Neurobehavioral toxicology/ 1, Foundations and methods / Stanley Berent and James W. Albers.

Contents of Volumes II and III ix From the Series Editor xvii Acknowledgments xix Disclosures xx 1 INTRODUCTION TO NEUROBEHAVIORAL TOXICOLOGY 1 Introduction 1 Some conceptual considerations 3 Neurotransmission 5 Neurotransmission and disease 7 Neurotoxicity 10 Common clinical neurobehavioral toxicology issues 11 Case presentations 12 Patient with progressive dementia 12 Patient with depression and suspected dementia 16 Importance of context with regard to toxic exposure 20 Exposure to a neurotoxicant in the context of a terrorist act Comments 24 2 CLASSIFICATION AND MANAGEMENT OF TOXICANT-RELATED INFORMATION 29 Introduction 29 Assessment and management of risk 30 Classification 32 Conclusion 47 3 CLINICAL AND CLINICAL RESEARCH CONSIDERATIONS 51 Introduction 51 Scientific method 52 Definition of the problem to be addressed 53 Hypothesis 53 Experiment 54 Analysis 59 Conclusions based on the scientific method 60 Special research considerations 61 Animal models 61 Additional issues related to sample selection 62 Protection of subjects in research 63 Bias 67 Masking and placebo controls 68 Evaluation of research claims regarding causality 69 Conclusion 73 4 CLINICAL APPROACHES 77 Introduction 77 Clinical neurology and clinical neuropsychology 78 The referral model 79 Managing the professional interaction 80 The clinical process 82 Some commonalities across fields 82 The need for objectivity 83 The need for an evidence-based approach to the clinical process 85 Some general clinical attributes of neurotoxic disease 86 Other considerations 88 Determining abnormality 88 Patient motivation and attention 91 Psychopathology 92 Presence of third parties during a clinical evaluation 94 Effects of litigation 95 Summary 97 5 THE NEUROPSYCHOLOGICAL APPROACH 101 Introduction 101 Psychology and the specialty of clinical neuropsychology 102 Brain and behavior 102 Clinical neuropsychology and its relationship to neurobehavioral toxicology 105 Neuropsychological evaluation 106 The history 107 vi Contents The clinical interview 110 The psychometric examination 113 The neuropsychological method 116 Nature of neuropsychological data 116 Clinical evaluation of neuropsychological data 116 Psychometrics: basic technical considerations 120 Reliability 121 Validity 122 Other issues in test construction, selection, and administration 126 Standardization 126 Normative data 127 Some additional comments on the neuropsychological clinical approach 127 Developing the neuropsychological impression 127 Localizing the abnormality 129 Identifying general diagnostic categories 130 Use of additional neurodiagnostic testing to arrive at a final neuropsychological diagnosis 130 Summary and conclusion 131 6 THE NEUROLOGICAL APPROACH 135 Introduction 135 The neurological approach 135 Foundations of clinical neurology as they relate to neurobehavioral toxicology 136 Clinical neurology 138 Normal or abnormal 138 Clinical neurological evaluation 139 Clinical history 140 Clinical examination 142 Developing the neurological impression 156 Localizing the lesion 157 Establishing a differential diagnosis 163 Use of neurological symptoms 164 Use of neurological signs 165 Preliminary differential diagnosis 168 Neurodiagnostic testing 169 Psychometric tests as viewed by the neurologist 170 Electrodiagnostic evaluations 170 Conclusion 182 Contents vii 7 CRITIQUE OF RELEVANT CLINICAL TESTS 189 Introduction 189 Psychometric examination (neuropsychological testing) 191 Neuroimaging 193 Neurophysiological tests 199 Electroencephalogram (EEG) 200 Electromyography (EMG) 205 Other tests of neurological function 212 Summary 217 8 CAUSALITY 225 Introduction 225 Causality as invention 229 Science as a belief system 231 On the nature of scientific knowledge 233 Science and the legal system 233 The logical (rational) and the empirical 235 In Science 235 In clinical practice 240 Evidence-based medicine (EBM) 241 Conclusions 242 POSTSCRIPT 247 Subject index 249