Massachusetts General Hospital Comprehensive Clinical Psychiatry

Front cover
Massachusetts General Hospital Comprehensive Clinical Psychiatry
Copyright page
Table of Contents
Preface
List of Contributors
Dedication
Part I: Approach to the Patient
Chapter 1: The Doctor–Patient Relationship
Key Points
Overview
The Optimal Healing Environment: Patient-Centered Care
Physician Practice in Patient-Centered Care
Collaborating Around History-Taking
Effective Clinical Interviewing
Planning the Path Forward: Creating a Clinical Formulation
Treatment Planning
Obstacles and Difficulties in the Doctor–Patient Relationship
Key References
References
Chapter 2: The Psychiatric Interview
Key Points
Overview
Lessons From Attachment Theory, Narrative Medicine, and Mindful Practice
The Context of the Interview: Factors Influencing the Form and Content of the Interview
The Setting
The Situation
The Subject
The Significance
Establishing an Alliance and Fostering Effective Communication
Building the Relationship and Therapeutic Alliance
Data Collection: Behavioral Observation, the Medical and Psychiatric History, and the Mental Status Examination
Behavioral Observation
The Medical and Psychiatric History
Presenting Problems
Past Psychiatric History
Past Medical History
Review of Systems
Family History
Social and Developmental History
Use of Corollary Information
The Mental Status Examination
Sharing Information and Preparing the Patient for Treatment
The Evaluation of Children and Adolescents
Difficulties and Errors in the Psychiatric Interview
Dealing with Sensitive Subjects
Disagreements about Assessment and Treatment
Errors in Psychiatric Interviewing
Key References
References
Chapter 3: Laboratory Tests and Diagnostic Procedures
Key Points
Overview
A General Approach to Choosing Laboratory Tests and Diagnostic Studies
Routine Screening
Psychosis and Delirium
Anxiety Disorders
Mood Disorders
Metabolic and Nutritional
Neuroendocrine Disorders
Immune Disorders
Infectious Diseases
Degenerative Disorders
Substance Use Disorders
Alcohol
Cocaine and Stimulants
Opiates
Steroids
Toxins
Eating Disorders
Drug Monitoring
Mood Stabilizers
Antipsychotics
Antidepressants
Electroencephalogram
Neuroimaging
Structural Neuroimaging
Computed Tomography
Magnetic Resonance Imaging
Positron Emission Tomography and Single-Photon Emission Computed Tomography
Conclusion
Key References
References
Chapter 4: Treatment Adherence
Key Points
Overview
Epidemiology of Adherence
Clinical and Economic Impact of Non-Adherence
Risk Factors for Non-Adherence
Clinical Factors
Mood
Anxiety
Psychosis
Substance Misuse
Patient Factors: Knowledge, Attitudes, and Beliefs
Economic and Racial/Ethnic Disparities
Clinical Encounters
Assessing Adherence
Integrating Adherence Into the Treatment Course
Initial Consultation
Treatment Planning
Introduction to Adherence
Ongoing Assessment
Problem-Solving Barriers to Adherence
Education
Motivation
Skills
Logistics
Future Directions
Research
Education
Conclusion
Key References
References
Part II: Human Development
Chapter 5: Child, Adolescent, and Adult Development
Key Points
Overview
Major Theories of Development
Sigmund Freud
Erik Erikson
Jean Piaget
Lawrence Kohlberg
Attachment Theory: John Bowlby and Mary Ainsworth
Brain Development
Infancy (Birth to 18 Months)
Temperament
Motor Development in Infancy
Cognitive Development in Infancy
Language Development in Infancy
Social and Emotional Development in Infancy
Pre-school Years ( to 5 Years)
Physical and Motor Development in the Pre-school Years
Cognitive Development in the Pre-school Years
Language Development in the Pre-school Years
Social and Emotional Development in the Pre-school Years
Moral Development in the Pre-school Years
Gender Identity
School-age Years (5 to 12 Years)
Language Development in the School-age Years
Motor Development in the School-age Years
Cognitive Development in the School-age Years
Social and Emotional Development in the School-age Years
Moral Development in the School-age Years
Adolescence (12 to 20 Years)
Physical Development during Adolescence
Cognitive Development during Adolescence
Social and Emotional Development during Adolescence
Moral Development during Adolescence
Sexual Development during Adolescence
Adult Development
Young Adulthood
Middle to Late Adulthood
Late Adulthood and Senescence
Key References
References
Part III: Psychological and Neuropsychological Testing
Chapter 6: Diagnostic Rating Scales and Psychiatric Instruments
Key Points
Overview
General Considerations in the Selection of Diagnostic Rating Scales
General Diagnostic Instruments
Scales for Mood Disorders
Scales for Psychotic Disorders
Scales for Anxiety Disorders
Scales for Substance Abuse Disorders
Scales for Cognitive Disorders
Conclusion
Key References
Suggested Reading
Chapter 7: Understanding and Applying Psychological Assessment
Key Points
Overview
Psychometrics: the Science of Test Development
Basic Psychometric Assumptions: Reliability and Validity
Definition of a Psychological Test
Major Categories of Psychological Tests
Intelligence Tests
Objective (Self-Report) Tests of Personality and Psychopathology
The Minnesota Multiphasic Personality Inventory–2
The Millon Clinical Multiaxial Inventory–III
The Personality Assessment Inventory
Objective Tests and the DSM-5
Performance-Based Tests of Personality
The Rorschach Inkblot Method
Thematic Apperception Test
Projective Drawings
The Assessment Consultation Process and Report
Obtaining the Assessment Consultation
Using Psychological Assessment to Enhance Care
Understanding the Assessment Report
Key References
References
Chapter 8: Neuropsychological Assessment
Key Points
Introduction
Dimensions of Behavior Assessed
Intellectual Function
Attention
Frontal/executive Functions
Memory
Language
Visuoperceptual, Visuospatial, and Visuoconstructional Functioning
Emotional Functions
Sensory-perceptual and Motor Functions
BRIEF Neuropsychological Screening Measures
Conclusion
Acknowledgments
Key References
References
Part IV: The Psychotherapies
Chapter 9: Coping with Medical Illness and Psychotherapy of the Medically Ill
Key Points
Background
History
Clinical and Research Challenges
Practical Pointers
References
Chapter 10: An Overview of the Psychotherapies
Key Points
Background
Psychodynamic Psychotherapy
Cognitive-Behavioral Therapy
Supportive Psychotherapy
Brief Psychotherapy
Psychiatric Medication with Psychotherapy
Interpersonal Psychotherapy
Dialectical Behavior Therapy
Group Therapy
Couples Therapy
Integrative Psychotherapy
Innovative Directions of Psychotherapy Research
Child and Adolescent Psychotherapy
Emotional, Cognitive, and Neurodevelopmental Issues for Children and Adolescents
Child and Adolescent Psychodynamic Psychotherapy
Manual-Driven Therapies and Behavioral Therapies
Systems-Based Care
Conclusion
Key References
References
Chapter 11: Brief Psychotherapy: An Overview
Key Points
Overview
History of Brief Psychotherapy
Modern Brief Psychotherapies
Psychodynamic Short-term Therapies
Cognitive-Behavioral Brief Therapies
Interpersonal Therapy
Eclectic Therapies
The Essential Features of Brief Therapy
The Initial Evaluation
Patient Selection
Exclusion Criteria
Inclusion Criteria
Developing a Focus
Completing the Initial Evaluation and Setting Goals
The Brief Therapy Mind-set
Being an Active Therapist
Phases of Planned Brief Therapy
Post-treatment Contact
KEY References
Suggested Reading
Chapter 12: Couples Therapy
Key Points
Overview
Seminal Ideas in Couples Therapy
Identification of Dysfunctional Relational Patterns
Mate Choice and the Contribution of One’s Family of Origin
Communication
Intimacy and Control
Life Cycle Context and Transition Points
Conducting a Couples Therapy Evaluation
The First Session with Both Members of the Couple
The Two Individual Meetings
Alcohol and Substance Abuse
Previous Therapy
History of Mental Illness
Sexual Abuse
Medical Problems
Intimate Partner Violence
The Fourth Meeting with Both Members of the Couple: Wrap-up and Recommendations
Couples Therapy Techniques
Cognition as the Focus of Change
Affect as the Focus of Change
Behavior as the Focus of Change
Conclusion
Key References
References
Chapter 13: Family Therapy
Key Points
Overview
Case Vignette
Psychodynamic Family Therapy
The Theory
The Practice
The Proponents
The Metaphor
Experiential Family Therapy
The Theory
The Practice
The Proponents
The Metaphor
Structural Family Therapy
The Theory
The Practice
The Proponents
The Metaphor
Strategic Family Therapy
The Theory
The Practice
The Proponents
The Metaphor
Systemic Family Therapy
The Theory
The Practice
The Proponents
The Metaphor
Narrative Family Therapy
The Theory
The Practice
The Proponents
The Metaphor
Behavioral Family Therapy
The Theory
The Practice
The Proponents
The Metaphor
Psychoeducational Family Therapy
The Theory
The Practice
The Proponents
The Metaphor
The Maudsley Model: an Example of Theory Integration
Conclusion
Key References
References
Chapter 14: Group Psychotherapy
Key Points
Overview
Creating a Group
Clinical Vignette
Creation and Goals of a Psychodynamic Group
Who Should be Treated in Group Therapy?
Combined Therapies
Legal and Ethical Considerations in Group Therapy
Research, Outcome, and Evaluation
Consultation and Supervision for Group Therapy
KEY References
Suggested Reading
Chapter 15: Hypnosis
Key Points
Overview
Historical Background
Anton Mesmer and Mesmerism
Early Applications of Hypnosis in Medical Practice
Hypnosis in Psychiatric Practice
Current Research and Theory
Theoretical Perspectives on the Hypnotic State
Effects on Physiological Function
Measurement of Hypnotic Susceptibility
Measurement of Hypnotic Depth
Functional Neuroanatomy of Hypnosis
Genetic and Molecular Basis of Hypnosis
Evidence for the Efficacy of Hypnosis
Clinical Indications for Hypnosis
Customary Clinical Use
Pain Management
Surgical Care
Medical and Dermatological Uses
Contraindications for Using Hypnosis
Potential Complications of Hypnosis
Hypnosis and Performance Enhancement
Training in Hypnotherapy
The Cochrane Collaborative
The Society for Clinical and Experimental Hypnosis
The American Society of Clinical Hypnosis
Conclusion
Current Controversies and Future Considerations
Key References
References
Chapter 16: Cognitive-behavioral Therapy, Behavioral Therapy, and Cognitive Therapy
Key Points
Overview
Behavioral Therapy, Cognitive Therapy, and Cognitive-Behavioral Therapy
Putting Behavioral Therapy and Cognitive Therapy Together
Basic Principles of Cognitive-behavioral Therapy
The Basic Practice of Cognitive-behavioral Therapy
The Practice of Cognitive-behavioral Therapy: The Case of Panic Disorder
The Efficacy of Cognitive-Behavioral Therapy
Adult Unipolar Depression
Adolescent Unipolar Depression
Bipolar Disorder
Generalized Anxiety Disorder
Panic Disorder
Social Anxiety Disorder
Obsessive-Compulsive Disorder
Post-traumatic Stress Disorder
Schizophrenia
Eating Disorders
Substance Dependence
Other Psychological Conditions
The Effectiveness of Cognitive-behavioral Therapy
Combining Cognitive-Behavioral Therapy with Medication
Recent Developments and Future Directions
Conclusion
Key References
References
Part V: Psychiatric Diagnoses and Conditions
Chapter 17: The DSM-5: A System for Psychiatric Diagnosis
Key Points
DSM-5 in Context: an Evolving Diagnostic System
The Process of Change for DSM-5
The Three-Section Structure of DSM-5
Section I
Section II
Section III
Diagnostic Criteria Changes
Neurodevelopmental Disorders
Schizophrenia Spectrum and other Psychotic Disorders
Bipolar and Related Disorders
Depressive Disorders
Anxiety Disorders
Obsessive-compulsive and Related Disorders
Trauma- and Stressor-related Disorders
Somatic Symptom and Related Disorders
Eating Disorders
Gender Dysphoria
Disruptive, Impulse Control, and Conduct Disorders
Substance-related and Addictive Disorders
Neurocognitive Disorders
Critiques and Limitations of DSM-5
Psychodynamic Approaches
Behavioral Approaches
Family/Systems Theory
Conclusion
Key References
References
Part VI: Disorders of Cognition
Chapter 18: Delirium
Key Points
Overview
Diagnosis
Differential Diagnosis
Examination of the Patient
Specific Management Strategies for Delirium
Drug Treatment
Delirium in Specific Diseases
Conclusions
Key References
References
Chapter 19: Dementia
Key Points
Overview
Epidemiology of Dementia
The Role of Age of Onset
Evaluation of the Patient with Suspected Dementia
Alzheimer’s Disease
Brief Description
Epidemiology of Alzheimer’s Disease
Pathophysiology
Genetics of Alzheimer’s Disease
Clinical Features and Diagnosis
Differential Diagnosis
Treatments
Supportive and Long-term Care
Prognosis
Dementia with Lewy Bodies
Definition
Epidemiology and Risk Factors
Pathophysiology
Clinical Features and Diagnosis
Differential Diagnosis
Treatment
Supportive Care and Long-term Management
Prognosis
Frontotemporal Dementias
Definition
Epidemiology and Genetic Risk Factors
Pathophysiology
Clinical Features, Diagnosis, and Differential Diagnosis
Treatment
Supportive Care and Long-term Management
Prognosis
Vascular Dementia
Definition
Epidemiology and Risk Factors
Pathophysiology
Clinical Features and Diagnosis
Differential Diagnosis
Treatment
Corticobasal Degeneration
Progressive Supranuclear Palsy
Normal Pressure Hydrocephalus
Creutzfeldt–Jakob Disease
Conclusions
Key References
References
Suggested Reading
Chapter 20: Intellectual Disability
Key Points
Overview
Epidemiology
Prevalence
Co-Morbid Psychopathology
Clinical Features and Diagnosis
Clinical Features
Diagnosis
Treatment Considerations
Overview
Behavioral Disorders
Traditional Psychiatric Disorders
Syndrome-associated Disorders
Conclusion
References
Part VII: Mental Disorders Due to Another Medical Condition
Chapter 21: Mental Disorders Due to Another Medical Condition
Key Points
Overview
Disorders
Psychiatric Differential Diagnosis
Primary Mental Disorders
Substance-induced Disorders
Another Medical Condition
Infectious Diseases
Herpes Simplex Virus (Figure 21-1)
Human Immunodeficiency Virus (Figure 21-3)
Rabies
Lyme Disease
Neurosyphilis
Chronic Meningitis
Chronic, Persistent Viral or Prion Diseases
Epilepsy
Complex Partial Seizures
Nutritional Deficits
Metabolic Encephalopathy
Hepatic Encephalopathy
Renal Insufficiency
Hypoglycemic Encephalopathy
Diabetic Ketoacidosis
Acute Intermittent Porphyria
Endocrine Disorders
Thyroid Dysfunction
Parathyroid Dysfunction
Adrenal Dysfunction
Pituitary Dysfunction
Demyelinating Disorders
Multiple Sclerosis
Amyotrophic Lateral Sclerosis
Lipid Storage Disorders
Mitochondrial Disease
Cerebrovascular Disease
Toxins
Neoplasm
Degenerative Disorders
Immune Diseases
Trauma
Evaluation
History
Examination
Treatment Considerations/Strategies
Conclusions
Key References
References
Part VIII: Sleep Disorders
Chapter 22: Sleep Disorders
Key Points
Overview
The History of Sleep Related to Psychiatry
Sleep Physiology
Examination of Sleep and Sleep-Related Complaints
Polysomnography
Multiple Sleep Latency Test
Patient-completed Rating Scales
Classification of Sleep Disorders
Insomnia
Principles of Management
Medications for Insomnia
Potential Adverse Effects of Hypnotics
Rebound Insomnia
Falls
Cognitive and Performance Disturbances
Behavior Management
Hypersomnia and Excessive Sleepiness
Narcolepsy
Treatment
Excessive Daytime Sleepiness
Cataplexy
Breathing-Related Sleep Disorders: Obstructive Sleep Apnea, Central Sleep Apnea, and Sleep-Related Hypoventilation
Central Sleep Apnea
Circadian Rhythm Sleep–Wake Disorders
Delayed Sleep Phase Disorder
Advanced Sleep Phase Disorder
Irregular Sleep–Wake Cycle Disorder
Non-24 hour Sleep–Wake Disorder
Shift-work Sleep Disorder
Parasomnias NREM Sleep Arousal Disorder
Sleepwalking or Somnambulism
Sleep Terrors (previously known as pavor nocturnus)
Sleep-related Eating Disorder, or Nocturnal Binge-eating Disorder
Nightmare Disorder, or Dream Anxiety Disorder
REM Sleep Behavior Disorder
Restless Legs Syndrome
Restless Leg Syndrome Treatment
Periodic Limb Movements of Sleep (in ICSD-2, Periodic Limb Movement Disorder, formerly called nocturnal myoclonus)
Key References
References
Part IX: Psychiatric Disorders
Chapter 23: Impulse-Control Disorders
Key Points
Overview
Intermittent Explosive Disorder
Epidemiology and Risk Factors
Pathophysiology
Clinical Features and Diagnosis
Treatment
Supportive Care and Long-term Management
Kleptomania
Epidemiology and Risk Factors
Pathophysiology
Clinical Features and Diagnosis
Differential Diagnosis
Treatment
Pyromania
Incidence and Epidemiology
Pathophysiology
Clinical Features and Diagnosis
Differential Diagnosis
Treatment
Complications and Prognosis
Gambling Disorder
Epidemiology and Risk Factors
Pathophysiology
Clinical Features and Diagnosis
Differential Diagnosis
Treatment
Prognosis
Trichotillomania
Epidemiology and Risk Factors
Pathophysiology
Clinical Features and Diagnosis
Differential Diagnosis
Treatment
Prognosis
Conclusion
Key References
References
Chapter 24: Somatic Symptom Disorders
Key Points
Overview
Cross-walking DSM-IV to DSM-5
Somatic Symptom Disorder
Illness Anxiety Disorder
Conversion Disorder
Psychological Factors Affecting Other Medical Conditions
Factitious Disorders
Other Specified Somatic Symptom and Related Disorder
Functional Somatic Syndromes
Shared Parameters of Somatically- Oriented Conditions
Manifestations
Production
Gratification
Treatment
Assigning a Leader to Develop a Treatment Plan
Informing the Patient about the Treatment Plan
Frequent, Scheduled Visits
Consideration and Treatment of Co-morbid Conditions
The Role of Psychiatrists
Suggestibility for Conversion Disorder
Conclusions
Key References
References
Chapter 25: Factitious Disorders and Malingering
Key Points
Overview
Factitious Disorders
Factitious Disorder Imposed on Self
Clinical Features
Diagnostic Approach
Differential Diagnosis
Treatment Approach
Factitious Disorder Imposed on Another
Clinical Features
Diagnostic Approach
Treatment Approach
Malingering
Clinical Features
Diagnostic and Management Approach
Conclusion
References
Suggested Reading
Chapter 26: Alcohol-Related Disorders
Key Points
Overview
Description and Definition
Alcohol-Induced Disorders
Alcohol Intoxication
Treatment
Alcohol-induced Coma
Alcohol Withdrawal Syndrome
Treatment
Alcohol Withdrawal Seizures
Treatment
Alcohol Withdrawal Delirium
Treatment
Wernicke–Korsakoff Syndrome
Wernicke’s Encephalopathy
Treatment
Korsakoff’s Psychosis (Alcohol-induced Persisting Amnestic Disorder)
Fetal Alcohol Spectrum Disorder
Alcohol Use Disorders
Etiology AND Epidemiology
Etiology
Epidemiology
Alcohol Use Disorders and Co-occurring Psychiatric Illness
Typologies
Pathophysiology and Imaging
Effects on Neurotransmitters
Screening and Assessment
Treatment for Alcohol Use Disorders
Brief Intervention
Intensive-Extensive Interventions
Pharmacological Interventions
Alcoholics Anonymous and Long-term Support
Conclusions
Key References
References
Chapter 27: Drug Addiction
Key Points
Overview
The Neurobiology of Addiction
Cocaine
Abuse
Management
Amphetamines
Abuse
Treatment
Club Drugs
Opioids
Opiate Substitution Therapy
Opiate Antagonist Therapy
Managing the Opiate-addicted Hospitalized Patient
Inpatient Detoxification
Outpatient Detoxification Treatment
Pain Management for Patients Receiving Opiate Substitution
Overdose Prevention and Reversal
Benzodiazepines
Neurobiology
Patterns of Chronic Use versus Abuse
Overdose
Withdrawal
Sedative-Hypnotics
Abuse
Clinical Syndromes
Withdrawal
Treatment for Withdrawal
Inpatient Management and Referral
Bath Salts
Mixed-Drug Addiction
References
Suggested Reading
Chapter 28: Psychosis and Schizophrenia
Key Points
Overview
Epidemiology and Risk Factors
Pathophysiology
Neurochemical Changes
Neurocellular Changes
Changes in Brain Structure
Changes in Brain Function
Clinical Features and Diagnosis
Evaluation
Tests and Laboratory Findings
Brain Neuroimaging
Differential Diagnosis of Psychosis
Pharmacological Treatment
Acute Phase
Maintenance Phase
Rehabilitation and Long-Term Management
Prognosis
Morbidity and Mortality Rates
Prognosis with Regard to Symptoms and Function
Current Controversies and Future Considerations
Key References
References
Chapter 29: Mood Disorders: Depressive Disorders (Major Depressive Disorder)
Key Points
Introduction
Major Depressive Disorder
Subtypes of Major Depressive Disorder
Anxious Depression
Mixed Depression
Melancholic Depression
Atypical Depression
Psychotic Depression
Catatonic Depression
Peri-partum Depression
Seasonal Depression
Evaluation of the Patient with Potential Major Depressive Disorder
Other Depressive Disorders
Epidemiology of Major Depressive Disorder
Morbidity, Disability, and Mortality Rates in Depression
Impact of Depression on Medical Co-Morbidity
Impact of Non-Psychiatric Medical Illnesses on Major Depressive Disorder
Depression and Primary Care
Risk Factors of Depression in Primary Care
Associated Features of Depression in Primary Care
Indication for Referral to Psychiatrists
Conclusions
Key References
References
Chapter 30: Bipolar Disorder
Key Points
Overview
Epidemiology and Risk Factors
Historical Context
Clinical Features and Phenomenology
Associated Illness Features
Bipolar I versus II
Psychosis
Suicide
Cognitive Symptoms
Features of Longitudinal Course
Age at Onset and Prodrome
Mood Episodes and Chronicity
Rapid Cycling
Antidepressant-induced Mania/Hypomania
Seasonality and Climate
Changes in Episode Frequency
Neurobiology and Pathophysiology
Hypotheses
Animal Models
Post-mortem Studies
Neuroimaging Studies
Genetic Studies
Evaluation, Tests, and Laboratory Work-Up
Diagnosis of Bipolar Disorder
Differential Diagnosis
Schizophrenia and Schizoaffective Disorder
Major Depressive Disorder
Anxiety Disorders
Substance Use Disorders
Borderline Personality Disorder
Secondary Mania
Bipolar Spectrum Illness
Consequences of Misdiagnosis
Role of Diagnostic Testing (Including Neuroimaging and Other Biomarkers)
Tools for Screening, Diagnosis, and Symptom Monitoring
Treatment
Determination of Mood State and Symptom Severity
Treatment Strategies
General Treatment Strategies
Approach to Mania
Approach to Mixed States
Approach to Depression
Approach to Maintenance Treatment
Use of Psychosocial Interventions
Special Considerations in Treatment
Features of Course
Psychiatric and Medical Co-Morbidity
Bipolar II
Pregnancy
Childhood, Adolescence, and Geriatric Patients
Prognosis
Medical Co-Morbidity among Bipolar Patients
Controversies
Child Bipolar
Key References
References
Chapter 31: Psychiatric Illness during Pregnancy and the Post-partum Period
Key Points
Overview
Diagnosis and Treatment of Mood Disorder during Pregnancy
Antidepressant Use during Pregnancy
Pharmacological Treatment of Depression during Pregnancy: Clinical Guidelines
Bipolar Disorder during Pregnancy
Psychotic Disorders during Pregnancy
Anxiety Disorders during Pregnancy
Electroconvulsive Therapy during Pregnancy
Post-Partum Mood and Anxiety Disorders: Diagnosis and Treatment
Breastfeeding and Psychotropic Drug Use
Perinatal Psychiatry: From Screening to Treatment
Key References
References
Chapter 32: Anxiety Disorders
Key Points
Overview
Panic Disorder and Agoraphobia
Introduction
Clinical Characteristics and Diagnosis
Panic Disorder
Agoraphobia
Panic Attack Specifier
Epidemiology
Impairment and Quality of Life
Co-morbidity
Pathophysiology
Neurobiology
Psychopathological Processes
Social Anxiety Disorder
Clinical Characteristics and Diagnosis
Epidemiology
Impairment and Quality of Life
Co-morbidity
Pathophysiology
Neurobiology
Psychophysiology
Cognitive-behavioral models
Generalized Anxiety Disorder
Overview
Clinical Characteristics and Diagnosis
Epidemiology
Impairment and Quality of Life
Co-morbidity
Pathophysiology
Neurobiology
Psychopathological processes
Conclusion
Key References
References
Chapter 33: Obsessive-compulsive Disorder and Obsessive-compulsive and Related Disorders
Key Points
Overview
Clinical Features and Diagnosis
Epidemiology and Risk Factors
Prevalence
Age of Onset
Gender
Race and Cultural Factors
Risk Factors
Genetics
Pathophysiology
Evaluation, Tests, and Laboratory Findings
Treatment
Prognosis
Current Controversies, Unanswered Questions, and Future Challenges
Clinician and Patient Resources
Key References
References
Suggested Reading
Chapter 34: Trauma and Posttraumatic Stress Disorder
Key Points
Overview
Diagnosis
Etiology
Clinical Features
Acute Stress Disorder
Differential Diagnosis
Epidemiology
Incidence and Prevalence
Co-morbidity
Risk Factors
Prognosis
Recovery and Course of Illness
Suicide Attempts
Impairment
Pathogenesis
Psychophysiology
Biology
Treatment
Utilization
Psychotherapy
Pharmacotherapy
Current Status of Posttraumatic Stress Disorder Treatment
Current Controversies and Future Directions
Key References
References
Chapter 35: Dissociative Disorders
Key Points
OVERVIEW
History
Causes of Dissociation
The Epidemiology of Dissociation
Different Dissociative Disorders
Dissociative Amnesia
Dissociative Identity Disorder
Depersonalization/Derealization Disorder
Dissociative Disorder Not Otherwise Specified
Factitious Disorders or Malingering of Dissociative Presentations
Conclusion
Key References
References
Chapter 36: Sexual Disorders and Sexual Dysfunction
Key Points
Overview
Epidemiology and Risk Factors
Pathophysiology
Clinical Features and Diagnosis
Approach to Sexual History-taking
Physical Examination and Laboratory Investigation
Diagnostic Features of Specific Sexual Dysfunctions
Male Disorders of Sexual Function
Erectile Disorder.
Delayed Ejaculation.
Premature (Early) Ejaculation.
Male Hypoactive Sexual Desire Disorder.
Female Disorders of Sexual Function
Female Sexual Interest/Arousal Disorder.
Female Orgasmic Disorder.
Genito-Pelvic Pain/Penetration Disorder.
Sexual Dysfunctions Affecting Both Genders
Substance/Medication-Induced Sexual Dysfunction.
Other Specified and Unspecified Sexual Dysfunction.
Diagnostic Features of Specific Paraphilic Disorders
Diagnostic Features of Gender Dysphoria
Gender Dysphoria in Children.
Gender Dysphoria in Adolescents and Adults.
Differential Diagnosis of Sexual Disorders
Treatment
Organically-Based Treatment
Premature Ejaculation
Erectile Disorder
Female Sexual Dysfunction
Paraphilic Disorders
Gender Dysphoria
Psychologically-Based Treatments
Sexual Dysfunction
Paraphilic Disorders
Gender Dysphoria
Future Outlook
Suggested Reading
Chapter 37: Eating Disorders: Evaluation and Management
Key Points
Overview
Classification
Epidemiology
Course, Co-Morbidity, and Mortality Rate
Etiological Factors
Diagnostic Features
Anorexia Nervosa
Bulimia Nervosa
Binge-eating Disorder
Other Specified Feeding or Eating Disorder
Evaluation and Differential Diagnosis
Medical Complications
Medical Assessment
Laboratory Findings
Treatment
Medical Management
Psychotherapeutic Treatment
Anorexia Nervosa
Bulimia Nervosa
Binge-Eating Disorder
Pharmacological Treatment
Pharmacological Management of Anorexia Nervosa
Pharmacological Management of Bulimia Nervosa
Pharmacological Management of Binge-eating Disorder
Pharmacological Considerations in Treating Children and Adolescents
Conclusions
Current Controversies and Future Considerations
Key References
References
Suggested Reading
Chapter 38: Grief, Bereavement, and Adjustment Disorders
Key Points
Grief and Bereavement
Definition
Epidemiology and Risk Factors
Clinical Findings and Differential Diagnosis
Treatment Options
Complications
Prognosis
Adjustment Disorders
Epidemiology
Clinical Findings and Differential Diagnosis
Treatment Options
Prognosis
References
Suggested Readings
Chapter 39: Personality and Personality Disorders
Key Points
Overview
Personality Theory
The Origins of Personality
Adult Personality Traits
DSM-5 Personality Disorders
Cluster A Personality Disorders
Paranoid Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder
Cluster B Personality Disorders
Antisocial Personality Disorder
Borderline Personality Disorder
Histrionic Personality Disorder
Narcissistic Personality Disorder
Cluster C Personality Disorders
Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive-compulsive Personality Disorder
DSM-5 Personality Disorders
DSM-5 Section III: Hybrid Diagnosis
Criterion A: Level of Personality Functioning
Criterion B: Traits and Types
Diagnosing Personality Disorders
Treatment of Personality Disorders
Psychotherapy
Pharmacotherapy
Agents
Antipsychotics.
Mood Stabilizers.
Antidepressants.
Benzodiazepines.
Opioid Antagonists.
Approach to the Pharmacotherapy of Personality Disorders
Key References
References
Part X: Treatment Approaches
Chapter 40: Psychiatric Neuroscience:
Key Points
Overview
History of Psychiatric Neuroscience
Psychiatric Diagnosis: Biomarkers and Biological Validity
Methods in Psychiatric Neuroscience
Brain Lesions and Behavior
Neuropsychology and Endophenotypes
Neuroimaging
Neurophysiology
Brain Stimulation and Neuromodulation
Neuropathology
Psychopharmacology
Animal Experiments
Human Genetics and Molecular Biology
Biological Case Formulation: Neuroscientific Content and Process
Process
Content
Overview of the Structure of the Central Nervous System
Cellular Diversity in the Brain: Neurons and Glia
Neurons
Glia
The Structure of the Synapse
Neurotransmitters
Synaptic Transmission, Second Messenger Systems, and Activity-Dependent Gene Expression
A Review of Clinically Relevant Neurotransmitter Systems
Glutamate
The N-methyl-d-aspartate Receptor and the Role of Glutamate in Neuropsychiatric Illness
GABA
GABA Receptors
GABA in Neuropsychiatric Illness
Dopamine
Dopamine Pathways and Relevance to Neuropsychiatry
Dopamine Synthesis, Binding, and Inactivation and More Clinical Correlates
Norepinephrine
Norepinephrine in Opiate Withdrawal
Serotonin
Acetylcholine
Acetylcholine and Cognition
Histamine
Other Neurotransmitters, and Interactions among Neurotransmitters
Genes, Environment, and Epigenetics
Conclusion
Acknowledgments
Key References
References
Chapter 41: The Pharmacotherapy of Anxiety Disorders
Key Points
Overview
Panic Disorder and Agoraphobia
Antidepressants
Tricyclic Antidepressants (TCAs)
Monoamine Oxidase Inhibitors
Benzodiazepines
Other Agents
Generalized Anxiety Disorder
Antidepressants
Selective serotonin Reuptake Inhibitors and Serotonin Norepinephrine Reuptake Inhibitors
Tricyclic Antidepressants
Benzodiazepines
Buspirone
Anticonvulsants
Antipsychotics
Other agents
Riluzole
Chamomile
Kava
Social Anxiety Disorder
Selective serotonin Reuptake Inhibitors and Serotonin Norepinephrine Reuptake Inhibitors
Beta-blockers
Monoamine Oxidase Inhibitors
Benzodiazepines
Other medications
Conclusions and Future Directions
References
Chapter 42: Antipsychotic Drugs
Key Points
Introduction
History
Chlorpromazine and the Early Agents
Clozapine, the First Atypical Antipsychotic
Other Atypical Agents
The CATIE Study
Currently Available Antipsychotic Agents
General Clinical Considerations
Drug Selection
First-Generation (“Typical”) Antipsychotics
Extrapyramidal Symptoms and Tardive Dyskinesia
Neuroleptic Malignant Syndrome
Second-Generation (“Atypical”) Antipsychotics
Clozapine
Risperidone and Paliperidone
Olanzapine
Quetiapine
Ziprasidone
Aripiprazole
Iloperidone
Asenapine
Lurasidone
Drug Interactions with Antipsychotic Agents
Ongoing Challenges
Key References
References
Chapter 43: Antidepressants
Key Points
Overview
Mechanism of Action
Mechanism of Action of Selective Serotonin Re-uptake Inhibitors
Mechanism of Action of Serotonin Norepinephrine Re-uptake Inhibitors
Mechanism of Action of Norepinephrine Re-uptake Inhibitors
Mechanism of Action of Serotonin Receptor Agonist/Antagonists
Mechanism of Action of Norepinephrine/Dopamine Re-uptake Inhibitors
Mechanism of Action of Alpha2-Adrenergic Receptor Antagonists
Mechanism of Action of Tricyclic Antidepressants
Mechanism of Action of Monoamine Oxidase Inhibitors
Clinical Uses of Antidepressants
Continuation and Maintenance of Antidepressant Treatment
Suicide Risk
Choice of an Antidepressant
Selective Serotonin Re-uptake Inhibitors
Dosage
Side-effect Profile
Selective Serotonin Re-uptake Inhibitors Discontinuation Syndrome
Drug Interactions
Use of Selective Serotonin Re-uptake Inhibitors in Pregnancy and the Post-partum Period
Serotonin Norepinephrine Re-uptake Inhibitors
Venlafaxine and Desvenlafaxine
Duloxetine
Levomilnacipran and Milnacipran
Norepinephrine Re-uptake Inhibitors
Reboxetine
Atomoxetine
Norepinephrine/Dopamine Re-uptake Inhibitors
Bupropion
Serotonin Receptor Antagonists/Agonists
Trazodone
Nefazodone
Vilazodone
Vortioxetine
Ritanserin
Agomelatine
Buspirone and Gepirone
Alpha2-Adrenergic Receptor Antagonists
Mirtazapine
Mianserin
Tricyclic and Related Cyclic Antidepressants
Side-effect Profile
Prescribing Tricyclic and Related Cyclic Antidepressants
Use of Tricyclic and Related Cyclic Antidepressants during Pregnancy and the Post-partum Period
Overdoses with Tricyclic and Related Cyclic Antidepressants
Drug Interactions
Monoamine Oxidase Inhibitors
Side-effect Profile
Dietary Restrictions and Drug Interactions
Dosage
Overdose
Drug Interactions
Key References
References
Chapter 44: Pharmacological Approaches to Treatment-Resistant Depression
Key Points
OVERVIEW
Definition of Treatment-Resistant Depression
Staging Models of Treatment-Resistant Depression
Clinical Features Associated with Treatment-Resistant Depression
Clinical Approach to Treatment-Resistant Depression
Common Treatment Strategies for Treatment-Resistant Depression
Switching an Antidepressant
Combining Two Antidepressants with Different Mechanisms of Action
Augmentation
Lithium
Triiodothyronine (T3)
Atypical Antipsychotics
Buspirone
l-Methylfolate
S-adenosyl-l-methionine
Novel Therapeutic Agents
Non-pharmacological Interventions
Research Challenges
Conclusions
References
Chapter 45: Electroconvulsive Therapy
Key Points
Overview
Indications for Electroconvulsive Therapy
Risk Factors Associated with Electroconvulsive Therapy
Technique for Conducting Electroconvulsive Therapy
Adverse Effects of Electroconvulsive Therapy
Maintenance Electroconvulsive Therapy Treatment
Electroconvulsive Therapy in Children
Conclusion
References
Chapter 46: Neurotherapeutics
Key Points
Overview
Ablative Limbic System Surgery
Deep Brain Stimulation
Vagus Nerve Stimulation
Electroconvulsive Therapy
Transcranial Magnetic Stimulation
Conclusion
Key References
References
Chapter 47: Lithium and Its Role in Psychiatry
Key Points
Historical Context
Lithium’s Mechanism of Action
Pharmacokinetics and Pharmacodynamics
Evidence for Lithium’s Efficacy
Lithium in Acute Mania
Lithium in Acute Bipolar Depression
Lithium for Maintenance Treatment and Relapse Prevention of Bipolar Disorder
Lithium in Rapid-cycling Bipolar Disorder
Lithium in Suicide Prevention
Lithium in Children and Adolescents
Pediatric Bipolar Disorder
Conduct Disorder
Other Uses of Lithium
Augmentation of Antidepressants in Treatment-refractory Major Depressive Disorder
Relapse Prevention in Major Depressive Disorder
Lithium in Psychotic Disorders
Lithium in Alcohol Dependence
Principles of Lithium Treatment
Predictors of Lithium Response
Laboratory Monitoring
Lithium Dosing
Adverse Effects and Their Management
Other Bothersome Adverse Effects
Lithium in Pregnancy and Breast-feeding
Lithium Adherence
Current Controversies and Future Directions
Key References
References
Chapter 48: The Use of Antiepileptic Drugs in Psychiatry
Key Points
Overview: Historical Context
Valproic Acid
Lamotrigine
Carbamazepine
Pharmacokinetics, Pharmacodynamics, Adverse Effects, and Monitoring
Valproic Acid
Lamotrigine
Carbamazepine
Other Anticonvulsants
Oxcarbazepine
Gabapentin
Levetiracetam
Pregabalin
Tiagabine
Topiramate
Zonisamide
Conclusion
References
Chapter 49: Pharmacotherapy of Attention-Deficit/Hyperactivity Disorder across the Life Span
Key Points
Overview
Stimulants
Pharmacodynamic Properties of Stimulants
Methylphenidate
Amphetamines
Clinical Use of Stimulants
Side Effects of Stimulants
Growth
Sleep
Appetite Suppression
Medication Interactions with Stimulants
Atomoxetine
Clinical Use of Atomoxetine
Side Effects of Atomoxetine
Alpha-adrenergic Agonists
Suggested Management Strategies Across the Life span
Safety of Medications Used to Treat Attention-Deficit/Hyperactivity Disorder
Cardiovascular Safety of Attention-Deficit/Hyperactivity Disorder Treatments
Aggression during Treatment with Attention-Deficit/Hyperactivity Disorder Medications
Psychotic or Manic Symptoms during Treatment with Attention-Deficit/Hyperactivity Disorder Medications
Alternative (Not FDA-Approved) Treatments for Attention-Deficit/Hyperactivity Disorder
Bupropion
Tricyclic Antidepressants
Modafinil
Novel Treatments for Attention-Deficit/Hyperactivity Disorder
Nicotinic Agents
Medications Used in the Treatment of Alzheimer’s Disease
Metadoxine
Selegiline
Pharmacotherapy of Attention-Deficit/Hyperactivity Disorder and Common Co-Morbid Psychiatric Disorders
Attention-Deficit/Hyperactivity Disorder and Aggression
Attention-Deficit/Hyperactivity Disorder Plus Anxiety Disorders
Attention-Deficit/Hyperactivity Disorder Plus Obsessive-compulsive Disorder
Attention-Deficit/Hyperactivity Disorder Plus Tic Disorders
Attention-Deficit/Hyperactivity Disorder Plus Depression
Attention-Deficit/Hyperactivity Disorder Plus Bipolar Disorder
Attention-Deficit/Hyperactivity Disorder Plus Substance Use Disorders
Attention-Deficit/Hyperactivity Disorder Plus Autism Spectrum Disorders
Attention-Deficit/Hyperactivity Disorder Plus Epilepsy
Managing Sub-Optimal Responses
Conclusion
Key References
References
Chapter 50: Drug–Drug Interactions in Psychopharmacology
Key Points
Overview
Classification
Pharmacokinetics
Absorption
Distribution
Metabolism
Excretion
Antipsychotics
Mood Stabilizers
Lithium
Valproic Acid
Lamotrigine
Carbamazepine
Antidepressants
Selective Serotonin Reuptake Inhibitors and Other Newer Antidepressants
P450 2D6
P450 3A4
P450 2C
P450 1A
Tricyclic Antidepressants
Monoamine Oxidase Inhibitors
St. John’s Wort
Benzodiazepines
Psychostimulants and Modafinil
Key References
References
Chapter 51: Side Effects of Psychotropic Medications
Key Points
Overview
Antidepressants
Tricyclic Antidepressants
Selective Serotonin Reuptake Inhibitors
Serotonin-Norepinephrine Reuptake Inhibitors
Venlafaxine
Duloxetine
Monoamine Oxidase Inhibitors
Other Antidepressants
Bupropion
Mirtazapine
Trazodone
Vilazodone
Mood Stabilizers
Lithium
Valproic Acid
Carbamazepine
Oxcarbazepine
Lamotrigine
Antipsychotics
Typical Antipsychotics
Atypical Antipsychotics
Risperidone
Paliperidone
Iloperidone
Asenapine
Lurasidone
Ziprasidone
Aripiprazole
Olanzapine
Clozapine
Antianxiety and Sleep Agents
Benzodiazepines
Short-acting Sedative-Hypnotic Sleep Agents (Zolpidem, Zaleplon, and Eszopiclone)
Ramelteon
Buspirone
Gabapentin
Other Agents Used in the Treatment of Psychiatric Conditions
Beta-blockers
Clonidine
Stimulants
Modafinil
Atomoxetine
Anticholinergics
Topiramate
Acamprosate
Naltrexone
Buprenorphine
Key References
References
Chapter 52: Natural Medications in Psychiatry
Key Points
Overview
Efficacy and Safety
Mood Disorders
Omega-3 Fatty Acids
St. John’s Wort
S-Adenosylmethionine
Folate and Vitamin B12
Inositol
Anxiety and Insomnia
Valerian
Melatonin
Kava
Premenstrual and Menopausal Symptoms
Black Cohosh
Chaste Tree Berry
Cognition and Dementia
Ginkgo biloba
Dehydroepiandrosterone
Conclusion
Key References
References
Part XI: Special Topics in Psychiatry
Chapter 53: The Suicidal Patient
Key Points
Overview
Epidemiology and Risk Factors
Epidemiology
Psychiatric Risk Factors
Medical Risk Factors
Familial and Genetic Risk Factors
Social Risk Factors
Past and Present Suicidality
Contact with Physicians
Pathophysiology
Neurobiology
Psychological, Psychodynamic, and Neuropsychological Perspectives
Clinical Features and Diagnosis
Treatment of Suicide Risk
Difficulties in the Assessment of Suicide Risk
Key References
References
Suggested Reading
Part XII: Psychosomatic Medicine
Chapter 54: Psychiatric Consultation to Medical and Surgical Patients
Key Points
Overview
Epidemiology and Differential Diagnosis
Principles of Psychiatric Evaluation of Medical and Surgical Patients
Speak with the Consultee
Review the Record
Review Medications
Gather Information from Family and Others
Interview the Patient
Conduct a Mental Status Examination
Arousal
Attention
Motivation
Language
Memory
Executive Function
Structured Instruments
Conduct Physical and Neurological Examinations
Write a Note
Speak with the Consultee
Treatment
Biological
Psychological
Social
Special Situations
Diagnosis, Treatment, and Patient Advocacy
Somatic Symptom Disorders
The Reticent Patient
Difficult and Hateful Patients
Conclusions
Key references
References
Chapter 55: Life-threatening Conditions in Psychiatry: Catatonia, Neuroleptic Malignant Syndrome, and Serotonin Syndrome
Key Points
Overview
Catatonia
Definition
Epidemiology and Risk Factors
Subtypes
Clinical Features and Diagnosis
Pathophysiology
Management and Treatment
Prognosis and Complications
Neuroleptic Malignant Syndrome
Epidemiology and Risk Factors
Clinical Features and Diagnosis
Management and Treatment
Serotonin Syndrome
Definition
Epidemiology
Clinical Features and Diagnosis
Pathophysiology
Management and Treatment
Prognosis and Complications
Key References
References
Chapter 56: Psycho-oncology: Psychiatric Co-morbidities and Complications of Cancer and Cancer Treatment
Key Points
The Role of Psychiatry in the Care of Cancer Patients
Denial and “Middle Knowledge”
Hope and the Doctor–Patient Relationship
Medical Choices
Distress
Screening
Psychosocial Interventions
Anxiety Syndromes
Nausea and Vomiting
Depression
Fatigue
Prevalence
Diagnosis
Treatment
Stimulants
Exercise
Behavioral Interventions
Confusion and Cognitive Impairment
Hypercalcemia
Hyponatremia
Brain Tumors
Leptomeningeal Disease
Delirium in Hematopoietic Stem Cell Transplantation
Hyperviscosity Syndrome
Cushing’s Syndrome
Paraneoplastic Neurological Disorders
Paraneoplastic Limbic Encephalitis
Toxic Leukoencephalopathy
Chemotherapy-related Cognitive Impairment
Effects of Hormonal Therapy in Cancer Patients
Survivors of Childhood Cancer
Key References
References
Chapter 57: Psychiatric Aspects of HIV Infection and AIDS
Key Points
Overview
Epidemiology
Basic Biology
Classification and Diagnosis
General Approach to Psychiatric Care
Psychiatric Disorders
Substance Use Disorders
Depressive and Anxiety Disorders
Psychotic Disorders
HIV-associated Psychosis
“AIDS Mania”
Cognitive Disorders
Delirium
HIV-associated Neurocognitive Disorder
Neurological Disorders
Treatment
Special Clinical Problems
Adherence
Fatigue
Suicide
Serious Mental Illness
Co-infection with HIV and Hepatitis C
Cigarette Smoking
Internet Resources
Key References
References
Chapter 58: Organ Transplantation: Pre-transplant Assessment and Post-transplant Management
Key Points
Overview
Psychiatric Evaluation of the Transplant Patient
Pre-transplant Psychiatric Evaluation
Pre-transplant Psychiatric Disorders
Treatment of the Pre-Transplant Patient
Care of the Post-Transplant Patient
Short-term Care
Long-term Care
Pediatric Transplantation
Pre-transplant Evaluation
Post-transplant Care
Conclusion
References
Chapter 59: Approaches to Collaborative Care and Primary Care Psychiatry
Key Points
Overview
Epidemiology
Barriers to Treatment
The Goals of Collaboration
Access
Treatment
Outcomes
Communication
Roles, Relationships, and Expectations
Models of Collaboration
Outpatient Consultation Models
Specialty Psychiatric Clinics
Consultation Psychiatrists
Three-component Model
Psychiatrist on the Primary Care Clinic Medical Staff
Staff Consultant
Parallel Care
Collaborative Management
Primary-care-driven Model
Choosing the Right Model
Conclusion
Key References
References
Chapter 60: Psychiatric and Ethical Aspects of Care at the End of Life
Key Points
Overview
Goals of Treatment
The Role of the Psychiatrist
Depression
Anxiety
Personality Considerations
Delirium and Cognitive Changes
Pain
Psychosocial Considerations
Challenges for Care Providers
Ethics and End-of-Life Care
Principles
Limitation of Life-sustaining Treatment
Physician-assisted Suicide
Conclusion
Key References
References
Part XIII: Psychiatric Epidemiology and Statistics
Chapter 61: Psychiatric Epidemiology
Key Points
Overview
Epidemiological Measures of Disease Frequency
Criteria for Assessment Instruments
Assessment of New Instruments
Study Designs
Descriptive Studies
Ecological Studies
Cross-sectional Studies
Case-control Studies
Cohort Studies
Randomized Controlled Trials
Development of Assessment Tools
Case Definition
Standardized Instruments for Case Assessment
Contemporary Studies in Psychiatric Epidemiology
The Baseline National Comorbidity Survey (NCS)
The NCS General Findings
NCS-Replication Survey
Mental Health Services Utilization
The European Study of the Epidemiology of Mental Disorders Project
Epidemiology
Under utilization of Health Services
Epidemiology of Major Psychiatric Disorders
Schizophrenia
Epidemiology
Risk Factors
Bipolar I Disorder
Epidemiology
Risk Factors
Co-morbidities
Major Depressive Disorder
Epidemiology
Risk Factors
Depression as the Cause of Disability
Generalized Anxiety Disorder
Epidemiology
Risk Factors
Panic Disorder
Epidemiology
Risk Factors
Social Burdens of Panic
Alcohol Abuse and Dependence
Epidemiology
Risk Factors
Co-morbidity
References
Chapter 62: Statistics in Psychiatric Research
Key Points
Three Classes of Statistics in Psychiatric Research
Concrete Examples of the Three Classes of Statistics in a Research Article
Experiment-wise Error Rate
Selecting an Appropriate Statistical Method
The Importance of Assessing Statistical Power
Statistical Terms and Their Definitions
Analysis of Covariance
Analysis of Variance
Analysis of Variance with Repeated Measure(s)
Bonferroni Correction
Canonical Correlation
Chi-Square (χ2) Test
Cluster Analysis
Confidence Interval
Contingency Table Analysis by Chi-Square (χ2)
Correlation
Correlation Matrix
Covariate
Dependent t-Test
Dependent Variable
Descriptive Statistics
Discriminant Function Analysis
Effect Size
End-point
Experiment-wise Error Rate
Factor Analysis
Frequencies
Intent-to-Treat Analysis
Interaction Effect
Level of Measurement
Logistic Regression
MANCOVA
Mann–Whitney U Test
MANOVA
Mean
Median
Mediation
Mixed-effect Model Repeated Measure Model
Moderation
Multiple Linear Regression
Multivariate Analysis of Variance
Multivariate Statistical Analysis
Null Hypothesis
Outcome Variable
P-Value
Pearson Correlation Coefficient
Phi Correlation Coefficient
Planned Comparisons
Point-Biserial Correlation
Power
r
Random Assignment
Rank-Order Correlation
Regression
Reliability
Rho
Standard Deviation
Statistical Analysis Software
Statistical Power
Tau
t-Test
t-Test for Dependent Means
Univariate Statistical Analysis
Validity
Variance
Current Controversies and Future Directions
Suggested Reading
Part XIV: Genetics and Psychiatry
Chapter 63: Genetics and Psychiatry
Key Points
Overview
Basic Organization of the Human Genome
Genetic Variation and Polymorphism
Linkage Disequilibrium and Haplotypes
Gene Expression
The Complex Genetic Architecture of Psychiatric Disorders
Approaches to the Study of Psychiatric Genetics
Genetic Epidemiology
Family Studies.
Twin Studies.
Adoption Studies.
Linkage Analysis.
Association Analysis.
Candidate Gene Studies
Genome-Wide Association Studies
Copy Number Variants
Whole-Exome Sequencing
Gene–Environment Interaction
Intermediate Phenotypes and Endophenotypes
Genetics of Psychiatric Disorders
Genetic Aspects of Psychopathology
Disorders of Childhood and Adolescence
Attention-Deficit/Hyperactivity Disorder
Genetic Epidemiology.
Molecular Genetic Studies.
Autism
Genetic Epidemiology.
Molecular Genetic Studies.
Tourette Syndrome
Genetic Epidemiology.
Molecular Genetic Studies.
Dementia
Alzheimer’s Disease
Genetic Epidemiology.
Molecular Genetic Studies.
Psychotic Disorders
Schizophrenia
Genetic Epidemiology.
Molecular Genetic Studies.
Mood Disorders
Bipolar Disorder
Genetic Epidemiology.
Molecular Genetic Studies.
Major Depressive Disorder
Family Studies.
Molecular Genetic Studies.
Anxiety Disorders
Panic Disorder
Family Studies.
Molecular Genetic Studies.
Phobic Disorders
Genetic Epidemiology.
Molecular Genetics.
Generalized Anxiety Disorder
Genetic Epidemiology.
Molecular Genetics.
Obsessive-Compulsive Disorder
Genetic Epidemiology.
Molecular Genetic Studies.
Substance Use Disorders
Alcohol Abuse and Dependence
Family Studies.
Molecular Genetic Studies.
Drug Abuse and Dependence
Genetic Epidemiology.
Molecular Genetic Studies.
Pharmacogenetics
Psychiatric Aspects of Medical Genetic Disorders
Psychiatric Symptoms Secondary to Genetic Syndromes
Selected Genetic Syndromes with Psychiatric and Behavioral Symptoms (Table 63-2)
Disorders Due to Chromosomal Abnormalities and Microdeletions
Klinefelter Syndrome
Turner Syndrome
Duplication 15
Prader-Willi Syndrome
Velocardiofacial Syndrome
Smith-Magenis Syndrome
Williams Syndrome
Disorders Due to Single Gene Mutations
Fragile X Syndrome
Huntington Disease
Rett Syndrome
Tuberous Sclerosis
Selected Inborn Errors of Metabolism with Psychiatric and Behavioral Symptoms (see Table 63-3)
Autosomal Dominant Disorders
Acute Intermittent Porphyria
Autosomal Recessive Disorders
Homocystinuria
Metachromatic Leukodystrophy (Juvenile- or Adult-onset Forms)
Niemann-Pick, Type C
Tay-Sachs, Late-onset Form
Wilson Disease
X-Linked Disorders
Adrenoleukodystrophy
Mitochondrial Disorders
Conclusion
Clinical Applications of Psychiatric Genetics
References
Part XV: Social and Community Psychiatry
Chapter 64: Serious Mental Illness
Key Points
Overview
Definition and Scope of the Problem
Complications of Serious Mental Illness
Comprehensive Assessment
Treatment and Recovery Goals
Establishing a Collaborative Treatment Relationship
Preventing Suicide
Preventing Violence
Preventing Late-stage Psychiatric Disease and Disability
Preventing Medical Morbidity and Mortality
Reducing Substance Misuse
Improving Quality of Life
Ongoing Challenges
Key References
References
Chapter 65: Aggression and Violence
Key Points
Overview
Epidemiology and Risk Factors
Pathophysiology
Clinical Features and Diagnosis
Medical Causes
Psychiatric Causes
Psychotic Disorders
Affective Disorders
Disruptive, Impulse-control, and Conduct Disorders
Post-traumatic Stress Disorder
Personality and Developmental Disorders
Psychosocial Factors
Assessment in the Acute Setting
The Interview
History
Examination of the Violent Patient
Management in the Acute Setting
Strategies for Long-Term Management
Current Controversies and Future Considerations
Key References
References
Chapter 66: Culture and Psychiatry
Key Points
Overview
Cultural Assessment
Determination of Cultural Identity of the Individual
Determination of Cultural Conceptualizations of Distress
Determination of Psychosocial Stressors and Cultural Features of Vulnerability and Resilience
Determination of the Cultural Features between the Individual and the Clinician
Impact of Ethnicity on Psychiatric Diagnosis
Differences in Presentation of Illness
Acculturation and Immigration
Culture-Bound Syndromes (Cultural Concept of Distress)
Working with Interpreters
Recommendations When Working with Interpreters
Ethnicity and Psychopharmacology
Biological Aspects of Psychopharmacology
Techniques to Minimize Cultural Clashes, Misdiagnosis, and Adverse Events
References
Chapter 67: Community Psychiatry
Key Points
Overview
Terms and Definitions
Related Fields
Social and Public Health Terms
Terms of Managed Care
Historical Background
The Age of Enlightenment
Early Twentieth-century Awareness
Mid-twentieth Century
Birth of the American Community Mental Health Movement
Late Twentieth Century
Start of the Twenty-first Century
Underlying Principles of Community Mental Health
Population Responsibility
Prevention
Community-based Care
Continuity of Care
Components and Services of Community Mental Health Systems
Inpatient Care
Partial Hospitalization
Outpatient Services
Emergency Services
Community Consultation/Education
Case Management
Homeless Outreach
Disaster or Trauma Response
Evaluation and Research
Trends
Disenfranchisement
Managed Care: The “Fourth Psychiatric Revolution?”
Primary Care
Creative Solutions
Conclusion
Key References
References
Chapter 68: Managed Care and Psychiatry
Key Points
Overview
The History of Mental Health Care Finance in the United States
The Rise of Private Health Insurance
The Community Mental Health Center Movement and Deinstitutionalization
The Rise of Public Health Insurance: Medicare and Medicaid
Insuring Mental Health Care: Moral Hazard, Adverse Selection, and the Rise of Managed Behavioral Carve-Outs
Managed Care and the Rise of “Carve-Out” Plans
Recent Trends in Mental Health Care Financing
Gross Spending on Mental Health Care
Sources of Health Care Expenditures
Parity, Expansion of Coverage, and the Future of Mental Health Care in the United States
Conclusion
Key References
References
Part XVI: Child Psychiatry
Chapter 69: Child and Adolescent Psychiatric Disorders
Key Points
Overview
Developmental Variations in Psychopathology
Childhood Anxiety Disorders
Separation Anxiety
Treatment of Separation Anxiety
Psychosocial Treatments for Separation Anxiety.
Pharmacotherapy for Separation Anxiety.
Obsessive-compulsive Disorder
Treatment of Obsessive-compulsive Disorder
Psychosocial Treatment of Obsessive-compulsive Disorder.
Pharmacotherapy of Obsessive-compulsive Disorder.
Generalized Anxiety Disorder
Treatment of Generalized Anxiety Disorder
Psychosocial Treatments for Generalized Anxiety Disorder.
Pharmacotherapy for Pediatric Generalized Anxiety Disorder.
Acute Stress Disorder/Post-traumatic Stress Disorder
Treatment of Acute Stress Disorder/Post-traumatic Stress Disorder
Psychosocial Treatments of Acute Stress Disorder/Post-traumatic Stress Disorder.
Pharmacotherapy for Acute Stress Disorder/Post-traumatic Stress Disorder.
Tic Disorders
Treatment of Tic Disorders
Psychosocial Treatments for Tic Disorders
Pharmacotherapy for Tic Disorders
Attention-Deficit/Hyperactivity Disorder
Treatment of Attention-deficit/ Hyperactivity Disorder
Psychosocial Treatments of Attention-deficit/Hyperactivity Disorder
Pharmacotherapy of Attention-deficit/ Hyperactivity Disorder
Oppositional Defiant Disorder
Treatment of Oppositional Defiant Disorder
Psychosocial Interventions
Pharmacotherapy of Oppositional Defiant Disorder
Mood Disorders
Depression
Treatment of Depressive Disorders
Psychosocial Treatment of Juvenile Depression.
Pharmacotherapy of Juvenile Depression.
SSRI Antidepressants and Suicidality
Clinical Use of SSRIs
Disruptive Mood Dysregulation Disorder
Bipolar Disorder
Treatment of Pediatric Bipolar Disorders
Psychosocial Treatments for Bipolar Disorder.
Pharmacotherapy of Bipolar Disorder.
Lithium.
Anticonvulsants.
Antipsychotics for Juvenile Bipolar Disorder.
Autism Spectrum Disorder
Treatment of Autism Spectrum
Psychosocial Treatments for Autism Spectrum Disorder
Pharmacotherapy of Autism Spectrum Disorder
Psychotic Disorders
Treatment of Childhood-onset Schizophrenia
Psychosocial Treatments for Childhood- onset Schizophrenia
Pharmacotherapy of Childhood-onset Schizophrenia
Key References
References
Chapter 70: Psychiatric and Substance Use Disorders in Transitioning Adolescents and Young Adults
Key Points
Overview
Salient Neurobiology of Transitioning Adolescents and Young Adults
Epidemiology
Substance Abuse in Transitioning Adolescents and Young Adults
Medication Misuse in Transitioning Adolescents and Young Adults
Signs and Symptoms of Prescription Drug Abuse
Treatment Issues
Conclusion
Acknowledgments
Key References
References
Part XVII: Geriatric Psychiatry
Chapter 71: Geriatric Psychiatry
Key Points
Overview
Mental Health Disorders Common in Late Life
Late-life Depression
Late-life Depression and Suicide
Alcoholism
Anxiety
Psychosis
Dementia
Behavioral and Psychological Symptoms of Dementia
Schizophrenia
Bipolar Disorder
Personality Disorders
Disasters
Caregiver Stress and Burden
Elder Abuse
References
Part XVIII: Neuropsychiatry
Chapter 72: Neuroanatomical Systems Relevant to Neuropsychiatric Disorders
Key Points
Overview
Prefrontal Cortex
Orbitofrontal Cortex
Medial Prefrontal Cortex
Dorsolateral Prefrontal Cortex
Prefrontal Cortex: Summary and Conclusions
Basal Ganglia
Basal Ganglia Anatomy
Nuclei
Connections
Basal-Ganglia-Thalamocortical Circuits or “Loops”
Striatal Organization
Pallidal Complex Organization
Subthalamic Nucleus Organization
Substantia Nigra Organization
Basal Ganglia Function
Overall
Motor
Cognition
Affective and Reward-Related Functions
Medial Temporal Lobe: Amygdala and Hippocampus
Amygdala Nuclear and Cellular Structure
Intrinsic Amygdala Connections
Extrinsic Amygdala Connections
Outputs
Inputs
Functions of the Amygdala
The Amygdala and Emotional Processing in Health and Psychiatric Disease
Genetic and Neurotransmitter Associations of the Amygdala
Hippocampal and Parahippocampal Cellular Structure
Intrinsic Connections of the Medial Temporal Lobe Memory System
Extrinsic Connections of the Medial Temporal Lobe Memory System
Genetic Influences on the Medial Temporal Lobe Memory System
The Medial Temporal Lobe Memory System in Neuropsychiatric Disorders
Conclusion
References
Chapter 73: The Neurological Examination
Key Points
Overview
The Examination
The Psychiatric Portion of the Mental Status Examination
Initial Observations of the Patient
General Appearance.
Behavioral Appearance.
Speech.
Mood and Affect.
Thought Process.
Thought Content.
Perceptions.
Insight/Awareness/Concern.
Judgment.
The Neurological Portion of the Cognitive Mental Status Examination
Level of Consciousness
Attention
Performance of Serial 7s.
Spelling Tests.
Other Tests.
Language
Comprehension.
Repetition.
Memory
Immediate Recall.
Short-term Memory.
Long-term Memory.
Visuospatial/Constructional Skills
Describing the Results
Cortical Sensory or Secondary Sensory Modalities.
Double Simultaneous Stimulation.
Abstraction.
Praxis (Greek for “Action”).
Executive Function.
Principles of Interpretation of the Mental Status Examination
Cranial Nerves
Olfaction (Cranial Nerve [CN] I)
Optic Nerve (CN II)
Visual Acuity (CN II)
Visual Fields (CN II)
Pupillary Responses (CNs II and III)
Funduscopy (CN II) and the Retina
Ocular Movements (CNs III, IV, and VI)
Trigeminal Nerve (CN V)
Muscles of Mastication
Facial Nerve (CN VII)
Vestibulocochlear Nerve (CN VIII)
Glossopharyngeal and Vagus Nerves (CNs IX and X)
Speech (CNs IX and X)
Palate (CNs IX and X)
Spinal Accessory Nerve (CN XI)
Hypoglossal Nerve (CN XII)
Motor Examination
Muscle Bulk
Tone
Strength
Abnormal Movements
Sensory Examination
Coordination Testing
Rapid Alternating Movements
Heel to Shin
Gait Testing
Reflex Assessment
Deep Tendon Reflexes
Cutaneous or Superficial Reflexes
Plantar Reflex
Primitive Reflexes or Atavistic Reflexes (Mistakenly Called “Frontal Release Signs”)
Key References
References
Chapter 74: Neuropsychiatric Principles and Differential Diagnosis
Key Points
General Principles of Neuropsychiatry
Cognitive-Behavioral Neuroanatomy
Cortical Networks
Frontal-Subcortical Networks
Neuropsychiatric Evaluation
Neuroimaging
Electroencephalogram
Sleep Studies
Lumbar Puncture for Cerebrospinal Fluid Analysis
Neuropsychiatric Differential Diagnosis
Clinical Symptoms and Signs Suggesting Neurological or General Medical Conditions
Treatment Principles
Conclusions
Key References
References
Chapter 75: Neuroimaging in Psychiatry
Key Points
Overview
Structural Neuroimaging Modalities
Computed Tomography
Technology
Contrast
Clinical Utility
Magnetic Resonance Imaging
Technology
Magnetic Resonance Contrast
Clinical Utility
Use of Structural Neuroimaging in Psychiatry
Functional Neuroimaging Modalities
Positron Emission Tomography
Single-Photon Emission Computed Tomography
Use of Functional Neuroimaging in Psychiatry
Use of Neuroimaging in Psychiatric Research
Structural Neuroimaging
Functional Neuroimaging
Conclusion
References
Chapter 76: Clinical Neurophysiology and Electroencephalography
Key Points
Overview
The Normal Routine EEG
EEG and Age
EEG Abnormalities
Non-epileptic EEG Abnormalities
Epileptic EEG Abnormalities
Clinical Utility of the EEG in Psychiatry
The EEG in Delirium and Patients with an Altered Mental Status
The Effect of Medications and Toxins on the EEG
The EEG in Dementia and in Pseudodementia
The EEG in Mood Disorders, Anxiety Disorders, and Obsessive-compulsive Disorder
The EEG in Psychosis
Quantitative EEG
Evoked Potentials
Nerve Conduction
Peripheral Nerve Conduction Studies
Sensory Nerve Conduction
Motor Nerve Conduction
Late Responses
Electromyography
Findings on the Electromyogram
Acute Partial Injury (e.g., Partial Laceration of a Nerve)
Chronic Partial Injury
Complete Injury
Myopathy
Neuromuscular Junction Studies
Key References
References
Chapter 77: Psychiatric Manifestations and Treatment of Seizure Disorders
Key Points
Overview
Epidemiology and Risk Factors
Pathophysiology
Basic Mechanism and Genetics
Classification of Seizures and Epilepsies
Classification of Seizures
Classification of Epilepsy by Etiology and Electro-clinical Syndrome
Clinical Manifestation of Seizures
Generalized Seizures
Focal (Partial) Seizures
Focal Motor Seizures
Experiential Seizures, Epileptic Auras, and Ictal Hallucinations.
The Post-ictal State
Selected Epilepsies and Epileptic Syndromes
Mesial Temporal Lobe Epilepsy
Idiopathic/Genetic Generalized Epilepsy
Status Epilepticus
Evaluation of a Patient with a Seizure
History
Laboratory Investigations
Electroencephalogram
Neuroimaging
Differential Diagnosis
Psychogenic Non-epileptic Seizures
Other Conditions Mimicking Seizures
Treatment for Seizure Disorders
Medical Treatment
Surgery
Vagus Nerve Stimulation
Psychiatric Disturbances in Epilepsy
Depression
Psychosis
Anxiety and Panic
Neuropsychological Disturbances in Epilepsy
Cognitive Impairments
Inter-ictal Personality Traits
Supportive Care and Long-Term Management
Key References
References
Chapter 78: Differential Diagnosis and Treatment of Headaches
Key Points
Overview
Epidemiology and Risk Factors
Genetics
Pathophysiology
Differential Diagnosis
Headache “Red Flags”
Other Secondary Headaches
Treatment
Headache Syndromes: Clinical Features, Diagnosis, and Treatment
Primary Headaches
Tension-type Headaches
Migraine
Chronic Daily Headache
Cluster Headaches
Other Primary Headache Syndromes
Secondary Headaches
Post-traumatic Headache
Intracranial Hemorrhage
Subarachnoid Hemorrhage
Aneurysm
Intracranial Mass Lesions
Ischemic Stoke
Cerebral Venous Thrombosis
Pheochromocytoma
Acute and Chronic Meningitis
Encephalitis
Temporal Arteritis
Trigeminal Neuralgia
Medication-overuse Headaches
Headaches due to Substances of Abuse
Headaches due to Withdrawal from Substances
Conclusion
Key References
References
Suggested Reading
Chapter 79: Pathophysiology, Psychiatric Co-morbidity, and Treatment of Pain
Key Points
Overview
Epidemiology
Pathophysiology of Pain Transmission
Cortical Substrates for Pain and Affect
Interactions between Pain and Psychopathology
Pain Terminology
Assessment of Pain
Core Psychopathology and Pain-Related Psychological Symptoms
Pain and Co-Morbid Psychiatric Conditions
Major Depression
Symptoms
Medication Treatment
Selective Serotonin Reuptake Inhibitors.
Other Antidepressants.
Coping and Psychotherapy
Anxiety Disorders
Symptoms
Treatment
Antidepressants
Somatoform Disorders
Classification
Symptom Presentation
Treatment Concepts
Conversion Disorder
Hypochondriasis
Pain Disorder
Factitious Disorder with Physical Symptoms
General Principals of Multimodal Analgesia
Major Medication Classes
Non-steroidal Anti-inflammatory Drugs
Side Effects.
Muscle Relaxants
Tricyclic Antidepressants
Serotonin-norepinephrine Reuptake Inhibitors
Antiepileptic Drugs
Opioids
Treatment of Neuropathic Pain
Sympathetically-Maintained Pain
Treatment of Pain Behavior and the Use of Multidisciplinary Pain Clinics
Rehabilitation
Conclusions
References
Chapter 80: Psychiatric Aspects of Stroke Syndromes
Key Points
Overview
Definition
Anatomy of Cerebral Circulation
Epidemiology/Risk Factors
Epidemiology
Risk Factors
Risk-profile Generation
Ischemic Stroke
Types
Clinical Presentation
Differential Diagnosis
Examination
Diagnosis
Treatment
Acute Management
Primary Prevention
Secondary Prevention
Prognosis
Hemorrhagic Stroke
Overview
Intracerebral Hemorrhage
Subarachnoid Hemorrhage
Subdural Hematoma/Epidural Hematoma
Clinical Presentation
Differential Diagnosis
History/Examination
Diagnosis
Treatment
Prognosis
Neuropsychiatric Sequelae of Stroke
Acute Symptoms Following Stroke
Post-stroke Delirium
Post-stroke Mania
Post-stroke Psychosis
Other Syndromes
Post-acute Symptoms Following Stroke
Post-stroke Depression
Post-stroke Anxiety
Post-stroke Dementia
Conclusion
Key References
References
Suggested Reading
Chapter 81: Movement Disorders
Key Points
Overview
Pathophysiology
Circuitry
Pharmacology
Electrophysiology
Clinical Findings
Patient History
Physical Examination
Hypokinetic Signs
Rigidity.
Bradykinesia.
Mixed Signs
Rest Tremor.
Action Tremor.
Dystonia.
Hyperkinetic Signs
Chorea and Athetosis.
Dyskinesia.
Akathisia.
Tics.
Myoclonus.
Gait
Movement Disorders with Psychiatric Symptoms
Hypokinetic Syndromes
Idiopathic Parkinson’s Disease
“Parkinson’s Personality”.
Depression.
Treatment-induced Mood Lability and Mania.
Dementia.
Psychosis.
Atypical Parkinsonism
Hyperkinetic Syndromes
Huntington’s Disease
Tourette’s Disorder
Wilson’s Disease
Action Tremors
Drug-Induced Movement Disorders
Acute Drug Reactions
Neuroleptic Malignant Syndrome
Diagnosis.
Treatment.
Akathisia
Acute Dystonia
Drug-induced Ataxia
Drug-induced Action Tremor
Drug-induced Parkinsonism
Tardive Drug Reactions
Diagnosis.
Treatment.
Psychogenic Movement Disorders
Pathophysiology
Diagnosis
Treatment
Key References
References
Chapter 82: Psychiatric Manifestations of Traumatic Brain Disorder
Key Points
OVERVIEW
Epidemiology and Risk Factors
Pathophysiology
Clinical Features
Cognitive Impairment (Table 82-4)
Personality and Behavioral Changes
Psychiatric Disorders
Diagnosis
Evaluation
Treatment
Medications
Antidepressants
Anxiolytics
Benzodiazepines.
Antiepileptic Drugs
Antipsychotics
Stimulants
Environmental Interventions
Cognitive Rehabilitation
Psychotherapy
Conclusion
Key References
References
WebSites
Part XIX: Law and Psychiatry
Chapter 83: Intimate Partner Violence
Key Points
OVERVIEW
Epidemiology
Risk Factors for Victims and Perpetrators
Clinical Presentation of Victims
Clinical Presentation of Perpetrators
The Nature of Violent Relationships
Evaluation
Differential Diagnosis
Treatment Considerations
Conclusion
Key References
References
Chapter 84: Psychiatric Correlates and Consequences of Abuse and Neglect
Key Points
Overview
Types of Abuse and Neglect
Child Abuse and Neglect
Types of Maltreatment
Physical Abuse
Emotional Abuse
Neglect
Emotional Neglect.
Physical Neglect.
Medical Neglect.
Failure to Thrive.
Educational Neglect.
Epidemiology
Risk Factors
Child-associated Risk Factors
Family-associated Risk Factors
Environmental Characteristics
Clinical Features of Abuse and Neglect
Physical Abuse
Emotional Abuse
Neglect
Treatment
Parental Treatment
Child Treatment
Elder Abuse and Neglect
Epidemiology and Risk Factors
Detection and Reporting
Treatment
Key References
References
Suggested Reading
Child and Adolescent
Elderly
Websites
Child and Adolescent
Elderly
Chapter 85: Legal and Ethical Issues in Psychiatry I: Informed Consent, Competency, Treatment Refusal, and Civil Commitment
Key Points
Overview
An Introduction to Interactions with the Legal System
Basic Concepts
Informed Consent
Treatment Refusal
Consent to Participate in Research
Civil Commitment
Civil Commitment of Sex Offenders
Outpatient Commitment
Conclusion
Key References
References
Chapter 86: The Role of Psychiatrists in the Criminal Justice System
Key Points
OVERVIEW
Criminal Competencies
Competency to Plead, Decline Counsel, and Represent Oneself
Competency to be Executed
Criminal Responsibility
Justification Defenses
Excuse Defenses
Ignorance
Compulsion
Duress.
Extreme Passion.
Compulsion Due to Addiction or Insanity.
Lack of Criminal Responsibility
Evaluations of Criminal Responsibility
Demographics of the Insanity Defense
Conclusion
Key References
References
Chapter 87: Legal and Ethical Issues in Psychiatry II: Malpractice and Boundary Violations
Key Points
Overview
The Medical Liability Climate
Malpractice Liability
Liability and Managed Care
Selected Areas of Liability Risk in Psychiatry
Assault, Battery, and False Imprisonment
Misdiagnosis
Failure to Treat
Abandonment
Liability for the Acts of Others
Confidentiality and Privilege
Psychotherapist–Patient Privilege
Suicide
Boundary Violations
Reducing Malpractice Risk
Conclusion
Key References
References
Part XX: Care in Special Settings
Chapter 88: Emergency Psychiatry
Key Points
Overview
Demographics
Types of Delivery Models
The Psychiatric Interview
The Medical Evaluation
The Safety Evaluation
Psychiatric Symptoms and Presentations
The Depressed Patient
The Anxious Patient
The Psychotic Patient
The Manic Patient
The Patient with Intoxication or Withdrawal
Alcohol
Benzodiazepines and Barbiturates
Opiates
Cocaine
Crystal Methamphetamine
Phencyclidine
Marijuana and Herbal Marijuana Alternatives
Bath Salts
The Patient with a Change in Mental Status
The Agitated Patient
Management of Acute Symptoms
Environmental Intervention
Psychological Intervention
Intervention with Medication
Restraint and Seclusion
Treatment after the Acute Crisis
Special Populations
The Personality-Disordered Patient
The Grieving Patient
Victims of Domestic Violence and Trauma
The Homeless Patient
Emergency Assessment of Children
Demographics
Basic Principles
The Evaluation
Management
Legal Responsibilities of the Emergency Psychiatrist
Capacity Evaluation
Confidentiality and Release of Information
Civil Commitment
Mandatory Reporting
Role of the Psychiatrist in Disaster Preparation
References
Chapter 89: Rehabilitation Psychiatry
Key Points
Overview
Psychiatric Complications that Arise in the Context of Chronic Medical Illness and Rehabilitation
Problems that May Occur During Rehabilitation
The Rehabilitation Environment
Common Psychiatric Problems in Patients Undergoing Rehabilitation and in Those with Chronic Medical Illnesses
Some Disabling Neurological Conditions and Their Potential Impact on Psychiatric Diagnosis and Treatment
Depression, Cardiovascular Disease and Cardiac Rehabilitation
Pathophysiology
Diagnosis
Rehabilitation
Treatment
Smoking
Diagnostic Dilemmas
Issues in Patients Receiving Psychiatric Care Who are Also Likely Receiving Rehabilitative Services
Making the Connection
Key References
References
Chapter 90: Military Psychiatry
Key Points
Overview
Psychiatric Syndromes in the Immediate Aftermath of Military Operations and Terrorist Events
Delirium
Depression
Acute Stress Disorder and Post-traumatic Stress Disorder
Somatic Symptom Disorder and Illness Anxiety Disorder (Formerly Hypochondriasis)
Unexplained Physical Symptoms and Conversion Symptoms
Dissociation and Dissociative Disorders
Battle Fatigue and Operational Stress
Effects of Resuscitative Medications
Confidence in a Potentially Toxic Environment
Levels of Clinical Prevention and Intervention: Symptoms Versus Function
Factors Related to Development of Psychiatric Disorders Among Service Members Exposed to Combat or Terrorist Attack
Neurobiological Factors
Predisposing Factors
Protective Factors
Precipitating Factors
Mitigating or Perpetuating Factors
Management and Care Delivery
General Principles
Therapeutic Interventions in Psychiatric Casualties
Military Psychiatric Care in Peacetime
Ethical Challenges
Conclusion
References
Chapter 91: Disaster Psychiatry
Key Points
Overview
History
Disaster Psychiatry
Clincal and Research Challenges
Preparation for a Disaster
Systems
Staged Disaster Intervention
Practical Pointers
Victims of Disaster
Cultural Awareness
Resiliency
Diagnosis
General Principles of Intervention and Treatment
Psychopharmacology
Psychotherapy
Critical Incident Stress Debriefing
Psychological First Aid
Conclusion
References
Suggested Reading
Websites
Part XXI: Preparing for the Future
Chapter 92: Coping with the Rigors of Psychiatric Practice
Key Points
Overview
Epidemiology
Etiologies for Stress and Burnout
Frequent Encounters with Distress
Ethical Dilemmas
Transference and Countertransference
The Perception of Failure
Controlling Affect
Responsibility and Uncertainty
Disruption of Social Relationships
Delayed Gratification
Being the Caregiver
Financial Stress
Special Situations in Psychiatry
Coping with Patient Suicide
A Profound and Enduring Effect
Reactions to Suicide
Coping
Treating Dying Patients
Coping with Boundary Crossings and Violations
Boundary Violations
Decreasing Vulnerability
Coping with Malpractice Litigation
Protecting Yourself
Coping with a Lawsuit
Coping with Residency Training
When the Cobbler’s Children Have No Shoes
Denial of Vulnerability
Negation of Personal and Familial Concerns
Deferment of Seeking Help
How to Recognize Stress in Oneself
Healing the Wounded Healer
Be Your Own Most Important Patient
Process Experiences Regularly
Review Your Own History and Keep a List of Methods That Work
Decrease Vulnerability to Stress
Mentally Rehearse Potential Problems
Engage in Directed Fantasy
Cultivate and Maintain Professional and Personal Relationships
Communicate with Family and Friends about Anticipated Unavailability
Enjoy Your Achievements and Your Goals
Learn and Practice Relaxation Techniques
Maintain a Pleasurable Existence
When to Seek Consultation
Types of Professional Help
Psychotherapy
Psychopharmacology
Couples Therapy
Group Therapy
Autognosis Rounds
Conclusion
Acknowledgment
References
Suggested Reading
Chapter 93: Psychiatry and the Media
Key Points
Overview
How the Mass Media Affect Public Understanding of Mental Illness
How Mass Media Interventions Can Affect Stigma
Effects of Mass Media on Suicide
Effects of Media Content on Children’s Behavior
Media Literacy: Advising Parents on Media Use
The Media as Part of the Psychiatric Interview
The Use of Mass Media to Educate and Counteract Stigma
Key References
References
Chapter 94: Global Mental Health in the Twenty-first Century
Key Points
Overview
The Cost of Mental Illness
The Prevalence of Mental Disorders
Ethiopia and Mental Health in the Developing World: an Example of Global Mental Health
Primary Care Mental Health Services in the Developing World
The Ethiopian Public Health Training Initiative
Child and Adolescent Psychiatry
Psychiatry in Areas of Conflict
Definitions of Torture
Types and Purpose of Torture
Medical and Psychiatric Effects of Torture
Medical and Psychiatric Treatment for Torture Survivors
Ask about the Patient’s Trauma Story
Identify Concrete Physical and Mental Effects
Diagnose and Treat
Use of Screening Instruments for Treatment of Psychiatric Diagnosis.
Psychiatric Treatment.
Refer
Reinforce and Teach
Recommend Work, Altruism, and Spirituality
Reduce High-risk Behaviors
Be Culturally Attuned in Communicating and Prescribing
Prescribe
Identify Target Symptoms.
Pay Attention to the Patient’s “Explanatory Model.”
Use Counseling.
Keep the Medication Regimen Simple.
Pay Attention to Ethnic Differences in Metabolism of, and Response to, Medication.
Schedule Follow-up Visits
Prevent Burnout
Evaluation
Psychiatric Research in the Developing World
World Health Organization Mental Health Global Action Program
Conclusion
Key References
References
Index
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