bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychologist, 30 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter highlights the importance of adopting a position of curiosity with regard to dissociative seizures (DS). The author has treated many patients with DS with various degrees of success. A few patients were highly anxious and had adopted a range of coping strategies, which were inadvertently perpetuating their symptoms and experiences. Most had significant others who were inadvertently making their problem worse by reinforcing unhelpful coping responses. Some had experienced traumas in the past, which had clearly contributed to the onset of the problems. Their initial dissociative reaction had been protective or adaptive but had since become maladaptive. Such transdiagnostic processes are relatively straightforward to assess and are commonly encountered. However, the presentation of some patients was difficult to classify. One patient had an extreme form of physiological arousal including a high pulse rate associated with blackouts. Another patient had been seen by a team of experts and been given a diagnosis of DS but, eventually, was given a diagnosis of parietal lobe epilepsy. Ultimately, the evidence for psychological treatments for DS is growing. However, therapists treating patients with DS should be experienced and work closely with neurologists and psychiatrists to ensure that patients receive the best possible care.
Psychologist, 16 years’ experience, USA
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter details how a psychologist opened up therapy groups to accommodate patients with psychogenic non-epileptic seizures (PNES). In those groups, the psychologist had the chance to hear multiple stories and, quite by accident, informally conducted what might be considered qualitative research. The one thing that began to stand out pretty consistently was the presence of psychological trauma. Often while discussing the trauma, patients would experience a seizure. As such, a trauma-based treatment modality that has been around for decades and that has been specifically designed to treat posttraumatic stress disorder (PTSD) might be useful to treat patients who carry a dual diagnosis of PNES and PTSD. The chapter then argues that perhaps the dismissive attitudes of many health professionals toward these patients stem from ignorance and that if they really understood the profound suffering these patients have been through and now continue to experience, they might change their views and behaviors.
Psychotherapist, 3 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter demonstrates how a psychotherapist treated a patient with extreme Non-Epileptic Seizures (NES). During the patient’s seizure episodes, her face and neck would change color, from red to white or the reverse. She would hold her chest and grimace in pain. Her skin would break out in a cold sweat and she would describe experiencing nausea and double vision. Sometimes she would lose consciousness. So distressing was the seizure episode, both for the patient and the psychotherapist, that a first course of psychotherapy was purely dedicated to stabilization and anxiety prevention techniques.

After the end of this initial course of psychotherapy, the patient was understandably dismayed that she continued to suffer from regular NES. The psychotherapist then tried Lifespan Integration, a directive, somatic trauma-based therapy. Since the patient’s last session, she has been seizure free. Moreover, she has returned to work and has been able to enjoy the time spent with her family.
Psychiatrist, 12 years’ experience, USA
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter highlights the experience of a psychiatrist in treating patients with Psychogenic Non-Epileptic Seizures (PNES). There is no single risk factor that can be found in every patient with PNES, but rather a broad range of biopsychosocial factors that interact with each other and lead to the symptoms. Thus, clinicians should remain open to hear each patient’s story and not force the same formula on all of them or try to “classify” patients into subgroups that may not really be relevant. Each person with PNES arrives at the symptom through a unique set of life circumstances and risk factors. Each person has a different degree of insight and understanding about the illness. As such, each person will approach treatment differently and therefore will respond to treatment in unique ways. Ultimately, the best approach that clinicians can offer to any patient is to embrace the diversity of patients with openness and curiosity to learn and to help.
Junior Doctor (Core Medical Training), 3 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter suggests that the best way to learn that someone in the hospital is having or has had a non-epileptic attack is to have a visitor or patient point it out, someone who does not know enough about the condition to hold biases against it, who does not have expectations of what the “right” response should look like. If the author hears about an attack in this way, the author gets that rarest thing in a junior doctor’s working life: freedom. Freedom not to shout for help or pull the emergency buzzer. Freedom not to pin the person down, to fight for blood samples or intravenous access. Most importantly, freedom to do what is necessary to be reassured that the author is watching a non-epileptic attack and to reassure the patient that he or she is safe.
Epilepsy Specialist Nurse, 10 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter discusses the experience of an Epilepsy Nurse with a patient with Dissociative Seizures. The patient had been brought up in social care and had a history of abuse of all kinds. She developed seizures as a teenager, which presented as blank spells and periods of “being absent.” She was then referred to a Neurologist, who diagnosed her with a Functional Disorder. The Neurologist told her this was due to anxiety, and there was no need for further investigation. The chapter then highlights the importance of keeping such individuals within the epilepsy services until they have been given access to the right pathway, or have at least engaged with appropriate services such as Cognitive Behavioral Therapy (CBT). Although the authority of an epilepsy clinic can lead to a false sense of diagnostic certainty, it does protect patients within a service that knows their story. Later, the Epilepsy Nurse met the patient once again when he had been admitted after he had experienced five seizures at work. The Epilepsy Nurse hoped that the previous course of CBT had provided a quick fix and helped her to recover from a debilitating condition. What had happened, however, was the transference of her own symptoms to her partner.
Linguist, 5 years’ experience, Italy
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter presents an analysis of patients’ descriptions of their Psychogenic Non-Epileptic Seizures (PNES). When analyzing a particular patient’s conversation during consultation, a linguist was intrigued by the fact that there seemed to be much more in her seizure narratives than just an objective and neutral description of her fits, even when compared to descriptions made by other patients with PNES who had suffered similar traumas. The more the linguist examined her consultation, the more the linguist started wondering whether those descriptions could be related in some way to her personal history. When describing her worst seizure, the patient provided specific descriptions of one of the seizure witnesses. Such a focus on witnesses being around her and watching her during her seizures, which is so closely connected to feelings of fear, as well as the focus on the gender of a male witness, seems to go far beyond what is required in the description of a seizure and may instead be related to the traumatic sexual abuse the patient has experienced.
Epileptologist, 7 years’ experience, USA
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter looks at the experience of an Epileptologist. The Epileptologist insists that he or she is not tired of seeing patients with epileptic seizures or Psychogenic Non-Epileptic Seizures (PNES), nor are they tired of reading EEGs, returning patient phone calls, and signing prescriptions. However, the Epileptologist is tired of misinformation and of inappropriate medication trials. The Epileptologist is also tired of working with reluctant Psychiatrists and dealing with Neurologists who insist on treating “organic” disease. As such, after having thought long and hard about how to provide a clear and concise message to patients with PNES or Non-Epileptic Seizures, the Epileptologist decided to frame the response as an FAQ (frequently asked questions). The chapter then identifies the important questions that patients should ask their neurologists.
Clinical Psychologist, 2 years’ experience, USA
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter studies the experience of a Clinical Psychologist who has evaluated patients with Psychogenic Non-Epileptic Seizures (PNES). In clinical practice, the Clinical Psychologist has found it essential to understand with each person what the condition means to him or her, and what the symptoms might represent—not unlike working with any other mental health diagnosis. For example, one resilient and talented young person the Clinical Psychologist worked with had infrequent but highly disruptive episodes. After previously being initially diagnosed with epilepsy, she had been more recently confirmed as having PNES. She readily accepted the diagnosis, and in treatment, the clinical psychologist focused on the disconnection between her own bodily experiences and her ability to understand or explain them. By working to identify how her PNES had previously functioned, in their own way, as an adaptive mechanism for her, the Clinical Psychologist was able to help her build a new life in which the seizures no longer had a role.
Foundations of phenomenology/descriptive psychopathology
Authors: Möller Hans-Jürgen
Published: March 2020

Descriptive psychopathology, also called phenomenology, is the core of psychiatric diagnostics and refers to the description of symptoms that can appear in the context of mental disorders. As such, it forms the basis for psychiatric diagnoses, either on the syndromal level (for example, depressive syndrome) or on the disease/disorder level (for example, Alzheimer’s dementia). The assessment of symptoms in the context of descriptive psychopathology is conceptualized as an objective procedure. However, in reality, this idealistic view faces several limitations. These have to be considered carefully, and actions need to be taken to come as close as possible to the ideal of an objective assessment. Some major factors contributing to objectivity include the application of precise definitions of symptoms, consideration of potential psychosocial distortions during the assessment process, and establishment of a good interaction between interviewer and client (empathetic, but still distant enough).
Neurotransmitters and signalling
Authors: Sharp Trevor
Published: March 2020

Chemical transmission at brain synapses is critical to neuronal signalling, and when it goes wrong, psychiatric or neurological disorder likely ensues. Chemical transmission was once considered to involve a simple ‘forward-direction’, on–off signal generated through the interaction between one of a small number of neurotransmitter molecules and their receptor. This concept has evolved to the synapse being viewed as an extremely complex chemical machine that utilizes a vast array of neurotransmitter-specific proteins to assemble, store, mobilize, and break down one or more of potentially hundreds of chemically diverse transmitter molecules. Individual molecules generate signals over different timescales and spatial domains by interacting with multiple receptor types. Moreover, rather than functioning through the use of a single neurotransmitter, most, if not all, synapses likely operate through the co-release of multiple neurotransmitters. Even the idea that signals are transmitted in a ‘forward direction’ is an oversimplification—certain neurotransmitters signal in the reverse direction. These issues, and more, are reviewed here.
Psychoneuroimmunology
Authors: Leza Juan C. , Caso Javier R. , García-Bueno Borja
Published: March 2020

Human psychoneuroimmunology studies how episodes of stress and anxiety affect a person’s immune system and how this activation of the immune system affects mental processes and health in extension. Cross-talk between oxido-nitrosative and inflammatory pathways in brain cells and circuits occurs after stress exposure and can lead to behavioural responses. Many basic and clinical evidences have been presented on the mechanisms by which the immune system interact with neurotransmitters and neurocircuits to influence the risk for depression, psychosis, and other psychopathologies.
Genetics of autism spectrum disorders
Authors: Gupta Abha R. , Fernandez Thomas V. , Hoffman Ellen J.
Published: March 2020

A revolution in genetic technologies and methods, such as high-throughput DNA sequencing, has enabled significant progress in identifying mutations in Mendelian disorders and complex diseases. Given the tremendous clinical and genetic heterogeneity of autism spectrum disorder (ASD), similar progress for this disorder has been slower and more challenging, yet accelerating advancements have been made over the last decade. These advancements are due to the declining costs of genotyping and sequencing, as well as invaluable efforts by research-funding agencies, private foundations, research consortia, and affected families to increase collaboration and provide the critical resources and participation needed for this work. This chapter broadly reviews recent findings in the genetics of ASD, the importance of modelling ASD variants to bridge the genetics and neurobiology of ASD, and guidelines for clinical genetics testing in ASD.
Management and treatment of autism spectrum disorders
Authors: Simonoff Emily
Published: March 2020

Autism spectrum disorder (ASD) is a chronic disorder beginning early in development and comprising lifelong impairments in social communication and restricted and repetitive behaviours and interests. The manifestations of these core symptoms frequently vary across individuals, especially with differences in intellectual ability, and may change with age. In addition, people with ASD have high rates of co-occurring psychiatric disorders, including attention-deficit/hyperactivity disorder, anxiety and depression, tics/Tourette’s syndrome, and sleep problems. They frequently exhibit behaviours that challenge others, including aggression, self-injury, and high levels of irritability. Hence, their treatment and management requires a comprehensive approach to core and co-occurring symptoms. Management should include evidence-based approaches from health and also ASD-specific support from education, employment, social care, and the wider community. There is insufficient evidence to guide best practice, and more research on interventions is urgently required.
Dementia due to Huntington’s disease
Authors: Margolis Russell L.
Published: March 2020

Huntington’s disease (HD), first described in 1872, is perhaps the prototypical hereditary dementia and movement disorder. Key features include autosomal dominant inheritance, typically mid-life clinical onset, and a clinical triad of abnormal voluntary and involuntary movements, subcortical dementia, and psychiatric symptoms. The disease progresses inevitably, with death typically 15–20 years after onset. Neurodegeneration is most prominent in the striatum and cerebral cortex. The discovery of the causative mutation, an expanded CAG repeat in the gene huntingtin, has led to the development of reliable genetic testing for affected and at-risk individuals and an explosion of neurobiological research into HD pathogenesis. While present treatment of HD is limited to managing symptoms, there is considerable optimism that treatments to prevent, slow, or stop disease progression may be feasible in the near future.
Opioids
Authors: Farrell Michael , Larance Briony , Breen Courtney
Published: March 2020

As with other substances of dependence, prolonged exposure to moderate or high dosages of pharmaceutical or illicit opioids can result in people developing the chronic, often relapsing, condition known as opioid dependence. Opioid dependence has profound social effects on the person and the people around them. The major health consequences include increased risk of blood-borne virus infections, such as HIV, hepatitis C, and hepatitis B, through injection and drug overdose, with highly elevated risks of premature mortality. The chronic nature of opioid dependence results in repeated treatment episodes and prolonged treatment need. The aims of any opioid treatment programme should be guided by the principles of reducing or ceasing non-prescribed opioid use, preventing future harms, minimizing mortality risk, and improving quality of life and well-being. Opioid agonist (maintenance) treatments, typically methadone or buprenorphine, used at the optimal dose range, are effective and lifesaving treatments. However, they remain controversial. This chapter examines key clinical considerations, including assessment and diagnosis, comorbidity, social issues, risk, and special considerations.
Cannabis and mental illness
Authors: Castle David J.
Published: March 2020

Cannabis sativa is a drug of potential dependence, and its users are also at increased risk of using other drugs. It has anxiolytic and sedative properties, but in some individuals, it can precipitate panic. There is an association between cannabis consumption and depression, but cohort studies suggest the association is mostly reverse causality. Cannabis can produce psychotic phenomena, notably in individuals with psychosis proneness. It appears to ‘bring forward’ the onset of schizophrenia, and it may act as a cumulative causal factor for schizophrenia. Acute cognitive effects of cannabis are well described, as is an amotivational syndrome with heavy prolonged use. Some evidence suggests enduring neurocognitive effects in heavy users. There is particular concern regarding use of high-potency cannabis in youth, as it appears that its effects on cognition and its potential contribution to depressive and psychotic disorders are particularly marked during this developmental phase.
Structural and functional neuroimaging of schizophrenia
Authors: Diaconescu Andreea O. , Iglesias Sandra , Stephan Klaas E.
Published: March 2020

Neuroimaging methods have greatly contributed to our understanding of structural and functional brain changes in schizophrenia. This chapter reviews seminal studies that started the field, as well as more recent neuroimaging research, including discovery-oriented and theory-driven approaches. The chapter structures the latter literature according to four major contemporary pathophysiological theories of schizophrenia, including: (1) the neurodevelopmental theory; (2) the dopamine theory; (3) the GABAergic and glutamatergic theory; and (4) the dysconnection theory. The chapter focuses on those neuroimaging studies that have contributed to elucidating the proposed disease mechanisms. Finally, the chapter discusses the central challenge of neuroimaging in schizophrenia research—to provide tools for individual treatment response prediction. It considers how technical advances in neuroimaging techniques, in combination with computational modelling approaches that strive for mechanistic interpretability, can improve the clinical utility of neuroimaging methods.
Prevention and early intervention in psychotic disorders
Authors: Bora Emre , Jayaram Mahesh , Pantelis Christos
Published: March 2020

This chapter considers treatment approaches in early psychosis and the possibility of prevention prior to the development of illness. The chapter first considers the various definitions of the pre-psychotic state, including prodrome, and the concept of clinical high-risk (CHR) groups. The CHR groups, including the ultra-high-risk (UHR) and basic symptoms (BS) groups aim to identify individuals at imminent risk of transitioning to full-blown psychosis. Further, the chapter summarizes the notion of a staging model for psychosis, which incorporates these earliest pre-psychosis stages, and considers the onset and progression of the illness to chronicity, with differing intervention options for each stage. The relevance of interventions targeting non-specific risk factors, such as trauma, stress, bullying, drug abuse, and migration, in the early years is considered. The chapter discusses possible interventions to prevent or delay psychosis onset or progression (for example, prenatal choline or vitamin D), and public health measures at the population level. It also explores the issues relating to drug prescribing in the pre-psychosis stage and outlines controversies regarding the risk–benefit ratio and ethics of these pre-emptive strategies. Models of care aimed to reduce the duration of untreated psychosis may prove useful. Integrative treatment in early psychosis has been more successful than ‘treatment as usual’ in reducing symptoms, relapse rates, and improving engagement. Early detection and intervention services and public awareness campaigns are key to primary prevention. Studies that investigate trajectories of symptom development and emergence of psychosis are needed, in order to evaluate the effectiveness of pre-emptive and later interventions.
Primary prevention of mood disorders: building a target for prevention strategies
Authors: Malhi Gin S.
Published: March 2020

Despite the advent of many treatments, mood disorders remain a considerable burden. Tracing their evolution points to inception early in life—birth, infancy, childhood, and adolescence, with full-blown debilitating syndromes eventuating as young adults and in later years. The inability to satisfactorily treat these illnesses, especially once established, has increasingly focused attention on early intervention and ideally prevention. For this, universal and targeted preventive strategies have been trialled that address various aspects of the emerging syndromes along their anticipated trajectories of illness. The success of these endeavours has been limited. The efficacy and effectiveness of targeted interventions are marginally superior to community-wide universal interventions, but in most cases, the benefits are modest and short-lived. This chapter discusses the preventive interventions that have been tested and implemented to date, with a view to identifying the factors contributing to these deficiencies. At the same time, alternative strategies that may be able to overcome these shortfalls are explored, with particular emphasis on the integration of neurobiological and neuropsychological components in prevention paradigms.
Classification and descriptive psychopathology of post-traumatic stress disorder and other stressor-related disorders
Authors: Kilpatrick Dean G. , Friedman Matthew J. , Gilmore Amanda K.
Published: March 2020

This chapter addresses the new section in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) called ‘Trauma and stressor-related disorders’. All diagnoses within this category have two things in common: (1) a discrete traumatic/adverse event or experience that preceded the onset or aggravation of symptoms; and (2) a wide range of cognitions, emotions, and behaviours embedded within DSM-5 diagnostic criteria for each disorder. The chapter also discusses the comparable proposed diagnostic criteria for the eleventh edition of the International Classification of Diseases (ICD-11). Current considerations and challenges regarding the classification of stressor-related disorders are reviewed.
Genetics of stress-related disorders
Authors: Gottschalk Michael G. , Domschke Katharina
Published: March 2020

This chapter on genetics of stress-related disorders reviews the state of the art in molecular variations associated with post-traumatic stress disorder (PTSD), including cross-disorder phenotypes like anxiety sensitivity, state/trait anxiety, and harm avoidance. It summarizes the wealth of information collected in family and twin studies, genome-wide association studies (GWAS), and candidate gene, gene–environment, and epigenetic investigations. The molecular overlap between PTSD and anxiety disorders is highlighted. Emphasis is laid upon findings relating to serotonin, catecholamine, and the hypothalamic–pituitary–adrenal (HPA) axis signalling pathways, as well as the integration of physiological, imaging, and psychological readouts. Genetic variants linked to treatment response prediction, susceptibility, and resilience, as well as disease course, are discussed, and the complexity of gene–environment interactions in PTSD is addressed. Finally, a future outlook is offered into personalized therapy and innovative drug discovery, dimensional psychopathology, and polygenic risk evaluation in light of dynamic epigenetic markers and systems biology-informed nosology.
Neuroimaging of anxiety disorders
Authors: Leicht Gregor , Mulert Christoph
Published: March 2020

Neuroimaging has extensively contributed to the identification of the neurobiological basis of anxiety and the pathophysiological mechanisms underlying anxiety disorders. Studies in human models of anxiety, as well as investigations in anxiety disorder patients, consistently demonstrated the pathophysiological role of a ‘fear network’ comprising the amygdala, insula, medial prefrontal cortex, and anterior cingulate cortex. This chapter reviews the main neuroimaging findings from human models of anxiety disorders such as fear conditioning, fear generalization, and pharmacologically induced panic attacks. Moreover, the chapter summarizes evidence from research in patients aiming to identify the neural processes underlying the pathophysiology of clinically relevant anxiety disorders. Finally, the chapter provides an overview on neurobiological aspects of successful therapeutic interventions, which might prospectively contribute to the refinement of existing approaches, the prediction of the success of certain treatment strategies in individual patients, and the development of more effective options for the treatment of anxiety disorders.
Genetics of obsessive–compulsive disorder
Authors: Nestadt Gerald , Samuels Jack
Published: March 2020

There is strong evidence that obsessive–compulsive disorder (OCD) has a genetic basis. This chapter focuses on recent findings on the genetics of OCD from genetic epidemiological (family and twin) studies, as well as from molecular genetic studies (linkage studies, candidate gene association studies, and genome-wide association studies), of common and rare variants associated with OCD. The chapter discusses the challenges and prospects in elucidating the specific genetic basis of OCD, including the genetic complexity and phenotypic definition. Genetic studies in humans and animals offer great promise in elucidating the pathophysiology of OCD and in developing more rational treatment approaches.
Hoarding disorder
Authors: Fernández de la Cruz Lorena , Mataix-Cols David
Published: March 2020

Hoarding disorder (HD) is a mental disorder that was newly included in the obsessive–compulsive and related disorders chapter of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It is also planned for inclusion in the International Classification of Diseases, eleventh revision (ICD-11). Individuals meeting the diagnostic criteria for HD experience persistent difficulty discarding or parting with possessions due to a perceived need to save the items and distress associated with discarding them. This results in the accumulation of possessions that congest and clutter active living areas and substantially compromise their intended use, causing clinically significant distress or impairment. These symptoms must not be attributable to another medical or mental disorder. A majority of people diagnosed with HD excessively acquire items that they do not need or for which no space is available. Currently, the intervention with the strongest evidence base for HD is cognitive behavioural therapy tailored to the hoarding difficulties.
The eating disorders
Authors: Fairburn Chris , Murphy Rebecca
Published: March 2020

This chapter describes the three main eating disorders (anorexia nervosa, bulimia nervosa, and binge eating disorder), together with other similar related states. It explains how they are classified and describes their clinical features, development, and course. It is noted that the eating disorders have many features in common and that people move between them over time. These two observations support adopting a transdiagnostic perspective on these conditions.
Epidemiology and primary prevention of feeding and eating disorders
Authors: Halmi Katherine A.
Published: March 2020

In the past 20 years, the incidence of anorexia nervosa (AN) in industrialized countries has remained stable at 4.2–7.7 new cases per 100,000 per year. During this period, the incidence of bulimia nervosa (BN) has decreased from 12.2 to 6.1 per 100,000. The lifetime prevalence of AN in females in the United States in the past decade was 0.9% and 0.3% in males, and that of BN was 0.88% in females and 0.12% in males in a European study. Binge eating disorder (BED) is the most common eating disorder (ED), with a lifetime prevalence of 3.5% in women in the United States and 2.0% in men. AN has the highest standardized mortality rate of 5.86, followed by BN with a standardized mortality rate of 2.29. Less than half of AN patients have a full recovery, compared to two-thirds of BN patients who recover. The prevalence of EDs is increasing in the Middle East and Asian countries, as well as among Latinos, African-Americans, and Asians in the United States. Body dissatisfaction and a family history of ED are consistent risk factors across all EDs. Perfectionism is a greater risk factor for restricting AN and conduct disorders, and substance abuse and sexual abuse are risk factors for BN and BED. ED prevention programmes have mainly targeted at-risk persons in specific age groups and environments. Both Internet-based and group session programmes have reduced ED-related symptoms. There are multiple issues concerning the implementation and maintenance of prevention programmes, including clinician training, costs, attrition rate, and effectiveness over time.
Imaging of feeding and eating disorders
Authors: Kurniadi Natalie , Wierenga Christina E. , Berner Laura A. , Kaye Walter H.
Published: March 2020

The conceptual framework regarding the aetiology of eating disorders (EDs) has changed dramatically in recent decades. Cutting-edge neuroimaging techniques have led to advancements in understanding the underlying neurobiology of anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Techniques such as magnetic resonance imaging (MRI), positron emission tomography (PET), and diffusion tensor imaging (DTI) allow the opportunity to examine not only structural, but also functional, abnormalities that contribute to extreme eating behaviours characteristic of these life-threatening disorders. Furthermore, research using imaging paradigms suggests that variations in neurobiology are associated with traits that persist after recovery. This chapter will provide insights regarding neural pathways involved in the processing of appetite, reward, mood, body perception, and cognitive inhibition as they pertain to EDs. Findings relevant to feeding disorders will also be discussed. Conclusions will include considerations of treatment applications and directions for future research.
Basic mechanisms of, and possible treatment targets for, sleep–wake disorders
Authors: Pritchett David , Fisk Angus S. , Foster Russell G. , Peirson Stuart N.
Published: March 2020

Circadian rhythms are endogenous 24-hour oscillations in physiology and behaviour that enable organisms to predict and adapt to the rhythmic changes of the day/night cycle. While the rhythm of activity and rest is perhaps the most familiar, changes in body temperature, heart rate, hormone production, and even cognitive function also occur. By contrast, the daily pattern of sleep and wake is not solely determined by the circadian system and is also regulated by a homeostatic process that increases with prolonged waking. Sleep and circadian rhythm disruption (SCRD) is commonly observed in psychiatric disorders, such as schizophrenia, although it is unclear as to the basis of this comorbidity. The chapter provides an overview of the links between SCRD and schizophrenia, highlighting the potential sources of this association. Moreover, the chapter describes how targeted treatment of the underlying sleep and circadian disruption in this patient group may provide a novel therapeutic avenue to ameliorate their primary symptoms.
Diagnosis of sleep and circadian rhythm disorder
Authors: Anderson Kirstie
Published: March 2020

The diagnosis of sleep and circadian rhythm disorders provides a detailed framework to correctly diagnose the primary sleep disorders that a psychiatrist will see in daily practice, including common sleep-related movement disorders. This includes the specific sleep history, the role of sleep diaries, validated questionnaires, and how to interpret the scores and the role of both home and inpatient sleep studies (polysomnography). The most recent diagnostic criteria within the International Classification of Sleep Disorder, third edition (ICSD-3) are used for the four major categories of sleep disorder: hypersomnia, insomnia, parasomnia, and circadian rhythm disorder. Common sleep disorders such as obstructive sleep apnoea (OSA), restless legs syndrome (RLS), narcolepsy, and both non-rapid eye movement (NREM) sleep parasomnia and rapid eye movement (REM) parasomnia are described. It is written for qualified specialist doctors.
Management of insomnia and circadian rhythm sleep–wake disorders
Authors: Kyle Simon D. , Henry Alasdair L. , Espie Colin A.
Published: March 2020

Insomnia disorder and circadian rhythm sleep–wake disorders (CRSWDs) are prevalent and impairing sleep disorders and often co-present with psychiatric disorder. Insomnia is characterized by difficulty with initiation and/or maintenance of sleep, driven primarily by cognitive behavioural processes. CRSWDs manifest because of alterations to the endogenous circadian clock (intrinsic) or as a consequence of environmental circumstances (extrinsic). This chapter reviews evidence-based treatments for the management of insomnia and intrinsic CRSWDs (delayed sleep–wake phase disorder, advanced sleep–wake phase disorder, non-24-hour sleep–wake disorder, irregular sleep–wake rhythm disorder). The chapter covers cognitive behavioural therapies, sleep-promoting hypnotics, phototherapy, and exogenous melatonin administration. The chapter also highlight gaps in the existing clinical science and reflects on emergent therapeutic approaches.
Core dimensions of personality pathology
Authors: Skodol Andrew E. , Morey Leslie C.
Published: March 2020

This chapter describes the emergence of dimensional models for the classification and diagnosis of personality pathology. Broad personality traits underlie the meta-structure of psychopathology in general and describe the myriad manifestations of personality disorders (PDs) specifically. Domains of personality functioning distinguish personality styles from PD, and PD from other types of psychopathology, and represent the important construct of severity in personality pathology. This chapter describes the alternative Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) model for personality disorder (AMPD) and the five-factor model of personality (FFM) by which it was inspired. It summarizes the development and longitudinal course of personality traits, personality functioning, and PD; the relationship of personality and PD with physical health and psychosocial impairment; and the clinical utility of dimensional diagnostic approaches. Finally, it illustrates how traditional DSM subtypes of PD can be rendered according to impairments in personality functioning and pathological personality traits in a ‘hybrid’ dimensional–categorical model.
Conduct disorders and antisocial personality disorder in childhood and adolescence
Authors: Scott Stephen , Palmer Melanie
Published: March 2020

Oppositional defiant and conduct disorders are the most common mental health problems in childhood. They have a poor prognosis if left untreated, with increased crime, violence, drug misuse, academic failure, dependence on state welfare, psychosis, and early death. A number of children additionally have callous-unemotional traits, and they are at risk for going on to develop antisocial personality disorder, which has its origins in childhood. Children with comorbid callous-unemotional traits or attention-deficit/hyperactivity disorder (ADHD) symptoms have a high genetic contribution to their problems and reduced functioning in the limbic and prefrontal areas. There have been over 100 randomized controlled trials of interventions, with evidence-based parenting programmes repeatedly being shown to be effective in both the short and the longer term. There is emerging evidence that they may help prevent personality disorder. In the absence of ADHD, medication has no role to play in the routine management of oppositional defiant and conduct disorders.
Biological aspects of suicidal behaviour
Authors: Mann J. John , Currier Dianne
Published: March 2020

Suicide and non-fatal suicide attempts are complex multi-determined behaviours that occur generally in the context of a diathesis or predisposition. This diathesis is characterized by traits in multiple domains, including clinical, cognitive, behavioural, and biologic aspects. Research over the past 30 years has revealed much about neurobiological dysfunction associated with suicidal behaviour and underlying other traits that characterize the diathesis, including reactive aggression, deficits in executive function, negative or rigid cognitive processes, impaired problem-solving, and recurrent mood disorders. These neurobiological deficits and the associated clinical, behavioural, and cognitive traits are likely to originate from combinations of genes and early-life experiences during critical formative developmental periods. This chapter will describe neurobiological abnormalities found in suicidal behaviour, relate those findings to traits characterizing the diathesis for suicide, and examine the evidence from genetic studies suggesting a potential aetiology for those abnormalities.
Prevention of suicide and treatment following self-harm
Authors: Hawton Keith , Saunders Kate E. A. , Pitman Alexandra
Published: March 2020

Suicide prevention strategies generally combine broad population or universal approaches with complementary high-risk or targeted prevention interventions, with evidence favouring greater impacts of population strategies. This chapter summarizes the evidence supporting a range of approaches to suicide prevention at the population level (restricting access to means of suicide, limiting the effects of suicide suggestion, influencing media portrayals of suicidal behaviour, using psychoeducation to improve help-seeking, primary care training, school interventions, telephone/Internet support services, lay training in gatekeeping) and for high-risk groups (risk management for specific psychiatric disorders, optimizing psychotropic medication, service delivery reform, enhanced support for specific high-risk groups—people with substance misuse and physical health problems, people who self-harm, people in specific occupational groups, prisoners, and people bereaved by suicide). Particular attention is given to evaluating the evidence base for interventions for people who self-harm. The chapter concludes that a comprehensive multi-sectoral approach is required for suicide prevention, tailored to specific local epidemiological patterns.
Deconstructing dualism
Authors: Sharpe Michael , Walker Jane
Published: March 2020

Illness is conventionally categorized into two main types: ‘medical’ or ‘psychiatric’. This dichotomization is such an accepted feature of current medical practice that we take it for granted. But is it really the best way to think about and manage illness? In order to answer these questions, the chapter reviews what is meant by ‘medical’ and ‘psychiatric’ illness and considers the assumptions underpinning this division. The chapter then outlines alternative and more unified conceptualizations of illness, as well as the development of integrated models of clinical care.
Organization of psychiatric services for general hospital departments
Authors: Sledge William H. , Dorset Julianne
Published: March 2020

A modification in consultation liaison psychiatry/psychosomatic medicine is introduced and explored by a review of the concepts of prevention and proactivity in other disciplines of medicine. Three major advantageous outcomes of a proactive/preventive approach are noted—namely, early recognition and treatment result in less mortality and morbidity, staff satisfaction, and care that is less expensive overall. Three psychiatric proactive programmes that have been published are reviewed. These are: the Rapid Assessment, Interface, and Discharge (RAID) model in the United Kingdom, developed to serve the City Hospital of Birmingham; the quality improvement programme of co-management with internist developed at Columbia University Medical Center; and the Behavioral Intervention Team (BIT) of the Yale School of Medicine. All three are economically effective, provide innovative approaches to co-management of patients with co-occurring mental and physical illnesses, and aim to develop integrated care.
Refugees and populations exposed to mass conflict
Authors: Fazel Mina , Rees Susan , Silove Derrick
Published: March 2020

The mental health implications of forced migration because of conflict, leading to large populations of displaced and refugee adults and children, are the focus of this chapter. The factors leading to forced migration are discussed in light of their impacts on mental illness, both in the short and long term. Rates of mental illness, especially depression, anxiety disorders, and post-traumatic stress disorder, are raised in these populations, with exposure to torture and other forms of violence the strongest predictors for subsequent disorders. A framework for assessment is proposed, and a discussion of the cycles of violence that can impact on children and women raised. Specific populations of note are considered, including those in immigration detention, unaccompanied minors, and trafficked populations. The range of interventions that have been trialled to treat mental illness in refugee populations are presented.
Associations between psychiatric disorder and offending
Authors: Fazel Seena , Toynbee Mark
Published: March 2020

This chapter provides an overview of the links between mental health disorders and crime, particularly violent crime. The chapter summarizes the increasing evidence that mental illnesses, such as psychosis, bipolar disorder, and depression, are associated with an increased risk for violent offending, even after accounting for sociodemographic and familial factors. Among the full range of psychiatric disorders, the strongest associations for violence are reported to be with substance misuse and personality disorder. The chapter outlines a smaller body of mostly observational evidence that suggests that treatment of these disorders is associated with a reduction in offending. In conclusion, the chapter recommends some broad risk assessment and management principles, highlights a role for risk assessment to inform the screening of low-risk persons and tailors non-harmful interventions towards higher-risk patients, and suggests that treatment plans should be informed by evidence on modifiable risk factors for violence.
Homicide
Authors: Large Matthew , Nielssen Olav
Published: March 2020

A range of killings of one person by another can be described as a homicide. Homicide rates vary greatly between geographic regions, reflecting differences in social factors such as weapon availability, patterns of substance use, the efficacy of the police and other institutions, and overall levels of violent crime. Domestic homicide is killing within a family and includes fatal domestic violence and most homicides of infants, children, and older people. Most homicides by people with mental illness are of family members, but most domestic homicide offenders are not mentally ill. People with mental illness, particularly those with schizophrenia, commit a small percentage of all homicides, but a disproportionate number, compared to the incidence of mental illness. Mental health professionals have a role in preventing homicides by offering interventions for domestic violence, substance use disorder, and the early and continued treatment of psychotic disorders.
How to use the Oxford Handbook of Medical Statistics
Authors: Peacock Janet L. , Peacock Philip J.
Published: March 2020

This chapter provides an overview of the contents of the handbook, adding detail about how doctors should think about statistics in the context of diagnosis, research, and appraising evidence. It includes a rationale for the importance of statistics in medicine, the importance of collaboration and consultancy to researchers and clinicians, and challenges to effective working. Ways of using the handbook for different healthcare professionals at various career stages are highlighted.
Analysing multiple observations per subject
Authors: Peacock Janet L. , Peacock Philip J.
Published: March 2020

This chapter describes the statistical issues involved in analysing studies with more than one data point or observation per subject, such as when a series of measurements are made on each individual over time or when a group of subjects are analysed together, forming a cluster. For each of these situations, the statistical analysis needs to take account of the design of the study, and for most situations there are several possible approaches which may be used. The most common approaches are described in terms of when the methods are appropriate, how they work, and how the results are interpreted.
Analysing multiple variables per subject
Authors: Peacock Janet L. , Peacock Philip J.
Published: March 2020

This chapter describes the statistical issues involved in analysing studies with more than one variable for each subject such as when adjusting for confounding or nuisance variables or wishing to disentangle the effect of multiple variables on a single outcome. There is a wide range of modelling techniques that can be used and so the approaches commonly used when analysing different outcome variables and/or different study designs are described. The chapter discusses the approaches in terms of when the methods are appropriate, how they work, and how the results are interpreted.
C
Authors: Ainsworth Sean
Published: March 2020

This chapter presents information on neonatal drugs that begin with C, including use, pharmacology, adverse effects, fetal and infant implications of maternal treatment, treatment, and supply of Cabergoline, Caffeine citrate, Calcium gluconate and other calcium salts, Captopril, Carbamazepine, Carglumic acid, Carnitine (levocarnitine [INN], L-carnitine), Caspofungin, Cefalexin = Cephalexin (USAN and former BAN), Cefotaxime, Ceftazidime, Ceftriaxone, Cefuroxime, Chloral hydrate, Chloramphenicol, Chloroquine, Chlorothiazide, Chlorphenamine = Chlorpheniramine (USAN and former BAN), Chlorpromazine, Ciprofloxacin, Citrulline, Clarithromycin, Clindamycin, Clobazam, Clonazepam, Clonidine, Co-amoxiclav = amoxicillin/ clavulanic acid (iNN), Codeine phosphate, and Co-trimoxazole