the role of mental processes. motivational conflict. and loss of emotional control as factors that
640
influence the four determinants of the disease-genetic endowment, constitutional vulnerability. intrapsychic processes. and the external environment. They do not maintain that in trapsychic processes are the cause of ulcerative colitis: instead. they conclude that their 40 years of experience in working with hundreds of patients shows mainly that intrapsychic processes may predispose to the development of the disease, arise as reactions to the symptoms and disability caused by the disease. or may reinforce and intensify the disability. The effects of psychotherapy in ulcerative colitis are variable. Treatment requires the combined efl'orts of the internist, the psychiatrist. and the surgeon. But j udiciously selected psychotherapeutic interventions can improve patients' chances for lasting improvement. The authors conclude. "Without sacrificing the important pharmacological and surgical contributions to treatment. a more deliberate and prolonged use of dynamic psychotherapy can only help the colitis patient and reduce the burden of disability." Although this is a short volume. it successfully summarizes a massive amount of clinical experience with chronic ulcerative colitis patients. Chapter 3 presents an excellent review of the psychosomatic literature on this subject. beginning with a short discussion of Murray's pioneering report on the psychological study of ulcerative colitis patients in 1930 and encompassing the contributions of Groen, Lindemann. Weinstock. Alexander. Engel, and others. The volume is worth buying just for the definitive
review presented in this chapter. Five case studies supplement the presentation of the data and illustrate principles of psychotherapy that are described in detail. And in Chapter 7. the authors descri be their patients' physiologic and psychological responses to removal of the colon. This brief. meaty volume is highly recommended to psychosomaticists. psychiatrists. internists. and others working with ulcerative colitis patients or interested in the topic. Although the results of 40 years of experience with these difficult patients are somewhat inconclusive, Karush and his colleagues have made a distinct contribution to psychosomatic medicine by distilling the results of their work and offering them to us in a readable. interesting volume. John J. Schwah. M.D. Vnil'enir\, LouiSl'iIIe
or
The Biochemical Basis of Neuropharmacology, ed 3 By Jack R. Cooper. Floyd E. Bloom. and Roher! H. Roth. 327 pp. S13.95 hard cover. S6.95 paperhack. New York. OXftHd Universi Iv Press. 197X.
• As with the previous editions. the third edition of The Biochemical Basis of Neuropharmacolo?.1' selectively focuses on the neurochemical and neurophysiologic aspects of neuropharmacoiogy. with particular reference to the role of neurotransmitters and neurotransmitter candidates. Two excellent new chapters have been added: a chapter on receptors and one on neuroactive peptides. The same high quality of vigorous. searching scholarship. and easy readability PSYCHOSOMATICS
that was present in the earlier editions is strikingly eviden t in this edi tion as well. Chapters from the previous editions now revised in accordance with new knowledge include: Cellular Foundations of Neuropharmacology; Metabolism in the Central Nervous System; Acetylcholine: Catecholamines; Serotonin; Neuroactive Peptides; Cyclic N udeotides. Prostaglandins. and Histamine; and Cellular Mechanisms in Memory and learning. These chapters follow essentially the format of the two previous editions. The new 13-page chapter on receptors provides a concise essay on this emergent area of biochemical neuropsychopharmacology. The concept that drugs. hormones. and neurotransmitters exert their biologic effect by interacting with receptors has flourished in recent years with the isolation of macromolecular substances that fit receptor criteria. Receptors that have been isolated and identified to date incl ude cholinergic. fi-adrenergic. gonadotropin. angiotensin II. glucagon. prolactin. and TSH. The currently most sensitive receptor assay involves the measurement of binding affinity of radiolabeled. high-affinity ligands to the receptor. Additional sections in the chapter provide a lucid discussion of receptor characterization and the kinetics and theories of drug-receptor interactions. The 23-page chapter on neuroactive pep tides includes sections on peptide-synthesizing enzymes and peptidases. TRH. the endorphins and enkephalins. angiotensin II. oxytocin and vasopressin. lH-RH. substance P and SEPTEMBER 1979· VOL 20· NO 9
neurotensin. and somatostatin release inhibiting factor (SRIF). The recen t data in this area of increasing interest provide an ever-increasing list of potentially neuroactive peptides that could function as neurotransmitters or modulators of neural transmission. The sensitive assay methods used to analyze neuronal-peptide interaction include radioimmunoassay and immunocytochemical tests. Interesting questions that are presented as currently under consideration in this area of research include: Do the peptides act presynaptically. postsynaptically. or at both sites? Can the pep tides modulate the release of the transmitters of other neurons? Can peptide chemistry provide useful antagonists for the identification of receptors? The selected references that accompany this chapter are particularly noteworthy. John L. Slil/iI'Gn. M. D. Duke Un;ven;/r
Manic-Depressive Illness: History of a Syndrome Edited by Edward A. Wolpert. 604 pp. 522.50. New York. International UniversiI ies Press. 1977.
• WolperCs plan was to present an historical account of modern-day concepts of manic-depressive illness. He does this via the original articles by the primary exponents of their theses. The book includes 3 I such articles. The first two papers are by Kraepelin (1902-1921), who created order and a unified thesis out of the inchoate mass of concepts existing in his time. The next stage in development of the psychiatric thesis in-
volved psychoanalytic concepts. These are covered in two articles by Abraham, two by Freud. two by Fromm-Reichmann, and several by other authors. The third stage in this historical progression involved neurophysiologic concepts. In the last few decades, there has been an explosion of studies in this area. I came away from the book with the sense that this aspect has been only summarily treated. There is an excellent article on the "Biogenic Amines" by Schildkraut and Kety. A current (1969) article on the genetics of mania is good. but the more comprehensive historical studies (Kallman, Slater, Stenstedt) are missing. The limbic system, which plays such an important role in current physiology of emotions. is not mentioned (Papez. Maclean. Old;; belong here). The shock therapies still universally used were a potent factor in focusing attention on the physiologic nature of the manicdepressive illness; they are discussed only incidentally in sections on other subjects. Meduna's work is of historical importance here. The whole face of therapy of the depressions has been changed with the advent of tricyclic drugs and MAO inhibitors. Here again. there is a paucity of information on the development and significance of these medications. Only lithium is given full historical coverage. in articles by Cade and Schou. The historical approach of this volume is excellent. Its defect lies not in errors of commission but in those of omission. Samuel H. Kraines. M. D. Chicago
641