Dewa, Lindsay H.
Detecting signs of deterioration in young patients with serious mental illness: a systematic review.
This is a major international textbook for psychiatrists and other professionals working in the field of mental healthcare. With contributions from opinion-leaders from around the globe, this book will appeal to those in training as well as to those further along the career path seeking a comprehensive and up-to-date overview of effective clinical practice backed by research evidence. The book is divided into cohesive sections moving from coverage of the tools and skills of the trade, through descriptions of the major psychiatric disorders and on to consider special topics and issues surrounding service organization. The final important section provides a comprehensive review of treatments covering all of the major modalities. Previously established as the Essentials of Postgraduate Psychiatry, this new and completely revised edition is the only book to provide this depth and breadth of coverage in an accessible, yet authoritative manner.
'… a great strength of the volume, the book does not cover only adult and old age psychiatry but includes excellent contributions on child and adolescent mental health, sexual problems and the psychiatry of intellectual disability. … the reference remain a very useful spur to postgraduate study and the calibre of the authors as clinicians, researchers and policy-makers makes every chapter fresh, relevant and exciting. The editors deserve great congratulation for bringing this volume together and I for one am very grateful for its publication: I'm sure it will serve me as well for the future as the last edition did for the past 11 years.'
Source: Journal of Public Mental Health
'… useful and interesting … the editors are successful in their core mission of assisting readers in identifying the key differences between classification systems, as well as educating them about the variations in treatment of certain psychiatric disorders. Overall, this book might be most valuable for those who have frequent contact with colleagues overseas or those who are planning to spend time … in Europe or any other location that uses the ICD-10.'
Source: Doody's Notes
'… Essential Psychiatry, fourth edition is an excellent reference book with up-to-date evidence-based knowledge which will be an invaluable resource for psychiatrists and mental health professionals alike. … for a comprehensive understanding of fundamental issues in psychiatry this textbook is a must-have.'
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Abnormalities of mental state are frequently treated in psychiatry merely as symptoms that act as sign-posts pointing towards particular diagnostic conclusions. This chapter describes the mental phenomena prior to their becoming part of the formulation of particular disorders, but for convenience and coherence some common syndromes, such as mania, are used to draw together the associated phenomena. A hierarchy moving from feelings through emotions, moods, and affective state to temperament involves increasing complexity in terms of state of mind and usually to an increasing duration of that state. Delusion involves abnormal beliefs that arise in the context of disturbed judgements and an altered experience of reality. Depersonalisation and derealisation are assumed to arise from a disruption in the functions of consciousness to create amnesia, dissociative identity disorder and depersonalisation disorder. Speech disorder is usually separated from language and thought disorder.
Two international classifications currently dominate research and clinical practise; the International Classification of Diseases (ICD)-10 and the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV. Both classifications provide detailed descriptions of all the main psychiatric syndromes, personality disorders and other disorders of behaviour or function. The first comprehensive nosology covering an entire range of diseases and including a classification of mental illness was produced by the newly formed World Health Organisation (WHO) in 1948. The WHO has the responsibility to produce regular revisions of the ICD for international use. Disorders in ICD-10 are arranged in groups according to major common themes or descriptive likenesses. DSM-IV has more categories than ICD-10, which may reflect the requirements of the health care system in the United States. The International Personality Disorder Examination (IPDE) assesses the phenomena and life experiences that are relevant to the diagnoses of personality disorders in DSM-IV and ICD-10.
Psychiatric studies are characterised by large numbers of variables, clinical outcomes that are difficult to measure, small sample sizes and conflicting results. Study designs are classified along the axes of time (longitudinal or cross-sectional design), level of causal inference (descriptive or analytical design) and role of the investigator (observational or experimental). Descriptive designs can be used to examine associations between exposures and outcomes in such a way that the results may lead to the formulation of more specific hypotheses regarding the causal implications of the exposure-disease relationship. The case-control design is suitable to examine aetiological heterogeneity or different exposures resulting in the same outcome, because a range of exposures in patients and control subjects can be assessed. Medical scientific studies generally have two main interests in the examination of the results: examination of the morbidity force of a disease phenotype in populations and examination of associations.
This chapter presents studies of depression that use structural and functional imaging to examine the roles of different brain circuits and neurochemicals in the pathophysiology and treatment of the illness. Functional imaging studies have demonstrated changes in metabolism in the prefrontal cortex, anterior cingulate and amygdala in depression, and these findings are at least in part reversed with antidepressant treatment and cognitive behavioural therapy. Brain imaging in major depressive disorder has contributed to a better understanding of the pathophysiology of the illness from a neural system perspective as well as at the synaptic level. A recent meta-analysis of magnetic resonance imaging (MRI) studies in schizophrenia found that the most significant changes occur within the medial temporal lobe. The chapter also discusses neuroimaging in Alzheimer's disorder within the context of an emergent public health crisis concerning an illness with a relatively well-characterised histopathology.
Genetic epidemiology explores the interrelationship of genetic and environmental risk factors in which genes are measured indirectly in ways that reflect aggregate effects "averaged" across the entire genome. This chapter describes the principles and methodology of psychiatric genetics using four-paradigm framework: basic genetic epidemiology, advanced genetic epidemiology, gene finding, and molecular genetics. Each of these paradigms has strengths and limitations, and they are in a process of dynamic interaction with each other. Genetic epidemiology has proved a reliable method to answer basic questions about the overall importance of genetic risk factors for psychiatric illness. The advanced genetic epidemiology paradigm has been used to study the relationships between neuroticism and depression. Molecular genetics is an entirely laboratory-based discipline applying a range of modern methods from genomics to neuroscience to try to identify and then trace pathophysiological pathways.
This chapter concerns emotional, behavioural and developmental disorders that arise in the first two decades of life. Few formal tests or assessments can contribute to the clinical assessment for common behavioural and emotional disorders. Clinical physiological assessments can provide helpful information for neuropsychiatric disorders. Risks for psychopathology occur from a variety of sources both internal and external to the child. Many children and adolescents demonstrate an ability to withstand exposure to risk processes and not develop psychiatric disorders. Disturbances in parent-child relationships in infancy significantly influence the development of psychopathology. Hyperactivity and impulsivity are more closely associated with each other than either is to attentional difficulties. Autistic syndromes are lifelong disorders even in those who show real improvements by young adult life. Child psychiatrists should continue to contribute to basic research aimed at understanding the causes of mental illness and behavioural syndromes.
Our understanding of personality disorders has come of age since the mid-1990s. At a time of frequent change, some of the issues discussed in this chapter will be likely to be incorporated into the core of learning about these conditions, whereas others may well be abandoned. There are five common ways of classifying personality disorder, namely, category, cluster, severity, impact on social functioning, and attribution. The Personality Assessment Schedule gives social function priority in creating a hierarchy in which the personality disorder creating the greater social dysfunction is given primacy over others in a subsequent description of personality disorder. Social function is affected by many other aspects of mental functioning apart from that of personality. Environmental and genetic factors interweave to influence personality development almost equally, and many genes interact to create different trait groupings. The main treatments for personality disorders are psychological, drug and alternative or complementary treatments.
The anxiety disorders are conventionally subdivided into: generalised anxiety disorder (GAD), panic disorder (PD), social phobia (social anxiety disorder (SAD)), posttraumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD). The current edition of the Diagnostic and Statistical Manual of Mental Disorders, the (DSM)-IV-TR lists 12 anxiety disorders, with broadly similar categories listed in the International Classification of Impairments, Disabilities and Handicaps, 10th revision (ICD-10). Neurochemistry and brain imaging studies have influenced the development of theoretical models of GAD. Current neuroanatomical models of panic disorder draw on the understanding of the functional neuroanatomy of fear conditioning in animals. SAD is second only to specific phobia as the most common anxiety disorder in population-based community studies; onset is in the mid-teenage years and extends into the middle of the third decade. There are a wide range of medical conditions that can cause and perpetuate symptoms of anxiety.
This chapter talks about comorbidity, aetiology, clinical conceptualisations, and assessment and management of four eating disorders: anorexia nervosa, bulimia nervosa, binge-eating disorder, and obesity. The classification systems of eating disorders according to Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV and the 10th revision of the International Classification of Diseases (ICD-10) are also presented in the chapter. Eating disorders expanded from the historical accounts, which were of restricting anorexia nervosa to include a variety of disorders typified by the binge-eating disorders. A systematic review of the epidemiology of eating disorders concluded that the prevalence of bulimic disorders varies according to time and place. Many of the risk factors for bulimia nervosa are shared by people with binge-eating disorder although they may be less intense. The outcome of community ascertained binge eating disorder in terms of abnormal eating behaviour is better than that reported for bulimia nervosa.