bluuebunny/crossref_metadata_2025 huggingface dataset:
Non-Epileptic Seizures in Our Experience
Authors: Schachter Steven C.
Published: March 2020

To an outside observer, Psychogenic Non-Epileptic Seizures (PNES) look like epileptic seizures. The manifestations of PNES include collapses, impaired consciousness, and seizure-related injuries. However, unlike epileptic seizures, which are the result of abnormal electrical discharges in the brain, most PNES are an automatic psychological response to a trigger perceived as threatening. Not least because the changes in the brain that underpin PNES cannot be visualized easily with clinical tests (such as the EEG), there are many uncertainties and controversies surrounding the condition.

Patients often provoke a mixture of emotions in healthcare professionals. In the authors’ previous book, In Our Words: Personal Accounts of Living with Non-Epileptic Seizures, over 100 individuals with PNES and their families wrote about their experiences with the condition. While some had positive care experiences, most were left feeling confused, angry, and abandoned by the clinicians they had encountered. Non-Epileptic Seizures in Our Experience: Accounts of Healthcare Professionals complements the previous book by presenting the perspectives of over ninety healthcare professionals from around the world. The anonymous publication format enabled many not only to share success stories but also to be open about difficulties and failures.

There will be something to learn from this book for highly experienced professionals as well as for relative novices and those experiencing PNES. The hope is that this book will challenge negative attitudes surrounding the condition, improve understanding between healthcare professionals and patients, and, ultimately, advance the quality of care provided for those with PNES.
Epilepsy Specialist Nurse, 7 months’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter discusses how, although the cause is not always obvious, Non-Epileptic Seizures (NES) are often caused by emotion or stress. It is important to acknowledge that this is an unconscious mechanism that the brain uses to protect itself from overwhelming stress. However, because the understanding is not out there, it is difficult for patients to gain insight and understand that treatment for these seizures is not with medicine, but by way of talking therapies such as Cognitive Behavioral Therapy (CBT). What if the person does not feel comfortable with talking therapies—what next? Some people instantly want to talk about the trauma they have experienced so they can verify the link between the experience and NES for themselves. For others, it can create a wall between the health professional and the patient. The chapter then explains how there should be appropriate training for non-epileptic attack disorder (NEAD), by way of a university module or compulsory mandatory training within health trusts that teach professionals what these conditions are, how they can best manage the care of these patients, and what resources are out there to help both the professional and the patient.
Psychiatrist, 17 years’ experience, Australia
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter examines patients’ broad range of responses to their initial psychiatric consultation with a psychiatrist. Over the years, psychiatrists have grown more comfortable when discussing non-epileptic seizures, and the responses have become more positive as a result. However, there is still a large group of patients who do not come back after that first visit, and they are hard to get a hold of again. When they can be contacted, they sometimes say that they have not come back because they have stopped having seizures. This can be a bit frustrating for the psychiatrist. There is a missing story and the psychiatrist has to fill in the gaps by making it up.
Neurologist, 15 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter describes the experience of a neurologist in the UK. Patients would often inform the neurologist that Accident and Emergency (A&E) staff had directly told them that they knew they were “making it up” and to “stop wasting our time.” When the neurologist saw how A&E staff routinely dealt with vulnerable, fragile people with Non-Epileptic Attacks (NEAs), the neurologist found it hard to square this blatant if unintentional cruelty with a job whose raison d’être is meant to be to care, heal, and comfort. And when doctors, nurses, and family members still ask, “Why do you bother with these conditions? Why not focus on more deserving patients?,” the neurologist finds their logic perverse for two reasons. First, many people with NEAs were traumatized in childhood, often abused. Having been doubted and abandoned once, surely they need to be believed and supported the second time around? Second, NEA disorder is a condition where the main predisposing factors are beyond the sufferer’s control.
Clinical Psychologist, 10 years’ experience, Hong Kong
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter discusses the experience of a Clinical Psychologist with a patient with Psychogenic Non-Epileptic Seizures (PNES), which forced the psychologist to adopt a nonjudgmental attitude. After failing many times to treat the patient, the Psychologist finally tried to listen to the patient. This caused the patient to open up and talk about his daily life, his hobbies, his dreams, and his past. However, when he talked, he talked about facts, lacking any emotions. When they talked about his parents, he had another attack. The Psychologist then offered psychoeducation and a number of games on emotional recognition and expression in the following consults, coupled with mind–body exercises including breathing and muscle relaxation. The patient was motivated and showed much improvement on recognizing the spectrum of emotions in his daily living, as well as through illness experiences. Over time, the patient learned cognitive approaches to examine and manage his thoughts and feelings and started practicing mindfulness.
Assistant Psychologist and Trainee Clinical Psychologist, 1 year’s experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter looks at the experience of a Psychologist who has worked with patients with Non-Epileptic Seizures (NES) across a range of settings. The Psychologist has witnessed how uncertainty, ambiguity, and resultant stigma associated with NES can directly impact the way in which systems interact with these individuals. Likewise, the Psychologist has seen the positive, enabling, and empowering impact that education and understanding around NES can facilitate. Often, NES are viewed as “malingering” and are not recognized as a valid, disabling health condition that people do not choose to experience. When staff have been appropriately trained and work in a psychosocial informed way, patients seem better to understand their condition and present with reduced guilt and shame about their difficulties.
Resident in Neurology, 4 years’ experience, Italy
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter highlights the experience of a Neurologist when seeing and studying different patients suffering from Psychogenic Non-Epileptic Seizures (PNES). It specifically looks at two opposite cases. These stories are emblematic of the neurologist’s opposing feelings when PNES is suspected. Many times, the Neurologist asks what the best way to approach patients is and how the Neurologist can explain to them what kind of problem they are suffering from. Sometimes, patients do not accept being seen as “psychiatric,” so it is important to underline that their seizures are the manifestation of a real problem that must be treated. To give them real help, Neurologists should refer patients to Psychologists specialized in this kind of pathology and it would be very useful to receive feedback from them, working together in a multidisciplinary team. This should help patients feel reassured and supported.
Epilepsy Nurse Specialist, 15 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter describes the experience of an epilepsy nurse with patients with Non-Epileptic Attack Disorder (NEAD). It specifically details a rare case where the patient was undoubtedly diagnosed with NEAD and the diagnosis was met with complete acceptance. The patient was able to move forward with her life, putting this period of living with NEAD behind her, a period of time that possibly spanned several years. Ultimately, carers have a duty to provide ongoing support throughout the trajectory of the journey of patients with NEAD despite it being a psychiatric and not a neurological disorder. This condition if untreated or treated inappropriately can fundamentally affect quality of life on a daily basis, and health professionals all have a duty of care to address that.
Neurologist, 10 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter narrates how a Neurologist’s assumptions about Neuropsychiatric conditions suddenly collapsed the first time the Neurologist came face to face with a patient whose seizures were not caused by epilepsy. As soon as non-epileptic seizures are labeled as “psychogenic,” a collision between two paradigms occurs, whereby the traditional dualistic paradigm clashes against the current reductionistic or monistic view of science. In essence, René Descartes' dualism—his assertion that human beings are made of two separate kinds of stuff, matter and spirit—has been controversial since he proposed it in the 17th century and has long been deemed unfashionable by modern science. Most Neuroscientists explicitly agree on the monistic view that mental states can be reduced to their underlying brain states. However, surveys have shown that dualism persists in the science of mind and indeed in people’s religious beliefs and internal narratives.
Clinical Psychologist, 3 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter focuses on the experience of a clinical psychologist when working with a 22-year-old woman who has epileptic seizures and psychogenic Non-Epileptic Seizures (NES) following a severe traumatic brain injury as a child. Part of the challenge the Psychologist faced was to find out how the patient’s NES had been previously formulated, understood, and treated, and how these interventions had helped. The patient had previously attended sixteen individual Cognitive Behavioral Therapy (CBT) sessions, but there had been inconsistency between strategies used in sessions and strategies used in the patient’s school and family home. To some extent, it seemed that the patient’s family had been protecting her from the world, in case a NES were to occur. This, however, was contributing to the patient’s anxiety and sense that she would never be able to live the independent and “normal” life she wanted. In addition, the patient’s brain injury had a significant impact on her inhibitory control and emotional regulation, which contributed to the NES themselves. The Psychologist found Reuber and Brown’s Integrative Cognitive Model of NES extremely helpful when trying to make sense of the NES and design an intervention.
Neurologist, 7 years’ experience, India
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter assesses the experience of a Neurologist with patients with Psychogenic Non-Epileptic Seizures (PNES). These seizures are psychogenic, but the Neurologist has seen many young people who are otherwise “normal” and do not have any obvious psychiatric or psychological issues. For example, there was a teenage girl from a regular lower middle-class family who was genuinely concerned about her recurrent seizures. She had had a slight weakness in her left arm and leg since early childhood and a corresponding abnormality in her brain; this made all her treating physicians increase the numbers and doses of her anticonvulsant medicines over time. However, after thorough assessment and being told that her frequent attacks were in fact non-epileptic in nature, she has had no seizures for over three years now, and is only on one antiepileptic drug. But it is not that easy every time: many patients continue to have these episodes even after rigorous counseling, begin given psychiatric advice, and medications. Those who do not accept or adjust to some undesirable situation, which they feel they cannot change, end up having these episodes. The greater the inability to accept, the more severe the PNES. In most cases though, neither the caregiver nor the patient has been able to tell the Neurologist what exactly the stressor was.
Neuropsychologist, 7 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter demonstrates the rise and fall of a Non-Epileptic Attack Disorder (NEAD) service. The first recorded NEAD referral to the Neuropsychology Service arrived in 2004. The patient was referred to Neuropsychology by a Consultant Neurologist, who wrote that having captured some of the attacks on telemetry, it was clear that these were “non-epileptic.” The patient was also under the care of mental health services for depression and other psychiatric difficulties. She was sent a waiting list letter, but the referral was not followed up and she was never seen. Even at this early stage in the provision of NEAD services, it was evident that the remit of mental health and physical health services was unclear and that patients could fall through the gap. In the following three years, referrals remained low at one or two per year. However, in 2012, NEAD made up 7% of all referrals. Recognizing that this group of people needed specialist intervention, a Neuropsychologist undertook an extensive literature review. Some facts stood out: the extreme delay in obtaining a diagnosis, the importance of receiving a clear and compassionately delivered diagnosis in reducing or stopping seizures, the sense of being left in limbo following diagnosis, and the need for clients to have a safe place to process painful emotions.
Neurologist, 30 years’ experience, Italy
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter assesses how, in clinical practice, the diagnostic and therapeutic borders between epileptic and Psychogenic Non-Epileptic Seizures (PNES) are ill-defined and sometimes contrast with the schematic views offered by scientific reports. It specifically considers two case reports that illustrate how it is difficult to distinguish the two clinical conditions at the time of the diagnosis and, when the diagnosis is apparently clear, to start the correct treatment. The first patient was referred with seizures characterized by “convulsions” accompanied by loss of awareness. His seizures started when he was caught in an emergency and was at risk of death. The second patient, a 24-year-old girl, was hospitalized because she had experienced “convulsive” seizures. She received contrasting opinions regarding her diagnosis.
Clinical Research as a Neuroscientist, 4 years’ experience, UK
Authors: Reuber Markus , Rawlings Gregg H. , Schachter Steven C.
Published: March 2020

This chapter highlights the experience of a Neuroscientist who has done clinical research. When the Neuroscientist started researching Non-Epileptic Attack Disorder (NEAD) and Functional Neurological Symptom Disorder (FND), the Neuroscientist had no doubt about the legitimacy or “realness” of these conditions. It has been shown that FND is the second most commonly diagnosed disorder in Neurology clinics, and that NEAD is the most common type of FND. FND has also been shown to be distressing and potentially more disabling than other neurological conditions. However, it was not long before the Neuroscientist realized that there were issues around awareness of and attitudes toward these symptoms. Unfortunately, there have been several instances where the Neuroscientist has met medical professionals who were not as familiar with NEAD or FND as they perhaps should be.
Adolescents and Young Adults
Authors: Benedict Catherine , Ahmad Zeba , Lehmann Vicky , Ford Jennifer S.
Published: March 2020

Adolescents and young adults (AYA) represent a unique patient population with a number of age-specific care needs that should be understood and attended to as a part of comprehensive cancer care. The effects of cancer and its treatment on sexual functioning and fertility are common and ranked as among the most distressing survivorship issues faced by this age group. Difficulties associated with sexuality, body image, and intimacy; facing infertility risk; and coping with loss of fertility are all relevant issues for patients across disease and treatment groups. Further, when cancer occurs during this age range, its sequelae can disrupt key developmental tasks and have long-lasting effects on areas of life connected to and affected by sexual and reproductive health problems. Patients are often not fully informed about the sexual side effects and infertility risks associated with treatment and as a result are typically unprepared for the challenges they experience. This chapter describes the challenges AYAs face related to their sexual and reproductive health after a cancer diagnosis, provides information for screening patients for heightened distress and dysfunction, and reviews treatment strategies to help clinicians prepare to discuss these complex issues with AYA patients and survivors.
Principles of Treatment of Sexual Dysfunction
Authors: Peate Michelle , Juraskova Ilona
Published: March 2020

The prevalence of cancer-related sexual dysfunction and body image problems varies according to diagnosis and treatment, but they affect at least half of those treated for pelvic malignancies or breast cancers and greater than a quarter of patients with other cancers. This chapter on psychosexual and psychoeducational issues outlines the impact of cancer treatment on psychosexual well-being (e.g., body image and sexual dysfunction) in males and females. It describes mechanisms to identify psychosexual problems and how to assess the potential needs of patients according to cancer site. It provides recommendations for effective evidence-based interventions to manage psychosexual problems according to presenting symptoms.
DSM-5 and ICD-11 classifications
Authors: Regier Darrel A. , Goldberg David P. , Reed Geoffrey M. , Üstün Bedirhan T.
Published: March 2020

The fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the eleventh edition of the World Health Organization’s International Classification of Diseases (ICD-11) chapter on mental and behavioural disorders represent interrelated milestones in the understanding of psychiatric (mental) disorders. Following a brief history of the scientific and professional forces that contributed to their rise as international standards, there is a succinct summary of their characteristics, similarities, and differences. Their advantages and limitations for research, specialty clinical, and primary care clinical use are identified, as is the need for a briefly described ICD-11 primary care version (ICD-11-PC). Likewise, the need for, and development of, a separate International Classification of Functioning, Disability, and Health (ICF) is described that is now more closely linked to these mental disorder classifications. These interim classifications now await further understanding of the aetiology and pathophysiology for iterative advances.
Neuroimaging technologies
Authors: Woolrich Mark , Jenkinson Mark , Mackay Clare
Published: March 2020

The brain is a highly complex system that is inaccessible to biopsy, which puts human brain imaging at the heart of our attempts to understand psychiatric disorders. Imaging has the potential to uncover the pathophysiology, provide biomarkers for use in the development and monitoring of treatments, and stratify patients for studies and trials. This chapter introduces the three main brain imaging technologies that are used to assay brain structure and function: magnetic resonance imaging (MRI), molecular imaging positron emission tomography (PET), and single-photon emission computed tomography (SPECT); electrophysiology [electroencephoaography (EEG)]; and magnetoencephalograpy (MEG). The chapter outlines the principles behind their use and the nature of the information that can be extracted. Together, these brain imaging methods can provide complementary windows into the living brain as an increasingly essential suite of tools for experimental medicine in psychiatry.
Core dimensions of intellectual disabilities
Authors: Holland Anthony J.
Published: March 2020

The core dimensions that define what is meant when a person is said to have an ‘intellectual disability’ include evidence of intellectual and functional impairments and disabilities. They will have been first apparent in early childhood, with a significant delay in reaching key developmental milestones. This umbrella term, the definition of which has been refined over time, refers to a highly heterogenous population, given the multiple possible causes of intellectual disability, differences in severity, and the presence of other impairments and disabilities. Core dimensions of alternate definitions emphasize the role of education, life experience, and opportunities in optimizing the acquisition of skills and the identification and subsequent removal of barriers impeding development and full participation. Developmental, biomedical, and functional models inform our understanding of, and interventions for, the high prevalence rates of mental ill health and of challenging behaviours in this population. These different explanatory models guide the assessment and subsequent diagnostic formulation and interventions described in this chapter.
Epidemiology and course of intellectual disabilities
Authors: Cooper Sally-Ann
Published: March 2020

In high-income countries, about 5/1000 adults have intellectual disabilities. Population prevalence of intellectual disabilities is higher in children/young persons than adults, and prevalence decreases in older age groups to about 2/1000 over the age of 65. Intellectual disabilities are more common in boys/men, and in low-income countries; prevalence varies with geography and over time. Mental ill health is more common in people with intellectual disabilities than in the general population, with a point prevalence of 41% in adults and 36% in children/young people. Physical health problems and disabilities are common, and multi-morbidity and polypharmacy typical in people with intellectual disabilities; hence, clinical assessment and management are complex. The lifespan of people with intellectual disabilities is currently about 20 years less than that of other people, and more than 37% of their deaths are preventable deaths amenable to high-quality health care. Improving health care for people with intellectual disabilities needs to become a priority for clinicians, service commissioners, and policymakers.
Core dimensions of attention-deficit/hyperactivity disorder
Authors: Taylor Eric
Published: March 2020

This chapter presents an account of the clinical picture of attention-deficit/hyperactivity disorder (ADHD) and the severe form hyperkinetic disorder. They are disabilities that change with development and are often accompanied by other problems that can mask it or themselves be masked by it. Clinical and standardized ways of making the diagnosis are described. Inattentiveness and impulsive hyperactivity are rewarding challenges for diagnosis and treatment in adulthood, as well as during childhood and adolescence.
Epidemiology of attention-deficit/hyperactivity disorder and the implications for its prevention
Authors: Polanczyk Guilherme V.
Published: March 2020

The first part of this chapter describes the prevalence of attention-deficit/hyperactivity disorder (ADHD) in childhood and adulthood, developmental changes, and risk factors. Methodological aspects that are pertinent to the different types of studies are reviewed, and future developments considered. In the second part, conceptual issues concerning the science of prevention are reviewed, together with the challenges related to developing preventive strategies for mental disorders, specifically ADHD.
Genetics of attention-deficit/hyperactivity disorder
Authors: Langley Kate , Thapar Anita
Published: March 2020

Studies have demonstrated that attention-deficit/hyperactivity disorder (ADHD) is a highly heritable disorder. The evidence for this and the investigation into specific genetic risk factors associated with the disorder are discussed in this chapter. Both common and rare genetic risk variants have been identified for the disorder, although sample sizes have limited the discovery of such risk factors to date. Identification of additional risk factors, as well as further investigation to understand the role of these factors in the pathophysiology of ADHD, are now under way. As with other multifactorial disorders, there are both genetic and environmental risks associated with ADHD, and the interplay of these different risk types, as well as how they have been studied, is discussed. ADHD is a phenotypically heterogenous disorder, and the influences of comorbid conditions and developmental age on the genetic risk factors for the disorder are considered, as well as the genetic overlap between ADHD and other psychiatric conditions.
Frontotemporal dementias
Authors: Takeda Akitoshi , Miller Bruce
Published: March 2020

Fronto-temporal dementia (FTD) is a heterogenous clinical syndrome with a progressive decline in behaviour, executive function, and language. Approximately 40% of FTD patients report a family history, and 10–15% of FTD cases show an autosomal dominant pattern of inheritance. FTD often mimics psychiatric disorders because of the prominent behavioural features, and particularly in the early stages, the only manifestation of illness may be purely behavioural. There is significant clinical, pathological, and genetic overlap between FTD and motor neuron disease/amyotrophic lateral sclerosis (FTD-ALS) and two atypical Parkinsonian syndromes—progressive supranuclear palsy (PSP) and cortico-basal degeneration (CBD). FTD is associated with non-Alzheimer’s disease pathology and the molecular aggregation of specific proteins—tau, TAR-DNA binding protein (TDP), and fused in sarcoma (FUS). Advances in clinical, imaging, and molecular characterization have increased the accuracy of FTD diagnosis. At present, appropriate management of FTD symptoms involves a combination of pharmacological therapy with techniques involving behavioural, physical, and environmental manipulation.
Dementia in Parkinson’s disease
Authors: Hu Michele , Baig Fahd
Published: March 2020

Lewy body dementia includes Parkinson’s disease dementia (PDD) and dementia with Lewy bodies (DLB), and is the second most common form of dementia after Alzheimer’s disease (AD). Both conditions share significant phenotypic and pathological signatures but differ in terms of whether Parkinsonian symptoms appear first (PDD) or after/the same time as cognitive symptoms (DLB). In the United Kingdom, over 100,000 people are affected, with numbers predicted to double by 2050. Average care costs per patient are more than double those of AD, reflecting the associated multi-morbidity and unmet therapeutic needs. PDD has a long-term cumulative prevalence of 80% and major consequences for independence, nursing home admission, psychiatric comorbidity, caregiver burden, and mortality. Consequently, there is interest in a potential transition stage—Parkinson’s disease with mild cognitive impairment (PD-MCI)—to identify those at increased risk for PDD, to facilitate intervention studies. Advances in both symptomatic and disease-modifying treatments have so far been limited. Future research must address patient-specific factors influencing variability in treatment response and progression to be effective.
Psychedelics and dissociative substances
Authors: Winstock Adam R. , Rucker James
Published: March 2020

Psychedelics and hallucinogens represent some of the most commonly used drugs in the world, with a history of use steeped in spirituality, counter-culture, and more recently latent therapeutic potential. Sharing a common mechanism of action at the 5-HT2a receptor, drugs such as lysergic acid diethylamide (LSD) and psilocybin, while they can rarely induce significant short-term psychopathology, are remarkably safe physiologically, do not cause dependence, and are now being actively researched again for their therapeutic potential in non-psychotic conditions such as anxiety, addictions, and depression. Ketamine is also being explored as a treatment for resistant depression and is in common use as an anaesthetic. However, it has increasingly become recognized as a drug with abuse potential. Although safe in overdose, ketamine carries acute risks related to vulnerability while intoxicated, and chronic use is associated with urinary tract toxicity.
Genetics of schizophrenia
Authors: Kendall Kimberley M , Walters James T.R , O’Donovan Michael C
Published: March 2020

This chapter on genetics of schizophrenia briefly summarizes the key findings from genetic epidemiology and the early, but largely unsuccessful, findings from molecular genetics, based on linkage and candidate gene studies. It then reviews in detail the contemporary findings from genome-wide studies of the disorder, including those from genome-wide association studies (GWAS) of common variation, copy number variant studies (CNV) of rare variation, and exome-wide sequencing studies. It considers the implications of these studies with respect to pathophysiology, the relationship between schizophrenia and other psychiatric disorders, and the current clinical implications of the findings.
Basic mechanisms of and treatment targets for bipolar disorder
Authors: Churchill Grant C. , Singh Nisha , Berridge Michael J.
Published: March 2020

This chapter on basic mechanisms of, and treatment targets for, bipolar disorder examines the cause and treatment of bipolar disorder from the perspective of intracellular signalling pathways implicated by the convergence of evidence from efficacious drugs, pathophysiology, and genetics and concludes that the unifying concept is calcium signalling. It discusses the pathways for cyclic adenosine monophosphate and inositol trisphosphate/calcium in the context of the action of drugs, with emphasis on lithium, the most effective true mood stabilizer. It proposes that the calcium signalling pathway and its components, such as channels, pumps, messengers, and enzymes, can explain both how dysfunction can affect neural activity and how this can be remedied by drugs. It argues for the central role of calcium, based on new evidence for the inositol depletion hypothesis and evidence of calcium dysregulation in peripheral and inducible pluripotent stem cells, as well as genome-wide association studies and drugs implicating a plasma membrane calcium channel.
Perinatal psychiatry
Authors: Jones Ian , Di Florio Arianna
Published: March 2020

Perinatal psychiatric disorders are common, with around 10% of women experiencing depressive symptoms in pregnancy or in the months after delivery. They may also be severe, with post-partum psychosis representing some of the most severe episodes of illness seen in psychiatric practice. Perinatal mental illness is not only significant for the health of the mother, but also for the well-being of her child, and may have a considerable impact on her family and wider society. Despite their importance, maternal psychiatric disorders remain underdiagnosed and undertreated. This chapter will focus attention on episodes of severe mental illness occurring in the periantal period but will also consider other, more common mental disorders. The chapter will consider both episodes having their onset in the perinatal period and those that represent a continuation of pre-existing condition.
Management and treatment of depressive disorders
Authors: Cowen Philip J
Published: March 2020

This chapter covers the range of treatments available for depressive disorders and how they are best implemented in specific management plans. The chapter first summarizes the evidence base for the efficacy of commonly used therapies in depression, including drug treatments, bright light therapy, neurostimulation, and the various forms of psychotherapy. Their utility is considered both in the context of acute phase treatment and longer-term remission and recovery. The next section describes the assessment of depressed patients and the development of individual treatment plans based on a stepped-care approach. Many patients managed in secondary care have not responded well to first-line psychological or pharmacological approaches, and a variety of further possible treatment steps are outlined. Patients at high risk of recurrence and those who have required complex treatment regimes to achieve remission often require long-term follow-up and additional treatment to maintain remission and promote lasting recovery.
Core dimensions of anxiety disorders
Authors: Koen Nastassja , Stein Dan J.
Published: March 2020

While clinical approaches to anxiety disorders are typically categorical, a more dimensional perspective to understanding the psychobiology of anxiety and its dysfunction may prove of increasing importance. A dimensional approach is supported by evidence of the value of a transdiagnostic approach to the evaluation of anxiety and related symptoms, to the assessment of neurobiological and cognitive–affective profiles, and to treatments for anxiety conditions. This chapter provides a conceptual basis for approaching key psychobiological dimensions thought to underpin the anxiety disorders. The chapter outlines, in turn, spectrum approaches to the assessment of anxiety, dimensional approaches to research on mechanisms underlying anxiety disorders, and transdiagnostic approaches to treatment. While categorical approaches have clinical utility and are likely to remain key, dimensional approaches may hold particular promise for informing translational research in the future.
Epidemiology of anxiety disorders
Authors: Wittchen Hans-Ulrich , Beesdo-Baum Katja
Published: March 2020

This chapter describes the prevalence, onset, course, persistence, comorbidity, and outcome, as well as correlates and risk factors of anxiety disorders, namely separation anxiety disorder, specific phobia, social anxiety disorder, agoraphobia, panic disorder, and generalized anxiety disorder. The focus is laid upon the early years of life (childhood, adolescence, and young adulthood), given that most anxiety disorders have their onset at this time, typically persisting over the life course, and thus representing powerful risk factors for the onset of subsequent mental disorders such as depression and substance use disorders. Despite progress, continued research efforts are needed towards identifying which vulnerability and risk factors play a causal role for the onset and persistence of pathological anxiety. An improved understanding of the complex underlying biological and psychological mechanisms and interactions is crucial to facilitate more effective targeted prevention research and treatment.
Obsessive–compulsive disorder
Authors: Carmi Lior , Fineberg Naomi A , Arush Oded Ben , Zohar Joseph
Published: March 2020

The prevalence of obsessive–compulsive disorder (OCD) in the general population has been changed dramatically in the last 40 years, from less than 0.5% in the early 1980s to about 2% in the 1990s. Nowadays, with the inclusion of OCD spectrum disorders in the OCD category (DSM-5), the estimated prevalence of OCD (and OCD-related disorders) is 9%. Despite the high prevalence of OCD and due to its ego-dystonic nature, OCD and OCD-related disorders will not appear on the ‘clinical radar’, unless specific screening questions are included in every mental status examination. OCD is a disorder in which environmental factors (for example, family accommodation) play a key role in its trajectory. Other environmental factors, such as increased use of digital tools, turn Internet-related compulsions to a more frequent clinical presentation and might contribute to the increase in prevalence of OCD-related disorders (for example, Internet addiction).
Imaging of obsessive–compulsive disorder
Authors: Shahab Rebbia , Stern Emily R.
Published: March 2020

Neuroimaging has allowed researchers to measure the complexity of brain functioning in ways never before possible. The cognitive neuroscience approach investigates neural responses to cognitive–emotional stimuli, which has yielded critical insights into the mechanisms of psychiatric disorders. This chapter reviews some of the major findings from studies using a cognitive neuroscience approach to investigating obsessive–compulsive disorder (OCD). Focusing on studies of conflict and error monitoring, response inhibition, switching and reversal, reward processing, and decision-making, the chapter evaluates the consistency of results and interprets findings within the context of OCD symptoms. The chapter concludes by discussing the small body of work comparing brain functioning between different OCD subtypes, which highlights the importance of considering the heterogeneity of the disorder when designing and interpreting studies. Although further research is needed, this work sheds considerable light on the underlying mechanisms of OCD, which could be targeted by future strategies for intervention and prevention.
Management and treatment of feeding and eating disorders
Authors: McElroy Susan L. , Guerdjikova Anna I. , Mori Nicole , Houser Paul L. , Keck Paul E.
Published: March 2020

This chapter reviews the management and treatment of feeding and eating disorders. The cornerstone of managing anorexia nervosa (AN) is refeeding, nutritional rehabilitation, and weight restoration. Evidence of efficacy is strongest for family-based psychotherapy for adolescents with AN. Other forms of psychotherapy have less evidence of efficacy. No medication has regulatory approval for the treatment of AN; agents with possible efficacy are zinc, olanzapine, and dronabinol. For bulimia nervosa, there is evidence of efficacy for cognitive behavioural therapy (CBT), interpersonal therapy (IPT), antidepressants, and topiramate. For binge eating disorder, there is evidence of efficacy for CBT, IPT, lisdexamfetamine dimesylate, topiramate, and antidepressants. Less is known about the management and treatment of pica, rumination disorder, avoidant/restrictive food intake disorder, and other specified feeding or eating disorders. As feeding and eating disorders often co-occur with medical and other psychiatric disorders, the management and treatment of these conditions must also be addressed.
Genetics of sleep–wake disorders
Authors: Mazzotti Diego R. , Pack Allan I. , Gehrman Philip R.
Published: March 2020

Sleep disorders and related traits have important genetic components. The characterization of genetic factors explaining the variability of sleep disorders is extremely relevant to understand their biological basis. Most of the sleep-related traits investigated so far show moderate to high heritability, and linkage and association studies have identified a number of potential genetic regions for narcolepsy, circadian rhythm disorders, and restless legs syndrome, as well as insomnia and obstructive sleep apnoea. Although it is still considered an emerging field, substantial progress have been made so far. Nevertheless, there is a lack of functional studies confirming the role of the identified genes and variants in the aetiology of sleep disorders. Given the strong relationship between sleep and psychiatric disorders, characterization of genetic factors that affect sleep can be useful to understand the pathophysiology of mental disorders.
The sexual dysfunctions and paraphilias
Authors: Graham Cynthia A. , Bancroft John
Published: March 2020

This chapter examines the various ways in which sexual aspects of an individual or a relationship can go wrong. It describes the clinical features, prevalence, and classification of these disorders. The major changes in the classification of sexual disorders introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders are reviewed. Evidence related to the aetiology of sexual disorders and paraphilias is briefly reviewed. Outcome research on psychological and pharmacotherapy treatment approaches is examined. Practical information on how to carry out clinical assessment of individuals or couples presenting with sexual dysfunction, using a ‘three-windows’ approach, and on planning a sex treatment programme is provided.
Epidemiology and causes of suicide
Authors: Nordentoft Merete , Madsen Trine , Erlangsen Annette
Published: March 2020

Suicide is often the outcome of a personal crisis; yet many conditions, both societal and individual, are established predictors of suicide. It remains a major public health problem worldwide, although rates of suicide vary substantially across nations. The highest rates are reported in Russia and East European countries. This chapter summarizes the existing evidence regarding societal and individual risk factors for suicide. At the societal level, risk factors such as economic crisis, social cohesiveness, and media portrayal are mentioned. Individual risk factors include sociodemographic factors, physical and mental disorders, history of suicide attempt, and suicide risk in minority groups. The risk factors associated with the highest risk are mental disorders and history of suicide attempt. Population-attributable risk calculations suggest that preventive efforts should be directed towards the excess risk associated with recent suicide attempt, mental disorders, and common social factors.
Treatment of fibromyalgia (chronic widespread pain) and chronic fatigue syndrome
Authors: Price Jonathan
Published: March 2020

Fibromyalgia (FM), one of the chronic widespread pain syndromes, and chronic fatigue syndrome (CFS) are important and common conditions. They are considered together here because they are commonly comorbid and because of their similarities—they are long-term conditions with a relatively poor prognosis; central nervous system mechanisms and deconditioning play an important role in aetiology; graded exercise and psychological treatments have an important role in management; and comorbid mental disorders are common and have an adverse impact on important outcomes, including disability and chronicity. The prevalence of FM is rising, while that of CFS is declining. There is increased acceptance of the pivotal role of central nervous system factors in FM, while in CFS, the positions of different aetiological ‘movements’ appear bitterly entrenched. The main focus of this chapter is on FM and, in particular, key aspects of aetiology and treatment, especially those relating to the central nervous system.
Developmental approach to understanding the needs of young people in contact with the criminal justice system
Authors: Bailey Sue , Chitsabesan Prathiba
Published: March 2020

Over the last decade, studies have highlighted that young people with disproportionately high and multiple needs have clustered in the juvenile justice system. These young people experience higher levels of diagnosable mental health problems and neurodisability than the general population. This chapter provides a developmental approach to understanding the needs of young people in contact with the criminal justice system. It reviews the prevalence of a range of mental health and neurodevelopmental disorders in young offenders and describes the key principles of assessment and intervention approaches. The policy and legal framework have been illustrated by reference to the system in England but will have relevance to readers from further afield.
Child molesters and other sexual offenders
Authors: Hucker Stephen J.
Published: March 2020

General psychiatrists, and not just forensic specialists, will encounter sex offenders, as well as their victims, in their practices and need to be familiar with the topic in general terms. Broadly, sexual assaults can encompass a wide range of unlawful sexual behaviours, ranging from the non-contact and ‘hands-off’ types through to very severe attacks that can include murder. The clinical and criminological characteristics of these types are summarized in this chapter, as well as the essentials of general and risk assessment of those charged with, or convicted of, sexual offences, psychological and pharmacological treatments and their efficacies, and the ethical dilemmas that can make work in this area a challenge.
Stalking and querulous behaviour
Authors: Purcell Rosemary , Mullen Paul E.
Published: March 2020

Stalking and querulousness describe problem behaviours characterized by persistently pursuing a person or a cause in such a manner, or to such an extent, that the behaviour creates fear, distress, or disruption to those involved or targeted. An obvious obsessive or fixated quality is associated with both behaviours, and personality traits of rigidity and rumination are frequently observed, though the state of mind rarely conforms to that found in obsessional disorders. Stalkers and querulants rarely regard their behaviour as unjustified, let alone irrational, and few see their persistence as senseless. They may resist the impulse or urge to pursue their victims or cause on occasion but, for the most part, devote themselves wholeheartedly to their objectives. This chapter explores the epidemiology ad phenomenology of stalking and querulousness and the role of (forensic) psychiatry in responding not only to the perpetrators of these behaviours, but also to the unfortunate victim’s of their disordered attention.
The expert witness in the criminal and civil courts
Authors: O’Grady John
Published: March 2020

The psychiatric expert witness in court acts at the interface between psychiatry and the law. This chapter explores the legal, ethical, and procedural frameworks for this work, with special reference to the criminal court in common law jurisdictions.
Statistical tests
Authors: Peacock Janet L. , Peacock Philip J.
Published: March 2020

Statistical tests are widely used to evaluate numerical evidence in a similar way to how clinical tests help evaluate a patient. This chapter discusses the rationale behind statistical tests, when to use them, what assumptions are involved, and how the results can be presented and interpreted. Formulae are given for the most common simple tests to allow the reader to do the tests themselves and to understand the mathematics behind them should they wish. More complex statistical methods and tests are included largely without formulae. The emphasis is on the correct use of statistics and the interpretation of statistical results. Methods are illustrated with examples and references are given for further details.
Drug prescribing and drug administration
Authors: Ainsworth Sean
Published: March 2020

Safe prescribing during pregnancy and lactation requires an understanding not only of the effects of a drug on the mother but also on the fetus or infant. Many mothers are prescribed at least one medicine with the potential for harmful effects on either the fetus or infant. Few drugs are deemed safe and effective during these periods and most medications in pregnancy are used ‘off label’. Neonates, too, are ‘therapeutic orphans’—most drugs used in the neonatal intensive care unit (NICU) are not approved by regulatory authorities and are, therefore, used ‘off label’. As such there is greater onus on the prescriber to make sure that they understand the consequences of their prescription. This first section covers important aspects of prescribing, medicines storage, and administration. It also explains how medicines safe at other ages cause toxicity, not just from the drug itself but also from the excipients that are sometimes required.