bluuebunny/crossref_metadata_2025 huggingface dataset:
Anemia
Authors: Devata Sumana
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and management of anemia in hospitalized patients.
Eosinophilia
Authors: Devata Sumana
Published: January 2019

This chapter guides the reader on the diagnosis and management of eosinophilia in hospitalized patients.
Lymphadenopathy
Authors: Devata Sumana
Published: January 2019

This chapter guides the reader on the diagnosis and management of lymphadenopathy in hospitalized patients.
Lymphoma
Authors: Bixby Dale
Published: January 2019

This chapter guides the reader on the diagnosis and management of lymphoma in hospitalized patients.
Plasma Cell Dyscrasias
Authors: Bixby Dale
Published: January 2019

This chapter guides the reader on the diagnosis and management of plasma cell dyscrasias in hospitalized patients.
Systemic Autoimmune Diseases
Authors: Marks Rory M.
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and evaluation of systemic autoimmune disease in hospitalized patients.
Diabetic Ketoacidosis
Authors: Choksi Palak , Lash Robert W.
Published: January 2019

This chapter guides the reader on the diagnosis and management of diabetic ketoacidosis in hospitalized patients.
Adrenal Insufficiency
Authors: Choksi Palak , Lash Robert W.
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and management of adrenal insufficiency in hospitalized patients.
Altered Mental Status
Authors: Burke James
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and management of altered mental status in hospitalized patients.
Peripheral Neuropathy
Authors: Burke James
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and management of peripheral neuropathy in hospitalized patients.
Hiccoughs
Authors: Burke James
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and management of hiccoughs in hospitalized patients.
Stroke
Authors: Burke James
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and management of stroke in hospitalized patients.
Spinal Cord Compression
Authors: Burke James
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and management of spinal cord compression in hospitalized patients.
Exanthems
Authors: Do Thy Thy
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and management of exanthems in hospitalized patients.
Pruritus
Authors: Do Thy Thy
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and management of pruritus in hospitalized patients.
Toxicologic Emergencies
Authors: Shewakramani Sanjay
Published: January 2019

This chapter guides the reader on the approaches and considerations in managing toxicologic emergencies in hospitalized patients.
Perioperative Cardiovascular Risk Reduction in Noncardiac Surgery
Authors: Grant Paul J.
Published: January 2019

This chapter guides the reader on preoperative cardiovascular risk reduction for noncardiac surgery in hospitalized patients.
Perioperative Medication Management
Authors: Grant Paul J.
Published: January 2019

This chapter guides the reader on the approaches and considerations for perioperative medication management in hospitalized patients.
Overview of the Immune System
Authors: Pavón Lenin , Alvarez-Herrera Samantha , Bauer Moises E.
Published: January 2019

This chapter presents an overview of the immune system, presenting its organization, major cellular and molecular components, as well as functional responses. The main objective of this chapter is to provide the reader the basic information necessary to understand the immunological terms in the following chapters. More in-depth information can be found in several excellent basic immunology books. In addition to the well-known roles in generating immunity against infections, cells of the immune system are also involved in regulating non-immune physiological processes, including tissue remodeling and brain functions. The generation of sterile inflammation and the role of T-lymphocyte subsets are important hallmarks discussed here.
Immunoneuropharmacology
Authors: Silveira Vivian Thaise da , Candelario-Jalil Eduardo , Oliveira Antonio Carlos Pinheiro de
Published: January 2019

This chapter presents an overview of the current literature on the pathophysiological mechanisms of inflammatory mediators in neuroimmune modulation, as well as pharmacological strategies in inflammatory signaling pathways in the central nervous system (CNS). Increasing attention has been paid to the importance of brain–immune interaction for the maintenance of brain homeostasis. If immune activation persists, inflammatory mediators and their signaling pathways can influence neurons/neuronal circuits, leading to mood, cognitive, and behavioral impairment. Therefore, immune dysregulation can play a role in the pathophysiology of psychiatric disorders through its direct and indirect ability to alter the synthesis, reuptake, and release of multiple neurotransmitters, and to induce oxidative stress, mitochondrial dysfunction, cytoskeletal disruption, and cytotoxic lipid peroxidation, among other effects. In this sense, inflammatory mediators and their signaling pathway are currently regarded as attractive targets for promising therapeutic and preventative therapeutic strategies in clinical psychiatry, especially for patients who are resistant to treatment and exhibit inflammatory phenotypes. The efficacy and precision of anti-inflammatory treatments can be further tuned, and they depend on the methodologically rigorous design of future clinical trials.
Immunology of Substance Use Disorders
Authors: Salem Haitham , Lane Scott D. , Teixeira Antonio L.
Published: January 2019

As in other psychiatric disorders, the role of the immune system is gathering increasing attention as an important mechanism in substance use disorders. Addiction is a complex condition in which a person engages in drug-seeking and drug-taking behaviors to accentuate the reward processes in the brain and avoid negative withdrawal states. Due in part to the activation of stress responses during drug withdrawal, high levels of peripheral pro-inflammatory cytokines are observed in this phase, and these immune changes might contribute to the behavioral negative reinforcing effects of the drug. This and other observations suggest that the immune system might play a role in the development of substance use disorders, also representing a potential target for biomarker and therapeutic strategy development (e.g., vaccines).
Immune System Dysregulation and Schizophrenia
Authors: Stertz Laura , Walss-Bass Consuelo
Published: January 2019

Schizophrenia is a common disease with a lifetime prevalence of 1% and a complex etiopathogenesis, probably involving multiple and heterogeneous genetic and environmental factors. Stress and immune system reactivity are implicated in both the pathogenesis and exacerbation of psychotic symptoms in schizophrenia. Exposure to environmental stressors in genetically susceptible individuals may alter brain processes and potentially have long-term consequences leading to the onset of schizophrenia. Here we discuss the role that genetic architecture, in combination with environmental stimuli, plays in immune system regulation and the development of schizophrenia, and review recent and accumulating evidence of associations between immune system genes with schizophrenia.
Immunology of Post-Traumatic Stress Disorder (PTSD)
Authors: Wieck Andrea , Barbosa Izabela G. , Teixeira Antonio L. , Bauer Moises E.
Published: January 2019

Following exposure to a severe traumatic event, such as warfare, sexual assault, or traffic accidents, a person may develop post-traumatic stress disorder (PTSD). This psychiatric disorder is characterized by constant re-experiencing of the traumatic event, with disturbing thoughts, feelings, or dreams related to the events, as well as irritability and exaggerated stressor reactivity. The increase of “fight-or-flight” responses leads to chronic dysregulation of stress-responsive mechanisms, including hypothalamic-pituitary-adrenal (HPA) and sympathetic axis activation, as well as immune imbalance. PTSD has been associated with alterations in regulatory mechanisms of the HPA axis, low cortisol levels, a low-grade inflammatory profile, and activated immune cells. These systemic changes further increase the risk for inflammatory diseases. The underlying mechanisms of these abnormalities are not completely known, but they include alterations in cellular sensitivity to glucocorticoids and epigenetic changes. The current chapter summarizes the main neuro-immuno-endocrine alterations observed in PTSD.
Immunology of Eating Disorders
Authors: Ferreira Adaliene Versiani Matos , Martins Laís Bhering , Monteze Nayara Mussi , Marcelin Geneviève , Clément Karine
Published: January 2019

Eating disorders (EDs) are characterized by dysregulation in eating behavior leading to extreme increase or decrease in food intake that, in turn, changes body weight, adiposity, and physical health. Anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) are the three major eating disorders. Peculiar immune abnormalities occur in these conditions. Previous studies have reported a higher number of CD4+ T lymphocytes in patients with AN, which are related to a relative resistance to viral infections, even in the presence of leukopenia. It has also been proposed that a cluster of cytokines is altered in these patients. A chronic low-grade inflammation has been observed in obese people with BED and in patients with AN, but with a different profile in each condition. In this context, antagonist drugs of specific cytokines, such as anti-TNF, showed improvement of AN-related symptoms, but increased weight gain in obese subjects. The identification of specific molecules and/or immune cells that impair neuronal circuits implicated in eating behaviors may contribute to the development of pharmacological strategies for eating disorders.
Off-pump versus on-pump coronary artery bypass grafting
Authors: Halkos Michael E. , Moss Emmanuel , Puskas John D.
Published: January 2019

Although an abundance of literature comparing on-pump (ONCAB) versus off-pump (OPCAB) coronary artery bypass grafting exists, the optimal surgical strategy remains controversial. While many centers have adopted off-pump techniques, OPCAB surgery remains in the minority of coronary artery bypass grafting procedures performed in the United States. Proponents of ONCAB cite the lack of convincing data in randomized trials demonstrating a benefit for OPCAB, while also citing large observational and registry data that suggest an associated reduction of in-hospital mortality and morbidity with OPCAB. Even more controversial are the reports of graft patency, completeness of revascularization, and the need for repeat revascularization. The advantages and limitations of off-pump surgery, along with its technical considerations, are discussed in detail in this chapter.
Current status of minimally invasive, robotic and hybrid coronary artery bypass surgery
Authors: Mick Stephanie , Keshavamurthy Suresh , Bonatti Johannes
Published: January 2019

While coronary artery bypass graft (CABG) remains the gold standard in the treatment of multivessel coronary artery disease, it remains quite invasive. Techniques and evolving technologies of minimally invasive (including hybrid and robotic) approaches to coronary revascularization are reviewed in this chapter with a summary of the available supporting literature. Minimally invasive direct coronary bypass (MIDCAB) surgery uses an anterior, medially placed, mini-thoracotomy incision for both direct-vision left internal mammary (LIMA) harvest and creation of an anastomosis of the LIMA to a coronary artery in off-pump fashion. As in standard CABG, all patients should undergo a complete preoperative work-up, and body mass index and body habitus are to be noted. Obesity is considered a relative contraindication for MIDCAB as it may predispose to wound infection; this concern is primarily due to tissue necrosis caused by pressure on the wound edges by the retractor during LIMA harvest.
Open and endovascular treatment options in thoracic aortic surgery
Authors: Preventza Ourania , Coselli Joseph S.
Published: January 2019

Open endovascular and hybrid repairs have recently emerged as a method for treating the different segments of the thoracic aorta. A full or upper-mini median sternotomy is the usual approach for proximal aortic disease and proximal and transverse arch repairs. Other approaches, such as minimally invasive right thoracotomy, have also emerged. Until recently, a left thoracotomy and thoracoabdominal approach has been the sole approach for treating lesions of the descending and thoracoabdominal thoracic aorta. In the 1980s, the first aortic repair with a self-fixing endoprosthesis was performed. In subsequent years, the technique of using a stent graft to treat an abdominal aortic aneurysm, and subsequently thoracic aortic aneurysm, was popularized, followed by extensive development of this technology. The different techniques and modalities for treatment are discussed in this chapter.
Mitral valve repair: Conventional open techniques
Authors: Gillinov A. Marc , Mihaljevic Tomislav
Published: January 2019

Mitral valve repair is the preferred surgical option for nearly all patients with mitral regurgitation (MR) as its durability is widely recognized to be excellent. Advantages of mitral valve repair over mitral valve replacement include better preservation of left ventricular function, greater freedom from endocarditis and anticoagulant-related hemorrhage, and, in some cases, improved survival. Mitral valve repair has particular advantages in younger patients, who require lifelong anticoagulation if they receive mechanical prostheses. Mitral valve repair can be achieved in more than 90% of patients who have MR caused by prolapse. The forthcoming account includes an overview of the various techniques used in current practice.
Minimally invasive mitral valve repair
Authors: Rodriguez Evelio , Chitwood W. Randolph
Published: January 2019

The practice of minimally invasive surgery is becoming increasingly widespread in the current era of cardiac surgery. Minimally invasive mitral valve surgery (MIMVS) describes many different surgical techniques used in the management of mitral valve (MV) disease. Variations in surgical techniques include a combination of the type of incision, direct visualization (videoscopic or robotic visualization), cardiopulmonary perfusion techniques, and aortic occlusion (external clamping, endo-clamping, or fibrillatory arrest). In this chapter, the history and current literature related to MIMVS are reviewed in detail. In addition, we discuss both important technical aspects associated with MIMVS, as well as our approach at the Saint Thomas Heart Institute.
Mechanical circulatory support
Authors: Stansfield William E. , Koliopoulou Antigone , McKellar Stephen H. , Selzman Craig H.
Published: January 2019

The 1950s, 1960s, and 1970s saw the transition of mechanical circulatory support (MCS) from the necessary extension of cardiopulmonary bypass to the development of durable devices. Within the last 20 years, enhanced pumps as well as surgical and medical experience have allowed MCS to become a routine part of the armamentarium for treating heart failure patients. Most recently, within the last 10 years, there has been a dramatic shift from the use of large, pulsatile left ventricular assist devices (LVADs) to smaller continuous flow devices. In this chapter, the current state of MCS for treating advanced heart failure as well as the detail of the surgically related issues with LVADs are reviewed.
Current status of lung transplantation
Authors: Puri Varun , Patterson G. Alexander
Published: January 2019

Lung transplantation is well established as a viable therapy for end-stage lung disease. Appropriate patient and donor selection, meticulous attention to technique, and continued improvement in the postoperative care of these patients will lead to optimal outcomes. Donor shortage and chronic allograft rejection continue to be the biggest hurdles preventing lung transplantation from reaching its full potential. Indications, recipient selection, donor procurement, surgical techniques, and postoperative outcomes are reviewed. The major identified causes of death in the first 30 days postoperatively are graft failure and non-cytomegalovirus (CMV) infections. After the first year, bronchiolitis obliterans syndrome and non-CMV infections were the predominant causes of death. Death caused by malignancies rises consistently until the 10-year mark, accounting for 12% of all deaths between 5 and 10 years after transplant.
Cerebral Physiology
Authors: Bittner Stefan , Göbel Kerstin , Meuth Sven G.
Published: January 2019

This chapter reviews the physiology of cerebral metabolism and cerebral blood flow (CBF), the effects of anaesthetic agents on cerebral physiology, and, most importantly, their effects on the CBF and metabolism. Adequate CBF to all regions of the brain is essential as cerebral tissue is intolerant of hypoxic conditions. Anaesthetic agents cause dose-dependent and reversible effects on important physiological cerebral parameters, including intracranial pressure, CBF, and cerebral metabolic rate of oxygen consumption (as a parameter of cerebral metabolism). These changes can either be of clinical therapeutic importance or need to be taken into account during patient management to avoid unwanted side effects. In neuroanaesthesia, considerable emphasis is placed on the manner in which anaesthetics influence the CBF as a surrogate parameter of cerebral metabolism, including how modest alterations in the CBF can substantially influence neuronal outcome, and how CBF control is central to the management of intracranial pressure.
The Autonomic Nervous System
Authors: Glick David B. , Glick Gerald , Stein Erica J.
Published: January 2019

This chapter on the autonomic nervous system (ANS) covers the neural anatomy of the sympathetic (SNS), parasympathetic (PNS), and enteric (ENS) nervous systems. The activation and inactivation as well as the interaction between the SNS and PNS are examined with specific attention to the receptor and secondary messenger systems associated with the SNS and PNS. It also describes in detail the upregulation and downregulation of the SNS and PNS. It examines both adrenergic (synthesis, storage, and release of norepinephrine) and cholinergic pharmacology (acetylcholine synthesis, storage and release, and inactivation) and also discusses the genetic contributors to autonomic function and dysfunction.
Principles of Neuroprotection
Authors: Yi Sophia C. , Lemkuil Brian P. , Patel Piyush
Published: January 2019

This chapter on the principles of neuroprotection includes information on cerebral metabolism, energy failure and pathophysiologic mechanisms, oxidative stress, acidosis, cell death, and difficulties encountered in the translation of neuroprotective strategies from animals to humans. It also covers peri-operative neuroprotective strategies (including barbiturates, volatile anaesthetics, etomidate, propofol, ketamine, and xenon), physiologic management and neuroprotection (including systemic temperature, neonatal hypothermia, induced hypothermia after cardiac arrest, hypothermia and spinal cord injury, hypothermia and traumatic brain injury (TBI), hypothermia and focal ischaemic stroke, arterial oxygen tension, arterial carbon dioxide tension, glucose management, cerebral perfusion pressure, and tPA). Finally, it covers interventional procedures (including mechanical thrombectomy) to treat acute ischaemic stroke.
Neurobiology of Acute and Chronic Pain
Authors: Pichurko Adrian , Harris Richard E.
Published: January 2019

Pain is a complex phenomenon that may involve both peripheral and central neurobiological processes. Nociception is the unconscious registration of a noxious stimulus by the nervous system, while pain is a conscious experience. Neurobiological correlates of pain perception have been characterized from the initial point of tissue damage to its realization in the brain. Importantly, various pharmacological and psychological interventions exist that can target various points along this pathway. Evidence shows the nervous system remodels in response to chronic pain. More evidence-based treatments showing efficacy for chronic pain conditions are needed. Finally, an individualized and multidisciplinary approach in concordance with the biopsychosocial model of illness is often advocated. The neuroanaesthetist requires a nuanced understanding of pain, since many patients presenting for neurosurgical procedures suffer chronic pain.
Neurologic Emergencies
Authors: Martini Ross P. , Koerner Ines P.
Published: January 2019

The primary goal of the neuroanaesthetist and neurointensivist is to preserve brain structure and function, especially in the setting of neurologic insults. Neurologic emergencies can also develop peri-operatively in patients undergoing non-neurosurgical procedures, which the general anaesthetist should be prepared to manage. This chapter on neurologic emergencies discusses herniation syndromes (including pathophysiology of intracranial hypertension, symptoms of herniation, and therapies to reduce intracranial pressure and reverse herniation). It also covers coma (including differential diagnoses of postoperative coma, clinical evaluation of the comatose patient, CT imaging, advanced tests, and directed therapies). Finally, it discusses key aspects of ischaemic stroke, status epilepticus, and transition of care.
Supratentorial Craniotomy for Mass Lesion
Authors: Gruenbaum Shaun E. , Bilotta Federico
Published: January 2019

This chapter provides an introduction to the topic of supratentorial craniotomy for mass lesion. Because there are few randomized clinical trials that guide the decision-making process for these patients, a combination of applied theory and expert consensus primarily guides anaesthetic management. With this in mind, the chapter discusses epidemiology, pre-operative considerations (including history-taking, physical examination, premedication, intravascular access and monitoring), and intra-operative management (including induction, muscle relaxation, use of cranial pins, anaesthesia maintenance, and fluid balance). It also discusses possible intra-operative complications (for example, venous air embolism, acute increase in ICP). Finally, it covers various aspects of postoperative management (including emergence, extubation, pain management, and postoperative nausea and vomiting ).
The Posterior Fossa
Authors: Welch Tasha L. , Pasternak Jeffrey J.
Published: January 2019

The posterior fossa contains structures essential for life, including the brainstem. The pathophysiology of disease states affecting the posterior fossa and surgery within the posterior fossa pose several challenges distinct from those encountered during supratentorial craniotomy. This chapter discusses the unique anaesthetic implications of posterior fossa surgery. It covers anatomy, indications for surgery in the posterior fossa, (including discussion of tumours, vascular abnormalities, and structural anomalies), signs and symptoms of posterior fossa pathology, surgical approaches, and pre-operative assessment and management. It also reviews the induction of anaesthesia, maintenance of anaesthesia, patient positioning, surgical complications, and monitoring. Finally, it covers patient emergence from anaesthesia, as well as complications associated with posterior fossa surgery.
Cerebrovascular Surgery
Authors: Sharma Deepak , Wright David R.
Published: January 2019

This chapter discusses the common cerebrovascular disorders that present for surgical intervention, which include intracranial aneurysms, vascular malformations (arteriovenous malformation, dural arteriovenous fistula, cavernoma), occlusive cerebrovascular diseases (moyamoya, atherosclerotic vascular occlusion), and cranial vascular compression syndromes (trigeminal neuralgia, hemifacial spasm). It covers the critical goals of peri-operative management of cerebrovascular surgery, including maintenance of adequate cerebral perfusion, optimization of haemodynamic and ventilation parameters to avoid cerebral ischaemia and hyperaemia, creation of favourable surgical conditions, and facilitation of intra-operative neurophysiological monitoring and brain protection. Anaesthetic management of cerebrovascular surgery involves integrating the implications of intracranial as well as extracranial manifestations of the neurological pathology with the principles of anaesthetic neuropharmacology in the context of planned surgical procedure and neuromonitoring. Careful pre-operative evaluation, selection of suitable anaesthetic agents and monitors, and preparedness to deal with potential complications are the key to successful outcome of cerebrovascular surgery.
Awake Craniotomy for Tumour, Epilepsy, and Functional Neurosurgery
Authors: Venkatraghavan Lashmi , Manninen Pirjo
Published: January 2019

An awake craniotomy for tumour and epilepsy surgery allows for the mapping of eloquent brain function to minimize its injury and/or for the localization of an epileptic focus. The insertion of deep brain stimulators for the treatment of functional neurosurgical disorders is also frequently performed with an awake patient. The role of the anaesthetist is important in order to have a comfortable and cooperative patient, for the use of appropriate sedation to allow for mapping, and careful vigilance to rapidly diagnose and treat any complication. This chapter discusses the overall rationale for, and the anaesthetic management of, patients undergoing awake craniotomy for tumours, epilepsy surgery, or deep brain stimulator placement.
Basics of Neurocritical Care
Authors: Teig Magnus , Smith Martin
Published: January 2019

Neurocritical care is a subspecialty of intensive care medicine dedicated to the treatment of critically ill neurological patients. It has matured over the last decade through new knowledge, advances in imaging and monitoring techniques, and the introduction of neurointensivists and neurocritical care units. The management of acute brain injury is particularly complex and focuses on prevention of intracranial complications, optimization of systemic physiological variables to maintain cerebral perfusion and substrate delivery, and management of non-neurological complications. This chapter describes how a coordinated and stepwise approach incorporating multi-faceted management strategies guided by neuromonitoring measured physiological changes, rather than generic treatment targets, is associated with improved outcomes.
Epilepsy
Authors: Niesen Adam D. , Jacob Adam K. , Kopp Sandra L.
Published: January 2019

The general population has approximately a 3% lifetime chance of developing a persistent seizure disorder. This represents a significant number of patients presenting for anaesthetic care. Common peri-operative conditions, such as sleep deprivation, NPO status, changes in gastrointestinal absorption, stress, and fluid and electrolyte shifts can contribute to the risk of having a peri-operative seizure. In addition, changes in anti-epileptic medication administration and introduction of additional medications may alter the occurrence of seizures in the peri-operative period. Patients who experience a seizure a short time before surgery and those that have more frequent seizures at baseline are at higher risk for postoperative seizure activity. Avoidance of medications that lower the seizure threshold, maintaining the patient’s usual regimen of anti-epileptics, and replacement of oral anti-epileptic medications with intravenous formulations when appropriate are mainstays in reducing the occurrence of postoperative seizures.
Parkinson’s Disease
Authors: James M. Luke , Hoffmann Ulrike
Published: January 2019

This chapter on Parkinson’s disease discusses the epidemiology and clinical features of the disease. It also covers the pathophysiology and clinically relevant staging, as well as peri-operative considerations for the anaesthetist, including the effects of surgery and anaesthesia on various organ systems of the patient with Parkinson’s disease. The chapter also covers a range of appropriate drug treatments, including dopamine, dopamine agonists, monoamine oxidase-B inhibitors (MAO-B inhibitors), anticholinergic agents, NMDA antagonists, and catechol-O-methyl-transferase inhibitors (COMT inhibitors). Lastly, it discusses the treatment of Parkinson-associated depression, fatigue, dementia and psychosis, neuroleptic malignant syndrome (NMS), anaesthesia management, and implantation of deep brain stimulators.
Classification
Authors: Harrison Paul , Cowen Philip , Burns Tom , Fazel Mina
Published: January 2019

‘Classification’ introduces concepts of mental illness before briefly reviewing the reasons for, and criticisms of, psychiatric classification. Key issues of reliability, validity, and stigma associated with classification are covered. After an overview of the history of classifications, the organizing principles of the two current major classification systems used in psychiatry (ICD-10 and DSM-5) are then outlined: the World Health Organization’s International Classification of Diseases (‘ICD-10’), and the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (‘DSM-5’). Additional schemes, used in particular countries, are also briefly mentioned. Finally, the chapter summarizes how psychiatric classification may develop in the future, with particular reference to ICD-11, which is due in 2018 or 2019.
Assessment
Authors: Harrison Paul , Cowen Philip , Burns Tom , Fazel Mina
Published: January 2019

The psychiatric interview is at the heart of psychiatry, since it provides the cornerstone of diagnostic assessment as well as being central to establishing a therapeutic relationship. This chapter, ‘Assessment’, describes the goals, principles, and practice of psychiatric interviewing. There is a detailed review of the various components of a full psychiatric assessment (the history, mental state examination, physical examination and investigations), as well as descriptions of how the assessment process is tailored to suit different situations (e.g. in emergency departments, in primary care, or in the community). The chapter proceeds to discuss how the information collected during the assessment is recorded and communicated. The chapter ends with a description of the major standardized assessment methods and ratings scales used in psychiatry.
Ethics and civil law
Authors: Harrison Paul , Cowen Philip , Burns Tom , Fazel Mina
Published: January 2019

‘Ethics and civil law’ is concerned with the ways in which general ethical principles, relating to matters such as confidentiality, consent, and autonomy, are applied in the care of people with mental disorders. The chapter also covers the law as it applies to psychiatry in the United Kingdom. Ethical principles require extra careful attention in psychiatry because some patients lack capacity and because of the power of involuntary treatment. The ethical principles of beneficence, non-maleficence, autonomy, and dignity are outlined with their inherent potential conflicts. The Mental Health Act for the detention of patients who are unable to recognize their need for treatment is also covered, as are some aspects of civil law that relate to the practice of psychiatry.
Evidence-based approaches to psychiatry
Authors: Harrison Paul , Cowen Philip , Burns Tom , Fazel Mina
Published: January 2019

‘Evidence-based approaches to psychiatry’ describes the application of evidence-based medicine (EBM) to psychiatric practice. The chapter covers the key processes in EBM, including the formulation of a clinically relevant question, the systematic search for high-quality evidence and the meta-analytic synthesis of data. It demonstrates how evidence-based approaches to psychiatry have led to important developments showing quantitative effects of different treatments through advanced meta-analysis of data from randomized trials. This has underpinned the development of clinical guidelines that have the aim of improving the reliability and quality of treatments that patients receive. The chapter also describes how meta-analyses should be critically reviewed, as well as their problems and limitations. Not all relevant questions in psychiatric research are susceptible to the quantitative approach offered by EBM, and the chapter also outlines how qualitative methodologies can play a key role in answering important questions related, for example, to the patient experience.
Schizophrenia
Authors: Harrison Paul , Cowen Philip , Burns Tom , Fazel Mina
Published: January 2019

The chapter ‘Schizophrenia’ covers all aspects of this disorder. It first describes in detail the major and varied clinical features, before reviewing the diagnosis and classification of schizophrenia and how these have varied over time. The section on aetiology includes description of the recent major genomic advances, plus consideration of environmental and psychological factors. The neurobiology and pharmacology of schizophrenia are discussed before a summary is given of the neurodevelopmental model. Returning to clinical matters, the chapter then reviews the course and prognosis of schizophrenia before a detailed description of treatment and management. It concludes with the important issue of how schizophrenia is discussed with patients and carers.
Eating, sleep, and sexual disorders
Authors: Harrison Paul , Cowen Philip , Burns Tom , Fazel Mina
Published: January 2019

‘Eating, sleep, and sexual disorders’ covers these three areas of psychiatry, all of which are characterized by disturbances of bodily functioning. The section on eating disorders includes recent developments in how these conditions are classified, and improvements in their treatment. Disorders of sleep and circadian rhythm are increasingly recognized to be important in psychiatry beyond the involvement of sleep disturbance as a symptom, and their recognition and management are discussed at greater length than in previous editions of this book. The extent and nature of psychiatric involvement in sexuality and sexual disorders has also changed markedly in recent years, and this section has been revised accordingly; for example, with regard to how gender identity disorders are conceptualized and managed.
Dementia, delirium, and other neuropsychiatric disorders
Authors: Harrison Paul , Cowen Philip , Burns Tom , Fazel Mina
Published: January 2019

‘Dementia, delirium, and other neuropsychiatric disorders’ covers the disorders that share an ‘organic’ basis in the brain. It begins with a discussion of the concept of ‘organic’ in this context. A practical section follows, in which the clinical presentations of regional brain pathology are outlined, and the assessment of the ‘neuropsychiatric patient’ is discussed. Delirium, amnestic disorders, and dementia are then covered in turn. In each case, the causes, pathology, and epidemiology of these syndromes are discussed. Particular weight is given to the major forms of dementia, reflecting their prevalence and the recent advances in their understanding. Treatment of delirium is covered, but treatment of dementia is deferred until Chapter 19. Subsequent sections provide overviews of the other neuropsychiatric disorders, including cerebrovascular disorders, head injury, epilepsy, and intracranial lesions.
Forensic psychiatry
Authors: Harrison Paul , Cowen Philip , Burns Tom , Fazel Mina
Published: January 2019

‘Forensic psychiatry’ describes the branch of psychiatry concerned with the diagnosis and treatment of mentally disordered offenders, but also refers to all legal aspects of psychiatric practice, including the use of civil law. This chapter outlines current thinking in criminology and the causes of crime. It focuses on the association between mental disorder and crime, specific offender groups and the psychiatric aspects of specific crimes. It also explores psychiatric aspects of being a victim of crime. It covers the role of the psychiatrist in the criminal courts and the treatment of mentally disordered offenders and the management of violence in a range of health care settings. Lastly, it covers the status of risk assessment and the principles of preparing a psychiatric report for the courts.
Psychiatry of the elderly
Authors: Harrison Paul , Cowen Philip , Burns Tom , Fazel Mina
Published: January 2019

‘Psychiatry of the elderly’ covers the disorders which most affect older people. After an introduction to normal ageing and its psychological and biological correlates, the epidemiology of psychiatric disorders in the elderly is outlined. The principles and practice of psychiatry of the elderly are then described, focusing on the major disorders (other than dementia, which was covered in Chapter 14). We summarise the main features of assessments, services, and treatments, and how these differ from younger age groups. The treatment and management of dementia is an important aspect of psychiatry in the elderly, and both pharmacological and behavioural interventions are covered in detail.
The misuse of alcohol and drugs
Authors: Harrison Paul , Cowen Philip , Burns Tom , Fazel Mina
Published: January 2019

‘Misuse of alcohol and drugs’ covers the clinical and scientific aspects of substance misuse and dependence, including definitions and classifications in ICD-10 and DSM-5, as well as the important issue of comorbidity with other psychiatric disorders (‘dual diagnosis’). The first section covers alcohol use problems, ranging from epidemiology, aetiology, and public health to the identification and evidence-based management of individual patients. There follows a description of substance use problems associated with a range of other drugs, including those medically prescribed, such as opiates, benzodiazepines, and gabapentin, as well as recreational substances such as stimulants, MDMA, psychedelics, and ‘legal highs’. The clinical features of problem drug use are linked to the pharmacology and neural effects of particular substances together with descriptions of current strategies designed to lessen the harms of substance use for both the individual and society.
Psychiatry and medicine
Authors: Harrison Paul , Cowen Philip , Burns Tom , Fazel Mina
Published: January 2019

‘Psychiatry and medicine’ considers the relevance of psychiatry to the rest of medical practice. It covers the application of psychiatric knowledge and expertise in primary care and other general medical settings and also the psychiatric conditions associated with specific medical disorders. It addresses mind–body dualism and the epidemiology of psychiatric disorders in medical settings. It discusses the changing thinking around the classification and diagnosis of somatoform disorders and medically unexplained symptoms and the relationship with dissociative disorders. It outlines the nature of consultation–liaison services and deals in detail with both common comorbidities and the psychiatric aspects of medical and surgical conditions, including the organic disorders not covered in Chapter 14, and those related to women’s health.
Psychological treatments
Authors: Harrison Paul , Cowen Philip , Burns Tom , Fazel Mina
Published: January 2019

‘Psychological treatments’ is concerned with various kinds of counselling, psychotherapy, behavioural and cognitive therapies, and related techniques. Psychotherapy and psychological treatments have been an integral aspect of psychiatry from its beginning. The chapter describes the development and classifications of different psychological treatments and draws attention both to their differences but also the common factors on which they all draw. Some psychological treatments, such as counselling and crisis intervention and supportive psychotherapy, are part of routine psychiatric practice. The chapter also describes more specialized forms, including interpersonal psychotherapy, cognitive behaviour therapy, dynamic therapies, plus group and family therapies. Adaptations for treatment of elderly patients and children are covered and, lastly, superseded treatments of significant cultural and historical interest are outlined and the special ethical problems attending psychological treatments addressed.
Drugs and other physical treatments
Authors: Harrison Paul , Cowen Philip , Burns Tom , Fazel Mina
Published: January 2019

‘Drugs and other physical treatments’ provides coverage of the current drug and physical treatments used in the management of general psychiatric disorders. Following a historical introduction and general principles governing drug use and prescription, agents are considered according to the major psychotropic classes, namely: anxiolytic and hypnotic, antipsychotic, antidepressant, mood stabilizer, and psychostimulant. Each class is described according to its pharmacology, followed by the indications, pharmacokinetics, adverse effects and clinical use of individual compounds. Subsequent sections describe the indications, practical management, and adverse effects of electroconvulsive therapy, as well as other treatments designed to influence brain activity directly. Included here are descriptions of neurosurgery and various neurostimulation techniques (deep brain stimulation, transcranial magnetic stimulation, transcranial direct current stimulation, and vagal nerve stimulation), together with the evidence for their effectiveness as well as their proposed indications and adverse effects.
Psychiatric services
Authors: Harrison Paul , Cowen Philip , Burns Tom , Fazel Mina
Published: January 2019

‘Psychiatric services’ is concerned with the provision of psychiatric care for populations. It deals mainly with the needs of and provisions for people aged 18–65 years (‘adults of working age’), and focuses on the situation in the United Kingdom. (A more global perspective is provided in Chapter 23.) The chapter begins with an account of the historical development of psychiatric services, followed by descriptions of the commonly available psychiatric services and of the problems they encounter. It outlines the components of services, both those within primary care and those within specialized secondary care. These include services for acute disorders and those for complex long-term disorders (rehabilitation services). Service adaptations for patient groups with special needs (e.g. deafness, eating disorders) are also presented. The difficulties encountered by community care services are examined, as are emerging international service principles.
Assessing risk of prosthetic joint infection
Authors: Khan Umraz , Perks Graeme , Morgan-Jones Rhidian , James Peter , Esler Colin , Smyth Vince , Gant Vanya
Published: January 2019

This chapter discusses assessing the risk of prosthetic joint infection (PJI) and includes discussion on high-risk patients (classified by age, skin colour, extracellular matrix, cellular turnover, diabetes, obesity, rheumatoid arthritis, previous periarticular fractures and skin disorders). The aim is to allow the practitioner to identify high-risk patient attributes that can be positively influenced such that the risk of PJI is reduced. There are some patients with more than one risk factor and, as such, every effort must be made to reduce each even if there is a marginal gain in each. Delaying elective surgery until the risks of PJI are reduced must be encouraged but must be balanced with alleviating patient symptoms.
Thromboprophylaxis and haematomas
Authors: Khan Umraz , Perks Graeme , Morgan-Jones Rhidian , James Peter , Esler Colin , Smyth Vince , Gant Vanya
Published: January 2019

This chapter discusses thromboprophylaxis and haematomas within periprosthetic joint infection. The issue of venous thromboembolism is important for all surgical patients and, as such, those undergoing arthroplasty must undergo a careful and accurate risk assessment. Prolonged surgery and delayed postoperative mobilization are risk factors and are common to most major joint arthroplasty. Use of prophylactic agents to prevent thrombosis must be balanced with the avoidance of haematoma formation as the latter contributes to a risk of prosthetic joint infection. Should deep vein thrombosis occur then swift methods of diagnosis and treatment must be in place.
Considering safe patient pathways
Authors: Khan Umraz , Perks Graeme , Morgan-Jones Rhidian , James Peter , Esler Colin , Smyth Vince , Gant Vanya
Published: January 2019

This chapter discusses consideration of safe patient pathways. It includes discussion on skin necrosis, safe raising of fasciocutaneous flaps around the joints, tips and tricks to avoid iatrogenic skin necrosis, prosthetic joint infection negative-pressure dressings to reduce risk, and pathways for skin necrosis. The aim is to improve the safety and viability of the access incisions with the intention of enhancing primary healing of those incisions. This advice on tissue handling must be in addition to the holistic assessment of the patient as a ‘host’ for the arthroplasty implant.
Pathways for established prosthetic joint infection
Authors: Khan Umraz , Perks Graeme , Morgan-Jones Rhidian , James Peter , Esler Colin , Smyth Vince , Gant Vanya
Published: January 2019

This chapter discusses pathways for established prosthetic joint infection (PJI) and includes discussion on management of acute infection, surgical management of acute infection (including arthroscopic debridement and implant retention strategies), formal revision surgery, and management of chronic low-grade infection (including management of low-grade infection, antibiotic suppression, and free flaps). The main emphasis of this chapter is to guide the team on what are safe and accepted treatments for patients with confirmed PJI. The most important decision is whether the underlying implant should be retained or replaced. The latter can be in a single or multiple stages.
Specific microbiology issues relating to prosthetic joint infection
Authors: Khan Umraz , Perks Graeme , Morgan-Jones Rhidian , James Peter , Esler Colin , Smyth Vince , Gant Vanya
Published: January 2019

This chapter discusses specific microbiology issues relating to prosthetic joint infection (PJI) and includes discussion on antibiotic prophylaxis (including elective joint replacement in the uninfected case), choice of ‘prophylaxis/treatment’ in the infected, or presumed, infected case, a suggested framework for a safe practice, antibiotic use in PJI in the age of resistance, background on rising antibiotic resistance, approach to one- and two-stage surgical management, outpatient antibiotic therapy and when to use it, monitoring/stopping rules, the particular problems of Pseudomonas and Candida in PJI, and myths and facts about what ‘immunosuppression’ actually means in practice (including MRSA), and a conclusion.
Revision arthroplasty networks
Authors: Khan Umraz , Perks Graeme , Morgan-Jones Rhidian , James Peter , Esler Colin , Smyth Vince , Gant Vanya
Published: January 2019

This chapter discusses revision arthroplasty networks and includes discussion on the proposed model for revision networks, the proposed operating framework, and aims of the revision network. The risks of prosthetic joint infection are known to be higher when undertaking revisional arthroplasty. To reduce these risks the correct decisions must be made during the lead-up to the revisional surgery. The aim is to encourage centres to set up networks to allow discussion of all revisional cases in this forum. The result should be that all patients benefit from best practice.