Essential Psychiatry

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Cover......Page 0
Half-title......Page 3
Title......Page 4
Copyright......Page 5
Contents......Page 6
Contributors......Page 8
Preface to the fourth edition......Page 13
SECTION 1 The Tools of Psychiatry......Page 14
Abnormalities of mental state as symptoms......Page 16
Abnormal phenomena......Page 18
Synaesthesia......Page 19
Hallucinations......Page 20
Pseudo-hallucinations......Page 22
Feelings, emotions, affects and moods......Page 23
2. The characteristics, tone and strength of feelings generated......Page 25
Depressive states......Page 26
Manic states......Page 28
Obsessive and compulsive phenomena......Page 30
The nature of delusional experience......Page 32
Classification of delusion......Page 34
Morbid interpretations......Page 36
Beliefs about the world......Page 37
Delusions and reality......Page 38
Delusions of specific content......Page 39
Passivity phenomena (disturbances of ego boundary)......Page 40
Directed outwards......Page 41
Depersonalisation and derealisation......Page 42
Catatonia......Page 43
Disturbance of language......Page 44
Schizophrenic language disorder......Page 47
REFERENCES......Page 49
The development of an international classification of diseases......Page 52
The International Classification of Diseases, 10th edition: classification of mental and behavioural disorders......Page 53
The development of the DSM criteria......Page 55
Different schools of psychopathology......Page 57
Historical background......Page 58
Advantages and disadvantages of operational definitions......Page 60
Diagnostic interviews......Page 62
REFERENCES......Page 64
Making hypotheses......Page 66
Designs for observational descriptive studies......Page 67
Observational descriptive studies: when to use which design......Page 68
Designs for observational analytic studies......Page 69
Designs for experimental analytic studies......Page 70
Study designs: conclusion......Page 71
Analysis of disease frequency......Page 72
Analysis of association......Page 73
Dichotomous variables......Page 74
Continuous variables......Page 75
Bias......Page 77
Confounding......Page 78
Judging a cause-effect relationship......Page 79
REFERENCES......Page 80
4 Imaging of brain structure and function: relevance to psychiatric disorders......Page 81
Major depressive disorder......Page 83
Schizophrenia......Page 84
Dementia of the Alzheimer type (DAT)......Page 87
Conclusions......Page 89
REFERENCES......Page 90
Paradigm 1 – basic genetic epidemiology......Page 93
Family studies......Page 94
Twin studies......Page 95
Adoption studies......Page 97
Genetic modelling of twin data......Page 98
Complex segregation analysis......Page 100
Linkage studies......Page 101
Association studies......Page 102
Paradigm 4 – molecular genetics......Page 104
REFERENCES......Page 105
SECTION 2 Psychiatric Disorders......Page 108
Clinical assessment......Page 110
Resilience......Page 111
Child maltreatment......Page 112
Attachment disorders......Page 114
Classification of disorder......Page 116
Retentive soiling......Page 117
Causal pathways......Page 118
Attention-deficit/hyperactivity disorder......Page 119
Treatment......Page 121
Autism spectrum disorders......Page 122
Clinical features......Page 123
Detection and course......Page 124
Classification......Page 125
Prevalence and course......Page 126
Aetiology......Page 127
Child characteristics......Page 128
Treatment......Page 129
Prevention......Page 130
Epidemiology......Page 131
Treatment......Page 132
Bipolar disorder......Page 133
Separation anxiety disorder......Page 134
School-refusal anxiety disorder......Page 135
Posttraumatic stress disorder......Page 136
Obsessive-compulsive disorder......Page 137
REFERENCES......Page 138
Classification by category......Page 148
Classification by cluster......Page 150
Classification by severity......Page 151
Classification by impact on social functioning......Page 153
Treatment of personality disorder......Page 154
Drug treatments......Page 155
REFERENCES......Page 157
8 Anxiety disorders......Page 160
The classification of the anxiety disorders......Page 161
Diagnosis......Page 162
Pathogenesis......Page 163
Pharmacotherapy......Page 164
Phenomenology and diagnosis......Page 165
Pathogenesis......Page 166
Pharmacotherapy......Page 167
Psychotherapy......Page 168
Diagnosis......Page 169
Pathogenesis......Page 170
Pharmacotherapy......Page 171
Posttraumatic stress disorder......Page 172
Course......Page 173
Pathogenesis......Page 174
Prevention......Page 175
Epidemiology......Page 176
Course and comorbidity......Page 177
Pathogenesis......Page 178
Neurochemistry......Page 179
Pharmacotherapy......Page 180
Conclusion......Page 181
Anxiety disorders in pregnancy......Page 182
Conclusions......Page 183
REFERENCES......Page 184
Classification......Page 193
Epidemiology......Page 195
Comorbidity......Page 196
Clinical conceptualisations......Page 197
Assessment and management......Page 198
The assessment and management of risk......Page 199
The assessment of prognosis......Page 200
Medication......Page 201
Comorbidity......Page 202
Clinical conceptualisations......Page 203
Psychotherapy......Page 204
Psychotherapy......Page 205
Obesity......Page 206
REFERENCES......Page 207
Historical background......Page 211
Epidemiology......Page 212
"Dual diagnosis" or coexisting substance problems and psychological disorder......Page 216
Physical consequences of alcohol misuse......Page 217
Neurological nutritional deficiency syndromes......Page 218
Liver disease and gastrointestinal disorder......Page 219
Cardiovascular disease......Page 220
Other alcohol-related disorders......Page 221
Twin studies......Page 222
Adoption studies......Page 224
Association studies......Page 225
Employment......Page 226
Explanatory models of alcohol use......Page 227
Assessment and intervention......Page 228
Stages of change......Page 231
Pharmacotherapy......Page 232
Seizure prevention and treatment......Page 233
Acamprosate......Page 234
Alcohol and other psychiatric disorders......Page 235
REFERENCES......Page 236
11 Drug use and drug dependence......Page 243
Psychological effects of chronic cannabis use......Page 244
Interventions for cannabis dependence......Page 245
The adverse health effects of cocaine......Page 246
Psychotherapy and cognitive-behavioural therapy......Page 247
The adverse health effects of amphetamine use......Page 248
Heroin and other illicit opioid dependence......Page 249
Opioid overdose deaths......Page 250
Detoxification and withdrawal......Page 251
Opioid maintenance treatment......Page 252
Legally coerced treatment......Page 253
REFERENCES......Page 255
Depressive states......Page 263
Abnormal beliefs and perceptions in depression......Page 265
Mania......Page 266
Abnormal beliefs and perceptions inmania......Page 267
Classification......Page 268
Other classes, categories and dimensions of depression......Page 270
Gender......Page 271
Cohort effects......Page 272
Aetiology......Page 273
Genetics......Page 274
Molecular genetics......Page 276
Neurochemistry......Page 277
The hypothalamic-pituitary-adrenocortic system......Page 279
The hypothalamic-pituitary-thyroid system......Page 280
Other systems......Page 281
Brain imaging studies......Page 282
Psychosocial adversity......Page 283
Psychoanalytic theories......Page 285
The influence of personality traits......Page 286
Bipolar disorder......Page 287
Unipolar disorder......Page 288
Conclusions and forward view......Page 289
REFERENCES......Page 290
13 Schizophrenia and related disorders......Page 297
The classical subtypes......Page 298
Schneider’s criteria......Page 299
Operational de.nitions......Page 300
Schizoaffective disorder......Page 301
Psychosis as a dimension......Page 302
Illicit drugs and psychosis......Page 303
Paranoid states......Page 304
Urbanicity......Page 305
Studies of relatives......Page 306
Studies of twins......Page 307
Adoption studies......Page 308
Genetic models......Page 309
Biological abnormalities in the relatives of those with schizophrenia......Page 310
Obstetric complications......Page 311
Prenatal viral infection......Page 312
Brain structure and function......Page 313
Dopamine as “the wind of psychotic fire”......Page 315
The antecedents of schizophrenia......Page 316
Social factors......Page 317
Psychology......Page 318
Outcome......Page 319
Management......Page 320
Cognitive-behavioural therapy......Page 321
Family therapy......Page 322
Care in the community......Page 323
Early onset or prodromal services......Page 324
Assertive and intensive community treatment services......Page 325
REFERENCES......Page 326
A critique of organic and its proposed alternatives......Page 333
The clinical neuropsychiatric assessment......Page 334
Memory......Page 335
Investigations......Page 337
Functional imaging......Page 338
Mental disorders due to a general medical condition (secondary or “organic” mental disorders)......Page 339
General principles......Page 340
Hallucinations......Page 341
Stimulant psychosis......Page 342
Mood disorder due to a general medical condition and substance-induced mood disorder......Page 343
Catatonic disorder due to a general medical condition......Page 345
Personality change due to a general medical condition......Page 346
Cognitive disorders......Page 347
Familial Alzheimer’s disease......Page 348
Subcortical dementias......Page 349
Huntington’s disease......Page 350
Normal pressure hydrocephalus......Page 351
Creutzfeldt Jakob disease......Page 352
Clinical features......Page 353
Management......Page 354
Review......Page 355
Neuropsychiatric aspects of cerebrovascular disease......Page 356
Neuropsychiatric aspects of HIV infection and AIDS......Page 357
Psychiatric aspects of epilepsy......Page 359
REFERENCES......Page 360
Community care......Page 363
Liaison with the general hospital......Page 364
Dementia......Page 365
Aetiology of the dementia syndrome......Page 366
Risk factors for dementia......Page 367
Mental state examination......Page 368
Alzheimer’s disease......Page 372
Management of dementia......Page 373
Treatment of cognitive symptoms......Page 374
Treatment of vascular dementia......Page 376
Delirium......Page 377
Management......Page 378
Depressive symptoms in old age......Page 379
Aetiology......Page 380
Treatment......Page 381
Aetiology......Page 382
Very late onset schizophrenia (late paraphrenia)......Page 383
Aetiology......Page 384
Neurosis......Page 385
Suicide......Page 386
Senile self-neglect (Diogenes syndrome)......Page 387
Conclusions......Page 388
REFERENCES......Page 389
Background......Page 396
Psychiatric and behaviour disorders in people with intellectual disabilities......Page 397
Epidemiology......Page 398
Social factors......Page 400
Maintenance of mental health and prevention of mental ill health......Page 401
Assessment and treatment......Page 402
Psychotropic medication......Page 404
REFERENCES......Page 405
Sexual development......Page 408
Sexual behaviour......Page 409
Sexual identity, sexual orientation and sexual preferences......Page 410
The psychophysiology of sexual arousal......Page 411
Central mechanisms......Page 412
The role of hormones in sexual arousal......Page 413
Mood......Page 414
Schizophrenia......Page 417
Side effects of psychotropic drugs......Page 418
Child sexual abuse and sexual assault......Page 419
Women......Page 420
Clinical management......Page 421
Sex therapy......Page 422
Problematic sexual preferences......Page 423
Transvestism, transexuality and transgender......Page 424
Clinical management......Page 425
REFERENCES......Page 426
SECTION 3 Special Topics......Page 430
Culture and mental health......Page 432
The evolution of the discipline......Page 433
Culture and the classification of mental disorders......Page 434
Alternative worldviews of mental illness......Page 437
The contemporary relevance of cross-cultural psychiatry......Page 438
Poverty......Page 439
Gender......Page 440
Conflict and displacement......Page 441
Implications for population mental health......Page 442
REFERENCES......Page 445
Neuroendocrine......Page 447
Psychosocial......Page 448
Premenstrual syndrome and premenstrual dysphoric disorder......Page 449
Treatment issues......Page 450
Psychosis......Page 451
Issues for the foetus and infant......Page 452
Psychiatric disorders associated with menopause......Page 454
Mood disorders......Page 455
Alzheimer’s disease......Page 456
REFERENCES......Page 457
International comparisons......Page 464
Trends in suicide rates......Page 465
Social class and employment......Page 466
Biological factors and suicide......Page 467
Suicide and psychiatric disorder......Page 468
Cohort studies......Page 469
Sociodemographic and clinical characteristics......Page 470
In-patients and those recently discharged......Page 471
Affective disorders......Page 472
Sociological models of suicide......Page 473
Suicide prevention strategies......Page 474
Terminology......Page 476
Methods of self-harm......Page 477
Clinical factors and self-harm......Page 478
Guidelines for self-harm......Page 479
General principles......Page 480
Overnight admission facilities......Page 481
Aftercare and interventions......Page 482
REFERENCES......Page 483
SECTION 4 Psychiatry in Specific Settings......Page 490
Epidemiology......Page 492
Classification of mental disorders in primary care......Page 494
The detection of psychiatric disorder in primary care......Page 495
GP factors influencing recognition......Page 496
Case finding in primary care......Page 497
Improving outcomes of mental illness in primary care......Page 498
The interface between primary care and psychiatry......Page 499
Mental health skills training and education for primary care professionals......Page 500
Management of mental disorders in primary care......Page 501
Guided self-help and bibliotherapy......Page 502
Stepped care......Page 503
Management of psychosis in primary care......Page 504
REFERENCES......Page 505
Historical background......Page 511
Period 3. Balancing mental health care......Page 512
Service models in low-, medium- and high-level resource areas......Page 513
Mainstream mental health care......Page 515
Community mental health teams......Page 516
Acute in-patient care......Page 517
Occupation and day care......Page 518
Assertive community treatment teams......Page 519
Alternatives to acute in-patient care......Page 520
Alternative forms of occupation and vocational rehabilitation......Page 521
The ethical base of mental health care......Page 522
REFERENCES......Page 523
Psychiatric disorders are common......Page 528
Psychiatric disorders have significant consequences......Page 530
Diagnostic concerns......Page 531
Associations of depression......Page 532
Consequences of depression and anxiety......Page 533
Drug treatment......Page 535
Definitions and terminology......Page 536
Epidemiology......Page 537
Precipitating factors......Page 538
Biological mechanisms......Page 539
Iatrogenesis......Page 540
Recent onset symptoms......Page 541
Chronic symptoms with no defined onset......Page 542
Feigned illness – factitious disorders and malingering......Page 543
Delirium in general hospital patients......Page 544
Mental capacity in medical patients......Page 545
Conclusions......Page 546
REFERENCES......Page 547
Prevalence of violent behaviour among those with psychosis......Page 553
Risk factors for violence and criminality among those with psychosis......Page 554
Affective disorders......Page 557
Substance misuse......Page 558
Personality disorder......Page 559
Neurobiology of violence for those without seriousmental illness......Page 561
Neurobiology of violence for those with serious mental illness......Page 562
Homicide......Page 563
Risk assessment and management......Page 564
Clinical risk assessment......Page 565
Generalisability – can the instrument be applied to a particular population, setting and question of interest?......Page 566
Historical background......Page 567
Detention in hospital for those under the criminal justice system......Page 569
Fitness to plead......Page 570
Conclusions......Page 571
REFERENCES......Page 572
SECTION 5 Treatments in Psychiatry......Page 578
Distribution......Page 580
Metabolism......Page 581
Elimination......Page 582
Pharmacodynamics......Page 584
Behavioural pharmacology......Page 589
Pharmacogenetics of antipsychotic treatment......Page 591
Serotonin receptors......Page 592
Adverse effects of antipsychotic treatment......Page 593
Ethical considerations......Page 594
Conclusions......Page 595
REFERENCES......Page 596
History and drug development......Page 599
Mechanism of action......Page 600
Pharmacology......Page 601
Motor and neurological side effects......Page 603
Dyslipidemia......Page 606
Cardiovascular side effects......Page 607
Haematologic side effects......Page 608
Lithium......Page 609
Valproate......Page 611
Oxcarbazepine......Page 612
Topiramate......Page 613
The acute phase......Page 614
The first episode......Page 615
Treatment-resistant illness......Page 616
Additional considerations for the treatment of primary psychotic disorders......Page 617
Electroconvulsive therapy......Page 618
Additional considerations for the treatment of schizoaffective disorder......Page 619
The acute phase of manic and mixed episodes......Page 620
The acute phase of depressive episodes associated with bipolar disorder......Page 621
Maintenance treatment and relapse prevention for bipolar disorder......Page 622
Additional considerations for the treatment of bipolar disorder......Page 623
Psychotic depression......Page 624
REFERENCES......Page 625
27 Biological treatments of depression and anxiety......Page 635
Selective serotonin reuptake inhibitors......Page 636
Combined noradrenaline (norepinephrine) and serotonin reuptake inhibitors......Page 637
Tricyclic antidepressants......Page 638
Monoamine oxidase inhibitors......Page 639
Physical treatments......Page 640
Seasonal affective disorder and light therapy......Page 642
Refractory depression......Page 643
Continuation treatment......Page 644
Selective serotonin reuptake inhibitors and other antidepressants......Page 645
REFERENCES......Page 646
The evolution of cognitive-behavioural therapies......Page 649
General principles of therapy......Page 652
Cognitive models of depression......Page 654
Cognitive models of psychosis......Page 655
Outcome research......Page 657
Limitations......Page 658
Training......Page 659
Future directions......Page 660
Conclusions......Page 661
REFERENCES......Page 662
Background: theoretical and empirical sources......Page 665
Concept of depression......Page 667
Indications......Page 668
Phases of treatment......Page 669
Continuation and maintenance treatment......Page 671
Depressed adolescents......Page 672
Bipolar disorder......Page 673
Training and accreditation in IPT......Page 674
REFERENCES......Page 675
Theoretical models......Page 678
Technique of long-term psychodynamic psychotherapy......Page 679
Therapeutic interventions......Page 680
Transference......Page 681
Countertransference......Page 682
Resistance......Page 683
Working through and termination......Page 684
Technique of short-term psychodynamic psychotherapy......Page 685
Research......Page 686
Indications and contraindications......Page 687
REFERENCES......Page 688
Systems-oriented approaches......Page 691
Post-modern developments......Page 692
Indications......Page 693
History from the patient......Page 695
How does the family function?......Page 696
The family inadvertently maintains the problem......Page 697
Revised formulation......Page 698
The process of therapy......Page 699
Research in family therapy......Page 701
Training......Page 702
REFERENCES......Page 703
Index......Page 705