bluuebunny/crossref_metadata_2025 huggingface dataset:
Services for alcohol use disorders
Authors: Drummond D. Colin
Published: January 2013

The alcohol treatment field has seen considerable change over the past 30 years. Some of this has been evidence based, and some has been largely politically driven, particularly in the pursuit of containing health care costs. On the positive side, a shift in policy from a limited number of treatment services catering only for the small minority of severely dependent drinkers, to more community orientated services with a greater emphasis on early identification and intervention, is to be broadly welcomed. However, in some places a move towards services catering for early stage ‘at-risk’ drinkers has been at the expense of losing services for those with more severe alcohol problems. While the evidence in favour of matching treatments to individual needs is still at a relatively early stage of development, and clear evidence of matching effects is not yet available, clinical practice needs to be guided by pragmatic principles by which more intensive treatments are provided to more complex patients, and/or in a stepped care paradigm. It must be concluded that, despite a large research effort in evaluating intensive versus less intensive alcohol interventions, there is still a long way to go in developing pragmatic clinical trials that evaluate effectiveness and cost-effectiveness of treatment in a way that can best advise practitioners in the typical treatment setting. On the positive side, research has begun to address fundamental health economic issues that are highly relevant to the rational funding of treatment services. Important in this is the development of health economic analysis in randomized controlled trials. The assessment of the impact of treatment availability on the prevalence of alcohol-related harm also represents a significant advance. Nevertheless, treatment research cannot occur in a vacuum. Research needs to take account of the funding environment in which treatment takes place. Further, treatment research needs to provide answers to the key issues facing commissioners of health care. With the gradual improvement in the quality of treatment research over the past three decades and the development of more advanced health economic methods to evaluate treatment, the treatment research community is in a much better position than ever before to provide evidence to guide the rational development of treatment services for alcohol use disorders. While many differences between health care systems exist in different countries, the evidence points to the need for a wide spectrum of services to cater for different needs. The development of low-threshold community-based services should not occur at the expense of more specialized services for more severe alcohol use disorders. Similarly, a treatment system that provides only specialist services for the minority of severe cases misses a significant public health opportunity to reduce the prevalence of alcohol use disorders through early, brief interventions.
Disorders relating to the use of amphetamine and cocaine
Authors: Seivewright Nicholas , Fung Robert
Published: January 2013

Amphetamine and cocaine are classed as stimulant drugs, although the distinction between stimulants and depressants can be criticized on the grounds that the same drug may have both actions in turn. This does indeed occur with amphetamine and cocaine, but the initial desired effects are increased energy and activity, and elevation in mood. These appear to be mainly due to enhanced central transmission of dopamine and noradrenaline (norepinephrine), with a similar enhancement of serotonin playing a less certain role. This chapter discusses clinical features, classification, diagnosis, epidemiology, aetiology, course and prognosis, treatment and prevention.
Disorders relating to the use of ecstasy and other ‘party drugs’
Authors: Winstock Adam R. , Schifano Fabrizio
Published: January 2013

MDMA, methamphetamine, GHB, and ketamine are all capable of producing acute adverse psychological experiences in normal users and exacerbating symptoms in those with underlying psychological disorders. They also to varying degrees pose the risk of long-term neuropsychiatric consequences. Although dependent patterns of use are not commonly seen with this group of drugs, methamphetamines certainly can result in the very rapid development of severe dependence. Most acute presentations are typically short-lived and self-limiting and are only very rarely life-threatening. The precipitation of an underlying psychiatric disorder or an exacerbation of premorbid traits may well be one of the longer term consequences of heavy use of these drugs. In those who present with acute drug-related psychological symptoms there should be an emphasis on follow-up since in some cases the symptoms will represent the onset of a persistent independent disorder which requires treatment. Users who have experienced acute psychological problems should be encouraged to make the attribution that there may be something inherent in them that makes them susceptible to experiencing the unpleasant reactions with a drug and that they are likely to remain vulnerable to those adverse experiences. This may be difficult to accept for potentially vulnerable young people who may prefer to think that the experience was not enjoyable because the drugs were not good – ‘it was a bad pill’.
Assessing need and organizing services for drug misuse problems
Authors: Marsden John , Bradbury Colin , Strang John
Published: January 2013

In the present decade, there has been substantial investment in drug misuse treatment thereby expanding the workforce, the capacity of the treatment system and leading to reduced waiting times and better integration of local services. In 2006–07, an in-treatment population of approximately 200 000 individuals were recorded by the National Drug Treatment Monitoring System (NDTMS). Capture-recapture estimates suggest that there are approximately 327 000 users of opioids and/or crack cocaine. About two-thirds of adults entering drug misuse treatment services are dependent on illicit heroin—a clinical presentation complicated by between 20 per cent to 50 per cent of admissions by concurrent dependence on cocaine and other substances such as the misuse of pharmaceutical medications (such as benzodiazepines). Cannabis is reported as the main problem drug for younger patients under 18 years of age. Overall, treatment services for clients of all ages are able to assess and provide interventions across all illicit drugs including amphetamine-type stimulants, sedative/hypnotics, cannabis, hallucinogens and volatile substances (solvents and inhalants). Hazardous and harmful alcohol use characterizes a significant, but priority group of drug misuse treatment seekers. In 2006, a revised national drug misuse treatment effectiveness strategy stressed the need for better local partnerships to commission and organize local services and promote reintegration of treated patients into the community. A core component of the strategy was the creation of Criminal Justice Integrated Teams (CJITS) who were given the role of treatment case coordi-nation for individuals involved in the justice system with identified drug misuse. Nevertheless, improvements to the reach, operation, and effectiveness of treatments remains a priority—particularly tackling high-risk behaviours linked to the acquisition and transmission of blood-borne infections and ensuring that all service users receive good quality assessment and care coordination.
Descriptive clinical features of schizophrenia
Authors: Liddle Peter F.
Published: January 2013

The clinical features of schizophrenia embrace a diverse range of disturbances of perception, thought, emotion, motivation, and motor activity. It is an illness in which episodes of florid disturbance are usually set against a background of sustained disability. The level of chronic disability ranges from a mild decrease in the ability to cope with stress, to a profound difficulty in initiating and organizing activity that can render patients unable to care for themselves.
Genetic and environmental risk factors for schizophrenia
Authors: Murray R. M. , Castle D. J.
Published: January 2013

One thing that is certain about the aetiology of schizophrenia is that there is no single cause. This might reflect the fact that the schizophrenia construct itself is heterogeneous, such that specific subtypes might in the future be found to have specific causes. But it is more useful at this stage of our knowledge to conclude that, like other disorders such as ischaemic heart disease and diabetes mellitus, schizophrenia results from the cumulative effects of a number of risk factors. These may be crudely divided into the familial-genetic and the environmental, though there are clearly interactions between the two.
The neurobiology of schizophrenia
Authors: Harrison Paul J.
Published: January 2013

Significant progress has been made in understanding the neurobiology of schizophrenia over the past decade (Table 4.3.6.2.4). In particular, there is now good evidence for a dopaminergic dysfunction, and for structural brain changes that are present at, and in part before, the onset of illness. There is also emerging evidence for several susceptibility genes, accompanied by data suggesting mechanisms by which these genes contribute to the neurodevelopmental and other pathogenic processes that are thought to lead to schizophrenia. Whilst highlighting the progress, one must also acknowledge that much remains unknown (Table 4.3.6.2.5), and it is a moot point how and when the research advances will impact on the diagnosis, treatment, or prognosis of schizophrenia.
Persistent delusional symptoms and disorders
Authors: Munro Alistair
Published: January 2013

Paranoia/delusional disorder is unique in psychiatry in that it is virtually a newly discovered illness, yet much of the fundamental descriptive work was done a century or more ago. This long hiatus means that most practitioners have little knowledge or experience of the disorder, and the few who are aware of it usually only see a small part of the fabric. The dermatologist treats a case of delusional parasitosis, the cosmetic surgeon has an impossible patient wth a dysmorphic delusion, the lawyer does not know what to do with a totally unreasonable litigant, the police officer has to deal with a jealous murderer or an erotomanic stalker, and the personnel officer has an employee who is convinced his fellow workers are persecuting him, etc. How can we draw all this scattered material together and add it to the psychiatric literature to make a whole cloth? The answer is largely by consciousness raising and education. Kendler, an authority in this field, has said, ‘The paranoid disorders may be the third great group of functional psychoses, along with affective disorder and schizophrenia’. If he is correct, it is imperative that we hone our diagnostic and treatment skills in order to improve the help we might offer to delusional disorder sufferers and to facilitate research which is so badly needed.
Diagnosis, classification, and differential diagnosis of the mood disorders
Authors: Parker Gordon
Published: January 2013

Varying expressions of mood disorders make for difficulties in definition, diagnosis, and classification. DSMIV and ICD10 formal classifications with decision rules (see Chapter 1.9) provide a structure but their underlying models may or may not be valid. This chapter therefore considers how mood disorders can be variably conceptualized and structured—an issue of intrinsic importance but also influencing identification of causes and management. Some definitional and boundary issues are first detailed prior to considering sub-typing and differential diagnostic issues.
Recovered memories and false memories
Authors: Brewin Chris R.
Published: January 2013

Clinicians working with survivors of traumatic experiences have frequently noted the existence of memory loss with no obvious physical cause and the recovery of additional memories during clinical sessions. Indeed, amnesia is described in diagnostic manuals as a feature of post-traumatic stress disorder, although its presence is not necessary for this diagnosis. In the majority of these cases, people forget details of the traumatic event or events, or forget how they reacted at the time, although they remember that the event happened. They typically report that they have endeavoured not to think about the event, but have never forgotten that it occurred. Controversy is centred on memories of traumatic events, particularly concerning child abuse, that appear to be recovered after a long period of time in which there was complete forgetting that they had ever happened. It has sometimes been suggested that many, if not all, of these apparent recovered memories are the product of inappropriate therapeutic suggestion. This argument has been promulgated in particular by the False Memory Syndrome Foundation in the United States, by its counterpart, the British False Memory Society, and by their scientific advisors.
Obsessive–compulsive disorder
Authors: Zohar Joseph , Fostick Leah , Juven-Wetzler Elizabeth
Published: January 2013

The efficacy of the SRIs for OCD, together with the lack of efficacy of adrenergic antidepressants, has suggested that serotonin is involved in the pathophysiology of OCD. This relationship was validated by research on serotonergic markers in OCD and by the challenge paradigm. Which type of serotonergic receptor is involved in the pathogenesis and/or the mechanism of action of anti-obsessional drugs, is still unclear. However, the possible role of 5HT1B has emerged. Further studies are crucial for elucidating the role of serotonin and other neurotransmitters (i.e. dopamine) in the pathophysiology and management of OCD.
Depersonalization disorder
Authors: Medford Nick , Sierra Mauricio , David Anthony S.
Published: January 2013

Depersonalization, a term coined by Dugas in 1898, is defined in DSM-IV as ‘an alteration in the experience of self so that one feels detached from and as if one is an outside observer of one's outside mental processes or body’. Brief, self-limiting experiences of depersonalization commonly occur in healthy people in the context of fatigue, intense stress, or during/after intoxication with alcohol or illicit drugs. However, some people experience chronic depersonalization of a disturbing intensity, causing significant distress and impacting on quality-of-life and daily functioning. This may occur as a primary depersonalization disorder (DPD), or in the context of other psychiatric or neurological conditions. In this chapter, we consider the primary disorder, although some sections are also relevant to secondary depersonalization. The depersonalization experience is one of feeling strangely altered and unreal, in a way that sufferers often find very hard to convey. It is often accompanied by the related phenomenon of derealization, in which the person's surroundings are experienced as somehow remote and lacking immediacy and vibrancy, as if the world itself has become oddly unreal. Patients with persistent depersonalization and derealization often use the analogy of feeling as if they are on the set of a play or film, where nothing is real and they are acting out a role rather than living a real life.
Anorexia nervosa
Authors: Russell Gerald
Published: January 2013

The chapter begins by describing the two different approaches in the conceptualization of anorexia nervosa, before covering the epidemiology, aetiology, clinical features both of classical anorexia nervosa (postpubertal) and anorexia nervosa of early onset (premenarchal), classification, course, and prognosis. Treatment is covered in detail, and the chapter provides both a review of the evidence and advice on management. The chapter ends with a discussion of ethical and medico-legal issues and prevention.
Gender identity disorder in adults
Authors: Green Richard
Published: January 2013

The behavioural phenomenon of transsexualism (now gender identity disorder) is ancient. It has been recorded for centuries and in a broad range of cultures. The historic behavioural picture is comparable to that seen clinically. After a brief historical overview, this chapter covers epidemiology, diagnosis, origins, hormonal effects, treatment, surgery, sex reassignment outcome, family management, those with a transgendered identity, popularly known as ‘the third sex’, transsexual patient subgroups, gender identity as a disorder, and finally legal issues.
Diagnosis and classification of personality disorders
Authors: Reich James , de Girolamo Giovanni
Published: January 2013

There has been considerable interest in the study of personality and personality disorder (PD) since early times and in many different cultures. This chapter covers definitions of personality disorders, ICD and DSM classifications of personality disorders, similarities and differences between ICD-10 and DSM-IV, recent changes in the conceptualization of DSM personality disorders, categorical versus dimensional styles of classification, and assessment methods for personality disorders.
Epidemiology of personality disorders
Authors: Guzzetta Francesca , de Girolamo Giovanni
Published: January 2013

tbegun to be scientifically investigated. This development has taken place because a number of standardized instruments to assess personality and PD in an empirical fashion have been developed, in parallel with the refinement of a valid and reliable diagnostic system based on a categorical approach. The need for the epidemiological investigation of PDs seems justified for several reasons. 1 As seen in recent epidemiological surveys, PDs are frequent and have been found in different countries and sociocultural settings. 2 PDs can seriously impair the life of the affected individual and can be highly disruptive to societies, communities, and families. 3 Personality status is often a major predictive variable in determining the outcome of Axis I mental disorders and the response to treatment. In this chapter, we review the epidemiological literature on PDs up to October 2007, focusing on studies carried out since the development of the DSM-III. First, community prevalence studies of PDs are reviewed. We then look at the prevalence of individual PDs in the community. Finally, we consider the prevalence of PDs in clinical populations, and in special settings (e.g. primary care, prisons, etc.).
Psychotherapy for personality disorder
Authors: Bateman Anthony W. , Fonagy Peter
Published: January 2013

Psychotherapy has historically been the mainstay of treatment for personality disorder (PD). It remains so. Psychoanalysis was probably the earliest formal treatment for PD, which led to the first clinical descriptions of borderline personality disorder. A parallel but linked development was the application of psychoanalytic ideas in therapeutic communities which have been in existence for over 60 years and remain a treatment context and method for patients with PD. It was only in the 1960s that modified psychotherapeutic treatments were developed. Initially these were based on psychodynamic understanding of PD, but gradually other theoretically and practically driven models have developed, leading to the current situation in which there are behavioural, cognitive, dynamic, and supportive treatments offered in a range of contexts. Some of these methods have more empirical support than others. These methods will be described in this chapter. Psychological therapies for personality disorders take place against the background of the natural course and outcome of the disorder. Until recently, the natural history of personality disorder had not been systematically studied. Several major cohort follow-along studies have yielded surprising data concerning the rate of symptomatic remissions in a disorder that was assumed to have a lifelong course. For example, over a 10-year follow-along period, 88 per cent of those initially diagnosed with borderline personality disorder appeared to remit in the sense of no longer meeting DIB-R or DSM-III criteria for BPD for 2 years. The symptoms that remit most readily, irrespective of treatment, appear to be the acute ones, such as parasuicide and self-injury, which are the most likely to trigger psychotherapeutic intervention. Temperamental symptoms, such as angry feelings and acts, distrust and suspicion, abandonment concerns, and emotional instability, appear to resolve far more slowly. In the Collaborative Longitudinal Personality Disorder Study (CLPS), when remission was defined as 12 months at two or fewer criteria for PDs, over half of BPD and 85 per cent of major depressive disorder (MDD) patients were reported to remit over a 4-year period. Psychosocial functioning recovered far more slowly than acute symptoms. There is a considerable body of literature on psychotherapeutic interventions for personality disorders, but significant evidence for effective treatment remains sparse. Much of the literature is dominated by expert opinion, which is not invariably the most helpful guide. In this chapter, we focus on psychological treatments where at least some evidence for treatment effectiveness exists. The evidence is strongest for borderline personality disorder (BPD). Treatment of some other personality disorders, for example schizoid, narcissistic, obsessive–compulsive, dependent, is evidenced mainly by clinical case reports in which theory is combined with clinical description and where, if outcome is measured at all, it is measured for the purpose of illustration and has little probative value.
Excessive sleepiness
Authors: Billiard Michel
Published: January 2013

Excessive sleepiness is not an homogeneous concept. It can manifest itself as bouts of sleepiness, irresistible and refreshing sleep episodes, abnormal lengthening of night sleep with a major difficulty waking up in the morning or at the end of a nap or even periods of a week or so of almost continuous sleep recurring at several months’ intervals. According to the recent second edition of the International Classification of Sleep Disorders (ICSD-2), disorders of excessive sleepiness are distributed within three chapters: sleep-related breathing disorders, hypersomnias of central origin not due to a circadian rhythm sleep disorder, sleep-related breathing disorders, or other cause of disturbed nocturnal sleep, and circadian rhythm sleep disorders. However in this volume aimed at psychiatrists, the presentation of disorders of excessive sleepiness will obey another logic. Following “Generalities” including epidemiology, morbidity, clinical work-up, and laboratory tests, the various aetiologies will be presented according to the following six subchapters: ♦ Hypersomnia not due to substance or known physiological condition (non-organic hypersomnia or psychiatric hypersomnia) ♦ Hypersomnia due to drug or substance ♦ Behaviourally induced insufficient sleep syndrome ♦ Hypersomnia in the context of sleep-related breathing disorders ♦ Hypersomnias of central origin ♦ And the special case of delayed sleep phase syndrome.
Deliberate self-harm: epidemiology and risk factors
Authors: Arensman Ella , Kerkhof Ad J. F. M.
Published: January 2013

Deliberate self-harm is a major problem in many contemporary societies. DSH seems to reflect the degree of powerlessness and hopelessness of young people with low education, low income, unemployment, and difficulties in coping with life stress. As such, non-fatal suicidal behaviour should be a major concern for politicians. There are substantial differences between communities in the prevalence of deliberate self-harm. This suggests that some communities better meet the needs of their underprivileged youngsters than others do, but we barely understand the differences between communities and nations. Preventive action therefore is difficult to design. There is a need for a better nationwide continuous registration of DSH and related socio-economic conditions. There is also a need for better mental health care management of DSH patients, and for experimental studies on the prevention of repetition. Although we know that persons who engage in DSH are at high risk for future fatal and non-fatal suicidal behaviour, development of effective intervention, and prevention programmes is a key priority.
Somatoform disorders and functional symptoms
Authors: Mayou Richard
Published: January 2013

Non-specific symptoms that are not explained by organic pathology are extremely frequent in the general population and in all medical settings. Most are transient, but a substantial minority is persistent, disabling, and often associated with frequent consultation. They are likely, especially when there are multiple unexplained sym-ptoms, to be associated with psychiatric disorder (see Chapter 5.2.3). They are widely regarded as difficult to treat but only a very small proportion is seen by psychiatrists and psychologists. This chapter covers general issues relating to functional symptoms and syndromes and their psychiatric associations. The following chapters provide more detail about the more specific forms of somatoform disorder and about functional syndromes (pain, chronic fatigue).
Somatization disorder and related disorders
Authors: Fink Per
Published: January 2013

The essential feature of somatization disorder and related disorders is that the patient presents multiple, medically unexplained symptoms or functional somatic symptoms. These physical complaints are not consistent with the clinical picture of known, verifiable, conventionally defined diseases, and are unsupported by clinical or paraclinical findings. The phenomenon of medically unexplained symptoms cannot simply be classified into one or a few diagnostic categories, but must be regarded as an expression of a basic mechanism by which people may respond to stressors as in the cases of depression and anxiety. Somatization disorder and related disorders must thus be considered to possess a spectrum of severity. In this chapter, the focus will be on the chronic and multisymptomatic forms.
Pain disorder
Authors: Benjamin Sidney , Morris Stella
Published: January 2013

Persistent somatoform pain disorder is an ICD-10 diagnosis, which is included in the group of somatoform disorders. The term pain disorder is used in DSM-IV, and for convenience that is the term used here to refer to both classifications, unless a distinction needs to be made. This chapter aims to clarify the relationship of pain to mental disorders, the diagnosis of pain disorder and its differential diagnosis, and then considers how psychosocial factors contribute to pain, the treatments that stem from them, and the psychiatrist's potential contribution. Pain has been defined by the International Association for the Study of Pain (IASP) as ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage’. ‘Pain’ is used here in this sense; it is not used primarily to indicate mental distress or anguish. As a perception, pain is essentially a subjective experience, and is directly accessible only to the patient. By contrast, tissue damage can be assessed by others, and its relationship with the subjective characteristics of pain have been shown to be variable, modulated by social and cultural experience, as well as within the central and peripheral nervous system.
Body dysmorphic disorder
Authors: Phillips Katharine A.
Published: January 2013

Body dysmorphic disorder (BDD), also known as dysmorphophobia, is a relatively common, severe, and sometimes difficult-to-treat condition that has been described for more than a century. BDD consists of a distressing or impairing preoccupation with an imagined or slight defect in one's physical appearance. BDD is classified as a separate disorder in DSM-IV and a type of hypochondriasis in ICD-10. This disorder can cause severe distress and notably impaired functioning. In addition, risk behaviours—suicidality, violence, problematic substance use, and compulsive tanning—appear common in BDD. Despite its severity, BDD is underrecognized in clinical settings.
Neurasthenia
Authors: Mak Felice Lieh
Published: January 2013

The term neurasthenia has had a variegated history, and although retained as a diagnostic entity in the ICD-10 it does not appear in the DSM-IV. In cultures where neurasthenia still enjoys popular professional and lay acceptance it has a variety of usages: ♦ a nosological entity ♦ an idiom for expressing distress ♦ a culturally sanctioned illness behaviour ♦ an explanatory model for a constellation of somatic symptoms ♦ an euphemism for avoiding the stigma of mental disorder. Therefore, in diagnosing, understanding, and managing neurasthenia the clinician has to be aware of the context in which the term is used.
Psychiatric aspects of surgery (including transplantation)
Authors: Hales S. A. , Abbey S. E. , Rodin G. M.
Published: January 2013

Attention to psychiatric disturbances and to emotional distress is important in the surgical setting, from the time of the initial diagnostic assessment, to the perioperative period and the phase of subsequent recovery and rehabilitation. Psychiatric illness and psychological factors, which are not taken into account prior to surgery, may contribute to inaccurate diagnoses, unrealistic assessment of the surgical risk, unnecessary surgery, and complications that could have been avoided or minimized. This chapter will address these factors and provide an approach to the consideration of psychiatric factors and interventions in this setting.
Obstetric and gynaecological conditions associated with psychiatric disorder
Authors: Brockington Ian
Published: January 2013

This chapter covers the psychiatry of menstruation, various manifestations of the desire for children (such as surrogate pregnancy and pseudocyesis), pregnancy and mental health, the psychopathology of parturition, infant loss, postpartum psychiatric disorders, the mother–infant relationship and infanticide.
Management of psychiatric disorders in medically ill patients, including emergencies
Authors: Furlan Pier Maria , Ostacoli Luca
Published: January 2013

The coexistence of psychiatric disorders in patients with medical illnesses may influence both the diagnosis and the course of the illness by their effects on pathophysiological, diagnostic, and therapeutic processes. There may also be effects on patients’ collaboration with treatment and on their relationships with health care staff. Several factors change the management of, medical illnesses and psychiatric disorders, and their inter-relation ♦ increased life-expectancy and increasing survival of people with-severe illness alter the risk of other medical and psychiatric disorders; ♦ social changes affecting family structure can affect care giving. Other social factors include changes in the role of women (work, delayed maternity); increased immigration with consequent cultural diversity including different concepts of medical and psychiatric disorders (see Chapter 1.3.2); ♦ increased use of medication in medical and in psychiatric treatment, and changes in the organization of health care and social assistance from hospital-based to community-based. This chapter describes how to recognize, treat and manage psychiatric disorders in medical illnesses.
The organization of psychiatric services for general hospital departments
Authors: Huyse Frits J. , Kathol Roger G. , Söllner Wolfgang , Wulsin Lawson
Published: January 2013

The organization of psychiatric services for general hospital departments might change in far-reaching ways in the coming decades. Whereas the focus was primarily on reactive services for inpatients on medical and surgical wards, the future should focus on more proactive integrated service delivery for the complex medically ill. The essential difference from other psychiatric services is that the population served is taken care of by medical specialists in the general health setting. Consequently services are delivered in the context of the medical-psychiatric interface. Consult requests are always formulated in this perspective: the patient is treated for a medical illness or physical complaints and there are signs of an interfering psychiatric disorder. Nowadays these patients are referred to as the ‘complex medically ill’. Therefore triage and treatment integrated in the medical context is the area of expertise of consultation-liaison (CL) psychiatrists. The development of this area of psychiatry has been hampered by dysfunctional splits in health care, such as between general and mental health care, both on the level of its organization as well as its reimbursement. Recent reports, such as the report of the joint working group of the United Kingdom Royal College of Physicians and the Royal College of Psychiatrists, which describe the psychological needs of the medically and surgically ill, provide guidance to counteract these dysfunctional splits. As the delivery of care-trajectories for comorbid patients becomes more and more an issue on the health care agenda, CL psychiatrists should seize this opportunity and become advocates for integrated service delivery for the complex medically ill.
Phototherapy
Authors: Cowen Philip J.
Published: January 2013

Phototherapy or artificial bright-light treatment, has been used in the management of a number of medical disorders including psoriasis and hyperbilirubinaemia of the newborn. From the point of view of psychiatric treatment, the notion that light might help people with certain psychological symptoms has an ancient lineage. For example, Wehr and Rosenthal cite Aretaeus who suggested in the second century ad that ‘lethargics are to be laid in the light and exposed to the rays of the sun (for the disease is gloom)’. In 1898, a ship's physician named Frederick Cook recorded that the ‘languor’ which affected members of an Antarctic expedition during the winter darkness could be relieved with bright artificial light. The first systematic study of phototherapy as a psychiatric treatment was carried out in 1984 by Rosenthal et al. who used bright artificial light to treat patients with the newly identified syndrome of seasonal affective disorder. Seasonal affective disorder is a recurrent mood disorder in which patients experience regular episodes of depression in autumn and winter with remission in spring and summer. Since then phototherapy has become the mainstay of the treatment of seasonal affective disorder, particularly in patients with atypical depressive features such as hyperphagia and hypersomnia. Phototherapy has also been used as an investigational treatment in other psychiatric disorders but the evidence for its efficacy in these conditions less established.
Cognitive behaviour therapy for depressive disorders
Authors: Fennell Melanie J. V.
Published: January 2013

This chapter describes A.T. Beck's cognitive behaviour therapy (CBT) for depression. Beck's is probably the most fully developed, comprehensively evaluated, and widely disseminated cognitive behavioural approach to depression. Additionally, CBT is an effective treatment for a range of acute psychiatric disorders, shows promise for severe mental illness and personality disorder, and is thus helpful not only with primary depression, but also with a range of comorbid conditions.
Cognitive behaviour therapy for schizophrenia
Authors: Birchwood Max , Spencer Elizabeth
Published: January 2013

Cognitive behaviour therapy (CBT) for schizophrenia focuses on the core psychotic symptoms of hallucinations and delusions. Other psychosocial approaches to psychosis (e.g. intervention with families and to promote medication compliance) also frequently use CBT techniques. In this chapter, however, we focus on CBT for delusional beliefs and other psychotic phenomena and review evidence for its efficacy.
Group methods in adult psychiatry
Authors: Schlapobersky John , Pines Malcolm
Published: January 2013

After a century of development, group therapy is today one of the most widely practised treatment methods in psychiatry with an extensive literature. There are three principles common to its wide range of applications. First, the therapist calls the ‘community’ into the consulting room where, together with the therapist, it becomes the therapeutic agent. Second, the therapist assembles a group of people who can contribute to a commonly held resource from which its members can each derive benefits. And third, the therapist does nothing for them in the context of the group, that they can do for themselves, and one another. This chapter starts by providing a conceptual framework that differentiates methods, models, and applications for the practice of group therapy in adult psychiatry. After classification of the different methods and applications we discuss the main theoretical models; explore the dynamic life of therapy groups; consider some of the key clinical issues facing practitioners; their applications to a range of patient populations and settings; their evaluation and justification and their historical evolution this century. In the conclusion we consider the planning of group services and the training of their practitioners. This revision of the chapter has brought it up-to-date with the contemporary literature in a field that has seen a great deal of innovation since the original 2000 edition. The developing evidence base for group psychotherapy is ‘Guardedly optimistic. The literature has become stronger and deeper and is capable of supporting evidence-based treatment recommendations for some patient populations.’ The evidence base for the effectiveness of group psychotherapy has been growing with the field. Some 700 studies, spanning the past three decades, have shown that the group format consistently produced positive effects with diverse disorders and treatment models. These show that both individual and group psychotherapy will effect much the same set of results. For group therapy to be effective it has to utilize those therapeutic factors originally laid out by Foulkes and later by Yalom—the group has to be the primary focus of therapy; patients need to be well selected; and therapists need to be adequately trained. The chapter will address these questions of focus, selection, and training. Although the two authors of this chapter are both group analysts, we have set out to provide a full account of the wide range of group work practice. The United Kingdom is our own working location which lends emphasis to the chapter but it is compiled with sources and references that address the international field and it gives attention to current literature in many countries including North and South America and Continental Europe.
Psychiatry in primary care
Authors: Goldberg David , Tylee André , Walters Paul
Published: January 2013

At one time, it was asserted that the ‘worried well’ were treated in primary care, while true mental illnesses were seen by the mental illness services. This was not true when it was asserted, and is even less true now. The great majority of patients with common mental disorders are cared for within primary care, and many of those with severe mental illnesses are only seen in primary care. ‘Stepped care’ is a model for distributing clinical problems between the services, and ‘shared care’ refers to the care of patients seen by both primary care and specialist mental health services. Many other workers in primary care now assist GPs with the treatment of mental disorders, and special administrative arrangements within primary care are necessary to ensure that clinical services are available to those with special needs. In summary, mental disorders in primary care: ♦ Are an important public health problem ♦ Frequently present with somatic symptoms ♦ Are more likely to be detected if the doctor has better communication skills ♦ Those with disabling physical illnesses are also at greater risk ♦ Are on average less severe than those seen in specialist care
The role of the voluntary sector
Authors: Pinfold Vanessa , Teasdale Mary
Published: January 2013

The voluntary sector is a dynamic and vital part of any mental health system. Rooted in the experiences of mental health service users and carers, voluntary sector organizations across the world ensure that the voices of ‘experts by experience’ directly influence campaigns, policy debates, service redesign, and project planning and treatment guidelines. The sector is, however, fragile and in some countries organizations are increasingly dependent on state funding which could undermine their autonomy and independence. Psychiatrists can support their local voluntary organizations by joining them—as members, as campaigners, and as educators. The sector can also support psychiatrists, helping to transform the public image of psychiatry and encouraging young people to take an interest in mental health as a career option. The alliances forged with psychiatrists and their representative bodies are crucial for improving the quality of mental health services and to effectively tackle stigma and discrimination. We do need each other in order to deliver better outcomes for mental health service users and their families.
Mental health services for ethnic minorities
Authors: Craig Tom K. J. , Bhugra Dinesh
Published: January 2013

The diagnosis and treatment of mental ill health among multiethnic populations is probably one of the most complex and contentious challenges in psychiatric service provision. At the heart of this complexity are problems of ignorance, attitude, and failures of communication on all sides. It is also potentially one of the most rewarding endeavours if got right. No one service model is likely to apply to every community, even if people belong to the same ethnic group. The development of specialist psychiatric services may not always be possible or even essential. Instead, the requirements are for approaches that are flexible, sensitive, accessible, and accountable to the people they serve.
Assessment of mental disorder in older patients
Authors: Jacoby Robin
Published: January 2013

The assessment of older people is not fundamentally different from that of younger patients. The principles of taking history and mental-state examination are the same at any age. But if the goals are common, the routes taken to reach them are not necessarily so. For example, an assessment adequate enough to begin treatment of a 30-year-old woman presenting to an outpatient clinic with a depressive illness might take about an hour and involve speaking only to the patient and perhaps briefly to her partner, whereas the equivalent assessment of an 81-year-old woman in whom uncertainty exists as to whether the diagnosis is that of a depressive or a dementing illness may require more than one interview and necessitate enquiry from several informants. This section will not repeat what can be found in Chapter 1.8.1, but cover only those points which are specific to or need to be emphasized for older patients.
Suicide and deliberate self-harm in elderly people
Authors: Jacoby Robin
Published: January 2013

Although in some countries suicide rates in young males have risen dramatically in the last decade or so, suicide in old age is important because rates in older people, especially those over 74, are still proportionately higher in most countries of the world where reasonably reliable statistics can be obtained. For example, in 2004 in Lithuania where suicide incidence is currently the highest, the overall rate in males per 100 000 total population was 70.1, but in men over 74 the rate was 80.2. In the United States, where suicide is neither especially common nor rare, in 2002 the overall rate for males per 100 000 total population was 17.9, but 40.7 in men over 74. Rates for older women are nearly always much lower than for their male counterparts. A second reason for the importance of suicide in old age is that the proportion of older people in the population is rising worldwide. Indeed, the increase in developing countries is likely to be even greater than in developed countries. Although rates vary from year to year and birth cohort to cohort, it is highly likely that unless suicide prevention becomes a great deal more effective than at present, more and more older people will kill themselves in the coming years. As with younger people, completed suicide in old age may be seen as part of a continuum from suicidal thinking through deliberate self-harm (which does not lead to death), to completed suicide. An added component within this continuum for older people is that of ‘indirect self-destructive behaviour’, such as refusal to eat and drink or ‘turning one's face to the wall’ which is clearly intended to hasten death. Finally, although this section does not deal with euthanasia and related issues, assisted suicide in people with terminal illness such Alzheimer's disease and cancer may also be seen as part of the suicide continuum.
The planning and organization of services for older adults
Authors: Melding Pamela S.
Published: January 2013

Worldwide, population ageing is driving the development of mental health services for older adults. Finite resources, burgeoning costs, expanding therapeutic repertoires, and increasing consumer interest in involvement in health care is challenging health organizations to develop effective, efficient, and economic patient- centred services for older adults. Fundamentally, the quality of services is dependent on health personnel working with their patients and other providers, towards shared aims of improving health outcomes and quality of life. Clinicians’ adaptability, flexibility, responsiveness, availability for patients, and willingness to collaborate are the keys to success in developing future services for older adults.
Conduct disorders in childhood and adolescence
Authors: Scott Stephen
Published: January 2013

The term conduct disorder refers to a persistent pattern of antisocial behaviour in which the individual repeatedly breaks social rules and carries out aggressive acts which upset other people. It is the commonest psychiatric disorder of childhood across the world, and the commonest reason for referral to child and adolescent mental health services in Western countries. Antisocial behaviour has the highest continuity into adulthood of all measured human traits except intelligence. A high proportion of children and adolescents with conduct disorder grow up to be antisocial adults with impoverished and destructive lifestyles; a significant minority will develop antisocial personality disorder (psychopathy). The disorder in adolescence is becoming more frequent in Western countries and places a large personal and economic burden on individuals and society.
Suicide and attempted suicide in children and adolescents
Authors: Shaffer David , Pfeffer Cynthia R. , Gutstein Jennifer
Published: January 2013

Suicidal behaviour is a matter of great concern for clinicians who deal with the mental health problems of children and adolescents. The incidence of suicide attempts reaches a peak during the midadolescent years, and mortality from suicide, which increases steadily through the teens, is, in many countries, one of the leading causes of death at that age. This chapter starts with a historical review, and covers clinical features, assessment, classification of associated diagnoses, epidemiology, aetiology, course and prognosis, emergency treatment, and possibilities for prevention.