bluuebunny/crossref_metadata_2025 huggingface dataset:
Varieties of social constructionism and the problem of progress in psychiatry
Authors: Schaffner Kenneth F. , Tabb Kathryn
Published: November 2017

Chapter 11 discusses how the debates over the relationship between social factors and progress in psychiatry have been muddied by confusion over how the term “social construction” has been, and should be, used. It covers how one option is to move away from the language of social construction, like many in the literature have done since the 1990s. But this move risks obscuring the continued importance of attending to the role of the social in psychiatric progress. This chapter aims to clarify the different positions taken by social constructionists about psychiatric disorders and to advocate for what it calls “inclusionary social constructionism.” Through a comparison between the history of HIV/AIDS and the present state of schizophrenia in research and medical settings, the chapter illustrates and evaluates the space of possible characterizations of social construction by psychiatrists and philosophers of psychiatry.
Introduction to “Biography of a brain structure: studying the diencephalon as an epistemic object”
Authors: Parnas Josef
Published: November 2017

Chapter 13 is an introduction to Chapter 14, which discusses the biography of a brain structure and the practice of studying the diencephalon as an epistemic object, and it covers the study of a hypothesis representative of the numerous attempts of psychiatry to understand brain dysfunctions, including psychoactive drugs, and mid-brain interaction.
Some reflections on historiographic strategies for the neurosciences
Authors: Engstrom Eric J.
Published: November 2017

Chapter 15 is a commentary on Chapter 14, which discusses the biography of a brain structure and the practice of studying the diencephalon as an epistemic object, and the study of a hypothesis representative of the numerous attempts of psychiatry to understand brain dysfunctions, including psychoactive drugs, and mid-brain interaction. It addresses reflections on historiographic strategies for the neurosciences.
Introduction to “On attitudes toward philosophy and psychology in German psychiatry, 1867–1917”
Authors: Kendler Kenneth S.
Published: November 2017

Chapter 16 is an introduction to Chapter 17, which covers attitudes toward philosophy and psychology in German psychiatry between 1867–1917, including discussion related to Wilhelm Wundt, Emil Kraepelin, Theodore Ziehen, interdisciplinary history, philosophy, psychiatry, and experimental psychology.
On attitudes toward philosophy and psychology in German psychiatry, 1867–1917
Authors: Engstrom Eric J.
Published: November 2017

Chapter 17 examines the disciplinary threshold between psychiatry, philosophy, and psychology in late nineteenth-century Germany. It begins with a brief sketch of the post-Hegelian crisis before drawing on the work of several protagonists (Wilhelm Wundt, Emil Kraepelin, and Theodor Ziehen) to explore how that crisis influenced psychiatry, and then how they interpreted the relationship between psychiatry and philosophy, discussing some of the exchanges that transpired across the disciplinary threshold, and illustrating how these exchanges shaped the development of psychiatry. Specifically, it argues that much of Kraepelin’s early research encountered a well-entrenched, antimetaphysical bias within his profession, and how he (among many others) drew on experimental methods developed in the neighboring fields of philosophy and psychology in order to introduce new psychological dimensions into the overwhelmingly neuropsychiatric research paradigms of his day. Although remembered mainly for his contributions to the history of so-called biological psychiatry, Kraepelin’s career and research were initially inspired by the methods and promise of early Wundtian experimental psychology.
Introduction to “The development of psychoanalysis in the context of American psychiatry”
Authors: Kendler Kenneth S.
Published: November 2017

Chapter 19 is an introduction to Chapter 20, which discusses the development of psychoanalysis in the context of American psychiatry, including its origin in nineteenth-century medicine and neurology, and the clinical success of psychopharmacology, the growth of neuroscience.
Introduction to “The nature of nature”
Authors: Kendler Kenneth S.
Published: November 2017

Chapter 25 is an introduction to Chapter 26, which discusses the nature of nurture, and covers the ideas and concepts surrounding Galton, nature–nurture, twins, heritability, molecular genetics, biological determinism, Huntington’s disease, divorce, personality, and biological explanation.
Introduction to “What can evolution tell us about the healthy mind?”
Authors: Parnas Josef
Published: November 2017

Chapter 28 is an introduction to Chapter 29, which covers explores the application of evolutionary ideas to psychiatry, including evolutionary psychiatry, evolutionary psychology, neo-Darwinism, developmental systems theory, developmental plasticity, human nature, and process philosophy.
What can evolution tell us about the healthy mind?
Authors: Dupré John
Published: November 2017

Chapter 29 covers how a field of scientific research is often transformed by the influence of ideas or modes of thought from a quite different field. Though this can often be highly beneficial, it can also have negative effects, involving an inappropriate attempted expansion of the domain of the intervening science, something the author of this chapter has referred to in the past as “scientific imperialism.” This chapter explores the application of evolutionary ideas to psychiatry and diagnoses this as an example of such undesirable imperialism. At least in the neo-Darwinian guise in which evolutionary ideas have been applied to psychiatry, they suffer the fatal defect of treating psychiatric conditions as genetically determined responses to the environment. It is argued in this chapter that they should rather be seen as outcomes of a complex and multifactorial developmental process to which evolved genetic factors have very limited relevance.
What can history and social studies of sciences teach us about evolutionary psychiatry?
Authors: Bovet Emilie
Published: November 2017

Chapter 30 is a commentary on Chapter 29, which covers explores the application of evolutionary ideas to psychiatry, including evolutionary psychiatry, evolutionary psychology, neo-Darwinism, developmental systems theory, developmental plasticity, human nature, and process philosophy, and what history and social studies of sciences teach us about evolutionary psychiatry.
Introduction to “Depression in a biopsychosocioeconomic context”
Authors: Parnas Josef
Published: November 2017

Chapter 34 is an introduction to Chapter 35, which covers how the concept of depression still remains controversial, primarily due to its complicated composition involving not only medical/nosological factors but also significant nonmedical factors.
What do we want from a depression diagnosis?
Authors: Turkheimer Eric
Published: November 2017

Chapter 36 is a commentary on Chapter 35, which covers how the concept of depression still remains controversial, primarily due to its complicated composition involving not only medical/nosological factors but also significant nonmedical factors, and what is wanted in a diagnosis of depression.
Introduction to “On the ratio of science to activism in the shaping of autism”
Authors: Parnas Josef
Published: November 2017

Chapter 37 is an introduction to Chapter 38, which covers the ratio of science to activism in the shaping of autism, and includes discussion about the DSM, looping effects, philosophy, activism, the Internet, and the “internal” and the “external” factors that have shaped autism.
On the ratio of science to activism in the shaping of autism
Authors: Hacking Ian
Published: November 2017

Chapter 38 covers how the “internal” and the “external” factors that have shaped autism substantially overlap. Autism activists have done much of the shaping, and not scientific inquiry—except that for a critical period in the shaping of autism, many of the scientists were also activists. The most influential and effective experts were often involved in autism in their personal lives. That is, many of those who have shaped our current concept of autism have been PCA—personally connected to an autistic person. Other themes explored in this essay include: (1) the increasingly popular “neurodiversity movement” that contends that autism and related disorders reflect “just a difference”, not a disorder; (2) the substantial impact of the Internet on shaping autism (“Autism lives on the Internet”); and (3) a discussion of the “unparalleled efficacy of autism advocates.” The recent history of autism is viewed in this chapter through the lens of Hacking’s broader “Making up People Project.”
Introduction to “A DSM insiders’ history of premenstrual dysphoric disorder”
Authors: Parnas Josef
Published: November 2017

Chapter 40 is an introduction to Chapter 41, which covers an ‘insiders’’ history of premenstrual dysphoric disorder and a case study of the interactions between science and extra-scientific processes involved in the construction of nosological categories of psychiatry.
A DSM insiders’ history of premenstrual dysphoric disorder
Authors: Zachar Peter , Kendler Kenneth S.
Published: November 2017

Chapter 41 discusses a kind of in vivo case study of the interactions between science and extra-scientific processes involved in the construction of nosological categories of psychiatry. The very first medical report on a cluster of symptoms, regularly affecting some women over their menstrual cycle, the so-called syndrome of premenstrual tension, appeared in 1931. The name changed with time to premenstrual syndrome, subsequently renamed as late luteal phase dysphoric disorder (LLPDD) and is currently known as premenstrual dysphoric disorder (PMDD). It was listed as a psychiatric disorder in the DSM-III, but was later moved to the section on the condition deserving further study (aka the “appendix”). In the DSM-5, PMDD returned to the main section of the manual devoted to depressive disorders as a diagnosis approved for routine clinical use. The PDD is an ideal-type condition to stimulate a controversy about its justification as a psychiatric disorder. By its nature it affects only females (here, feminist issues may arise); it is clearly linked to physiological rhythm (is it not a somatic issue?); does it exist as a distinct behavioral abnormality or is it just a variant of female experience?: does it need to be treated pharmacologically? (the issues of medicalization and “big pharma”). It provides a detailed narrative on the vicissitudes of this psychiatric nosological category, which is not only based on a careful study by interested outsiders but is crucially enriched by the insights of one of the participants of the very process of DSM construction.
Immune mechanisms: HLA-B27
Authors: Colbert Robert A. , Bowness Paul
Published: November 2017

HLA-B27 is present in the majority of patients with ankylosing spondylitis (AS). Although we have learned a considerable amount about the natural immunologic function of HLA class I proteins, this has not provided a definitive mechanism of AS pathogenesis. While HLA-B27 is adept at presenting antigenic peptides to CD8+ T cells, ‘arthritogenic’ peptides targeted by a cross-reactive T or natural killer cell response have not been described, nor have autoreactive T cells been found. Newer concepts have evolved based on the propensity of HLA-B27 to ‘misbehave’, both inside cells and on the cell surface. Misfolded HLA-B27 molecules may stimulate an endoplasmic reticulum stress response, promoting production of IL-23 and then IL-17 and related cytokines. Aberrant cell-surface HLA-B27 molecules are ligands for natural killer and related immunoreceptors, and recognition can lead to IL-17 proinflammatory responses. There is growing evidence to suggest that these aberrant behaviours contribute to AS pathogenesis.
Immune mechanisms: adaptive immunity
Authors: Breban Maxime , Gaston Hill
Published: November 2017

The role of adaptive immunity (i.e. the involvement of B and T lymphocytes) in the pathogenesis of axial spondyloarthritis has been investigated in both human disease and relevant animal models. Studies of B cell responses have not generally implicated an autoantibody in the disease, but there are abnormalities of antibody responses, particularly increased titres of antibodies to various gut bacteria. T cells are critical to the disease in animal models other than those where overexpression of a cytokine is engineered, suggesting that they are the drivers of the inflammatory response. There is convergent evidence from animal models, genetics in humans, and direct observation of human peripheral blood and joints to implicate T cells producing IL-17 under the influence of IL-23. These in turn may be responding to bacteria either in the gut or on the skin.
Pathology: bone
Authors: Lories Rik J. , Schett Georg
Published: November 2017

Axial spondyloarthritis is associated with different types of skeletal damage. Inflammation at the affected sites is linked with both loss of trabecular bone and new bone formation on the cortical side, potentially leading to joint or spine ankylosis. Both aspects of the disease can result in a significant burden for the patient. Bone loss is directly linked to proinflammatory cytokines and activation of osteoclasts. Control of inflammation is therefore the best strategy to prevent loss of bone. The nature of the new bone formation process is less defined. A prominent role for developmental signalling pathways has been proposed. Current therapies have limited or no impact on this process. However, emerging data suggest that early control of disease activity may be part of a window of opportunity to prevent structural damage, as biomechanical factors and instability following inflammation may also play a role.
Patient registries
Authors: Lie Elisabeth , Kvien Tore Kristian , Østergaard Mikkel
Published: November 2017

Patient registries can be either disease-based or medication-based, and have a wide range of objectives, such as describing the natural history of disease, determining clinical effectiveness or cost-effectiveness of treatments, safety monitoring, and measuring quality of care. This chapter describes some of the major disease-based and medication-based registries in axial spondyloarthritis, including several so-called biologics registries, which were established in many European countries as well as in other parts of the world following the introduction of the first tumour necrosis factor (TNF) inhibitors in 1999. The main results from registry-based research in axial spondyloarthritis are reviewed, covering areas such as epidemiology, genetics, effectiveness of TNF inhibitor treatment and switching, predictors of TNF inhibitor response and retention, and safety of TNF inhibitors. The current and future role of patient registries within epidemiology, effectiveness research, and surveillance of new therapies in axial spondyloarthritis are discussed.
Cost-of-illness and economic evaluations in axial spondyloarthritis
Authors: Boonen Annelies
Published: November 2017

Consideration of costs and budgets plays an increasingly important role in decisions on access to innovative technologies. When clinicians want to influence such decisions, it is essential to understand the information on the burden of the disease and the evidence on cost-effectiveness of technologies. This chapter provides guidance to understanding the key methodological principles of economic evaluations, and describes available evidence on these issues in axial spondyloarthritis (axSpA). In the prebiologics era, the cost-of-illness for society of ankylosing spondylitis was slightly lower than for rheumatoid arthritis, and substantially lower than chronic low back pain. Cost of sick leave and work disability accounted for up to 75% of total cost-of-illness. Treatment with biologics increased cost-of-illness substantially, but the important gain in quality-adjusted life years resulted in acceptable cost-effectiveness in patients with active disease. There remains a gap in knowledge about the cost-effectiveness of diagnosing and treating axSpA earlier.
Axial spondyloarthritis in Asia
Authors: Xu Huji , Huang Feng , Choi Chan-Bum , Kim Tae-Hwan
Published: November 2017

The prevalence of axial spondyloarthritis (axSpA) in Chinese and Korean populations is not dissimilar to that in Caucasians. However, the age of onset is younger and peripheral arthritis of the lower limb is relatively more common. Multicenter studies have revealed similarities and differences among different ethnic backgrounds. For example, the dominant HLA-B27 subtype in Chinese SpA is B2704, while it is B2705 in Koreans. Both Chinese and Korean rheumatologists have adopted ASAS/EULAR guidelines to manage axSpA. TNFi are covered by insurance in Korea but not in China. Owing to early onset and the high cost of TNFi therapy, axSpA has placed enormous burdens on both patients and society in Asia. To achieve a higher HRQoL, rheumatologists are bringing forward cost-effective and treat-to-target therapeutic strategies by integrating nonpharmacological treatment, traditional medications, and biologics in a multimodality setting. Further basic and clinical studies in Asian populations are needed to improve decision-making in clinical practice.
Axial spondyloarthritis in India
Authors: Malaviya Anand , Kumar Ashok
Published: November 2017

Spondyloarthritis (SpA) is among the commonest rheumatological conditions in India, second only to rheumatoid arthritis (RA). This is consistent with the fact that the prevalence of SpA is linked to the prevalence of HLA-B27 in that population. Its prevalence in different regions of the country has been reported to be approximately 6%. That would put India prominently on the SpA map of the world, reflected in the large number of publications from the late 1970s onwards, dispelling any earlier misconceptions that it is largely a ‘white man’s disease’. This chapter summarizes the various aspects of SpA as reported from India.
The ethics of communication in cancer and palliative care
Authors: Siminoff Laura A. , Thomson Maria D.
Published: November 2017

Our knowledge and understanding of bioethics is informed by cancer communication research, particularly around the informed consent process and participation in clinical trials. This chapter provides an overview of several ethical theories used to guide bioethics, including principlism, casuistry, and virtue ethics. With these in mind, the informed consent process and the importance of quality communication is described. Despite many patients preferring a style of communication that is more participatory in nature, physicians still struggle with how much and what kind of information to share regarding clinical trials. In the context of palliative care, surrogate decision-making adds an additional layer of complexity to this process. Further, many patients still endorse the ‘therapeutic misconception’, meaning they believe experimental treatments are superior to standard treatments. The communication models of paternalism, the fully informed model, and shared decision-making are described, with the goal to provide patients with clear, unbiased information to inform decision-making.
Introduction: The growing innovation gap in life sciences
Authors: Barker Richard
Published: November 2017

We live in a world caught up in ever more rapid technological advance. Every week brings new IT products and services. Sectors as diverse as transport, energy, communications, and food are all bringing forward new ways to satisfy human need. However, biomedical innovation remains stubbornly slow and unproductive, as measured by output (benefit to patients) over input (investment). In fact, pharmaceutical innovation follows ‘Eroom’s Law’– an exponential decline in productivity that is the very reverse of Moore’s Law. This is despite very rapid progress in the underlying science. This ‘innovation gap’ puts at risk the very enterprise of life sciences, in which society and investors place so much faith. We need a scientific study of the gaps in translation and radical thinking to bridge them.
The accelerating pace of biomedical advance
Authors: Barker Richard
Published: November 2017

Bioscience has progressed exponentially, in scientific advances and enabling technology. From quicker and much cheaper gene sequencing to the emergence of data-mining tools, the last 20 years has been unprecedented in exploitable advances brought by research. We have the tools and insights to trace disease from underlying genetics and epigenetics, through proteins that represent intervention options, to ways to create molecules, diagnostics, and devices based on those insights. The life sciences enterprise, once largely confined to Europe, the USA, and Japan, is now seeing major investment from emerging economies. We should be poised to reap the benefits of this rising tide of research with lives transformed and health systems revolutionized. However, the two million biological science papers published annully results in about 14 000 patents, only 5000 drugs in the pipeline, and a mere 30 or so actual medicines. Translation of life sciences research into usable products is hugely inefficient.
Getting the environment right
Authors: Barker Richard
Published: November 2017

The changes proposed to enable sustainable innovation need the right environment in which to occur. Politicians, the media, ethicists, public and patient debate, funding agencies, and investors can all play a major role in supporting the future of medical innovation. Public–private partnerships and life science clusters are vehicles in which the new precision medicine can flourish. However, we need a new ‘social contract’ to underpin the innovation enterprise. Countries that wish to lead in the new era of precision medicine will need to unite their health and innovation policy agendas, be prepared to provide finance to achieve proof of concept, encourage public–private partnerships and the development of life science clusters, set up constructive public and ethical dialogues, invest in developing regulatory science and in bringing patients fully into policy development.
What is epidemiology? The nature, scope, variables, principal measures, and designs of a biological, clinical, social, and ecological science
Authors: Bhopal Raj S.
Published: November 2017

Populations, as with individuals, have unique patterns of disease. The science of epidemiology, which straddles biology, clinical medicine, social sciences, and ecology, seeks to describe, understand, and utilize these patterns to improve population health. Epidemiology’s central paradigm is that analysis of population patterns of disease, particularly by linking these to exposure variables (risk factors), provides understanding of their causes. Epidemiology is useful in other ways, including preventing and controlling disease in populations and guiding health and health-care policy and planning. Epidemiology can help clinicians to manage the health care of individuals. Epidemiology has a large toolbox. At its core lies the measurement of the prevalence and incidence of risk factors and outcomes. These measurements are generated by study types (designs) that serve the various purposes of epidemiology. Of the many kinds of studies available, the most important are case series (register studies), cross-sectional, case–control, cohort, and intervention (trials) studies.
Variation in disease by time, place, and person: Background and a framework for analysis of genetic and environmental effects
Authors: Bhopal Raj S.
Published: November 2017

Diseases wax and wane in their population frequency. The underlying reasons are often difficult to detect and may remain a mystery. The principles behind the investigation of clusters, outbreaks, epidemics, and inequalities in both of communicable and non-communicable diseases, are similar. On those occasions when the mystery is solved we tend to gain huge insights, both scientific and practical to help in disease control. Disease variations are often, however, artefactual, and arise from data errors. A systematic approach to the analysis of variation in disease begins by differentiating artefactual change from real change. Real change results from changes in host susceptibility, in the agent’s capacity to cause disease, and in the influence of the environment. The epidemiological challenge is to pinpoint the causal factors.
Influenza
Authors: Cartwright Joanna , Shah Anjila , Ghebrehewet Sam
Published: November 2017

This chapter describes the background to, and management of, outbreaks of influenza-like illness (ILI). Clear terminology and definitions are given in relation to influenza biology and epidemiology. The role of the WHO Global Influenza Programme is explained, together with the national surveillance programmes within the UK. The chapter is structured around an outbreak of suspected ILI in a care home. The importance of obtaining appropriate samples and initial infection control implementation is emphasized. Guidance is given on current recommendations for the use of antivirals for prophylaxis and treatment in the care home setting. As the number of cases increases, the decision to convene an Outbreak Control Team (OCT) is described. Another component of the chapter is managing the media interest in the outbreak, including liaison with other agencies involved. The chapter concludes with alternative scenarios that may occur, including outbreaks in colleges, and a hospital setting.
Measles
Authors: Baxter David , Marsh Gill , Ghebrehewet Sam
Published: November 2017

This chapter describes a case of measles in a school child who contracted measles following travel to a high-risk area. The case resulted in a measles outbreak in the school and further cases in the community. Background information on the epidemiology and clinical features of measles and the public health response to a single case, an outbreak of measles in a school, and measles exposure in a healthcare setting are discussed. Case definitions risk assessment, identification of close contacts including priority groups and the required public health actions including post exposure prophylaxis (PEP) with Human Normal Immunoglobulin (HNIG) and/or MMR vaccine, are described in detail. ‘Top tips’ are given to provide practical tips for the reader to think through the public health management of the case study, and ‘tools of the trade’ list the laboratory and epidemiological components of the investigation. Finally, the chapter encourages exploration of other potential scenarios, including the possibility of measles transmission in a nursery.
Fire and fear: Immediate and long-term health aspects
Authors: Mitchem Laura , Harrison Henrietta , Stewart Alex G.
Published: November 2017

Fires can cause significant health concerns within local communities impacted by any associated smoke plume. This chapter discusses the potential public health concerns associated with fires, in particular fires at waste-processing installations. Using an example scenario, actions to be undertaken throughout the incident response, from initial acute phase to recovery, are considered, along with health concerns and fears, real or perceived, involvement of asbestos-contaminant material, multi-agency communication mechanisms, and potential issues associated with long-running fires. The multi-agency mechanisms for response are detailed, including the various coordinating groups (strategic, tactical, recovery coordinating groups (SCG, TCG, RCG, respectively), and expert cells (scientific and technical advisor cell, air quality cell (AQC)). Key points to note in the incident response include concerns raised by the local population, typical health effects associated with exposure to a smoke plume, and tools that support the response to the incident and the public health risk assessment.
Health protection surveillance
Authors: Vivancos Roberto , Leonardi Giovanni , Elliott Alex J.
Published: November 2017

This chapter provides a broad definition of surveillance in relation to health protection, including infections, environmental hazards, and health delivery. Surveillance systems include active, passive, and sentinel surveillance, and guidelines are provided for assessing the quality of surveillance data. Surveillance tools include the statutory notification of diseases, laboratory reporting, and prevalence surveys. In addition, syndromic surveillance, the (near) real-time collection of data has become increasingly used, facilitated by increasing use of digital data collection within health care settings and the availability of other digital data sources (e.g. social media). Other surveillance types include event-based surveillance (e.g. during major sporting events), and environmental surveillance, including food related disease, air pollution and chemical hazards. The chapter finally brings these together in integrated surveillance and the use of such surveillance in health planning and assessment.
Conducting epidemiological studies in health protection
Authors: Ghebrehewet Sam , Cleary Paul , Kliner Merav , Wilkinson Ewan
Published: November 2017

This chapter describes the different types of epidemiological studies that are used in health protection investigations. These include descriptive studies such as case reports, case series, cross-sectional studies, and analytical studies, particularly case-control and cohort studies. It provides a number of real-life examples illustrating these different types of investigation and their application in health protection practice. It also gives guidance on the type of study to use in different incidents or outbreaks, and on sample size determination. The limitations of the different study designs are described. The particular requirements of randomized controlled trials and systematic reviews, and their role in health protection are described. The roles of qualitative and operational studies are also outlined.
New and emerging infectious diseases
Authors: Stewart Alex G. , Ghebrehewet Sam , MacPherson Peter
Published: November 2017

This chapter describes the increasing global problem of new and emerging infections, many zoonotic, ranging from the recently described Middle East respiratory syndrome (MERS) to bacteria now resistant to all locally available antimicrobial agents. The environmental, human, technological, and microbial factors contributing to disease emergence are assessed. Changes in environment and land use result in the spread of vector-borne diseases into new areas, and global travel and trade may introduce pathogens to non-immune populations. The breakdown of health services following political change or during conflict can result in the resurgence of previously controlled communicable diseases. The importance of collaboration between human and veterinary health services is emphasized, and the UK ‘DATER’ strategy (Detection, Assessment, Treatment, Escalation, Recovery) for dealing with pandemic influenza is applied to new and emerging infections. Finally, the role of internet-based, syndromic surveillance to create early awareness of new infections is considered.
The epidemiology, burden, and treatment of mental disorders in primary care
Authors: Puschner Bernd , Kösters Markus , Bouché Lea , Weinmann Stefan
Published: November 2017

Mental disorders have elevated prevalence rates worldwide. As a group, these disorders are leading causes of disability and impose elevated costs as well as suffering to those affected and their families. Furthermore, mental disorders are often comorbid with physical conditions with an acknowledged bidirectional negative impact on outcomes. Primary care providers are the first contact point for most people with a mental illness seeking treatment. Low detection rates of mental illness among general practitioners (GPs) are an ongoing source of concern. A wide range of interventions are effective for the treatment of common mental disorders in primary care. Pharmacotherapy can be an effective treatment, and evidence-based psychosocial interventions may improve outcome, especially when integrated in coherent collaborative care models. This chapter reports important recent findings on the epidemiology of mental disorders in the community and in primary care. Furthermore, issues related to the recognition of common mental disorders in primary care settings as well as the effectiveness of different interventions are thoroughly discussed.
Across the spectrum: Strategies to improve recognition and treatment of mental disorders in primary care
Authors: Palmer Victoria J. , Whitley Rob
Published: November 2017

There is an abundance of published literature documenting the important role of primary care in the recognition, treatment and management of mental disorders. Despite this, general practitioners, nurses, social workers, occupational therapists, physiotherapists, and other primary health care professionals remain under acknowledged, and the multidisciplinary team arrangements needed for effective management elusive. Individual and community stigma attached to seeking help has not been removed. This chapter provides an overview of these existing barriers and outlines strategies for implementation to improve recognition and treatment of mental disorders across the spectrum in primary care. These strategies are focused on the delivery of whole person, resulting in integrated and person-centred care.
Collaborative care models for the management of mental disorders in primary care
Authors: van der Feltz-Cornelis Christina , van Marwijk Harm , Hakkaart-van Roijen Leona
Published: November 2017

This critical review sketches the principles of collaborative care models in general practice for treatment of common mental disorders, such as depressive, anxiety, or somatoform disorders. Such disorders may not be self-limiting and have a tendency to become chronic, and their treatment in the general-practice setting demands a change in organization of general practice according to a chronic care model, i.e. collaborative care. In collaborative care, at least two of the following three professionals work together to alleviate the mental health burden of the patient: the general practitioner (GP), the nurse care-manager (CM), and the consultant psychiatrist (CL). The model is commonly effective but it is also more expensive. The implementation of collaborative care depends on the availability of CMs and CLs, guidelines for psychiatric consultation, reimbursement, and adequate web-based decision aids for the professionals. Its structural implementation in general practice requires a sustained effort at national level.
Anxiety disorders in primary care
Authors: Dold Markus , Kasper Siegfried
Published: November 2017

Chapter 7 summarizes the epidemiology, clinical characteristics, and evidence for pharmacological treatment options of generalized anxiety disorder, panic disorder, agoraphobia, specific phobia, and social anxiety disorder. With regard to the pharmacological management, serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) represent the well-established first-line medication for generalized anxiety disorder (GAD), panic disorder, agoraphobia, and social anxiety disorder. In GAD, also the calcium channel modulator pregabalin can be regarded as evidence-based treatment option. In simple cases of specific phobia, however, the initiation of a pharmacotherapy is not recognized as standard treatment according to international treatment guidelines and psychotherapeutic interventions should be preferred. Besides illustrating the pharmacological treatment options, we described the actualized diagnostic criteria for anxiety disorders established in the newly introduced fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).
Suicide and suicidal behaviour
Authors: Isometsä Erkki
Published: November 2017

Over 800 000 people are estimated to die worldwide by suicide. Based on psychological autopsy studies, nine out of ten subjects who die by suicide have likely suffered from a diagnosable mental disorder preceding death. Because primary health care in most countries provides services for the majority of patients with depressive or substance use disorders, this setting should be the first point of call for suicide prevention. However, despite this central importance, research on incidence and prevalence of suicide deaths, attempts, ideation, or risk factors for suicidal behaviour in primary care settings is quite limited. Information on risk factors is mostly extrapolated from psychiatric or general population epidemiological studies. For purposes of prevention, improving quality and continuity of care of depression and substance use disorders, as well as integrating brief psychosocial interventions into primary care to target suicidal behaviour, are factors of central importance.
Substance use disorders in primary care settings
Authors: Broad Kathleen , George Tony P.
Published: November 2017

This chapter provides a practical and evidence-based approach to the screening, assessment, and treatment of substance use disorders (SUDs) in the primary care setting. SUDs according to the DSM-5 is defined and the evidence for validated screening tools in the primary care setting is discussed. A primary care approach to the assessment of SUDs is described in detail including assessing readiness to change using the transtheoretical model, motivational interviewing techniques, assessing medical and psychiatric comorbidities, and determining treatment setting using the ASAM Criteria. A detailed overview of the epidemiology, acute and chronic effects, and withdrawal syndromes associated with alcohol, opioid, stimulant, cannabis, and nicotine is provided. Finally, behavioural interventions for SUDs including relapse-prevention and evidence-based pharmacotherapies for tobacco, alcohol, and opioids use disorders are reviewed.
Psychosis
Authors: Kulkarni Jayashri , Gavrilidis Emorfia , Nathoo Shainal , Grigg Jasmin
Published: November 2017

Treating patients with psychotic disorders like schizophrenia can be challenging for many primary care practitioners. Many health professionals are intimidated by the prospect of treating severe mental illness, and most do not have the training or experience required to deliver newer psychosis interventions.
Psychotherapeutic interventions
Authors: Cosci Fiammetta , Fava Giovanni Andrea
Published: November 2017

Primary care physicians may offer a comprehensive care of patients having psychiatric ailments. Psychological interventions are effective in treating major depressive disorder, anxiety disorders, somatic symptom disorders, and tobacco use disorders in primary care settings. Psychotherapeutic approaches are effective either as an alternative or as an adjunct to pharmacotherapy, with enduring benefits after discontinuation of drug treatment. Psychotherapy also represents a pilot area of intervention to treat withdrawal symptoms and disorders due to the tapering or discontinuation of psychotropic medications, in particular selective serotonin reuptake inhibitors (SSRIs). This chapter illustrates the basic steps to establish routine evidence-based psychotherapy for unipolar depression, anxiety disorders, somatic symptom disorder, and substance use disorders in primary care settings. Some factors should be considered to formulate a proper treatment plan for mental disorders in primary care, including primary care physicians’ clinical judgment, availability of treatment, and patient’s preference.
Major depressive disorder: how to evaluate and manage patients with psychiatric and medical comorbidities
Authors: Wang Sheng-Min , Pae Chi-Un
Published: November 2017

Major depressive disorder (MDD) is a highly prevalent, chronic, and recurring mental health condition. A substantially high rate of psychiatric and medical comorbidities occurs in individuals with MDD. Furthermore, MDD and these related comorbidities often exhibit bidirectional and reciprocal relationships, where psychiatric and medical comorbidities worsen the prognosis of MDD, and vice-versa. However, the significant symptomatic overlap between MDD and other chronic psychiatric and medical comorbid conditions imposes significant challenges for the assessment and management of these patients in primary care settings. Thus, the influence of psychiatric and medical comorbidities in the treatment of MDD has increasingly become an issue of major public health concern. Collaborative care models hold promise as an effective strategy for the management MDD and comorbid conditions in primary care. This chapter comprehensively reviews evidence pertaining to the evaluation and treatment of MDD and comorbid chronic health conditions in primary care.
The current classification of bipolar disorders
Authors: Malhi Gin S. , Byrow Yulisha
Published: November 2017

The current chapter describes and critically appraises the diagnosis of bipolar disorders in relation to widely used classification systems; namely, the Diagnostic and Statistical Manual of Mental Disorders (5th edition) (DSM-5) and the International Classification of Diseases (10th revision) (ICD-10). In addition, it overviews the diagnostic criteria in relation to the draft version of ICD-11. Patients with bipolar disorder experience extreme fluctuations in mood ranging from depression to mania and, because of the complex nature of the illness, diagnosis remains a clinical challenge. Recent iterations of DSM and ICD have attempted to harmonize taxonomy; however, notable differences remain. These differences are likely to impact the assessment and diagnosis of bipolar disorder and could potentially result in disparate epidemiological findings. Thus, practitioners and researchers alike need to apply careful clinical consideration when assessing those with bipolar disorder.
The treatment of bipolar disorder in its early stages: current techniques, challenges, and future outlook
Authors: Singh Ajeet B. , Eyre Harris A. , Callaly Edward , Berk Michael
Published: November 2017

The early intervention in psychiatry paradigm has offered the promise of improved tailored treatment. While pioneered in early psychosis, lines of evidence also suggest utility in early bipolar. A challenge is that the emergence of elevated states may post-date depression—preventing early diagnosis. Nonetheless, data suggests neuroprogression and an escalating diathesis to relapse occurs with successive episodes which may be impeded by early intervention. Mitigating psychosocial impacts, improving engagement, reducing the consequences of the progressive nature of the disorder, and enhancing adherence are key potential dividends of early intervention. This chapter provides an overview of the current literature, expert clinical opinions, and hints at future directions pertinent to early intervention. As genomics, informatics, and better appreciation of the importance of diet and lifestyle gain salience, there’s hope for a future rich with technologically enhanced tools to both sooner detect and intervene in early stage bipolar disorders to mitigate consequences.
The treatment of bipolar mixed states
Authors: Kittel-Schneider Sarah
Published: November 2017

Definition of mixed episodes has changed in the Diagnostic and Statistical Manual of Mental Disorders (5th edition) (DSM-5). A mixed feature specifier can be added not only to major depressive episodes and manic episodes in bipolar patients but also to hypomanic episodes in bipolar II patients and major depressive episode in major depressive disorder. Atypical antipsychotics seem to be effective in acute treatment as well as valproate and carbamazepine. Regarding prophylaxis of mixed states, monotherapy with valproate, olanzapine and quetiapine seems to prevent mixed episodes. Adjunctive therapy with valproate or lithium to quetiapine has also proven to be effective in prophylaxis of mixed episodes. In patients who suffer from pharmacotherapy-resistant mixed episodes electroconvulsive therapy can lead to response/remission. There is a lack of randomized controlled clinical trials investigating pharmacological and non-pharmacological treatments with focus on mixed states of bipolar patients, especially according to the DSM-5 definition.
The role of psychoeducation in the management of bipolar disorder
Authors: Colom Francesc
Published: November 2017

Psychological interventions play a major role in the prophylaxis of recurrences in bipolar disorders, always as an add-on to pharmacological care as none of them works in monotherapy. So far, the evidence for psychotherapy in the management of acute episodes is very limited so its use should be constrained to prevention. A common aspect of the majority of psychological interventions tested in bipolar disorder is that they are much more efficacious for patients with a low number of episodes prior to the treatment. Interestingly, all the psychological interventions showing preventive efficacy share psychoeducative ingredients including illness awareness, adherence enhancement, habits regularity, and warning signs identification. Future directions of psychoeducation should enhance its implementation worldwide, probably by using newer technologies such as smartphone applications. However, these need a proper testing before being included in clinical routines.
The assessment and management of suicide risk in bipolar disorder
Authors: Rihmer Zoltán , Gonda Xénia , Döme Péter
Published: November 2017

Bipolar spectrum disorders are among the most frequent psychiatric ailments associated with a considerable risk of suicidal behaviour. Approximately 4–19% of (mostly untreated) patients with bipolar disorders ultimately commit suicide, and about 20–60% of them make at least one suicide attempt in their lifetime. Compared with the general population, the risk of committing suicide is about 10–30 times higher in patients with bipolar disorder. However, the majority of bipolar patients never attempt or commit suicide. Therefore, the routine assessment of several risk factors for suicide in clinical practice may aid in the recognition of those patients who are at the highest risk. This chapter summarizes the clinically most relevant suicide risk and protective factors in bipolar disorders. In addition, we review evidence-based strategies for suicide prevention in bipolar disorder.
The treatment of bipolar disorder in women
Authors: Balzafiore Danielle , Robakis Thalia , Borish Sarah , Budhan Vena , Rasgon Natalie
Published: November 2017

Sex-specific effects in the clinical presentation and course of bipolar disorder in women have important treatment implications for the management of symptoms across the menstrual cycle and reproductive lifespan. Women with bipolar disorder are particularly vulnerable to premenstrual mood symptoms, menstrual abnormalities, and polycystic ovary syndrome. Special considerations include understanding the interactions between these reproductive issues, oral contraceptives, and mood-stabilizing agents. Additionally, the management of bipolar disorder during the perinatal period requires a careful approach to psychotropic medication to optimize the maintenance of mood stability while minimizing the potential for adverse risk of fetal and neonatal outcomes. Non-pharmaceutical approaches, including electroconvulsive therapy, transcranial magnetic stimulation, selected psychotherapies, and social and behavioural interventions may represent efficacious treatment options to reduce medication burden. Lastly, women with bipolar disorder may be at particular risk for worsening of affective symptoms during the menopausal transition, and strategies to reduce sleep disruption are imperative.