The Medical Basis of Psychiatry (eBook)

Foreword 7
Preface 9
Acknowledgments 11
Contents 13
Contributors 17
Color Plates 21
Part I Syndromes—Adult 24
The Mental Status Examination 25
1. The Importance of Signs and Symptoms in Psychiatry 26
2. Special Problems in Psychiatric Phenomenology 26
3. Recording Signs and Symptoms in Psychiatry 27
4. Conduct of the Mental Examination 28
5. Areas of the Mental Status 29
6. Common Errors in Mental Status Examination 35
7. Summary: Further Reading 36
Syndromes of Brain Dysfunction Presenting with Cognitive Impairment or Behavioral Disturbance: Delirium, Dementia, and Mental Disorders Caused by a General Medical Condition 39
1. Syndromes of Brain Dysfunction Presenting with Global Cognitive Impairment: Delirium 39
2. Dementia 45
3. Mental Disorders Caused by a General Medical Condition 54
The Amnestic Syndrome 61
1. Introduction 61
2. Anatomy of Memory 62
3. Symptoms of Amnesia 63
4. Amnestic Syndromes 64
5. Etiologies for Amnesia 65
6. Evaluation 66
7. Treatment 66
Bipolar Illness 69
1. Definition 70
2. Etiology 70
3. Epidemiology 75
4. Risk Factors 76
5. Clinical Picture 77
6. Course 79
7. Differential Diagnosis 81
8. Treatment 83
Major Depressive Disorder 95
1. Definition 95
2. Epidemiology 96
3. Clinical Picture 96
4. Depressive Subtypes 97
5. Etiology 97
6. Biological Theories of Depression 97
7. Laboratory Studies 98
8. Presentation of Depression in the Primary Care Setting 98
9. Presentation of Depression in a Mental Health Setting 99
10. Principles of Treatment 99
11. Treatments for Depression 99
12. Summary 103
Schizophrenia 107
1. History 107
2. Current Diagnostic Criteria 107
3. Epidemiology 108
4. Genetics 108
5. Etiology 109
6. Clinical Findings 116
7. Pharmacological Treatments of Schizophrenia 119
8. Antipsychotic-Related Side Effects 122
9. ECT Treatment of Schizophrenia 122
10. Psychosocial Treatment 123
11. Time Course of Schizophrenia 123
12. Prognosis and Course of Illness 123
Schizoaffective and Schizophreniform Disorders 131
1. Definition 131
2. Etiology 131
3. Epidemiology 135
4. Clinical Picture 135
5. Clinical Course 136
6. Differential Diagnosis 140
7. Treatment 140
8. Schizophreniform Disorder 141
Delusional Disorders 147
1. Definition 147
2. Epidemiology 148
3. Etiology and Pathophysiology 148
4. Clinical Picture 149
5. Some Illustrative Cases 150
6. Course 151
7. Differential Diagnosis 151
8. Laboratory Examinations 152
9. Treatment 152
Anxiety Disorders 155
1. Introduction 155
2. Panic Disorder 158
3. Generalized Anxiety Disorder 164
4. Phobic Disorders: Specific and Social Phobia 167
5. ObsessiveÒCompulsive Disorder 171
6. Trauma-Related Disorders: PTSD and Acute Stress Disorder 175
Obsessive–Compulsive Disorder 183
1. Introduction 183
2. Neuroanatomical Features of OCD: The Basal Ganglia 184
3. Neuropsychiatric Disorders Frequently Comorbid with OCD 184
4. Genetics of OCD 184
5. Neuroimaging Studies 186
6. Neuropsychologic Studies 187
7. OCD Induced by Psychological Trauma 187
8. Structural Brain Etiologies of OCD 187
9. Autoimmune Etiologies of OCD 189
10. Medication-Induced OCS 191
11. Medical Consequences of OCD 191
12. Treatment 191
13. Conclusions 194
Somatoform and Dissociative Disorders 203
1. Introduction: The Dualism of Psychogenic Versus Physiological Is False 203
2. Emotional Drives and Emotional Intelligence 205
3. Alexithymia—Deficits in Emotional Intelligence 206
4. Somatization Disorder (Briquet’s Syndrome) 210
5. Undifferentiated Somatoform Disorder 211
6. Conversion Disorders 212
7. Other Somatoform Disorders 213
8. Dissociative Disorders 213
Anorexia Nervosa and Bulimia Nervosa 217
1. Etiology and Pathogenesis 217
2. Comorbidity 221
3. Epidemiology 222
4. Clinical Picture 223
5. Clinical Course 224
6. Medical Findings 7. Differential Diagnosis 225
8. Treatment 227
Antisocial Personality Disorder 235
1. Definition 235
2. Etiology 236
3. Epidemiology 237
4. Clinical Picture 237
5. Pathology 239
6. Clinical Course 241
7. Differential Diagnosis 242
8. Treatment 242
Alcoholism 249
1. Definition 249
2. Epidemiology 250
3. Clinical Picture 253
4. Case History 254
5. Laboratory Findings 254
6. Sensitivity and Specificity of Rating Scales for Detecting Alcohol Dependence and Abuse 255
7. Clinical Course 255
8. Differential Diagnosis 258
9. Etiology 258
10. Treatment 260
11. Concluding Comment 267
Drug Addiction 273
1. Definition 273
2. Etiology and Pathogenesis 274
3. Epidemiology 276
4. Pathology 277
5. Clinical Picture 280
6. Clinical Course 281
7. Laboratory Findings 282
8. Differential Diagnosis 284
9. Treatment 285
Sexual Disorders: Dysfunction, Gender Identity, and Paraphilias 289
1. Introduction 289
2. Sexual Health Defined 289
3. Sexual Dysfunction Disorders ( Table 16.1) 289
4. Gender Identity Disorder 296
5. Paraphilias and Compulsive Sexual Behavior 299
Other Psychiatric Syndromes: Adjustment Disorder, Factitious Disorder, Illicit Steroid Abuse, and Cultural Syndromes 307
1. Adjustment Disorder 307
2. Factitious Disorder 311
3. Illicit Anabolic Steroid Use 314
4. Eponyms and Cultural Syndromes 318
Part II Child Psychiatry 321
Disruptive Behavior Disorders 323
1. Description, Symptoms 323
2. DSM-IV ADHD Criteria 324
3. Epidemiology 326
4. Comorbidity 330
5. Neuropsychology 331
6. Pathophysiology 333
7. Etiology 334
8. Evaluation 338
9. Treatment 339
10. Prevention 344
11. Conduct Disorder 345
12. Summary 347
Mood Disorders in Children and Adolescents 357
1. Diagnosing Mood Disorders in Children and Adolescents 357
2. Etiology, Pathogenesis, and Neurobiological Findings 358
3. Psychological Theories of Mood Disorders 361
4. Epidemiology 361
5. Clinical Presentations and Phenomenology 362
6. Sex Differences in Mood Disorders 362
7. Differential Diagnoses/Comorbidities 362
8. Treatment 363
9. Summary 369
Autistic Disorder 377
1. Introduction 377
2. Diagnostic Criteria, Assessment, and Measures 377
3. Genetics 379
4. Comorbid Medical Disorders and Autism 380
5. Special Sensory Disorders and Autism 381
6. Neuroimaging Findings 381
7. Histopathology 382
8. Immunological Abnormalities 384
9. Electroencephalography 384
10. Epidemiology 384
11. Putative Causes of Increasing Prevalence of Autism 385
12. Treatment 385
Childhood Anxiety Disorders 397
1. Epidemiology 397
2. Etiology 398
3. Separation Anxiety Disorder 399
4. Fears and Specific Phobias 400
5. Social Phobia 401
6. Generalized Anxiety Disorder 402
7. ObsessiveÒCompulsive Disorder 403
8. Panic Disorder 404
9. Treatment 405
Schizophrenia in Children and Adolescents 413
1. Introduction 413
2. Diagnosis 413
3. Epidemiology 414
4. Pathophysiology 415
5. Treatment of Schizophrenia in Children and Adolescents 417
6. Conclusions 419
Part III Symptom Clusters 423
Mood Disturbances 425
1. Affects, Moods, and Their Disorders 425
2. The Depressive Syndrome 426
3. The Distinction Between Grief and Melancholia 430
4. The Distinction Between Anxiety and Depressive States 431
5. The Heterogeneity of Dysthymic Disorders 432
6. The Manic Syndrome 432
7. The Distinction Between Bipolar and Schizophrenic Psychoses 434
8. Hypomania and its Diagnostic Significance 435
9. Mood Disorder in Different Clinical Settings 436
Anxiety Symptoms 441
1. Introduction 441
2. Organic Anxiety Syndromes: Anxiety Syndromes Associated with Medical Conditions 442
3. Treatment 446
4. Alcoholism 447
5. Other Anxiety Syndromes 448
6. Depressive Disorder 450
7. Bipolar Disorder 450
8. Psychoses 450
Addendum 450
Thought Disorder 457
1. Introduction 457
2. Definition 457
3. What are the Boundaries of Thought Disorder? 458
4. What are the Common Types of Thought Disorder? 459
5. Diagnostic and Prognostic Significance of Thought Disorder 462
6. Relationship between Thought Disorders and Other Symptoms of Schizophrenia 463
EditorÌs Comment (From 1994 Edition) 464
Phenomenology of Coarse Brain Disease 467
1. Introduction 467
2. Background 467
3. Traumatic Brain Injury 468
4. Cerebrovascular Accidents 471
5. Coarse Brain Injury Affecting Language Functions 472
6. Dementias 472
7. Blast Injuries 473
8. Summary 473
Catatonia in Psychiatric Illnesses 477
1. Introduction 477
2. Catatonia in DSM 477
3. Differential Diagnosis 479
4. Catatonia as a Syndrome 482
5. LeonhardÌs Psychomotor Psychoses 483
6. GABA Deficit Theory of Catatonia 483
7. Catatonia in Children 484
8. Catatonia in Autism 485
9. Catatonia and Childhood Disintegrative Disorder 486
10. Catatonia in Prader ÒWilli Syndrome 486
11. Evaluation of Catatonia 487
12. Medical Treatment of Catatonia 488
Acknowlegment 489
Personality Disorders 493
1. Introduction: Why are Personality Disorders Important? 493
2. What is Personality? 494
3. What is a Personality Disorder? 494
4. Deconstructing the Components of Personality and its Disorders 495
5. Stages in the Development of Self- Awareness and Well- Being 496
6. Pathophysiology 498
7. Treatment 499
Part IV Special Areas 507
Genetics of Psychiatric Disorders 509
1. Methods in Psychiatric Genetics 509
2. Epigenetics of Psychiatric Disorders 512
3. Mood Disorders 512
4. Alcoholism 515
5. AlzheimerÌs Disease 518
6. Antisocial Personality Disorder 518
7. Anxiety Disorders 519
8. Attention-Deficit Disorder 520
9. Autism (Pervasive Developmental Disorder) 520
10. Drug Abuse 521
11. Eating Disorders 521
12. Mental Retardation 523
13. ObsessiveÒCompulsive Disorder 524
14. Schizophrenia 524
15. Somatization Disorder 528
16. TouretteÌs Syndrome 528
17. Genetic Counseling 529
Novel Mechanisms of Drug Treatment in Psychiatry 541
1. Introduction 541
2. Depression 541
3. Bipolar Disorder 547
4. Anxiety 548
5. Obsessive–Compulsive Disorder 550
6. Schizophrenia 550
7. Future Directions 552
Use of Laboratory Assessments in Psychiatry 557
1. Use of Laboratory in Psychiatry 557
2. Laboratory Use to Establish the Diagnosis 558
3. Minimum Laboratory Tests Needed to Establish General Health 558
4. Additional Tests Needed to Assess Comorbid Medical Conditions 559
5. Special Cases with Specific Laboratory Assessments 560
6. Neuroimaging 561
7. Laboratory Use to Monitor Treatment Adequacy and Safety of Antidepressant and Antipsychotic Drugs 562
Epidemiology of Psychiatric Illness 569
1. Applications of Epidemiology 569
2. Key Terms and Methodologic Issues in Psychiatric Epidemiology 570
3. Descriptive Epidemiology: Prevalence Studies 573
4. Descriptive Epidemiology: Incidence Studies 576
5. Comorbidity 576
6. Use of Mental Health Services 577
7. Etiology of Psychiatric Disorders 577
Suicide and Attempted Suicide 583
1. Suicide and Attempted Suicide 583
2. Neurobiology of Suicidal Behavior 584
3. Heritability of Suicidal Behavior 585
4. Risk Factors for Suicidal Behavior 586
5. Prevention and Treatment 590
Clinical Psychopharmacology and Other Somatic Therapies 599
1. Schizophrenia and Other Psychoses 599
2. Depression 614
3. Mania 626
4. Anxiety Disorders 635
5. ObsessiveÒCompulsive Disorder 640
6. Dementia 641
7. Anti-Aggression 642
8. Hypnotics 642
Cognitive and Behavioral Therapies 657
1. Cognitive Model 657
2. Efficacy of CBT 662
3. Conclusion 666
Forensic Psychiatry 673
1. Overview 673
2. Assessment of Malingering 673
3. Assessment of Dangerousness 674
4. Competency 676
5. Criminal Responsibility (Insanity) 677
6. Medical Malpractice 677
7. The Psychiatrist as Expert Witness 678
8. Summary 679
Sleep Disorders 683
1. Introduction 683
2. Basic SleepÒWake Regulation 685
3. Insomnia 686
4. Movement Disorder: Restless Legs Syndrome 691
5. Obstructive Sleep Apnea 693
6. Hypersomnia 697
7. Parasomnias 700
Neuroimaging in Psychiatry 717
1. Introduction 717
2. X-Ray Transmission CT 725
3. Magnetic Resonance Imaging 726
4. Introduction to Molecular Imaging 731
Electroconvulsive Therapy: Indications, Use, and Adverse Effects 747
1. Introduction 747
2. Indications 748
3. Pre-ECT Evaluation 748
4. Concurrent Use of ECT and Psychotropic Medications 748
5. Method of ECT Administration 749
6. Number of Treatments 749
7. Adverse Reactions 749
8. Poor Treatment Response to ECT 750
9. Post-ECT Pharmacological Management 750
10. Continuation of ECT After Index Treatment 750
11. Maintenance of ECT 750
Profiles in the History of Neuroscience and Psychiatry 753
Normal Laboratory Values and Drug Therapeutic and Toxic Ranges 775
Index 785