bluuebunny/crossref_metadata_2025 huggingface dataset:
Behavior of n = 1 magnetohydrodynamic modes of infernal type at high-mode pedestal with plasma rotation
Authors: Zheng L. J. , Kotschenreuther M. T. , Valanju P.
Published: January 2013

Magnetohydrodynamic instabilities of high-mode (H-mode) pedestal are investigated in this paper with the inclusion of bootstrap current for equilibrium and rotation for stability. The jointed European torus-like equilibria of H-mode discharges are generated numerically using the VMEC code. It is found that, when the bootstrap current is taken into account, a safety-factor reversal or plateau can be generated near plasma edge. This confirms previous results of numerical equilibrium reconstructions using other types of codes. The n = 1 magnetohydrodynamic instabilities, where n is toroidal mode number, are investigated numerically in this type of equilibria using the AEGIS code. It is found that the infernal type harmonic can prevail at safety-factor reversal or plateau region. The toroidal plasma rotation effect with low Mach number is investigated. The numerical results show that the mode frequency is close to the rotation frequency at pedestal top, when the value of safety factor at plateau is slightly above a rational number. This mode frequency range seems to coincide with the experimentally observed frequencies of n = 1 edge harmonic oscillations (or outer modes) at the quiescent H-mode discharges.
Viral Surveillance of Cultured Rainbow Trout in the Eastern Black Sea, Turkey
Authors: Ogut H. , Altuntas C. , Parlak R.
Published: January 2013

To study the presence and spread of viral fish pathogens in Rainbow Trout Oncorhynchus mykiss in the eastern Black Sea region of Turkey, 172 pooled samples (seven fish per pool) of Rainbow Trout fry from 28 hatcheries were examined from December 2006 to July 2007. Forty-three pools (seven broodfish per pool) of seminal and ovarian fluids from 182 female and 119 male brood Rainbow Trout were also sampled during spawning. Moreover, reproductive fluids (22 pools) of wild trout (Salmo trutta labrax, S. t. caspius, S. t. abanticus, and S. t. macrostigma), captured by electroshocking in the rivers in and around the region, were sampled. Triplicate groups of 40 or 80 Rainbow Trout fry was also challenged with two similar isolates to determine their virulence on trout fry. Enzyme-linked immunosorbent assay was performed on the samples producing cytopathic effect on CHSE-214 cells. The positive results were confirmed with a reverse transcriptase polymerase chain reaction assay. Neither infectious hematopoietic necrosis virus (IHNV) nor viral hemorrhagic septicemia virus (VHSV) was detected during the survey. Of the 28 hatcheries sampled in the Black Sea region, 15 from six provinces tested positive for infectious pancreatic necrosis virus (IPNV) in trout fry. Unexpectedly, all reproductive fluids from both male and female cultured and wild broodstock tested negative for IPNV. Nucleotide sequences of the VP2/NS region of IPNV showed that all isolates collected (n = 38) in the region and surrounding areas belonged to the genogroup III. The findings strongly suggest that IPNV is endemic in the fry of farmed Rainbow Trout within the region. Virus prevention measures should be taken to prevent in-farm spread of these highly contagious, low-virulence isolates.

Received May 8, 2012; accepted September 16, 2012
Disorders of the Dermis
Authors: Sybert Virginia P.
Published: January 2013

Collagen – Ainhum – Amniotic Bands – Buschke-Ollendorff Syndrome – Dermatosparaxis – Ehlers-Danlos Syndromes – Ehlers-Danlos Types I, II, and III – Ehlers-Danlos Type IV – Ehlers-Danlos Type VI – Ehlers-Danlos Type VIII – Reactive Perforating Collagenosis – Elastin – Costello Syndrome – Cutis Laxa – Pseudoxanthoma Elasticum – Vascular – Ataxia Telangiectasia – Blue Rubber Bleb Nevus Syndrome – Cutis Marmorata Telangiectatica Congenita – Fabry Syndrome – Familial Flame Nevi – Hereditary Glomus Tumors – Hereditary Hemorrhagic Telangiectasia – Klippel-Trenaunay-Weber Syndrome – Maffucci Syndrome – Sturge-Weber Syndrome – Mixed – Aplasia Cutis Congenita – Focal Dermal Hypoplasia – Tuberous Sclerosis – Other Disorders of the Dermis – Albright Hereditary Osteodystrophy – Cutis Verticis Gyrata – Familial Dysautonomia – François Syndrome – Lipoid Proteinosis – Multiple Pterygia – Systemic Hyalinosis
Disorders of Subcutaneous Tissue
Authors: Sybert Virginia P.
Published: January 2013

Cerebrotendinous Xanthomatosis – Familial Multiple Lipomatosis – Familial Symmetric Lipomatosis – Fibrodysplasia Ossificans Progressiva – Lipogranulomatosis – Partial Lipodystrophy – Seip-Berardinelli Syndrome
Immune Deficiency Diseases
Authors: Sybert Virginia P.
Published: January 2013

Chediak-Higashi Disease – Chronic Granulomatous Disease – Epidermodysplasia Verruciformis – Familial Mucocutaneous Candidiasis – Griscelli Syndrome Types 1 and 2 – Job Syndrome – Mucoepithelial Dysplasia – Wiskott-Aldrich Syndrome
Cardiothoracic surgery
Authors: Gardiner Matthew D. , Borley Neil R.
Published: January 2013

This chapter begins by discussing the basic principles of cardiac physiology and respiratory physiology, before focusing on the key areas of knowledge, namely congenital heart disease, coronary artery bypass grafting, heart valve disease, thoracic aortic dissection, thoracic aortic aneurysm, miscellaneous cardiac and mediastinal conditions, lung cancer, and miscellaneous thoracic conditions. The chapter concludes with relevant case-based discussions.
Urology
Authors: Gardiner Matthew D. , Borley Neil R.
Published: January 2013

This chapter begins by discussing the basic principles of renal and urinary tract physiology, before focusing on the key areas of knowledge, namely congenital urological conditions, urinary retention, lower urinary tract symptoms and disorders, urinary incontinence and neuropathic bladder, iInflammation and infection of the urinary tract, urinary tract calculi, scrotal conditions, penile conditions, renal cancer, bladder cancer, prostate cancer, and testicular cancer. The chapter concludes with relevant case-based discussions.
Vascular surgery
Authors: Gardiner Matthew D. , Borley Neil R.
Published: January 2013

This chapter begins by discussing the basic principles of haemostasis and coagulation and atherosclerosis, before focusing on the key areas of knowledge, namely assessment and management of peripheral arterial occlusive disease, acute lower limb ischaemia, extracranial arterial disease, abdominal aortic aneurysm, chronic venous insufficiency, varicose veins, lymphatic conditions, diabetic foot, lower limb ulceration, and miscellaneous vascular conditions. The chapter concludes with relevant case-based discussions.
Trauma and orthopaedic surgery
Authors: Gardiner Matthew D. , Borley Neil R.
Published: January 2013

This chapter begins by discussing the basic principles of musculoskeletal physiology, fracture assessment, and fracture management, before focusing on the key areas of knowledge, namely congenital and developmental conditions, the foot, the ankle, the knee, the femoral and tibial shaft, the proximal femur, the pelvis, the shoulder, the upper limb, degenerative and inflammatory arthritis, bone and joint infection, crystal arthropathies, musculoskeletal tumours, and metabolic bone conditions. The chapter concludes with relevant case-based discussions.
Transplant surgery
Authors: Gardiner Matthew D. , Borley Neil R.
Published: January 2013

This chapter begins by discussing the basic principles of immunology and transplant rejection and immunosuppression, before focusing on the key areas of knowledge, namely organ donation, renal transplantation, and transplantation of other organs. The chapter concludes with relevant case-based discussions.
Core surgical skills and knowledge
Authors: Gardiner Matthew D. , Borley Neil R.
Published: January 2013

This chapter begins by discussing the basic principles of fluid and electrolyte homeostasis, fluid therapy, healthcare-associated infection, microorganisms and antimicrobials, preoperative assessment, and acute pain, before focusing on the key areas of knowledge, namely deep venous thrombosis, pulmonary embolism, respiratory tract infection, asthma, chronic obstructive pulmonary disease, acute respiratory failure, ischaemic heart disease, heart failure, cardiac arrhythmias, hypertension, diabetes mellitus, acute renal failure, stroke, acute confusional state, and haematological conditions. The chapter concludes with relevant case-based discussions.
Migraine treatment
Authors: Kernick David , Goadsby Peter J.
Published: January 2013

This chapter covers behaviour and lifestyle modification, pharmacological treatment of the acute attack, pharmacological treatment for prevention, and occipital nerve manipulation.
Migraine in women
Authors: Kernick David , Goadsby Peter J.
Published: January 2013

This chapter on migraine in women covers migraine and menstruation, migraine and contraception, and migraine and pregnancy.
Cervicogenic headache
Authors: Kernick David , Goadsby Peter J.
Published: January 2013

This chapter begins with an introduction to cervicogenic headache, before moving on to epidemiology, clinical features, differential diagnosis, pathogenesis, and treatment.
Other secondary headaches
Authors: Kernick David , Goadsby Peter J.
Published: January 2013

This chapter on other secondary headaches covers headaches attributed to vascular disorders, headaches due to systemic or metabolic diseases (disorders of homeostasis), and headaches associated with CNS infections.
Vitreoretinal surgery
Authors: Chen Fred K. , Chen Simon D.M.
Published: January 2013

This chapter begins by looking at retinal anatomy and physiology, before covering key clinical and practical skills, namely posterior segment history taking and examination, diagnostic lenses, optical coherence tomography, ultrasonography, and retinal photocoagulation. The following areas of clinical knowledge are then discussed: vitreous disorders, retinal detachment, peripheral retinal abnormalities, macular surgery, submacular surgery, retinal tumours, choroidal tumours, vitreoretinopathies, retinopathy of prematurity, and posterior segment trauma. The chapter concludes with two case-based discussions, on retinal detachment and elevated fundal mass.
Glucocorticoids and immunomodulating agents
Authors: Ponticelli Claudio
Published: January 2013

Although the rationale for an etiological treatment of primary glomerulonephritis is still lacking, a number of clinical studies have shown that some subtypes of these diseases may benefit from empirical treatment based upon the use of glucocorticoids or immunomodulating agents. In this chapter the clinical pharmacology, the mechanisms of action, and the toxic effects of these drugs will be reviewed.
Coronary artery disease: Chronic stable angina
Authors: Kaski Juan Carlos
Published: January 2013

Overview of stable angina 32

Treatment of stable angina 34

Pharmacological therapy for stable angina 36

Myocardial reperfusion therapies for stable angina 40

Prinzmetal’s variant angina 40

Cardiac syndrome X 41

Further reading 41

Clinical trials 42

Ischaemic heart disease is the leading cause of morbidity and mortality in the developed world. The prevalence of stable angina increases with age, affecting 10–15% of women and 10–20% of men aged 65–74 years. Below the age of 50–55 years, a more distinct discrepancy between the sexes is seen, with a higher incidence seen among middle-aged men. In fact, approximately 70% of all patients with chronic stable angina are male....
Arrhythmias, conduction disturbances, and neurocardiogenic syncope
Authors: Kaski Juan Carlos
Published: January 2013

Atrial fibrillation 114

New (acute)-onset atrial fibrillation 116

Paroxysmal atrial fibrillation 118

Persistent atrial fibrillation 120

Permanent atrial fibrillation 122

Secondary atrial fibrillation 124

Drugs used in electrical and chemical cardioversion 126

Antithrombotic treatment 128

Atrial flutter 132

Supraventricular (narrow complex) tachycardias 134

Landmark trials for atrial arrhythmias ...
Structural heart disease
Authors: Kaski Juan Carlos
Published: January 2013

Valvular heart disease 176

Mitral stenosis 177

Mitral regurgitation 178

Mitral valve prolapse 179

Aortic stenosis 180

Aortic regurgitation 182

Tricuspid disease 184

Pulmonary valve disease 186

Antithrombotic management in valve heart disease 187

Cardiomyopathy 188

The most common causes of 1° structural defects in the heart are valvular heart disease, heart muscle disease (cardiomyopathy), and congenital structural heart diseases. Less commonly, 2° heart damage may be caused by infection....
Perioperative cardiothoracic surgical management
Authors: Kaski Juan Carlos
Published: January 2013

Perioperative management of cardiac patients undergoing non-cardiac surgery 258

Risk stratification of cardiac patients undergoing non-cardiac surgery 260

Management of cardiac conditions associated with increased perioperative risk 262

Perioperative management of patients undergoing cardiac surgery 272

Pre-existing CVD is associated with a significant increase in morbidity and mortality in patients undergoing non-cardiac surgery. Coronary artery disease accounts for the vast majority of adverse cardiac events associated with non-cardiac surgery. Other conditions associated with increased perioperative risk include HF, valvular heart disease, and cardiac arrhythmias....
OSH Echocardiography
Authors: Leeson Paul , Augustine Daniel , Mitchell Andrew R.J. , Becher Harald
Published: January 2013

Comprehensively updated and now including over 175 videos, this new edition is a unique and practical training guide for all those wanting easily accessible, detailed information on how to get good images, make key measurements and report their findings.
Brain and mind
Authors: Davies Martin
Published: January 2013

Descartes's ontological dualism of mind and body made it difficult for him to describe the phenomenology of embodiment, the way we experience our own body. Contemporary theories of the mind–brain relation are predominantly physicalist, rather than dualist, in their ontology. But the duality of objective and subjective conceptions still presents a challenge for the sciences of the mind. Persons understood as such, partly from the first-person perspective—persons conceived as subjects and agents, with their experiences, thoughts, plans and actions—will not be visible in a purely objective, scientific story of the physical world.
Statistics and the design of experiments and surveys
Authors: Dunn Graham
Published: January 2013

Research into mental illness uses a much wider variety of statistical methods than those familiar to a typical medical statistician. In many ways there is more similarity to the statistical toolbox of the sociologist or educationalist. It would be a pointless exercise to try to describe this variety here but, instead, we shall cover a few areas that are especially characteristic of psychiatry. The first and perhaps the most obvious is the problem of measurement. Measurement reliability and its estimation are discussed in the next section. Misclassification errors are a concern of the third section, a major part of which is concerned with the estimation of prevalence through the use of fallible screening questionnaires. This is followed by a discussion of both measurement error and misclassification error in the context of modelling patterns of risk. Another major concern is the presence of missing data. Although this is common to all areas of medical research, it is of particular interest to the psychiatric epidemiologist because there is a long tradition (since the early 1970s) of introducing missing data by design. Here we are thinking of two-phase or double sampling (often confusingly called two-stage sampling by psychiatrists and other clinical research workers). In this design a first-phase sample are all given a screen questionnaire. They are then stratified on the basis of the results of the screen (usually, but not necessarily, using two strata—likely cases and likely non-cases) and subsampled for a second-phase diagnostic interview. This is the major topic of the third section. If we are interested in modelling patterns of risk, however, we are not usually merely interested in describing patterns of association. Typically we want to know if genetic or environmental exposures have a causal effect on the development of illness. Similarly, a clinician is concerned with answers to the question ‘What is the causal effect of treatment on outcome?’ How do we define a causal effect? How do we measure or estimate it? How do we design studies in order that we can get a valid estimate of a causal effect of treatment? Here we are concerned with the design and analysis of randomized controlled trials (RCTs). This is the focus of the fourth section of the present chapter. Finally, at the end of this chapter pointers are given to where the interested reader might find other relevant and useful material on psychiatric statistics.
Neurodevelopment
Authors: Zilles Karl
Published: January 2013

This chapter discusses neural induction, organogenesis of the central nervous system, histogenesis of the spinal cord, histogenesis of the brainstem and cerebellum, histogenesis of the cerebral cortex, hemispheric shape and the formation of gyri, and genetic factors during development.
Structural magnetic resonance imaging
Authors: Suckling J. , Bullmore E. T.
Published: January 2013

Magnetic resonance imaging (MRI) is a versatile and evolving technology for visualizing the structure, function, and metabolism of the living human brain. All kinds of MRI data can be acquired without exposing subjects to ionizing radiation or radioactive isotopes. Installing the hardware for MRI represents a major capital investment, of approximately £1.5 million. For these three reasons of versatility, safety, and (relative) affordability, MRI continues to be the dominant brain-imaging technique in psychiatric practice and research. In this chapter, we introduce the principles and practicalities of MRI and describe common methods of structural MRI data acquisition and analysis. Chapter 2.3.8 on functional MRI provides greater detail on statistical issues arising in image analysis.
Neuronal networks, epilepsy, and other brain dysfunctions
Authors: Jefferys John G. R.
Published: January 2013

The dynamics of highly interconnected networks of neurones are fundamental to both normal and pathological functioning of the brain. Epilepsy is perhaps the most dramatic example of a dysfunctional neuronal network, characterized by intense and highly synchronous neuronal activity, but more subtle dysfunction is associated with other conditions, such as schizophrenia. This chapter will largely focus on the hippocampus, and to a lesser degree on the neocortex. The hippocampal formation is implicated in several important psychiatric and neurological problems. The hippocampus and amygdala are often the site of epileptic foci, which can lead to problems in learning and memory, emotion, anxiety, and other problems. This kind of epilepsy is variously known as temporal lobe epilepsy, complex partial seizures, or limbic epilepsy. The hippocampus and associated limbic areas have been linked both to affective disorders and to psychoses. This chapter will consider the cellular organization of the hippocampus and then outline aspects of the emergent properties of neuronal networks in the hippocampus and speculative role in psychiatric disorders. Cellular and network mechanisms of focal epilepsy, and learning impairments associated with limbic epilepsy will be reviewed.
Dementia due to HIV disease
Authors: Maj Mario
Published: January 2013

The first description of a syndrome consisting of cognitive, motor, and behavioural disturbances in patients with AIDS was published in 1986. The syndrome was named ‘AIDS dementia complex’. In 1990, the World Health Organization (WHO) introduced the term ‘HIV-associated dementia’, pointing out that subclinical or mild cognitive and/or motor dysfunctions without impairment of performance in daily living activities cannot be subsumed under the term ‘dementia’. The expression ‘mild cognitive/motor disorder’ was proposed for those conditions. The same distinction was made in 1991 by the American Academy of Neurology, which identified an ‘HIV-associated dementia complex’ and an ‘HIV-associated minor cognitive/motor disorder’. The present chapter focuses on the dementia syndrome associated with HIV infection.
The management of dementia
Authors: Taylor John-Paul , Fleminger Simon
Published: January 2013

The term dementia is used in two different ways. First there are the dementias. These are diseases that cause progressive and diffuse cerebral damage, of which Alzheimer's disease is the most common. Second, dementia can be used to refer to a clinical syndrome. Thus dementia is ‘an acquired global impairment of intellect, memory, and personality, but without impairment of consciousness’. For clinicians this is the preferred usage, and the one adopted in this chapter. It demands that the cause of the dementia is explored, and makes no comment on the likely prognosis. This chapter will focus on the management of dementia regardless of the cause; however given the burden of dementia in older age, the discussion will be invariably, but not exclusively, slanted towards the management of dementia in this age group. Aspects of management specific to individual diseases which produce dementia will be avoided. In addition, a discourse on the management of cognitive and memory problems is excluded as these are described elsewhere (see Chapters 2.5.4 and 6.2.7). Patients who suffer the dementia before 18 years of age will, by and large, not be included; their needs are often best met by services provided for people with intellectual disability.
Opioids: heroin, methadone, and buprenorphine
Authors: Mayet Soraya , Winstock Adam R. , Strang John
Published: January 2013

Opioid dependence is a chronic relapsing and remitting disorder affecting a large proportion of people throughout the world with severe physical, psychological, and social consequences. Opioid overdose and spread of blood borne viruses are major causes of morbidity and mortality. Assessment of opioid use and dependence should be systematic and confirmation of dependence is of paramount importance before initiating treatment. The prescription of substitute opioids should be managed carefully to prevent harm, diversion to others and improve safety. Management of opioid dependence can greatly improve outcomes and may be based on opioid maintenance stabilization or detoxification combined with psychosocial interventions.
The clinical neuropsychology of schizophrenia
Authors: Harvey Philip D. , Bowie Christopher R.
Published: January 2013

Impairments in a variety of cognitive functions are found in patients with schizophrenia. These impairments affect a wide array of different cognitive abilities and are often quite severe, when compared to standards based on healthy individuals of the same age, education levels, and gender. Cognitive impairments appear to be present across the lifespan, detectable at the time of the first treatment episode, if not before, and to manifest a generally stable course over time. Although the current knowledge base regarding cognition in schizophrenia is quite broad, additional research information is constantly accruing. The main purpose of this chapter is to provide a broad overview of the domains, severity, and course of cognitive impairments in schizophrenia, with a focus on functional relevance and treatment possibilities.
Epidemiology of schizophrenia
Authors: Jablensky Assen
Published: January 2013

After nearly a century of epidemiological research, essential questions about the nature and causes of schizophrenia still await answers. Two major conclusions stand out. ♦ The clinical syndrome of schizophrenia is robust and can be identified in diverse populations, regardless of wide-ranging demographic, ecological, and cultural differences among them. This suggests that a common pathophysiology is likely to underlie the characteristic symptoms of schizophrenia. On balance, the evidence suggests that schizophrenia incidence and disease risk show relatively modest variation at the level of large population aggregates. However, the study of ‘atypical’ populations or pockets of very high or very low frequency of schizophrenia, such as in genetic isolates or minority groups, may provide novel clues to the aetiology and pathogenesis of disorder. ♦ No single environmental risk factor of major effect on the incidence of schizophrenia has yet been discovered. Further studies using large samples are required to evaluate potential risk factors, antecedents, and predictors for which the present evidence is inconclusive. Assuming that methodological pitfalls will be avoided by risk-factor epidemiology, and that multiple environmental risk factors of small to moderate effect will eventually be identified, the results will complement those of genetic research which also implicate multiple genes and networks. All this suggests that the key to understanding schizophrenia is likely to be in the unraveling of complex gene-environment interactions.
Acute and transient psychotic disorders
Authors: Garrabé J. , Cousin F.-R.
Published: January 2013

The heterogeneous group of acute and transient psychotic disorders are characterized by three typical features, listed below in descending order of priority: ♦ suddenness of onset (within 2 weeks or less); ♦ presence of typical syndromes with polymorphic (changing and variable) or schizophrenic symptoms; ♦ presence of associated acute stress (stressful events such as bereavement, job loss, psychological trauma, etc.). The onset of the disorder is manifested by an obvious change to an abnormal psychotic state. This is considered to be abrupt when it occurs within 48 h or less. Abrupt onset often indicates a better outcome. Full recovery occurs within 3 months and often in a shorter time (a few days or weeks). However, a small number of patients develop persistent and disabling states. The general (G) criteria for these acute disorders in DCR-10 (Diagnostic Criteria Research of ICD) are as follows. G1 There is acute onset of delusions, hallucinations, incomprehensible or incoherent speech, or any combination of these. The time interval between the first appearance of any psychotic symptoms and the presentation of the fully developed disorder should not exceed 2 weeks. G2 If transient states of perplexity, misidentification, or impairment of attention and concentration are present, they do not fulfil the criteria for organically caused clouding of consciousness as specified for F05, criterion A. G3 The disorder does not satisfy the symptomatic criteria for manic episode (F30), depressive episode (F32), or recurrent depressive disorder (F33). G4 There is insufficient evidence of recent psychoactive substance use to satisfy the criteria for intoxication (F1x.0), harmful use (F1x.1), dependence (F1x.2), or withdrawal states (F1x.3 and F1x.4). The continued moderate and largely unchanged use of alcohol or drugs in the amounts or with the frequency to which the individual is accustomed does not necessarily exclude the use of F23; this must be decided by clinical judgement and the requirements of the research project in question. G5 There must be no organic mental disorder (F00–F09) or serious metabolic disturbances affecting the central nervous system (this does not include childbirth). (This is the most commonly used exclusion clause.) A fifth character should be used to specify whether the acute onset of the disorder is associated with acute stress (occurring 2 weeks or less before evidence of first psychotic symptoms): ♦ F23.x0 without associated acute stress and ♦ F23.x1 with associated acute stress. For research purposes it is recommended that change of the disorder from a non-psychotic to a clearly psychotic state is further specified as either abrupt (onset within 48 h) or acute (onset in more than 48 h but less than 2 weeks). Six categories of acute psychoses are presented in ICD-10, and we shall discuss them in order.
Neurobiological aetiology of mood disorders
Authors: Goodwin Guy
Published: January 2013

Neurobiology provides an explanation of behaviour or experience at the level, either of systems of neurones or individual cells. The current era of progress is driven by contemporary cognitive neuroscience and a rapid evolution in the platform technologies of imaging and genetics. These will allow us to improve our accounts of the functional anatomy of the component elements of mood and its disorder, their functional neurochemistry and, in all probability, give meaning to what a cellular account of depressive illness may eventually describe. This chapter will offer a partial and personal view of these developments to date. There are now authoritative models of causation in mood disorder, established from well designed, large-scale twin studies (see Chapter 4.5.5). These inform the classical formulation of mood disorder as requiring a vulnerability, a precipitating factor or factors, and maintaining factors which prevent spontaneous recovery. Neurobiology will be addressed under these headings.
Post-traumatic stress disorder
Authors: Ehlers Anke
Published: January 2013

Clinicians have long noted that traumatic events can lead to severe psychological disturbance. At the end of the nineteenth and the beginning of the twentieth centuries, railway disasters, the World Wars, and the Holocaust prompted systematic descriptions of the symptoms associated with traumatic stress reactions. These include the spontaneous re-experiencing of aspects of the traumatic events, startle responses, irritability, impairment in concentration and memory, disturbed sleep, distressing dreams, depression, phobias, guilt, psychic numbing, and multiple somatic symptoms. A variety of labels were used to describe these reactions including ‘fright neurosis’, ‘combat/war neurosis’, ‘shell shock’, ‘survivor syndrome’, and ‘nuclearism’. This chapter covers clinical features of post-traumatic stress disorder, classification, diagnosis and differential diagnosis, epidemiology, prevalence, comorbidity of PTSD with other disorders, aetiology, course and prognosis, treatment, and finally advice on management.
Social anxiety disorder and specific phobias
Authors: Blackmore Michelle A. , Erwin Brigette A. , Heimberg Richard G. , Magee Leanne , Fresco David M.
Published: January 2013

As our classification systems have been refined, we have come to view social anxiety disorder (social phobia) and specific phobias as distinct disorders, with divergent patterns of prevalence, aetiology, and course. Moreover, treatments for these disorders have become increasingly sophisticated. This chapter presents an overview of the current state of the field with regard to social anxiety disorder and specific phobias.
Panic disorder and agoraphobia
Authors: Ballenger James C.
Published: January 2013

Panic disorder draws its name from the Greek god Pan, god of flocks. Pan was known for suddenly frightening animals and humans ‘out of the blue’. The spontaneous ‘out of the blue’ character of panic attacks is the principal identifying characteristic of panic disorder and central to its recognition and diagnosis. We know the syndrome that we currently call panic disorder with and without agoraphobia has probably existed since the beginning of recorded history. Hippocrates presented cases of obvious phobic avoidance around 400 bc. One of the first modern descriptions was by Benedikt around 1870, describing individuals who developed sudden anxiety and dizziness in public places. Certainly, our current modern ideas of panic disorder evolved essentially simultaneously in the United States and Europe in the early to mid-1960s. Donald Klein in the United States described in 1964 the panic syndrome and reported that it was responsive to imipramine. Isaac Marks in the United Kingdom also described panic attacks and agoraphobic avoidance, and treating the syndrome effectively with behaviour therapy. Until the last several decades, panic disorder and agoraphobia were actually thought to be rare syndromes. It is now clear that individuals with these difficulties are anything but rare. In fact, panic disorder is one of the most common presenting problems in individuals seeking mental health treatment and the fifth most common problem seen in primary care settings. It was thought to be a mild problem, but we now know that it is associated with significant dysfunction. The disability in social, occupational, and family life is in fact comparable to major depression. Although there are differences in the understandings of panic disorder and its treatments across the world, this chapter will review the current understanding about panic disorder, its characteristics, diagnosis, aetiology, and treatments.
The paraphilias
Authors: Fedoroff J. Paul
Published: January 2013

The characteristic essential to all paraphilias is the presence of a persistent and/or recurrent, sexually motivated interest that causes harm. This definition has several implications, discussed in this chapter. Also covered are classification of the paraphilias, diagnosis and differential diagnosis, epidemiology, aetiology and the four major explanatory perspectives that have been identified (disease, behavioural, dimensional, and life story), course and prognosis, and finally treatment and management.
Specific types of personality disorder
Authors: Carrasco José Luis , Lecic-Tosevski Dusica
Published: January 2013

This chapter begins by discussing the epidemiology, aetiology, clinical picture, course, differential diagnosis, and treatment of various Cluster A personality disorders (Paranoid personality disorder, paranoid personality disorder, schizotypal personality disorder), Cluster B personality disorders (antisocial personality disorder, borderline personality disorder (BPD), histrionic personality disorder, narcissistic personality disorder) and Cluster C personality disorders (avoidant personality disorder, dependent personality disorder (JLC), and obsessive–compulsive (anankastic) personality disorder). Other personality disorders (not included in DSM-IV) are also covered, including passive–aggressive (negativistic) personality disorder, self-defeating (masochistic) personality disorder, sadistic personality disorder, depressive personality disorder, and personality changes, including enduring personality changes after traumatic experiences and personality change due to a general medical condition (JLC).
Neuropsychological templates for abnormal personalities: from genes to biodevelopmental pathways
Authors: Tobeña Adolf
Published: January 2013

To give a broad overview of an area that may be crucial to illuminate the genesis of personality disorders, I shall discuss the studies that, during the last decade, have tried to find genetic traces for personality traits that are both behaviourally consistent and biologically well rooted. Previous work using classical (familial or twin) methods had found substantial heritability estimates for several personality traits. It was thus unsurprising that genetic tracking methods impulsed research aimed at showing that temperamental traits contribute to personality scaffolding via neuroendocrine targets specified by particular genes. I’ll be discussing the outcome of some of these efforts and I’ll explore afterwards how other basic temperamental traits, rooted within biodevelopmental processes, do mediate enduring neurocognitive organization resulting in long-lasting behavioural styles. Finally I’ll outline new avenues for the neuropsychology of personality. My approach is deliberately selective, discussing relevant evidence rather than performing a systematic assessment of the field. For reasons of convenience and possible clinical relevance, I have selected some of the traits heralding sound biological foundations, although they are not necessarily prominent in the state-of-the-art dimensional ‘solutions’ for normal and abnormal temperaments.
Special psychiatric problems relating to gambling
Authors: Moran Emanuel
Published: January 2013

Gambling is an activity with the following elements: A contract between two or more people, which is based on a forecast of the outcome of an uncertain event involving random processes; Property, referred to as the stake, is transferred between those taking part, so that some gain at the expense of others; The property transfer depends on the outcome or result of the uncertain event, which has been forecast; Participation is voluntary and not necessarily related to gaining the property, but used to obtain an experience. This chapter discusses the clinical features, classification, aetiology and epidemiology, diagnosis, predisposing factors, course and prognosis, management and treatment, and prevention.
Treatment of suicide attempters and prevention of suicide and attempted suicide
Authors: Hawton Keith , Taylor Tatiana
Published: January 2013

Suicide attempts occur for a wide range of reasons. In many cases the primary aim is not death but some other outcome, such as demonstrating distress to other people, seeking a change in other people’s behaviour or temporary escape. This means that a broad range of treatments are required since the needs of individual patients will vary widely. Treatments for suicide attempters include both psychosocial and pharmacological approaches. While these are considered separately below, in some patients both will be appropriate. This might be the case, for example, if a patient suffers from depression with biological features in the setting of employment and financial difficulties, when treatment with an antidepressant might be combined with problem-solving therapy. Suicide prevention programmes have been established in many countries. This is to be welcomed, not only because of the potential benefits in terms of suicide prevention, but also because of the likely benefits for the broader population of individuals with mental health problems. When considering prevention strategies, it is important to be aware of and sensitive towards issues relating to culture and ethnicity.
Conversion and dissociation disorders
Authors: Bass Christopher
Published: January 2013

Of all the disorders characterized by symptoms in the absence of disease, conversion disorders are perhaps the most difficult to explain. How, for example, can one explain functional blindness or a loss of function of both legs in the absence of conspicuous organic disease? The ancient Greeks recognized that if we suffer emotional disturbance as a result of some serious stress (such as personal injury or bereavement), this causes a change in the nervous system which leads in turn to symptoms in different parts of the body according to the underlying pathophysiology. Nineteenth century neurologists made significant advances when they identified specific ideas at the root of the symptoms. In the early nineteenth century Collie also observed that the significance of, and attention to, a symptom or set of symptoms may depend more on what they mean (or their value) to the individual than on the biological underpinnings of the symptom itself. Spence has recently argued that the problem in hysterical motor disorders is not the voluntary motor system per se: rather, it is in the way that the motor system is utilized in the performance (or non-performance) of certain willed, chosen, actions. This model invokes a consciousness that acts upon the body and the world. By contrast, the psychodynamic (‘conversion’) model, which Freud introduced and which held sway for most of the twentieth century, invokes an unconscious mechanism ‘acting’ independently of consciousness, to interfere with voluntary movement. Spence has further argued that hysterical paralyses are maintained not by unconscious mechanisms, but by conscious processes. The maintenance of these symptoms requires the patient's attention, a characteristic of higher motor acts; the paralyses break down when the subject is distracted, consciousness is obtunded, or when it (the ‘paralyses’) is circumvented by reflexive motor routines. Hysterical paralyses, Spence avers, are quintessentially disorders of action (or inactions), which the patient disavows, when faced with some overwhelming situation, which threatens the identity of the self. One regrettable development of psychiatry's adoption of Freudian theory was the fracture in communication between the disciplines of psychiatry and neurology, which has only recently been restored by the sort of collaborative research currently being carried out by neurologists and psychiatrists. In the last decade there have also been exciting advances in neuroimaging, which have stimulated research into the neurophysiology of hysteria, and these will be described later. This chapter will also emphasize contemporary approaches to management of these difficult clinical problems.
Factitious disorder and malingering
Authors: Bass Christopher , Gill David
Published: January 2013

Patients with factitious disorder feign or simulate illness, are considered not to be aware of the motives that drive them to carry out this behaviour, and keep their simulation or induction of illness secret. In official psychiatric nomenclature, factitious disorder has replaced the eponym Munchausen syndrome, introduced by Asher to describe patients with chronic factitious behaviour. Asher borrowed the term from Raspe's 1785 fictional German cavalry officer, Baron Karl von Munchausen, who always lied, albeit harmlessly, about his extraordinary military exploits. The criteria for factitious disorder in DSM-IV are (a) the intentional production or feigning of physical or psychological signs or symptoms; (b) motivation to assume the sick role; and (c) lack of external incentives for the behaviour (e.g. economic gain, avoidance of legal responsibility, or improved physical well-being, as in malingering) and lack of a better classification for the disorders. In the last 10 years there has been increased interest in deception in medical practice, with specific focus on pathological lying and the diagnostic dilemmas in this field: specifically, how to differentiate between hysteria, factitious disorders, and malingering. Some of these topics will be discussed in the next section. This chapter concentrates on factitious physical complaints; fabricated psychological symptoms are considered under malingering. The DSM-IV criteria have recently come under attack. Turner has argued that criterion B (motivation to assume the sick role) has no empirical content and fulfils no diagnostic function. He also argues that criterion A, the intentional production of physical or psychological signs or symptoms, emphasizes symptoms and cannot accommodate pseudologia fantastica (PF), voluntary false confessions, and impersonations. He concludes that the two criteria need reformulating in terms of lies and self-harm, respectively. Bass and Halligan have also suggested that because the conceptual justification for factitious disorders is ‘empirically unsubstantiated’ and the motivation for diagnostic purposes (conscious versus unconscious; voluntary versus involuntary) essentially unknowable, it seems reasonable to question the clinical status and legitimacy of factitious disorder. More recently there has been a resurgence of interest in pathological lying, because this is often easier to identify than, for example, the degree of ‘voluntariness’ or ‘motivation’ to attain the sick role (however that is defined).
General principles of drug therapy in psychiatry
Authors: Aronson J. K.
Published: January 2013

The successful use of psychotropic drugs demands an understanding of their pharmaceutical, pharmacokinetic, and pharmacodynamic properties. ♦ Pharmaceutical properties: Pharmaceutical formulations can be manipulated to produce different durations of action, for example the use of oily emulsions of antipsychotic drugs in depot formulations. ♦ Pharmacokinetic properties: Pharmacokinetics is the mathe-matical description of the disposition of drugs in the body by absorption, distribution (to plasma proteins and tissues), and elimination (usually by hepatic metabolism and renal excretion). Differences in drug disposition determine differences in dosage regimens and are important for drug interactions. ♦ Pharmacodynamic properties: Pharmacodynamics is the study of the pharmacological actions of drugs and how actions at the molecular level are translated, via actions at cellular, tissue, and organ levels, into therapeutic or adverse effects. The known pharmacological actions of psychotropic drugs are not necessarily the actions that produce their therapeutic or adverse effects.
Antidepressants
Authors: Bhagwagar Zubin , Heninger George R.
Published: January 2013

Major depressive disorder is a serious, recurrent illness which levies a crippling toll on individuals, families, and society in general. The importance of depression as a major public health problem is emphasized by findings from the World Health Organization Global Burden of Disease survey in showing that in 1990 it was the fourth largest cause of burden of disease (i.e. years of life lost due either to premature mortality or to years lived with a disability). It has been estimated that by the year 2020 it is expected to be the second largest cause of burden of disease. Depression is underdiagnosed and frequently under-treated, and depressed individuals have a much higher risk for suicide. The primary treatment for depression involves the use of antidepressant drugs, and it is therefore important that clinicians become familiar with and adept in utilizing this important group of compounds. Although primarily used for the treatment of depression, drugs within this category also have a number of other important uses. A thorough understanding of the pharmacology of antidepressants will aid the clinician in the selective use of these drugs for patients with depression as well as patients with a number of other disorders.
Antiepileptic drugs
Authors: Brennan Brian P. , Pope Jr. Harrison G.
Published: January 2013

Several drugs originally developed to treat epilepsy have been found effective in certain psychiatric disorders. This chapter reviews the antiepileptic drugs most extensively studied in psychiatric disorders: valproate, carbamazepine, lamotrigine, and topiramate. We then briefly mention six other antiepileptics currently under investigation in various psychiatric disorders, but not yet extensively studied: gabapentin, oxcarbazepine, levetiracetam, tiagabine, zonisamide, and pregabalin. The antiepileptic drug phenytoin is rarely used in psychiatric disorders, and is therefore not included in this chapter. The benzodiazepines, which have antiepileptic properties, are also omitted here, as they are discussed in Chapter 6.2.2. We briefly list studies documenting the efficacy of these various agents in psychiatric disorders, but the reader is referred to the individual chapters on specific disorders for a more detailed discussion of treatment strategies.