Mental and cognitive disorders in multiple sclerosis (MS) have been reported at least since the time of Charcot. However, very little space has been devoted to these abnormalities in the medical and psychiatric literature over the past century. Thus, MS has remained an essentially neurological, rather than neuropsychiatric, condition. Only during the past decade or so has interest in the psychiatric aspects of MS developed, and although there is now a considerable body of knowledge on the neuropsychiatry of the disease, there is still a lack of overviews on the subject.
Feinstein claims to provide “a detailed survey of the emotional, behavioural and cognitive disorders prevalent among patients with multiple sclerosis” and “clear clinical guidelines […] for (their) diagnosis and treatment”. This is a clinically oriented volume, which is well researched, written and edited. It will undoubtedly please readers seeking the practical clinical information and advice that is rarely found in neurology textbooks. The book begins with a helpful and clarifying introduction on the diagnosis of MS and definitions of its nomenclature, followed by chapters on depression, bipolar disorder, pathological laughter and crying, psychosis and cognitive dysfunction. Most chapters contain clinical vignettes, and all have helpful summary points at the end. Data are also provided on the correlation between brain lesions on magnetic resonance imaging and various abnormal mental states and cognitive deficits. There is an imbalance between the amount of space devoted to cognitive dysfunction (five out of ten chapters) and that given to the more strictly psychiatric aspects of MS. Also, reference to the effects of newer therapies, such as the beta-interferons and their alleged (and debated) potential to induce depression in a proportion of patients, would be welcome.
This work succeeds in providing a detailed review of the mental and cognitive disorders observed in MS. And although the provision of clear treatment guidelines is hampered by the small number of proper randomised placebo-controlled trails of treatments for depression, mania, or psychosis in MS, this is not the author's fault.
Feinstein should be congratulated for his effort in reviewing and bringing together what is known of the psychiatry of MS into this monograph, which will be useful to those interested in the psychiatric manifestations of structural brain disease and to clinicians who either have patients with MS under their care, or who encounter them in the course of their clinical practice. The volume would be a welcome addition to academic medical libraries and some departmental libraries. Those with a special interest in MS should benefit from the inclusion of this book on their personal shelves, although they might want to check whether a paperback edition is planned.
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