bluuebunny/crossref_metadata_2025 huggingface dataset:
S
Authors: Dickman Andrew
Published: January 2013

This chapter includes drugs beginning with the letter S
T
Authors: Dickman Andrew
Published: January 2013

This chapter includes drugs beginning with the letter T
Quantitative genetics
Authors: Thapar Anita , McGuffin Peter
Published: January 2013

In this chapter the authors consider the theoretical basis of inheritance and possible sources of phenotypic variation and familial resemblance. The investigation of the genetic basis of psychiatric disorders first requires us to examine to what extent genes and environment contribute to a given disorder or trait. Secondly, we need to know how genes and environmental influences exert their risk effects and finally we have to investigate the genetic basis of disorders at a molecular level. Traditional methods in psychiatric genetics research include family, twin, and adoption studies. Family studies enable us to examine to what extent a disorder or trait aggregates in families. Familiality of a disorder can of course by explained by shared environmental influences as well as by shared genes. Twin and adoption studies allow us to disentangle the effects of genes and shared environment. The statistical methods used in quantitative genetics may seem complex, the principles are straightforward. Here the authors consider the methods of analyses that are most commonly used for examining the contribution of genetic and environmental factors, to psychiatric disorders and traits. Finally, they discuss gene mapping, and molecular genetic studies investigating gene–environment interplay and intermediate phenotypes.
The anatomy of human emotion
Authors: Dolan R. J.
Published: January 2013

Emotions, uniquely among mental states, are characterized by psychological and somatic referents. The former embody the subjectivity of all psychological states. The latter are evident in objectively measurable stereotyped behavioural patterns of facial expression, comportment, and states of autonomic arousal. These include unique patterns of response associated with discrete emotional states, as for example seen in the primary emotions of fear, anger, or disgust often thought of as emotion proper. Emotional states are also unique among psychological states in exerting global effects on virtually all aspects of cognition including attention, perception, and memory. Emotion also exerts biasing influences on high level cognition including the decision-making processes that guide extended behaviour. An informed neurobiological account of emotion needs to incorporate how these wide ranging effects are mediated. Although much of what we can infer about emotional processing in the human brain is derived from clinic-pathological correlations, the advent of high resolution, non-invasive functional neuroimaging techniques such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) has greatly expanded this knowledge base. This is particularly the case for emotion, as opposed to other areas of cognition, where normative studies have provided a much richer account of the underlying neurobiology than that available on the basis of observations from pathology as in classical neuropsychology. Emotion has historically been considered to reflect the product of activity within the limbic system of the brain. The general utility of the concept of a limbic-based emotional system is limited by a lack of a consensus as to its precise anatomical extent and boundaries, coupled with knowledge that emotion-related brain activity is, to a considerable degree, configured by behavioural context. What this means is that brain regions engaged by, for example, an emotion of fear associated with seeing a snake can have both distinct and common features with an emotion of fear associated with a fearful recollection. Consequently, within this framework emotional states are not unique to any single brain region but are expressed in widespread patterns of brain activity, including activity within early sensory cortices, shaped by the emotion eliciting context. This perspective emphasizes a global propagation of emotional signals as opposed to a perspective of circumscribed limbic-mediated emotion-related activity.
The neuropsychiatry of head injury
Authors: Fleminger Simon
Published: January 2013

Head injury ‘imparts at a blow both physical and psychological trauma’, and the consequences are often devastating and enduring. Not infrequently head injury leads to a psychiatric consultation, which will need to take into account the interplay between the brain and its injuries as well as the psychodynamic processes that follow from the injury. In the immediate aftermath of the head injury, the management rests with the acute surgical and medical team. The psychiatrist is usually not involved at this stage. Nevertheless, to understand the later neuropsychiatric effects of head injury it is first necessary to know what happens to the brain when it is injured.
Amnesic syndromes
Authors: Kopelman Michael D.
Published: January 2013

Systematic clinical descriptions of amnesic disorders and their underlying pathology have become more detailed and rigorous over the years. In particular, recent advances in neuro-imaging (structural, metabolic, and activation) have provided the opportunity to relate particular cognitive abnormalities to specific changes in brain function. The use of pharmacological agents, in parallel with such imaging techniques, may promote the development of pharmacological agents more potent than the meagre array that we have at present for the treatment of severe memory disorder.
Remediation of memory disorders
Authors: Evans Jonathan J.
Published: January 2013

Memory disorders are frequently encountered in clinical practice and cause significant disability. Memory should therefore be carefully assessed as part of routine clinical assessment. Restoration of normal functioning is not typically possible and remediation is therefore usually concerned with compensating for impaired memory. A range of treatment approaches is available, and the treatment of choice will depend on the form and severity of memory disorder and the functional problems faced by the patient.
Alcohol dependence and alcohol problems
Authors: Marshall Jane
Published: January 2013

The problem of excessive alcohol consumption is a major cause of public health concern in most countries of the world today. Heavy consumption, which involves far more than ‘dependence’, can cause untold misery to the individual, who is usually affected by other physical, psychological, and social disabilities as well. As early as 1950, the World Health Organization (WHO) viewed the lack of a commonly accepted terminology as a serious obstacle to international action in the alcohol field. Definitions of ‘alcoholism’ have been proposed by a range of professional and other bodies, from biomedical scientists, medical doctors and psychiatrists, psychologists, sociologists, patients in treatment, to the general public. Terms such as ‘alcoholism’, ‘addiction’, and ‘chemical dependence’, have passed into everyday speech, becoming ‘popularly enriched’ and ‘technically impoverished’. These terms mean different things to different people and often have pejorative connotations. The lack of a precise definition of ‘drinking problems’ has hampered interdisciplinary communication. In this section, the evolution of the term ‘alcohol dependence’ will be traced and put into context as but one aspect of a wider spectrum of alcohol-related problems. The concept of the alcohol dependence syndrome (ADS) will be introduced and its influence on the 10th revision of the International Classification of Diseases (ICD-10) and the fourth edition of the Diagnostic and Statistical Manual of Diseases (DSM-IV) will be reviewed. The terms ‘harmful use’ (ICD-10) and ‘alcohol abuse’ (DSM-IV) will also be discussed. Finally ‘alcohol-related problems’ will be considered.
Disorders relating to use of PCP and hallucinogens
Authors: Abraham Henry David
Published: January 2013

Phencyclidine (PCP, ‘angel dust’) is an arylcyclohexylamine dissociative anaesthetic. It was first abused in the United States in New York and San Francisco in the 1960s, but abuse declined when a broad range of adverse complications was noted. Agents that alter perception and mood without disorientation typify hallucinogenic drugs. They have been known and used for millennia for purposes ranging from magical to medical. Hallucinogenic drugs comprise not so much a single class of compounds, but a multiple classes affecting different neuronal receptors. This chapter looks at the epidemiology, acute physiological effects, and adverse effects of both PCP and hallucinogens. it also covers PCP delirium, PCP-induced psychotic disorder, PCP abuse, dependence, and organic mental disorder, and finally human experimentation with hallucinogens.
Misuse of benzodiazepines
Authors: Welch Sarah , Farrell Michael
Published: January 2013

There is a valuable role for benzodiazepines, and a need for vigilance and care in their use, as well as active recognition and management of those who are dependent. However, there is a need for greater awareness of the risks of polydrug dependence with misuse of high doses of benzodiazepines in conjunction with both alcohol dependence and opiate dependence. Caution needs to be used in assessing patients, and benzodiazepine prescribing should be restricted to those where there is clear evidence of dependence. The risk of synergistic effects with other drugs and consequent overdose should be explained to all patients who are identified as being involved in such behaviour. Community detoxification or inpatient detoxification is the best option based on the evidence of available research and evaluation of current interventions.
Disorders relating to the use of volatile substances
Authors: Ives Richard
Published: January 2013

Volatile substance abuse (VSA)—also known as ‘solvent abuse’ and ‘inhalant abuse’—is the deliberate inhalation of any of a range of products (see Table 4.2.3.6.1), to achieve intoxication. Amyl (pentyl) and isobutyl nitrites (‘poppers’) have different patterns of misuse, and are not discussed here. VSA has dose-related effects similar to those of other hypnosedatives. Small doses rapidly lead to ‘drunken’ behaviour similar to the effects of alcohol, and may induce delusions and hallucinations. Some heavy misusers inhale large quantities; 6 l of adhesive weekly have been reported. Long-term effects include listlessness, anorexia, and moodiness. The hair, breath, and clothing may smell of the substance(s) used, and empty product containers (e.g. glue cans, cigarette lighter refills, and aerosol spray cans), and bags used to inhale from, may be found. Being readily available, volatile substances are, along with alcohol and tobacco, the first intoxicating substances some children try. However, most VSA is experimental and does not lead to the use of other psychoactive substances; problematic misusers have other difficulties in their lives.
Nicotine dependence and treatment
Authors: López-Ibor Ma Inés
Published: January 2013

Despite the reality that smoking remains the most important preventable cause of death and disability, most clinicians underperform in helping smokers quit. Nearly 70 per cent of smokers want to quit, and 42.5 per cent attempt to quit each year. The most effective smoking cessation programmes involve a combination of pharmacotherapy and behavioural and/or cognitive counselling to improve abstinence rates. Ways to counter clinicians’ pessimism about cessation include the knowledge that most smokers require multiple attempts before they succeed in quitting.
Diagnosis, classification, and differential diagnosis of schizophrenia
Authors: David Anthony S.
Published: January 2013

Until the early 1970s, the diagnosis of schizophrenia was one of the most contentious and fraught issues in the whole of psychiatry. Since then a massive international effort has been put in motion out of which explicit diagnostic criteria emerged. Some achieved widespread and even multinational agreement, allowing the painstaking process of calculating diagnostic specificity, sensitivity, reliability, and (perhaps) validity to begin. Although criticism of the diagnosis of schizophrenia continues, mostly from outside psychiatrists, the vast majority of psychiatrists look upon the major sets of diagnostic criteria with weary acceptance, seeing them as flawed but useful and possibly ‘as good as it gets’ given our current state of knowledge/ignorance. This chapter covers diagnostic criteria, basis of classification, early diagnosis, differential diagnosis, and finally the diagnostic process.
Acute stress reactions
Authors: Ehlers Anke , Harvey Allison G. , Bryant Richard A.
Published: January 2013

Exceptionally stressful life events can cause severe psychological symptoms, including anxiety, feelings of derealization and depersonalization, and hyperarousal. In one of the first studies to comprehensively document acute reactions to extreme stress, Lindemann observed that the symptoms reported by survivors of the Coconut Grove Fire included avoidance, re-experiencing scenes from the fire, reports of derealization, and the experience of anxiety when exposed to reminders of the event. Similarly, acute responses reported by soldiers who fought in the First and Second World Wars included re-experiencing symptoms and dissociative responses such as numbing, amnesia, and depersonalization. The International Classification of Diseases has recognized acute stress reactions since 1948 (ICD-6). In the most recent edition (ICD-10), early reactions to exceptionally stressful life events are diagnosed as acute stress reaction, one of the diagnoses in the section headed ‘reactions to severe stress, and adjustment disorders’. The diagnoses of acute stress reactions in ICD-10 and of acute stress disorder in DSM-IV have similarities in that they are caused by extreme stress and have some overlap in symptom patterns. They can be considered as two separate points on a continuum from transient to more enduring symptoms. However, there are also differences in the underlying concepts, as we will discuss in this chapter.
Bereavement
Authors: Raphael Beverley , Wooding Sally , Dunsmore Julie
Published: January 2013

Bereavement is the complex set reactions that occurs with the death of a loved one: the emotions of grief with yearning, angry protest, and sadness; the cognitive processes of understanding and making meaning of the finality and nature of death; and the social, cultural, spiritual, and religious contexts of adaptation. Grief may also result from other losses such as health, home, country, and safe worlds. There have been investigations into potential neurobiological substrates, without, as yet consensus about the explanatory model. This chapter covers the phenomenology of ‘normal grief’, neurobiology of bereavement, risk and protective factors influencing course and outcome, physical and mental health consequences of bereavement, and assessment and management. Counselling bereaved people requires hopeful, compassionate psychotherapeutic intervention which recognizes the human suffering involved, validates the person’s strengths, and respects their spiritual needs. Loss is a central issue for all of us, both our fears of it, and its reality. Counselling requires those involved to recognize their own sensitivities in this regard, and to assist the ‘journey’ of those affected in dealing with their loss. Most people grieve, remember with love those whom they have lost, and continue to love, and love anew.
Generalized anxiety disorders
Authors: Bitran Stella , Barlow David H. , Spiegel David A.
Published: January 2013

Anxious apprehension and overconcern are common to many anxiety and mood disorders. Prior to 1980 in the American DSM diagnostic system, and 1992 in the international ICD system, individuals who experienced those symptoms in the absence of a realistic focus of concern were classified as having an ‘anxiety neurosis’ (DSM-II) or ‘anxiety state’ (ICD-9). In DSM-III, panic disorder was split off from that classification, and the residual category was renamed generalized anxiety disorder (GAD). A similar nomenclature was adopted in ICD-10. Since its inception, GAD as a nosological entity has been troubled by problems of poor reliability and high comorbidity. Those concerns have prompted several revisions of the DSM criteria and also have raised more basic questions regarding the validity of GAD as a disorder distinct from other anxiety and mood states. The question of what is the nature of GAD is still being debated and it remains one of the least reliably diagnosed anxiety or mood disorders. This diagnostic unreliability has led to various suggestions for revisions to the diagnostic criteria and criticisms of the current definition of GAD.
Bulimia nervosa
Authors: Fairburn Christopher G. , Cooper Zafra , Murphy Rebecca
Published: January 2013

The history of the diagnosis bulimia nervosa begins as recently as 1979. Now, three decades later, the diagnosis bulimia nervosa is included in both DSM-IV(4) and ICD-10,(5) its prevalence is established, aspects of its aetiology are beginning to be understood, and much has been learned about its treatment. The chapter classification and diagnosis, clinical features, relationship to other disorders, distribution, aetiology, assessment, treatment, and course and outcome.
The sexual dysfunctions
Authors: Graham Cynthia A. , Bancroft John
Published: January 2013

Sexual relationships are central to the lives of most of us. The sexual component of those relationships can go wrong in various ways. This may be secondary to other difficulties in the relationship, mental health problems, specific sexual vulnerabilities of the individual, or the impact of disease or medication on sexual response. This chapter will describe the more common sexual problems and their prevalence. Evidence related to aetiology of sexual problems and treatment evaluation will be briefly reviewed. In the final section of the chapter, guidelines for the assessment and practical management of sexual problems will be presented.
Basic aspects of sleep–wake disorders
Authors: Stores Gregory
Published: January 2013

A sound working knowledge of the diagnosis, significance, and treatment of sleep disorders is essential in all branches of clinical psychiatry. Unfortunately, however, psychiatrists and psychologists share with other specialties and disciplines an apparently universal neglect of sleep and its disorders in their training. Surveys in the United States and Europe point to the consistently meagre coverage of these topics in their courses at both undergraduate and postgraduate levels. The following account is an introductory overview of normal sleep, the effects of sleep disturbance, sleep disorders and the risk of failure to recognize them in psychiatric practice, assessment of sleep disturbance, and the various forms of treatment that are available. The aim is to provide a background for the other chapters in this section. The close links between the field of sleep disorders and psychiatry which make it essential that psychiatrists are familiar with the field are as follows: ♦ Sleep disturbance is an almost invariable feature and complication of psychiatric disorders from childhood to old age, with the risk of further reducing the individual's capacity to cope with their difficulties (see Table 4.14.1.3 for further details). ♦ Sleep disturbance can presage psychiatric disorder. ♦ Some psychotropic medications produce significant sleep disturbance. ♦ Of importance to liason psychiatry is the fact that many general medical or paediatric disorders disturb sleep sufficiently to contribute to psychological or psychiatric problems. ♦ Because of lack of familiarity with sleep disorders and their various manifestations, such disorders may well be misinterpreted as primary psychiatric disorders (or, indeed, other clinical conditions) with the result that effective treatments for the sleep disorder are unwittingly withheld (see later). Some of these points will be amplified in later sections of this chapter.
Culture-related specific psychiatric syndromes
Authors: Tseng Wen-Shing
Published: January 2013

In certain ways, all psychiatric disorders are more or less influenced by cultural factors, in addition to biological and psychological factors, for their occurrence and manifestation. ‘Major’ psychiatric disorders (such as schizophrenia or bipolar disorders) are more determined by biological factors and relatively less by psychological and cultural factors, but ‘minor’ psychiatric disorders (such as anxiety disorders, conversion disorders, or adjustment disorders) are more subject to psychological causes as well as cultural factors. In addition to this, there are groups of psychiatric disorders that are heavily related to and influenced by cultural factors, and therefore addressed as culture-related specific psychiatric syndromes. Even though the encounter of culture-related specific psychiatric disorder in our daily psychiatric practice is relatively rare, the purpose of examining such specific syndromes has its significant purpose and implications. Through such unique examples, it helps us to appreciate the cultural attribution to the stress formation, reaction pattern, symptom manifestation, occurrence of frequency of disorders, and reaction to the disorders. It also concerns how to work on therapy for the disorder by complying patient’s cultural background.
Mind–body dualism, psychiatry, and medicine
Authors: Sharpe Michael , Walker Jane
Published: January 2013

Patients usually attend doctors because they are concerned about symptoms. When these symptoms are associated with persistent distress or disability we refer to the patient as having an illness. When assessing the patient's illness the doctor aims to make a diagnosis, on the basis of which management can be planned and prognosis made. The diagnoses available to doctors are conventionally defined as either ‘medical’ or ‘psychiatric’. This division of illness into two types is such an accepted feature of current medical practice that we tend to take it for granted. But is it really the best way to think about patients’ illnesses and to plan their care? In order to answer this question we will examine what is meant by ‘medical’ and ‘psychiatric’ diagnoses and the assumptions underpinning this division. The disadvantages of this dualistic approach will be considered and solutions proposed.
Epidemiology of somatoform disorders and other causes of unexplained medical symptoms
Authors: Simon Gregory
Published: January 2013

While nearly every psychiatric syndrome may include some somatic signs or symptoms, a specific group of syndromes has been traditionally defined as somatoform. This group of disorders is distinguished by certain key features: prominent reporting of somaticymptoms, concern about medical illness, and frequent presentation to general medical providers. As in other categories of mental disorder, the boundaries between individual syndromes are more distinct in our systems of classification than they are in nature. Understanding that various somatoform disorders often overlap, this review is organized according to the major categories of somatoform disorder described in the ICD and DSM classification systems.
Psychiatric aspects of cancer
Authors: Holland Jimmie C. , Stiles Jessica
Published: January 2013

Psycho-oncology addresses the two major psychiatric and psychological dimensions of cancer: first, the responses of patients and their families at all stages of disease and the psychological stresses on health professionals delivering their care. The patient and physician relationship, dependent on effective communication, impacts the care of all patients, at every visit, at all sites and stages of cancer, and during all treatments. The second dimension addresses the psychological, behavioural, and social factors that influence cancer risk, detection, and survival. Many cancer centres and hospitals now have multi-disciplinary psychosocial teams consisting of clinicians and clinical investigators from psychology, psychiatry, social work, nursing, and clergy. These teams provide consultation for patients and their caregivers, psychosocial education for oncology staff, and collaboration in studies in which quality of life is important. In addition, active research in brain, immune, and endocrine links is occurring, particularly in the mechanism of cytokines in producing ‘sickness behaviour’ that may provide a biological basis for common symptoms of fatigue, depression, anxiety, weakness, and cognitive chances in cancer patients. Despite the fact that many cancer centres and oncology divisions now have a psycho-oncology or psychosocial unit, only a few centres have programmes that include both research and training. This chapter describes the common psychiatric disorders and psychosocial challenges experienced by cancer patients and the range of interventions available.
Psychiatric aspects of accidents, burns, and other physical trauma
Authors: Malt Ulrik Fredrik
Published: January 2013

This chapter covers the epidemiology of accidents and injury, clinical features and assessment of trauma at the accident scene, responses seen in the emergency room, psychiatric treatment during hospital stay, long-term behavioural and psychiatric consequences of physical trauma, the assessment and treament of long-term psychiatric consequences of traumatic injury, and compensation claims and litigation.
Health psychology
Authors: Weinman John , Petrie Keith J.
Published: January 2013

Health psychology is concerned with understanding human behaviour in the context of health, illness, and health care. It is the study of the psychological factors, which determine how people stay healthy, why they become ill, and how they respond to illness and health care. Health psychology has emerged as a separate discipline in the past 30 years and there are many reasons for its rapid development. An important background factor is the major change in the nature of health problems in industrialized societies during the twentieth century. Chronic illnesses such as heart disease and cancer have become the leading causes of death, and behavioural factors such as smoking, diet, and stress are now recognized as playing a major role in the aetiology and progression of these diseases. The provision of health care has grown enormously and there is an increased awareness of good communication as a central ingredient of medical care and of the importance of such factors as patient satisfaction and quality of life as key outcomes in evaluating the efficacy of medical interventions. Although health psychology has developed over a similar time period to general hospital/liaison psychiatry and shares some common areas of interest, there are some clear differences between these two fields. Liaison psychiatry has a primary focus on hospital patients, particularly those experiencing psychological difficulties in the face of a physical health problem. In contrast, health psychology has a much broader focus on both healthy and ill populations and on the psychological processes that influence their level of health or their degree of adaptation to disease. Whereas health psychology has been mainly concerned with developing explanations based on theory, for health-related and illness-related behaviour, liaison psychiatry has concentrated on the diagnosis and treatment of either unexplained symptoms or psychiatric disorders occurring in people with medical conditions (see the other chapters in Part 5 of this volume). In this chapter we provide an overview of the main themes and areas in health psychology. Four broad areas of behaviour will be reviewed, namely behavioural factors influencing health, symptom and illness behaviour, health care behaviour, and treatment behaviour. Inevitably such an overview is selective and the interested reader should seek out a more comprehensive introductory text or more in-depth accounts of specific areas.
Anxiolytics and hypnotics
Authors: Lader Malcolm
Published: January 2013

In many countries the drug treatment of both anxiety and insomnia still largely revolves around the use of the benzodiazepines. Nevertheless, controversy and disagreement still rage about the risk–benefit ratio of compounds in this area. Short-term use in both indications is well established, with a favourable database as a rationale for this approach. However, long-term use is still only researched in a limited way. While both the efficacy and safety of long-term use remain unclear, acceptance of current guidelines limiting the use of benzodiazepines seems wise. The advent of the SSRIs as anxiolytics has driven a wedge between the treatment methods for anxiety and insomnia. Anxiety can be treated just as effectively with an SSRI (and probably, pregabalin) as with a benzodiazepine, and more safely. The treatment of insomnia still relies on the benzodiazepines until the risk–benefit ratio of newer drugs such as the melatonin-related compounds becomes clear. Nevertheless, in the author's opinion the most important outstanding issue is the relationship between drug and non-drug treatments. The management of anxiety disorders and of insomnia is complex and is hampered by a dearth of information concerning the relative merits of various treatment modalities. Much research is also needed on the optimum strategies for combining all the therapies available to us, and on identifying predictors of response. Developments in the neuropharmacology of insomnia hold out the promise of new compounds with novel and perhaps more effective modes of action. With respect to anxiety disorders, a major shift of emphasis has followed the demonstration of the efficacy of the SSRIs.
Antipsychotic and anticholinergic drugs
Authors: Meltzer Herbert Y. , Bobo William V.
Published: January 2013

The discovery by Delay and Denicker in 1953 that chlorpromazine was highly effective in alleviating delusions, hallucinations, and disorganized thinking, was the seminal breakthrough in the treatment of schizophrenia, the first agent to produce sufficient relief of core psychotic symptoms to permit life outside of institutions for many patients with schizophrenia, and even a return to a semblance of function within normal limits. Chlorpromazine and the other related typical antipsychotic drugs which were introduced over the next 30 years have proven to be of immense benefit to vast numbers of people who experience psychotic symptoms as a component of a diverse group of neuropsychiatric and medical disorders, as well as drug-induced psychoses. These drugs have been invaluable in providing clues to the aetiology of schizophrenia and other forms of mental illness with psychotic features and as tools in understanding fundamental neural processes, especially those involving dopamine, a key neurotransmitter involved in psychosis. This class of drugs has now been supplanted by the so-called atypical antipsychotic drugs, of which clozapine is the prototype. This chapter will describe the various classes of antipsychotic agents, with emphasis on the atypical antipsychotic drugs, their benefits and adverse effects, recommendations for use in clinical practice, and mechanism of action. The drugs used to treat the extrapyramidal side-effects (EPS) produced mainly by the typical antipsychotic drugs are also considered.
Drugs for cognitive disorders
Authors: Iversen Leslie
Published: January 2013

Cognitive disorders are among the most difficult of all nervous system illnesses to treat as they affect the most complex and least clearly understood aspects of brain function. Animal studies cannot accurately mirror the complexities of human cognition, and there are few, if any, animal models of human cognitive illnesses. As so few drugs have been found to exert clinically significant effects, animal models for testing novel cognition-enhancing agents have unknown predictive value. However, progress has been made in recent years with improved international agreement on the criteria used to approve new cognition-enhancing drugs, and the introduction of new drugs for the treatment of dementia.
Drugs used in the treatment of the addictions
Authors: Law Fergus D. , Nutt David J.
Published: January 2013

Medical treatment of the addictions remains controversial, with addiction itself viewed as a lifestyle problem, a hijacking of brain systems by drugs, or as a medical illness. Many of these controversies may be avoided by taking a goal-oriented approach to treatment, in which clinical objectives are defined, and both medications and psychological interventions are used to facilitate progress towards these. The effectiveness of medications is maximized when they are used as one component of a comprehensive treatment plan. There are no ‘magic bullets’ in addiction treatment—the same pharmacological principles apply to these drug treatments as to any other. Drugs need to be given in effective doses, at appropriate intervals, allowed time to reach steady state, and also to dissipate when terminated on the basis of their half-life. Some drugs also have an abuse potential of their own (e.g. opiates, sedative-hypnotics) especially those with a rapid onset of action, and such drugs need to be particularly closely monitored and controlled, to minimize their diversion and misuse.
Complementary medicines
Authors: Werneke Ursula
Published: January 2013

Complementary medicines pose a particular challenge to medical practitioners who may feel that their patients need conventional treatment but often find themselves out of their depth when patients ask about complementary therapies. Pharmacological options include herbal medicines, certain foods, and nutritional supplements such as vitamins and minerals. Physical treatments include acupuncture, massage, and osteopathy to name a few. Treatments, which purport to achieve their effects through changes in internal ‘energy flow’ include reiki, reflexology, healing, and therapeutic touch, and also homeopathy and traditional Chinese acupuncture. All these treatments are either used alternatively, i.e. instead of, or complementary, i.e. in addition to, conventional medicine. In patients with mental health problems, depending on the definition and inclusion criteria, estimates of the prevalence of complementary medicine use range from 8 per cent to 57 per cent. Depression and anxiety seem to be the most common indications.
Transcranial magnetic stimulation
Authors: McLoughlin Declan , Mogg Andrew
Published: January 2013

rTMS has an increasing role as a useful investigational tool for probing neuronal circuitry in a variety of neuropsychiatric disorders. However its therapeutic value is at present less certain. The anti-depressant efficacy of rTMS has now been investigated for over 15 years and despite initial early enthusiasm there is still not clear evidence for its usefulness as a treatment in depression, reflected in the recent FDA and NICE decisions. Further research is required to identify specific brain regions in specific conditions that may be appropriate targets for treatment with rTMS, allowing tailoring of treatments for individual patients. The recent development of neuronavigational techniques using MRI imaging should aid treatment site localization. Other future research should be directed at establishing optimal rTMS parameters, e.g. the intensity, frequency and number of treatments.
Neurosurgery for psychiatric disorders
Authors: Matthews Keith , Christmas David
Published: January 2013

Despite its chequered past, modern NMD bears little similarity to historical freehand procedures. Advances in neuroimaging mean that anatomical substrates for depression and OCD are being elucidated. Ablative procedures such as ACAPS and ACING are unlikely to undergo randomized controlled trials but prospective clinical audit suggests that such procedures may offer improvement to selected patients with treatment-refractory depression and OCD. Interventions such as VNS and DBS offer the possibility of double-blind testing but as yet there is insufficient evidence to suggest that such procedures offer greater effectiveness.
Brief individual psychodynamic psychotherapy
Authors: Ursano Amy M. , Ursano Robert J.
Published: January 2013

Brief dynamic psychotherapy is an important treatment for numerous disorders, primarily the adjustment, anxiety, and mood disorders. Both alone and in combination with medication brief dynamic psychotherapy is an effective part of the treatment armamentarium. Clinicians should be trained in the brief as well as the longer term treatments and their use as brief, intermittent, and maintenance treatments. Skill in the longer term psychotherapies is important to developing skill in the brief dynamic psychotherapy where the needs for rapid establishment of the therapeutic alliance and the accurate assessment of transference and defence patterns are important. Empirical studies comparing well-defined brief dynamic psychotherapy with cognitive and interpersonal psychotherapies are limited. Future research must address which form of brief psychotherapy may be most helpful for which patient. An individual's preferred learning path-what he or she may see and observe most easily such as thoughts or feelings or interpersonal relations-may be an important variable in determining which brief psychotherapy for which patient. State, trait, and contextual variables will influence this learning modality. The process of change in brief individual psychodynamic psychotherapy, a process of altering neuronal organization through verbal means, is influenced by the patient's diagnosis, medications, past history, cognitive style, developmental stage, and affective availability, as well as the doctor–patient match.
Public policy and mental health
Authors: Muijen Matt , McCulloch Andrew
Published: January 2013

Public policy, and specifically national public policy, is one of the key factors that affects the practice of psychiatry, the shape of mental health services, and the environment within which mental health services work. The specific content of public policy varies greatly across the world and often even across neighbouring countries. It is therefore impossible within the space of this chapter to undertake systematic international comparisons. This chapter gives an overview of: (a) what policy is and why it might be important; (b) types of policy and policy development internationally; (c) international structures and organizations that are relevant to the scope and content of policy, especially in the field of human rights which is often the starting point for policy; (d) the breadth of policy activity that is relevant to mental health—stretching beyond the health ministry and health policy—and the partnerships that are necessary to tackle the mental health of individuals and populations.
Cultural differences care pathways, service use, and outcome
Authors: van Os Jim , McKenzie Kwame
Published: January 2013

This chapter discusses the influence of culture on the route an individual takes to access treatment for psychological distress and the treatment received. Culture is difficult to measure. All categories of cultural variables have different meanings and measure different things. Research into them leads to different hypotheses. Given this reality, there is no need to join the cul-de-sac argument of whether one or the other is the most important. In the discussion below, the roles of ethnicity and of socio-economic, political, community, national, and other factors that help to define the culture of an individual or a group are acknowledged. Associations with pathways to care, service use, and outcome will be presented.
Planning and providing mental health services for a community
Authors: Burns Tom
Published: January 2013

The aim of this chapter is to assist clinicians and managers review and plan services effectively for their local population. Severe psychiatric disorders manifest themselves in social relations and often disrupt social structures; they have wide-ranging consequences and services need to be comprehensive. Health and social care have been intertwined in psychiatry from its origins—it is neither feasible nor sensible to ignore the wider context of their management. The last 30 years have seen an explosion of Mental Health Services Research alongside the shrinking and closure of mental hospitals (see Chapter 7.6). Policy considerations, particularly cost containment and public safety, have influenced the research agenda which is disproportionately Anglophone (from the United States, United Kingdom, and Australasia) and focused on new services developed as alternatives to institutional care with staffing and motivation that are not easily generalizable. More routine practices, crucial for safe and effective care, have been relatively neglected by researchers. This chapter is mainly devoted to describing the essential components of a mental health service—its ‘building blocks’. It will then consider how they relate to one another, how they can be prioritized, and how integrated into an effective local service linking into other essential services. Lastly it will stress how their inevitable evolution should be monitored. Services for adults (increasingly referred to as ‘adults of working age’ indicating 18–65 years) will be used as the template. In many settings these may be the only services, stretching to accommodate all comers. In better resourced health care systems a range of specialized services have evolved from this basic model and are described elsewhere in this section (refugees 7.10.1, homeless 7.10.2, and ethnic minorities 7.10.3).
Evaluation of mental health services
Authors: Tansella Michele , Thornicroft Graham
Published: January 2013

Evaluation is the basis for improving care to people with mental illness. It is vital to know whether interventions are beneficial or harmful, and whether they offer value for money. Mental health interventions need to be understood both in terms of their active ingredients and how they fit within their context. Such combined interventions, often including pharmacological, psychological, and social elements, are the epitome of ‘complex interventions’ and their evaluation poses considerable challenges. In this chapter we shall discuss definitions of evaluation, and go on to discuss why evaluate, what to evaluate, and how to evaluate mental health services. In our conclusion we shall offer an indication of the most important trends in this field in the coming years. The overall approach that we take is centred upon the idea that ongoing evaluative research is of fundamental importance in discovering which interventions are effective, neutral, or harmful, and that such information is essential to deliver better mental health care.
Economic analysis of mental health services
Authors: Knapp Martin , Chisholm Dan
Published: January 2013

Economics is concerned with the use and distribution of resources within a society, and how different ways of allocating resources impact on the well-being of individuals. Economics enters the health sphere because resources available to meet societal needs or demands are finite, meaning that choices have to be made regarding how best to allocate them (typically to generate the greatest possible level of population health). Economics provides an explicit framework for thinking through ways of allocating resources. Resource allocation decisions in mental health are complicated by the fact that disorders are common, debilitating, and often long-lasting. Epidemiological research has demonstrated the considerable burden that mental disorders impose because of their prevalence, chronicity, and severity: globally, more than 10 per cent of lost years of healthy life and over 30 per cent of all years lived with disability are attributable to mental disorders. Low rates of recognition and effective treatment compound the problem, particularly in poor countries. However, disease burden is not in itself sufficient as a justification or mechanism for resource allocation or priority-setting. A disorder can place considerable burden on a population but if appropriate strategies to reduce this burden are absent or extremely expensive in relation to the health gains achieved, large-scale investment would be considered misplaced. The reason is that scarce resources could be more efficiently channelled to other burdensome conditions for which cost-effective responses were available. For priority-setting and resource allocation, it is necessary to ask what amount of burden from a disorder can be avoided by using evidence-based interventions, and at what relative cost of implementation in the target population. Cost and cost-effectiveness considerations enter into health care reform processes, priority-setting exercises within and across health programmes, and regulatory decisions concerning drug approval or pricing. Two broad levels of economic analysis can be distinguished: macro and micro.
Mental health services for homeless mentally ill people
Authors: Craig Tom K. J.
Published: January 2013

Specialist multidisciplinary teams for homeless mentally ill people provide an essential safety net for those who have fallen out of the wider mental health care system. They offer distinct advantages in terms of their capacity to work across traditional geographical and bureaucratic barriers, to take the longer-term view of the task of engagement, and to bring together the multiple strands of care across different provider agencies. Introduced as a temporary measure over a decade ago, they are still with us and likely to remain a permanent fixture of urban mental health care.
The biology of ageing
Authors: Bittles Alan H.
Published: January 2013

Although old age is readily recognizable, methods to define and measure the underlying biological processes are much less amenable to study. For this reason, life expectancy has been widely used as a surrogate measure of ageing, as well as to monitor economic progress at national and regional levels. It is generally acknowledged that lifespan is a constitutional feature of the human phenotype, and twin studies have indicated that 25–33 per cent of the variance in human longevity is genetic in origin. External factors including lifestyle can also exert a major influence, as illustrated by the current mean life expectancies of 79 and 86 years for males and females in Japan, whereas the comparable figures for Botswana are 35 and 33 years, respectively. The importance of genetic inheritance as a determinant of extended survival has been illustrated by population level studies in Okinawa, an island prefecture of southern Japan with a very high prevalence of long-lived individuals. On the island, the mortality rates of the male and female siblings of centenarians were approximately half those of birth cohort-matched, non-centenarian siblings. These findings parallel an earlier study of the family of Jeanne Calment, who died in France in 1997 aged 122 years. Of her 55 relatives, 24 per cent had lived to >80 years compared to just 2 per cent of a matched control group. However, it remains unclear whether the enhanced lifespan of individuals who exhibit above average longevity is due to a slowing of the overall ageing process or is primarily associated with resistance to major life-threatening pathologies. The concept of an ‘allostatic load’, potentially involving the neuroendocrine, sympathetic nervous, immune and cardiovascular systems, and metabolic pathways, has been advanced to describe the lifetime costs of adapting to physical and psychological stresses. According to this hypothesis, while the actions of biological mediators of stress can be initially beneficial to health, chronic stimulation results in regulatory imbalance and subsequent pathophysiological changes. Empirical studies have indicated increased physiological dysregulation and functional decline at >70 years of age, which would imply that predicted global increases in the numbers of older persons will be accompanied by disproportionately larger groups of individuals with major age-related pathologies.