Traumatic Brain Injury: Methods for Clinical and Forensic Neuropsychiatric Assessment, Second Edition

Since the publication of Robert Granacher’s awardwinning first edition in 2003 of Traumatic Brain Injury: Methods for Clinical and Forensic Neuropsychiatric Assessment, the annual rate of traumatic brain injury (TBI) has increased by one-half to a total of almost three million, and Granacher’s database of TBI examinees has grown by one-third to 4000 cases. The book’s second edition contains 11 chapters written for an intended audience of clinical and forensic physicians and psychologists. Simply put, it is a gem. Many of the chapters can stand alone, although there are frequent cross-references among them. The first eight are directed toward clinical considerations, but comments about forensic applications frequently appear. The last three chapters are directly related to forensic concerns. Each chapter is replete with references and an adequate number of summary tables. Abstracts of important research are provided liberally throughout. The clinical chapters begin with one on the epidemiology and pathophysiology of TBI, a somewhat unusual combination for this type of publication. The author describes data from the United States and other countries, and there is ample discussion about civilian and military injuries, including blast injuries. New serum biomarkers for TBI, the S-100 protein and neuron-specific enolase, are presented. A chapter on the TBI-related neuropsychiatric and psychiatric syndromes includes a plea to the DSM-5 task force to bring diagnostic criteria up to date with the vast empirical evidence regarding these disorders. After viewing the proposed changes displayed on the American Psychiatric Association (APA) website, I fear Granacher’s request comes too late or simply was unheeded. Many definitive-sounding pronouncements in this chapter, despite references, will raise thoughtful questions in the minds of experienced neuropsychiatrists, given the high variability in TBI outcomes. A chapter on obtaining the history is comprehensive, yet borders on being overinclusive. Lists of summary questions for the clinical interview will be appreciated by trainees, while experienced forensic psychiatrists may find them tedious and redundant. A separate section addresses obtaining the history for injured children. The chapter on the neuropsychiatric examination provides a superb review of the neurologic assessment in adults and children. Bedside examination procedures are clearly explained and follow a logical progression. The relationships among TBI, cognitive domains, and neurologic systems receive careful attention and explanation from the author. Developmental aspects of the examination of children are emphasized nicely. Nevertheless, seasoned clinicians may find details to disagree with, based on their own training and examination style, and the detail on the neurologic examination may seem excessive for the non-physician readers. Granacher describes the classification of various types of TBI in a separate chapter that contains a discussion of how these injuries appear in neuroimaging studies. He organizes the discussion by neuroimaging technique; some readers may prefer a compilation by lesion type. The need for an onsite cyclotron for positron emission tomography (PET) studies is emphasized, but there is no mention of current delivery services for tracers for PET imaging, which renders this technique more widely available than is suggested in the book. Overall, there are good descriptions of the various techniques and their limitations, both for clinical and forensic purposes. Granacher emphasizes the inclusion of tests for cognitive distortion in his discussion of standardized neurocognitive assessment. Testing in adults and children each receives adequate treatment here, although the WAIS-IV (Wechsler Adult Intelligence Scale-4th ed.), and in a later chapter the MMPI2-RF (Minnesota Multiphasic Personality Inventory, 2nd ed., Restructured Form), available since 2008, are not mentioned. A review of behavioral assessments in adults and children includes a detailed discussion of the variety of test instruments available, from the familiar to the obscure. The clinical section ends with a chapter on neurobehavioral analysis and treatment planning in which the author tries to explain the integrative and analytical process applied among the component assessments, a tall order for any author. This is a diffi-