bluuebunny/crossref_metadata_2025 huggingface dataset:
Genetic aetiology of mood disorders
Authors: Oswald Pierre , Souery Daniel , Mendlewicz Julien
Published: January 2013

Advances towards the understanding of the etiological mechanisms involved in mood disorders provide interesting yet diverse hypotheses and promising models. In this context, molecular genetics has now been widely incorporated into genetic epidemiological research in psychiatry. Affective disorders and, in particular, bipolar affective disorder (BPAD) have been examined in many molecular genetic studies which have covered a large part of the genome, specific hypotheses such as mutations have also been studied. Most recent studies indicate that several chromosomal regions may be involved in the aetiology of BPAD. Other studies have reported the presence of anticipation in BPAD and in unipolar affective disorder (UPAD). In parallel to these new developments in molecular genetics, the classical genetic epidemiology, represented by twin, adoption and family studies, provided additional evidence in favour of the genetic hypothesis in mood disorders. Moreover, these methods have been improved through models to test the gene-environment interactions. In addition to genetic approaches, psychiatric research has focused on the role of psychosocial factors in the emergence of mood disorders. In this approach, psychosocial factors refer to the patient's social life context as well as to personality dimensions. Abnormalities in the social behavior such as impairment in social relationships have been observed during episode of affective disorders, and implicated in the etiology of affective disorders. Further, gender and socio-economic status also emerged as having a possible impact on the development of affective disorders. Finally, the onset and outcome of affective disorders could also be explained by interactions between the social life context and the individual's temperament and personality. The importance of temperament and personality characteristics in the etiology of depression has been emphasized in various theories, although disagreement exists with regard to terminology and the etiology. While significant advances have been done in these two major fields of research, it appears that integrative models, taking into account the interactions between biological (genetic) factors and social (psychosocial environment) variables offer the most reliable way to approach the complex mechanisms involved in the etiology and outcome of mood disorders. This chapter will review some of the most promising genetic and psychosocial hypotheses in mood disorders that can be integrated in interactive models.
Course and prognosis of mood disorders
Authors: Angst Jules
Published: January 2013

Ever since Kahlbaum's monograph 1863 the course and outcome of mental disorders have played important roles as criteria and validators of psychiatric classification. The prognosis is fundamental for doctor and patient when deciding whether to start long-term prophylactic medication and, at a later stage, whether to stop a successful long-term treatment. Course is a crucial factor in estimating the social consequences, costs, suicide risk, and mortality associated with mood disorders. The description of course includes the age of onset, episode length, recurrence of episodes, residual symptoms between episodes and outcome (remission, chronicity, death). These aspects are covered in this chapter.
Normal sexual function
Authors: Levin Roy J.
Published: January 2013

Normal human sexual function can be characterized simply by its biological mechanisms which are of obvious importance, not least to reproduction. The mechanisms have changed little over the centuries, but their expression as behaviour, when moulded by historical time, social class, ethnic grouping, religion, and society, creates the changing complex concept of human sexuality. Indeed, it has been said that human sexuality is more about fertilizing relationships than eggs! While we have increased hugely our knowledge about many of the mechanisms involved in human sexuality, the impact of a highly successful oral therapy for erectile dysfunction being an obvious example, those of the brain and spinal cord are practically unexplored. What creates human sexual desire and sexual excitement and what causes them to fade away, where in the brain is the pleasure of orgasms created, why do men have a PERT but not women, are just a few of the fascinating questions that remain to be answered.
Personality disorders: an introductory perspective
Authors: López-Ibor Jr. Juan J.
Published: January 2013

During the last few decades there has been an impressive growth in research and knowledge on personality disorders. There is a strong growing evidence that they are “real” disorders that can be managed in ways similar to the rest of psychiatric disorders. There is also a growing consensus on the need for a new classification able to capture the nuances beyond the rigidity of present nosological systems. There is also a need for a clearer delimitation from normal personality variants something that will have important impacts, for instance in forensic settings or for reimbursement purposes.
Management of personality disorder
Authors: Newton-Howes Giles , Davidson Kate
Published: January 2013

Some years ago that most sceptical of academic psychiatrists, Michael Shepherd, in referring to the contents of a book entitled Recent Advances in Psychiatry commented that the content was more accurately defined as ‘recent activities’, as ‘advances’ was too generous a word. Whilst not going quite as far as this in regard to advances in the treatment of personality disorder it is fair to add that the promise of effective therapies across the spectrum of personality dysfunction remains a long way off and we must be very careful not to oversell the evidence. The complexity of personality disorders often requires complex intervention, however, until we are confident that single treatments are effective the arguments for evaluating them in combination have to be very strong on theoretical grounds to justify the cost. We are still at the stage in which explanatory trials (ones demonstrating efficacy under optimal conditions) are at least as necessary as pragmatic ones (demonstrating benefit in conditions of ordinary practice). These need to be carried out with adequate numbers of patients (at least 50 in each treatment arm rather than an artificially derived sample size to justify a small number) and with good independent assessments carried out by research workers who are masked as much as possible from disclosure of treatment. These requirements are exacting but can be achieved. We also need better pragmatic trials of patients seen in ordinary mental health practice whose treatment and characteristics are both representative and from whom it is possible to generalize findings with confidence. Currently there are very few studies that satisfy this requirement; one recent study combining an educational intervention with problem-solving is an exception. Despite the caution of these statements these are exciting times in the management of personality disorder. We are no longer listening to the once powerful lobby that claimed that patients with these conditions should not be treated by psychiatric services, or to the pessimists that still regard these conditions as untreatable. We are in the equivalent position as those in the early 1950s who suddenly became aware of the possibility that powerful treatments for severe mental illness were ready and waiting to be used. They do indeed appear to be within reach, but we must use them wisely.
Impulse control disorders
Authors: McElroy Susan L. , Keck Jr. Paul E.
Published: January 2013

Growing research shows that the impulse control disorders are much more common than once thought to be. The consistency of the ‘structure’ of the irresistible impulse (a core disturbance of impulsivity and compulsivity) together with increasing research showing that it responds to certain treatments, especially cognitivebehavioural psychotherapies and medical treatments with thymoleptic or anticraving properties, regardless of its ‘content’ (the specific impulse experienced), strongly suggest that it is an important psychopathological symptom, and that impulse control disorders are legitimate mental disorders that are in fact likely to be related despite their apparent differences. This chapter first defines impulse control disorders, and then summarizes available research on the clinical features, epidemiology, psychiatric comorbidity, family studies, psychobiology, and treatment response of the most common of these conditions
Epidemiology and causes of suicide
Authors: Lonnqvist Jouko K.
Published: January 2013

Suicidal behaviour or suicidality can be conceptualized as a continuum ranging from suicidal ideation and communications to suicide attempts and completed suicide. A developmental process which leads to suicidal ideation, suicidal communication, self-destructive behaviour, in some cases even to suicide, and its consequences to the survivors is often referred to as a suicidal process. There is no single unanimously accepted definition of suicide, although in most proposed definitions it is considered as a fatal act of self-injury (self-harm) undertaken with more or less conscious self-destructive intent, however vague and ambiguous. Since the deceased cannot testify as to his or her intent, the conclusions about this must be drawn by inference. The evidence required for this inference depends on many factors, for example the mode of death, the use of autopsy, age, gender, social and occupational status, and the social stigma of suicide in the person’s culture. The assessment of suicide intent is always based on a balance of probabilities. This chapter discusses the suicide process and the act of suicide, epidemiology and public health aspects of suicide, basic characteristics of the suicide victim, and finally mental disorders and suicide.
Biological aspects of suicidal behaviour
Authors: Mann J. John , Currier Dianne
Published: January 2013

To understand the biological underpinnings of multi-determined behaviours such as suicide and attempted suicide it is necessary to situate them within an explanatory model that can elaborate the causal pathways and interrelations between biological, clinical, genetic, and environmental factors that all play a role in suicidal behaviour. Where possible, such a model should be clinically explanatory, incorporate biological correlates, be testable in both clinical and biological studies, and have some utility in identifying high-risk individuals. We have proposed a stress–diathesis model of suicidal behaviour wherein exposure to a stressor precipitates a suicidal act in those with the diathesis, or propensity, for suicidal behaviour. Stressors are generally state-dependent factors such as an episode of major depression or adverse life event. The diathesis, we have hypothesized, comprises trait characteristics such as impulsive aggression, and pessimism. Uncovering the biological mechanisms relevant to the stress and the diathesis dimensions of suicidal behaviour will facilitate the identification of both enduring and proximal markers of risk, as well as potential targets for treatment. One biological correlate of the diathesis for suicidal behaviour appears to be low serotonergic activity. Abnormal serotonergic function may be the result of numerous factors including genetics, early life experience, chronic medical illness, alcoholism or substance use disorder, many of which have been correlated with increased risk for suicidal behaviour. Moreover, serotonergic dysfunction may underlie recurrent mood disorders or behavioural traits that characterize the diathesis, such as aggression and impulsivity. In terms of stress response, the noradrenergic and HPA axis have been the focus of biological studies in suicidal behaviour. This chapter gives an overview of the major neurobiological findings in suicide and attempted suicide, as well as emerging findings from studies of genes related to those systems.
Hypochondriasis (health anxiety)
Authors: Noyes Jr. Russell
Published: January 2013

Hypochondriasis is a preoccupation with the fear that one has, or may develop, serious disease despite evidence to the contrary. So defined, the disorder affects between 2 and 7 per cent of patients attending general medical clinics and is a cause of physical dysfunction and disability. It is also a reason for increased health care utilization and dissatisfaction with care received. To their physicians, patients with this disorder are an enigma and a source of frustration. Unfortunately, relatively little is known about hypochondriasis. Primary care physicians have had little interest and psychiatrists see few patients with the condition. It is a pejorative label that, even if entertained, is rarely communicated. And, even if communicated, the diagnosis would not, until very recently, have led to effective treatment.
Adjustment to illness and handicap
Authors: House Allan
Published: January 2013

Not everybody who develops a serious physical illness will have psychiatric problems as a consequence. To understand why, it is useful to have a model of the normal process of adjustment to stress; psychiatric disorder can then be seen as arising when that process, often called coping, is either maladaptive or is adaptive but only partially successful. This chapter will start with an outline of one theory of stress and coping as it applies to physical illness, followed by a review of disorders of adjustment to illness. A distinction will be drawn between recent-onset illness, which provokes an acute response, and long-standing illness, where the challenge is more often to adjust to chronic disability.
Psychiatric aspects of neurological disease
Authors: Ron Maria A.
Published: January 2013

Psychiatric abnormalities are an integral part of neurological disease and their study can improve our understanding of the neural basis of psychiatric illness. This chapter deals with common neurological diseases where psychiatric symptoms are prominent (Stroke, Parkinson’s disease, Tourette syndrome, Multiple sclerosis, and space-occupying lesions).
Epilepsy
Authors: Toone Brian
Published: January 2013

An epileptic seizure has been defined as ‘a clinical manifestation presumed to result from an abnormal and excessive discharge of a set of neurones in the brain’. A diagnosis of epilepsy applies with the recurrence of two or more discrete and unprovoked seizures (febrile and neonatal seizures are excluded from this definition). Epilepsy is one of the more common neurological disorders. It carries with it a greater psychiatric morbidity than is to be found in other neurological disorders of comparable severity. Many of its manifestations resemble and may be confused with psychiatric phenomenology. It is often associated with learning difficulties; it may be a manifestation of acquired brain damage or disease; seizures may occur in the course of substance abuse or be caused by psychiatric treatment. For these and for many other reasons psychiatrists should be familiar with epilepsy, its manifold aetiologies, presentations, and treatment.
Psychiatric aspects of infections
Authors: Ayuso-Mateos José Luis
Published: January 2013

Neuropsychiatric disturbances stemming from infectious diseases are widespread in both the industrialized world and developing countries. Such neuropsychiatric syndromes are not necessarily the result of infectious processes directly involving the central nervous system, they may also be complications of systemic infections. There are many microbial, viral, and parasitic agents, as well as other types of infectious substances, which can affect the central nervous system, leading to the appearance of neurological and psychiatric symptoms that may cause suffering to the patient, and even be disabling. When considering the psychiatric manifestations of infectious illness, it is important to consider clinical manifestations derived from a possible systemic infection, which can be less obvious than a direct involvement of the central nervous system. Acute organic reactions may accompany many systemic infections, especially at the extremes of life. A clear example is the delirium that frequently occurs with pneumonia in the elderly. In these clinical syndromes, several factors could be responsible for the alterations in cerebral metabolism. The mere fact of having a fever could be involved. Cerebral anoxia often appears to be responsible, or the influence of toxins derived from the infecting micro-organism. More complex metabolic disturbances or the accumulation of toxic intermediate products can also be -implicated. Likewise, infections that course as chronic or subacute illnesses are frequently accompanied by the onset of depressive syndromes. One of the factors implied in clinical depression that occurs within the context of systemic infectious illnesses (e.g. tuberculosis and infectious mononucleosis), is a sense of physical vulnerability, possibly heightened by a loss of strength and negative changes in the patient's appearance. Patients are often afraid of losing their earning capacity or even their jobs, as well as other social and occupational problems associated with the illness. Another very important factor, above all with the human immunodeficiency virus (HIV) and other sexually transmitted disease (STD), is the social stigma that these patients may suffer. Sexually transmitted disease infection implies sexual activity that historically carries connotations of illicit, casual, sexual encounters, and acquiring an STD is frequently associated with embarrassment and social stigma. In addition to the disease itself, the medications commonly used to treat infectious illnesses can have side-effects that alter patients’ behaviour, as well as their cognitive and affective functioning (Table 5.3.5.1). In this chapter we consider infections of clinical interest in the practice of psychiatry. These conditions will be dealt with briefly, and textbooks of general medicine should be consulted for further details. Prion diseases and chronic fatigue syndromes, which are also related to the subject of the present chapter, are discussed in Chapters 4.1.4 and 5.2.7, respectively.
Electroconvulsive therapy
Authors: Fink Max
Published: January 2013

Convulsive therapy (ECT or electroshock) is an effective treatment for those with severe and persistent emotional disorders. It is safe for patients of all ages, for those with debilitating systemic illnesses and during pregnancy. It relieves symptoms in a briefer time than do psychotropic drugs. To achieve remission, treatments are usually given three times a week for two to seven weeks. To sustain recovery, treatments are continued either weekly or biweekly for several months. The overall duration of the treatment course is similar to that of the psychotropic medications frequently used for the same conditions. The treatment is severely stigmatized and its use is discouraged, even interdicted, in the belief that the electricity or the seizures irreversibly damage the brain. Few physicians are tutored in its use and facilities are limited making ECT unavailable to many who would benefit. The ease in the use of psychotropic medications, and neither greater efficacy nor greater safety, encourages their preferential use as ECT is relegated to the ‘last resort.’ In countries where psychotropic medications are expensive, ECT is prescribed, but the expense for anesthetics limits its use to its unmodified form. Despite these hurdles of stigma, expense and lack of training, its use has persisted for more than 70 years. Indeed, its use is increasing. Whole societies where it was interdicted at the end of the 20th century, as in the Netherlands, Germany, Austria, Italy, and Japan, interest and usage has increased, texts have been written or translated, and local psychiatric societies formed to encourage its use.
Cognitive behaviour therapy for eating disorders
Authors: Cooper Zafra , Murphy Rebecca , Fairburn Christopher G.
Published: January 2013

The eating disorders provide one of the strongest indications for cognitive behaviour therapy. This bold claim arises from the demonstrated effectiveness of cognitive behaviour therapy in the treatment of bulimia nervosa and the widespread acceptance that cognitive behaviour therapy is the treatment of choice. Cognitive behaviour therapy is also widely used to treat anorexia nervosa although this application has not been adequately evaluated. Recently its use has been extended to ‘eating disorder not otherwise specified’ (eating disorder NOS), a diagnosis that applies to over 50 per cent of cases, and emerging evidence suggests that it is just as effective with these cases as it is with cases of bulimia nervosa. In this chapter the cognitive behavioural approach to the understanding and treatment of eating disorders will be described. The data on the efficacy and effectiveness of the treatment are considered in the chapters on anorexia nervosa and bulimia nervosa (see Chapters 4.10.1 and 4.10.2 respectively), as is their general management.
Psychoanalysis and other long-term dynamic psychotherapies
Authors: Fonagy Peter , Kächele Horst
Published: January 2013

Psychoanalysis is hardly a practical treatment alternative for the twenty-first century. The principles derived from this treatment, however, have powerfully influenced other psychotherapeutic approaches, whether long-term or short-term therapy or psychiatric care more generally, particularly in the United States. At the time of its invention, it was the unique effective psychosocial treatment method for psychiatric disorder which offered a genuine alternative to the sometimes barbaric and generally ineffective treatment methods available. Not surprisingly, its proponents adopted an almost religious zeal in defending its value against alternative approaches. While understandable, such an attitude has no place in the sophisticated evidence base underpinning multi-agency service planning. Psychoanalytic clinicians face a challenge in identifying their niche in the complex mental health care delivery systems of the twenty-first century.
Psychotherapy with couples
Authors: Crowe Michael
Published: January 2013

The field of couple therapy is a wide and varied one, and there are almost as many different approaches to treatment as in individual psychotherapy. The relatively brief therapeutic method presented here, behavioural systems couple therapy, is an eclectic one, taking techniques from two approaches of proven efficacy and combining them into a flexible and versatile therapy capable of being used in a wide variety of presenting problems. These include simple relationship problems, psychosexual problems, and such psychiatric conditions as anxiety, depression, and morbid jealousy. It is relatively easy to teach, and although it has not yet been subjected to controlled trials it can be assumed to be no less effective than its component therapies which are both effective. It has recently also been recommended in a package for self-help with homework exercises and theoretical explanations to be used without the intervention of a therapist. There are few contraindications for the therapy, and it can be used both as a therapy in its own right or as an adjunctive therapy in, for example, the treatment of depression, psychosis or sexual dysfunctions. It can thus be a useful addition to the various methods available for the reduction of distress, whether in couples or individuals.
Therapeutic communities
Authors: Kennard David , Haigh Rex
Published: January 2013

Two of the best-known pioneers of therapeutic communities, Tom Main and Maxwell Jones, defined them as follows: An attempt to use a hospital not as an organization run by doctors in the interests of their own greater technical efficiency, but as a community with the immediate aim of full participation of all its members in its daily life and the eventual aim of the resocialization of the neurotic individual for life in ordinary society. What distinguishes a therapeutic community from other comparable treatment centres is the way in which the institution's total resources, staff, patients, and their relatives, are self-consciously pooled in furthering treatment. That implies, above all, a change in the usual status of patients. Today therapeutic communities can be defined by a number of common features, but a word of warning. For reasons of historical coincidence, the term is used in the fields of mental health and addictions to refer to two somewhat different treatment models. In the addiction field they are also known as hierarchical, drug-free or concept-based therapeutic communities, or simply addiction therapeutic communities, in contrast to the more democratized programmes in mental health. The two models have similar goals but their methods differ, although there are signs of increasing rapprochement between them. This chapter deals mainly with therapeutic communities in mental health, but reference will also be made to addiction therapeutic communities and those in long-term care settings. It is worth noting that those admitted to a therapeutic community for treatment are usually referred to as residents, clients, or members, rather than as patients.
Art therapy
Authors: Waller Diane
Published: January 2013

The fundamental principles of art therapy/art psychotherapy
Indigenous, folk healing practices
Authors: Tseng Wen-Shing
Published: January 2013

The comparative study of indigenous healing practices and modern psychotherapy has revealed the existence of certain universal elements of the healing process that operate as important factors for therapy, whether the therapy is carried out in a primitive or modern form. The universal and nonspecific healing factors identified are: the cultivation of hope, the activation of surrounding support, and the enhancement of culturally sanctioned coping. The study of indigenous healing practices has also pointed out the existence of supernatural dimensions of healing power, which are less intentionally utilized in modern therapy. Despite the general usefulness of folk therapies, the ill effects of some have not been widely studied and reported. Yet, clinical observation has disclosed that some folk therapists cause harm to the clients who seek their services. Under the guise of treatment, tricking a client out of his money by deceit or fraud, or sexual involvement with a client, are examples of disreputable behaviour that are occasionally reported. Harming a client by prescribing dangerous substances, and physically injuring or even killing a client by accident during the performance of an exorcism, are other examples of serious complications that have occurred. No matter what position is taken, there is one simple fact that deserves attention, namely, that there exists a wide range of professional quality among so-called folk healers, and different motivations for practice. Some are benign healers motivated by a desire to serve, while others are not. Some are well-trained in their particular professions and know how to practice within its limitations, while others are not—and are liable for malpractice. The major problem is that, from a public health point of view, in most societies, there still are no formal guidelines for regulating folk therapy, as there are for modern therapy. Folk therapy, whether it is shamanistic practice or faith healing, should be subject to periodic surveys and reevaluation by the public health administration, as is modern clinical work, so that its benefits to clients can be protected and any potential malpractice can be prevented. If any folk therapist refuses to be examined and regulated, he or she should be discouraged or prevented from practicing.
Primary prevention of mental disorders
Authors: Bertolote J. M.
Published: January 2013

Despite the demonstration of the possibility of preventing some forms of mental disorders, many mental health professionals continue to underestimate the possibilities of primary prevention in their field. This is due to: 1 a lack of clear concepts when referring to this issue; 2 the fact that the effective prevention of mental and neurological disorders often falls outside the usual remit of mental health professionals (in many cases it falls outside the health sector altogether). These two factors are discussed below, in addition to an indication of actions which effectively prevent some forms of mental disorders.
The special psychiatric problems of refugees
Authors: Mollica Richard F. , Culhane Melissa A. , Hovelson Daniel H.
Published: January 2013

While the forced displacement of people from their homes has been described since ancient times, the past half-century has witnessed an expansion in the size of refugee populations of extraordinary numbers. In 1970, for example, there were only 2.5 million refugees receiving international protection, primarily through the United Nations High Commission for Refugees (UNHCR). By 2006, UNHCR was legally responsible for 8.4 million refugees. In addition, it is conservatively estimated that an additional 23.7 million people are displaced within the borders of their own countries. Although similar in characteristics to refugees who have crossed international borders, internally displaced persons do not receive the same protection of international law. Adding all refugee-type persons together, the world is forced to acknowledge the reality that over the past decade more than 10 000 people per day became refugees or internally displaced persons. The sheer magnitude of the global refugee crisis, the resettlement of large numbers of refugees in modern industrial nations such as Canada, the United States, Europe, and Australia, and the increased media attention to civil and ethnic conflict throughout the world has contributed to the medical and mental health issues of refugees becoming an issue of global concern. This chapter will focus on a comprehensive overview of the psychiatric evaluation and treatment of refugees and refugee communities. Although this mental health specialty is in its infancy, many scientific advances have been made that can facilitate the successful psychiatric care of refugee patients.
The ageing population and the epidemiology of mental disorders among the elderly
Authors: Henderson Scott , Fratiglioni Laura
Published: January 2013

In the last decades the ageing of the populations has become a worldwide phenomenon. In 1990, 26 nations had more than 2 million elderly citizens aged 65 years and older, and the projections indicate that an additional 34 countries will join the list by 2030. In 2000, the number of old persons (65+ years) in the world was estimated to be 420 million and it was projected to be nearly 1 billion by 2030, with the proportion of old persons increasing from 7 to 12 per cent. The largest increase in absolute numbers of old persons will occur in developing countries; it almost triples from 249 million in 2000 to an estimated 690 million in 2030. The developing regions’ share of the worldwide ageing population will increase from 59 to 71 per cent. Developed countries, which have already seen a dramatic increase in people over 65 years of age, will experience a progressive ageing of the elderly population itself (see Fig. 8.3.1). The global trend in the phenomenon of population ageing has dramatic consequences for public health, health care financing, and delivery systems in the whole world. The absolute number of chronic diseases as well as psychiatric disorders is expected to increase. In this chapter, the epidemiological aspects of the most common psychiatric disorders of the elderly are summarized and discussed.
Stress-related, anxiety, and obsessional disorders in elderly people
Authors: Lindesay James
Published: January 2013

Stress-related, anxiety, and obsessional disorders in elderly people are common, distressing, costly to services, and potentially treatable. However, despite their clinical importance, many patients still go untreated, or are treated inappropriately. The specific conditions covered here are described in detail elsewhere; this chapter focuses on the differences and difficulties that are encountered when they occur in old age.
Developmental psychopathology and classification in childhood and adolescence
Authors: Scott Stephen
Published: January 2013

Classification of child psychiatric conditions has advanced enormously in the last 20 years. There is a much stronger empirical basis to support current schemes, which are grounded in the many scientific disciplines that contribute to developmental psychopathology. Nonetheless there are considerable obstacles to overcome if DSM V and ICD 11 are to be major steps forward.
Prevention of mental disorder in childhood and other public health issues
Authors: Lenroot Rhoshel
Published: January 2013

Enormous progress has been made in recognizing the scope of mental health problems for children around the world, and in developing the theoretical framework needed to address decreasing this burden in a systematic fashion. Technological advances in neuroimaging, genetics, and computational biology are providing the tools to start describing the biological processes underlying the complex course of development, and have renewed appreciation of the role of the environment in determining how a genetic heritage is expressed. However, rapid technological change is also altering the environment of children and their families at an unprecedented rate, and what kinds of challenges to public health these changes may present is not yet fully understood. What is becoming clear is that as technological advances increase the range of available health care treatments, along with the potential cost, the choices for societies between spending limited resources on treatment or prevention will have to become increasingly deliberate. A substantial body of work has demonstrated that prevention in mental health can be effective, but those who would benefit the most from preventive interventions are often not those with the political or economic resources to make them a priority. While the potential interventions to prevent mental health disorders in children are constrained by the knowledge and resources available, what is actually done depends upon the social and political values of individual communities and nations. It is to be hoped that as our understanding of these disorders grows, public policies to prevent the development of mental health disorders in children will become as commonplace a responsibility for modern societies as the provision of clean drinking water.
Neuropsychiatric disorders
Authors: Harris James C.
Published: January 2013

Developmental neuropsychiatry addresses the neurobiological basis of behaviour in infants, children, and adolescents with neurodevelopmental disorders and in those with brain damage occurring during the developmental period. As a field, it includes the aetiology, diagnosis, and treatment of behavioural, emotional, interpersonal, and psychiatric disorders. The parent’s response, adjustment to, and involvement in treatment is a critical element in outcome. The developmental neuropsychiatrist utilizes a developmental perspective that focuses on the developing person who is active, socially oriented, and emerging rather than passively responding to the environment. The adaptive plasticity of the developing nervous system to change is emphasized, and the essential role of environmental experience in brain development is acknowledged. When working with the affected child, an effort is made to provide the supports needed to facilitate the mastery of age-appropriate developmental tasks always keeping in mind the child’s individual capacities and strengths. This chapter focuses on foetal alcohol spectrum disorder syndrome, gestational substance abuse, endocrinopathies, traumatic brain injury, and epilepsy.
Specific developmental disorders in childhood and adolescence
Authors: Remschmidt Helmut , Schulte-Körne Gerd
Published: January 2013

The term ‘specific developmental disorders’ includes a variety of severe and persistent difficulties in spoken language, spelling, reading, arithmetic, and motor function. Skills are substantially below the expected level in terms of chronological age, measured intelligence, and age-appropriate education and cannot be explained by any obvious neurological disorder or any specific adverse psychosocial or family circumstances. As the deficits are quite substantial, analogies were initially made to neurological concepts and disorders such as word-blindness, alexia, aphasia, and apraxia, thus giving rise to the notion that neurological deficits are the aetiological basis of these disorders. Since this could not be demonstrated, the next step was to define the disorders in a more functional way, taking into account not only psychometric testing but also psychosocial risk factors and the quality of schooling and education. Today, numerous findings support the validity of the diagnostic concept of specific developmental disorders. These disorders and pervasive developmental disorders have the following features in common (ICD-10): ♦ An onset that invariably appears during infancy or childhood. ♦ An impairment or delay in the development of functions that are strongly related to biological maturation of the central nervous system. ♦ A steady course that does not involve the remissions and relapses that tend to be characteristic of many mental disorders. Thus the term ‘specific developmental disorders’ reflects the fact that the deficits are circumscribed and relatively isolated against the background of an otherwise undisturbed psychological functioning.
Attention deficit and hyperkinetic disorders in childhood and adolescence
Authors: Taylor Eric
Published: January 2013

The concept of ADHD arose from neurological formulations, but does not entail them, and the modern definition simply describes a set of behavioural traits. The historical evolution of the concept was described by Schachar. It began with the idea that some behavioural problems in children arose, not from social and familial adversity, but from subtle changes in brain development. The term ‘minimal brain dysfunction (MBD)’ was often applied, and covered not only disorganized and disruptive behaviour but other developmental problems (such as dyspraxias and language delays) presumed to have an unknown physical cause. MBD, however, stopped being a useful description when studies of children with definite and more-than-minimal brain damage made it plain that they showed a very wide range of psychological impairment, not a characteristic pattern (see Harris, this volume); and therefore it was invalid to infer the presence of brain disorder from the nature of the psychological presentation. The successor to the concept of MBD was attention deficit and hyperactivity: defined, observable behaviour traits without assumption of cause. ‘Attention Deficit/Hyperactivity Disorder’ (ADHD) in DSM-IV, and ‘Hyperkinetic Disorder’ in ICD-10, describe a constellation of overactivity, impulsivity and inattentiveness. These core problems often coexist with other difficulties of learning, behaviour or mental life, and the coexistent problems may dominate the presentation. This coexistence, to the psychopathologist, emphasizes the multifaceted nature of the disorder; to the sociologist, a doubt about whether it should be seen as a disorder at all; to the developmentalist, the shifting and context-dependent nature of childhood traits. For clinicians, ADHD symptoms usually need to be disentangled from a complex web of problems. It is worthwhile to do so because of the strong developmental impact of ADHD and the existence of effective treatments. Public controversy continues, but professional practice in most countries makes ADHD one of the most commonly diagnosed problems of child mental health.
Anxiety disorders in childhood and adolescence
Authors: Pine Daniel S.
Published: January 2013

The current chapter reviews data for paediatric anxiety disorders in three sections. The longest section reviews clinical characteristics of these disorders. This section describes the clinical features, demography, and outcome of paediatric anxiety disorders, the most common class of mental syndrome afflicting children and adolescence. The first section is followed by a shorter section focused on pathophysiology. Here, data on neural circuits implicated in anxiety are reviewed most comprehensively. Finally, treatment is briefly reviewed in the third section. More detailed considerations of therapeutics for a range of paediatric psychiatric disorders can be found in section 9.5. This includes a discussion of both psychotherapies and medication.
Paediatric mood disorders
Authors: Brent David , Birmaher Boris
Published: January 2013

In this chapter, we describe the nosology and epidemiology of paediatric unipolar and bipolar disorders, risk factors and predictors of course, and the evidence base for pharmacological and psychosocial treatments. We conclude this chapter by suggesting areas for future research.
Obsessive–compulsive disorder and tics in children and adolescents
Authors: Flament Martine F. , Robaey Philippe
Published: January 2013

Paediatric OCD is the disorder, in child psychiatry, whose clinical picture most closely resembles its adult counterpart. Despite a relative diversity, the symptom pool is remarkably finite, and very similar to that seen in older individuals. Prevalence, comorbidity, and response to behavioural and drug treatment also appear similar across the lifespan. For tic disorders, there is continuity between child and adult presentations, but the disease is much more prone to resolve spontaneously, or to be less disruptive in adulthood. Both OCD and tics occur more often in males than in females, and are likely to be linked to an array of neurobiological abnormalities, many of which remain to be understood. Invaluable benefits can now be obtained from available behavioural and pharmacological treatments, but complete remission remains uncertain and long-term management may be required. Thus, the treatment of OCD and tics in children and adolescents remains a clinical challenge. It requires careful assessment of the targeted symptoms and, in many cases, comorbidity; attention to the quality of the child's functioning at home and with peers; use of specific CBT interventions, which are not readily available (or accessible) in all communities; patience and caution in the choice and adjustment of medication; and vigilance in watching potential side effects. Given the possible chronicity of OCD and/or tic disorders, and their changing patterns in severity and impact over the childhood and adolescent years, optimal treatment generally requires a long-term ongoing relationship with the child and family. Current conceptualizations of OCD and tic disorders have been shaped by advances in systems neuroscience and functional in vivo neuroimaging. Continued success in these areas should lead to the targetting of specific brain circuits for more intensive research. This should include testing novel pharmacological agents, tracking treatment response using neuroimaging techniques, and possibly investigating circuit-based therapies using deep-brain stimulation for refractory cases. The identification of the PANDAS subgroup of patients, with an abrupt onset and dramatic exacerbations, certainly brings new insights into the pathophysiology of OCD and tic disorders, and may lead to new assessment and treatment strategies. The increasing evidence for susceptibility genes in OCD and tic disorders will also doubtless point to new therapeutic directions. Furthermore, it is likely that many of the empirical findings used in research on paediatric OCD and tic disorders will be relevant to a better understanding of both normal development, and other disorders of childhood onset.
Children's speech and language difficulties
Authors: Clegg Judy
Published: January 2013

Speech and language difficulties have a significant impact on the lives of children and their families. This chapter will give an overview of the types of speech and language difficulties children present with and how these are generally classified and diagnosed. Specific Language Impairment (SLI) and speech and language difficulties associated with child psychiatric disorder, specifically disorders of attention and selective mutism will be a focus. The life course of children with speech and language impairments will be described through childhood, adolescence, and adult life. Current management approaches will be presented and evaluated and strategies for effective communication considered.
The child as witness
Authors: Thompson Anne E. , Pearce John B.
Published: January 2013

In the last 20 years, many societies have paid greater attention to children's rights and the importance of protecting children from abuse. As perpetrators of abuse have been tried in court, so more children have been called as witnesses. From being described as ‘the most dangerous of all witnesses’, children have become recognized to be able to provide valuable and credible testimony in the correct circumstances. Many jurisdictions are now making allowances for children so that their testimony can be delivered in court as fully and accurately as possible. It is no longer tenable to dismiss the capacity of a child to be a witness in court simply because of their age. Children may be less reliable, as reliable, or more reliable than adult witnesses, depending on a variety of developmental and environmental factors.
Counselling and psychotherapy for children
Authors: Pearce John B.
Published: January 2013

There is a remarkable lack of high quality research to support an evidence base for counselling and psychotherapy for children. And the words ‘psychotherapy’ and ‘counselling’ are so non-specific that they should always be clarified in more detail. Nevertheless, these approaches are used frequently in child mental health. While most psychotherapeutic approaches are based on work with adults it is important to note that there are marked differences between children and adults. In spite of these obvious differences, psychotherapy for children is usually based on techniques used for adults. However, psychotherapy that may work perfectly well for adults has to be modified to accord with the developmental level of each child.
Caregiver-mediated interventions for children and families
Authors: Fisher Philip A. , Stormshak Elizabeth A.
Published: January 2013

This chapter summarizes interventions that have been developed to address child and adolescent behaviour problems and externalizing disorders within the therapeutic milieu of the family. Although it has long been recognized that caregiver-mediated treatments can be employed to address children's problems, research with families in the past two decades has resulted in numerous systematic, theory-driven approaches that have been subjected to rigorous scientific evaluation and have been found to be effective at improving outcomes. Although no intervention is certain to work for every child and it is not possible to engage every family in the intervention process, caregiver-mediated interventions are among the most promising approaches currently available to practitioners. In recent years, progress in the field of caregiver-mediated interventions has included an expansion of the evidence base supporting specific intervention practices for use with the general population, with high-risk segments of the population (e.g. children in foster care and children in Head Start settings), and with underserved populations (e.g. girls and racial/ethnic minorities). In addition, an increasing emphasis has been placed on the dissemination of proven interventions on large-scale bases within community settings in North America, Europe, and Australia. Evidence is currently being gathered to evaluate the impact of many of these large-scale dissemination efforts. The chapter that follows contains background information on the theoretical underpinnings of caregiver-mediated interventions to address child behaviour problems. Specific interventions that have been developed for children in specific age groups—prenatal through early childhood, the school-age period, and adolescence—are then described. Finally, we discuss adaptations that have been made to address issues of gender and cultural diversity within this field.