bluuebunny/crossref_metadata_2025 huggingface dataset:
α‎1-Antitrypsin deficiency and the serpinopathies
Authors: Lomas David A.
Published: January 2013

α‎1-Antitrypsin is an acute phase glycoprotein synthesized by the liver that functions as an inhibitor of a range of proteolytic enzymes, most importantly neutrophil elastase. Severe plasma deficiency of α‎1-antitrypsin results from homozygocity for the Z allele, which causes the protein to undergo a conformational transition and form ordered polymers that are retained within hepatocytes as PAS-positive inclusions....
Immune disorders of the gastrointestinal tract
Authors: Unsworth D.J.
Published: January 2013

The gastrointestinal tract is protected by gut-associated lymphoid tissue that provides an environment where interaction occurs between luminal antigen and specially adapted immune tissue in Peyer’s patches (small intestine only) or lymphoid follicles. T and B lymphocytes primed in the gut migrate into the systemic circulation via the thoracic duct but home preferentially to the lamina propria of the intestine. Plasma cells of the lamina propria secrete immunoglobulin A as a dimer linked by a joining peptide....
Diseases of the oesophagus
Authors: Fitzgerald Rebecca
Published: January 2013

Defective conduit function of the oesophagus readily induces clinical symptoms and may have serious effects on nutrition and the lungs, the latter resulting from aspiration of gastro-oeophageal contents. Oesophageal pain and dysphagia caused by benign or malignant diseases of the muscular layer or epithelium are often disabling....
Coeliac disease
Authors: Dubois Patrick C.A. , van Heel David A.
Published: January 2013

Case History—A 38 yr old woman presenting with a long history of tiredness and abdominal bloating.

Coeliac disease is a common disorder of the small intestine in which storage proteins in dietary wheat, rye, and barley (gliadin, secalins, hordeins, usually referred to as ‘gluten’) induce T-cell responses restricted by HLA DQ2 or DQ8. This immune response drives intestinal inflammation and loss of villous architecture and can lead to a wide spectrum of clinical manifestations....
Colonic diverticular disease
Authors: Ashraf S.Q. , Kettlewell M.G.W. , Mortensen N.J. McC.
Published: January 2013

Colonic diverticula are herniations of mucosa through the bowel musculature. They are seen most often in the sigmoid and descending colon, with a prevalence of up to 65% over the age of 80 in European populations, but they are uncommon in African and Asian countries, where the prevalence is 0.2%. A lifelong diet deficient in dietary fibre is associated with their development, but it is not known why some diverticula become symptomatic. A rise in intradiverticular pressure may play a role in perforation. Diverticula are usually discovered incidentally, but symptoms which are attributable to diverticular disease include colicky abdominal pain and bloating, often accompanied by a change in bowel habit with the passage of broken, pellety stools after considerable straining. All patients with such presentation should be investigated to exclude rectal or sigmoid carcinoma. Treatment is with reassurance that there is no serious underlying disease, a high-fibre diet, and—for patients with pain—antispasmodics such as mebeverine. Elective resection is indicated in the few patients who have repeated severe attacks....
Liver failure
Authors: Mells George F. , Alexander Graeme J.M.
Published: January 2013

Case History—A 53 yr old man, known to have alcoholic liver cirrhosis, now presenting with jaundice, ascites and deteriorating renal function.

Case History—A 62 yr old man presenting with confusion and ascites.

Liver failure occurs when loss of hepatic parenchymal function exceeds the capacity of hepatocytes to regenerate or repair liver injury. Acute liver failure is characterized by jaundice and prolongation of the prothrombin time in the context of recent acute liver injury. Acute liver failure is the syndrome of hepatic encephalopathy occurring within 8 weeks of the first onset of liver disease. Chronic liver failure is characterized by a chronic liver injury with one or more features of liver failure....
Liver transplantation
Authors: Hirschfield Gideon M. , Allison Michael E.D. , Alexander Graeme J.M.
Published: January 2013

Liver transplantation is considered for patients with liver disease that is predicted to shorten life or causes symptoms that preclude an acceptable quality of life and for individuals with life-shortening genetic disease that can be cured by transplantation. One-year survival exceeds 90%, 5-year survival approaches 80%, and individual median survivals exceed 20 years....
Hepatic granulomas
Authors: Spearman C.W.N. , Sonderup M.W. , Saunders S.J.
Published: January 2013

Case History—A 35 yr old woman from Southern Africa presenting with abnormal liver blood tests.

Granuloma formation occurs when persistent antigenaemia or poorly degradable antigens, such as chemicals or toxins, provide an ongoing stimulus that results in the focal accumulation of activated lymphocytes and macrophages, with the macrophages undergoing epithelioid transformation....
Drugs and liver damage
Authors: Neuberger J.
Published: January 2013

Case History—A 22 yr old man, being treated for pulmonary tuberculosis, now presenting with confusion and jaundice.

Drug-induced liver injury (DILI) is relatively uncommon but can very rarely be fatal. Almost all patterns of liver disease can be induced by drugs, and some drugs may be associated with more than one type of reaction. Some cases of DILI have a genetic component. Most cases present with jaundice and/or hepatitis....
Renal involvement in plasma cell dyscrasias, immunoglobulin-based amyloidoses, and fibrillary glomerulopathies, lymphomas, and leukaemias
Authors: Ronco P , Bridoux F , Touchard G
Published: January 2013

Plasma cell dyscrasias are characterized by uncontrolled proliferation of a single clone of B cells which is responsible for the secretion of a monoclonal immunoglobulin (Ig) or Ig subunit that can become deposited in tissues. They can cause a wide range of renal diseases.

Light-chain amyloidosis—renal presentation is usually with proteinuria, often progressing to nephrotic syndrome. Progressive decline in renal function usually occurs, leading finally to endstage renal failure. Diagnosis is made by the detection of monoclonal gammopathy in serum and/or urine (90% of cases) in combination with biopsy evidence of amyloid- forming light chain deposits. Chemotherapy with oral mephalan plus dexamethasone should be considered as first line treatment....
Sleep disorders
Authors: Reading Paul J.
Published: January 2013

Dysfunctional sleep is an important cause of morbidity. Sleep problems can loosely be divided into insomnias, disorders causing excessive daytime sleepiness, and parasomnias, with some conditions having elements of all three categories.

Chronic insomnia usually has a behavioural or psychological basis and responds best to cognitive or relaxation therapies, although ...
Syncope
Authors: Larner A.J.
Published: January 2013

Syncope is the commonest identified cause of transient loss of consciousness, being ten times more frequent than epilepsy. It is a consequence of cerebral underperfusion due to reduced cardiac output, often related to reduced venous return due to decreased peripheral vascular resistance, with pooling of blood volume in dependent body parts....
Hearing
Authors: Luxon Linda M
Published: January 2013

Hearing loss is the most common sensory impairment. The World Health Organization has estimated that at least 275 million people are affected worldwide, as are 17% of the adult population in the United Kingdom, three-quarters of these being over 60 years of age.

Clinical examination and investigation—examination includes visual inspection of the anatomy of the external ear and tympanic membrane, and tuning-fork tests to distinguish conductive from sensorineural hearing loss in some cases. Audiological investigations (1) quantify audiometric thresholds at each frequency; (2) differentiate conductive from sensorineural defects; (3) differentiate ...
Disorders of the neuromuscular junction
Authors: Hilton-Jones David , Palace Jacqueline
Published: January 2013

Two fundamentally different pathological processes are associated with disease at the neuromuscular junction: (1) acquired disorders in which autoantibodies are directed against nerve or muscle receptor or ion channels; (2) rare inherited conditions in which the defect may be pre- or postsynaptic.

Aetiology and epidemiology—the fundamental disorder is loss of functional acetylcholine receptors most frequently as a result of binding of anti-acetylcholine receptor (anti-AChR) antibodies. Incidence is about 10 per million population and prevalence about 8 per 100 000, with a marked female bias in cases aged under 40 years and male preponderance in those over 50 years. Thymomas occur in about 10% of cases....
Muscular dystrophy
Authors: Bushby K.
Published: January 2013

Abstracts and keywords to be supplied.
Getting to grips with the basics
Authors: Kernick David , Goadsby Peter J.
Published: January 2013

This chapter covers headache impact, the classification of headache, developing evidence-based headache care, and the headache consultation.
Investigating the headache
Authors: Kernick David , Goadsby Peter J.
Published: January 2013

This chapter covers investigating the headache, who to investigate, and images of headache.
Cluster headache and other trigeminal autonomic cephalalgias
Authors: Kernick David , Goadsby Peter J.
Published: January 2013

This chapter begins with an introduction to cluster headache and other trigeminal autonomic cephalalgias, before focusing on cluster headache, paroxysmal hemicranias, and SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing).
Medication overuse headache
Authors: Kernick David , Goadsby Peter J.
Published: January 2013

This chapter covers the clinical features, treatment, and prognosis of medication overuse headache.
Headache in the elderly
Authors: Kernick David , Goadsby Peter J.
Published: January 2013

This chapter on headache in the elderly covers specific problems in the elderly, primary headache in the elderly, and important secondary headaches in the elderly.
Facial pain
Authors: Kernick David , Goadsby Peter J.
Published: January 2013

This chapter covers facial pain associated with rhinosinusitis, facial neuralgias, post-herpetic neuralgia, temporomandibular disorder, and chronic idiopathic facial pain (atypical facial pain).
Alternative approaches where evidence is awaited or contested
Authors: Kernick David , Goadsby Peter J.
Published: January 2013

This chapter on alternative approaches where evidence is awaited or contested covers psychology in headache management, acupuncture, homeopathy, botulinum toxin, and patent foramen ovale (PFO) closure.
The role of the specialist nurse in headache
Authors: Kernick David , Goadsby Peter J.
Published: January 2013

This chapter on the role of the specialist nurse in headache covers role development and activities undertaken by the headache nurse.
The development of headache services
Authors: Kernick David , Goadsby Peter J.
Published: January 2013

This chapter covers current headache care and service development, the British Association for the Study of Headache model of care, and developing an evidence base for service development.
Preventive Cardiology
Authors: Jennings Catriona , Mead Alison , Jones Jennifer , Holden Annie , Connolly Susan , Kotseva Kornelia , Wood David
Published: January 2013

Preventive Cardiology provides practical advice on how to structure and run a preventive cardiology programme for existing patients, those at risk of developing cardiovascular disease, and their families, including patient identification and recruitment, assessment of lifestyle and risk factors, and implementing lifestyle change
Immunoglobulin A nephropathy
Authors: Glassock Richard J. , Lee Grace
Published: January 2013

The term immunoglobulin A nephropathy (IgA nephropathy or IgA N) refers to a primary glomerular disease characterized by the dominant or co-dominant, diffuse, and generalized mesangial deposition of IgA, often accompanied by deposition of IgG and the C3 component of complement in a similar distribution (Donadio and Grande, 2004; Barratt and Feehally, 2005; Tomino, 2007; Glassock, 2008; Lai, 2008). In the past, it has also been referred to as Berger's disease, to signify the senior author of the original publication describing the disorder that first appeared more than 4 decades ago in September of 1968 (Berger and Hinglais, 1968). IgA N is most likely the commonest primary glomerular disease in the developed world (D’Amico, 1987). The disease is characterized principally by episodic glomerular hematuria often with persistent proteinuria of a variable degree. It usually runs an indolent course, but may lead to end-stage renal disease (ESRD) in about 30–50% of cases after 25 years or more of follow-up.
A
Authors: Dickman Andrew
Published: January 2013

This chapter includes drugs beginning with the letter A
B
Authors: Dickman Andrew
Published: January 2013

This chapter includes drugs beginning with the letter B
C
Authors: Dickman Andrew
Published: January 2013

This chapter includes drugs beginning with the letter C
D
Authors: Dickman Andrew
Published: January 2013

This chapter includes drugs beginning with the letter D
E
Authors: Dickman Andrew
Published: January 2013

This chapter includes drugs beginning with the letter E
F
Authors: Dickman Andrew
Published: January 2013

This chapter includes drugs beginning with the letter F
G
Authors: Dickman Andrew
Published: January 2013

This chapter includes drugs beginning with the letter G
I
Authors: Dickman Andrew
Published: January 2013

This chapter includes drugs beginning with the letter I
O
Authors: Dickman Andrew
Published: January 2013

This chapter includes drugs beginning with the letter O
P
Authors: Dickman Andrew
Published: January 2013

This chapter includes drugs beginning with the letter P
Q
Authors: Dickman Andrew
Published: January 2013

This chapter includes drugs beginning with the letter Q
R
Authors: Dickman Andrew
Published: January 2013

This chapter includes drugs beginning with the letter R
Z
Authors: Dickman Andrew
Published: January 2013

This chapter includes drugs beginning with the letter Z
Mental disorders as a worldwide public health issue
Authors: Saraceno Benedetto
Published: January 2013

The twentieth century has witnessed significant improvements in somatic health in most countries. A number of key public health threats have been eradicated or brought under control under the leadership of WHO. Priority was given to communicable diseases in view of their inherent potential to spreading. At the present time, a focus on non-communicable diseases and mental health would now appear as the next natural step in public health priorities. In the case of mental health, this is due to the capacity of mental disorders to proliferate not only as a result of complex and multiple biological, psychological but also social determinants. WHO estimates that at any given time 450 million people suffer from some form of mental or brain disorder, including alcohol and substance use disorders. In other words, one in four of the world’s population suffer from different forms of mental, behavioural, and neurological disorders. This chapter looks at the economic and social costs of mental disorders, global resources for mental health, the treatment gap for mental disorders, and improving mental health care.
Transcultural psychiatry
Authors: Leff Julian
Published: January 2013

With the mass movements of populations that have characterized the second half of the twentieth century, there can be few psychiatrists who do not encounter members of an ethnic minority group in their practice. The principles of transcultural psychiatry are obviously of relevance to this type of psychiatrist–patient interaction, but they are also of central importance even when the psychiatrist and patient share the same ethnic background. This is because within a particular ethnic group there are invariably many subcultures, for example based on religious affiliation, which encompass a diversity of beliefs. It is essential that the psychiatrist be aware of the common belief systems likely to be encountered, not simply to enhance rapport with patients and relatives, but in order to avoid serious mistakes in ascribing pathology to experiences that are accepted as normal by the subculture. This chapter looks at the contribution of psychiatric epidemiology (cultural influences on both the psychoses and the neuroses), contributions of anthropology, and finally the concept of depression.
The history of psychiatry as a medical specialty
Authors: Pichot Pierre
Published: January 2013

The history of psychiatry as a medical specialty has to be distinguished from the history of psychiatric medical knowledge which began in ancient Greece with the birth of medicine as a science. For more than 2000 years, only physicians observed and treated mental illnesses, and institutions were created in which the ‘lunatics’ and the ‘insane’ were received. But, as rightly pointed out by Kraepelin, the truth is that psychiatry was not really a medical specialty. One can argue about the precise date of the appearance of psychiatry as a specific field of medicine and of the psychiatrist as a specialist, devoting his professional competence exclusively to the care of the mentally ill. Denis Leigh recognizes that ‘some degree of specialization occurred [in England] among respectable physicians’ in the middle of the eighteenth century when the monopoly of Bethlem was broken and new ‘lunatic hospitals’, such as St Luke’s were opened. On the other hand, the American historian Jan Goldstein stresses that in France the language, as an exact reflection of the underlying reality, began to use expressions such as homme spécial to describe a physician specializing in a branch of medicine such as psychiatry only around 1830. This chapter charts the history of psychiatry as a medical specialty from its beginnings to the present day.
Psychiatric ethics
Authors: Bloch Sidney , Green Stephen
Published: January 2013

A myriad of ethical problems pervade clinical practice and research in psychiatry. Yet with few exceptions, psychiatric ethics has generally been regarded as an addendum to mainstream bioethics. An assumption has been made that ‘tools’ developed to deal with issues like assisted reproduction or transplant surgery can be used essentially unmodified in psychiatry. These tools certainly help the psychiatrist but the hand-me-down approach has meant that salient features of psychiatric ethics have been prone to misunderstanding. Psychiatric ethics is concerned with the application of moral rules to situations and relationships specific to the field of mental health practice. We will focus on ethical aspects of diagnosis and treatment that challenge psychiatrists, and on codes of ethics. Resolution of ethical dilemmas requires deliberation grounded in a moral theoretical framework that serves clinical decision-making, and we conclude with our preferred theoretical perspective.
The psychiatrist as a manager
Authors: López-Ibor Jr. Juan J. , Stefanis Costas
Published: January 2013

It is clear that the modern role of both the physicians, in general, and psychiatrists, in particular, requires intensive decision-making which is helped by management principles. Psychiatrists, in addition to their clinical qualifications and skills are asked to occupy positions and undertake responsibilities as clinical executives, directors of health care facilities, administrators of Academic units and even Mental Health Commissioners, all of them requiring managerial knowledge and leadership qualities. Increased pressure by patients for improved quality of services and access to new and innovative treatments needs to be balanced against the expectation of the health care system of the physician to act ‘economically’, following cost containment guidelines and staying within expenditure ceilings. Such decisions require specialized knowledge and a deep understanding of the principles and the functions of management and health economics. Such knowledge is only gained through specialized training by introducing management teaching, either at the undergraduate level or preferably at the residency level, as part of the core curriculum or as an elective which may include items such as administration principles, quality assurance, budgeting, resource allocation, accreditation procedures and what is close to the psychiatrist's clinical background the personnel management. This may be extended to ongoing professional education programmes for psychiatrists who are already active in the field.
Assessment of personality
Authors: Cloninger C. Robert
Published: January 2013

The assessment of personality provides the context needed to understand someone as a whole person with particular goals and values that they pursue with a unique emotional style. A person's way of adapting to life experience can tell an experienced clinician much about his level of well-being and his vulnerability to various forms of psychopathology. Knowing a person's personality well can allow a psychiatrist to predict what other mental and physical disorders are likely to occur in the same person or in the same family. For example, individuals with antisocial personality are more likely to have substance abuse and less likely to have Parkinson's disease than others. On the other hand, if you learn someone has substance abuse, then you can reasonably suspect that they may be impulsive or novelty seeking. Recognition of the many associations between personality and psychopathology can greatly enhance clinical assessment and differential diagnosis in general. Understanding personality also helps in treatment planning because people differ markedly in the types of treatments to which they respond and with which they will comply. For example, personality traits predict much of the variability in response to antidepressants, whereas the symptoms of depression or other psychopathology do not. Personality develops over time in response to a changing internal and external environment. As a result, the longitudinal course of a person's development of personality and psychopathology is a key element in the clinical assessment of personality. Specifically, it is highly informative to know what a patient's personality was like as a child when assessing him in the presence of additional psycho-pathology, like a depression or anxiety state that modifies his emotions, thoughts, and behaviour. However, personality traits are not fixed and completely stable. Rather, each of us has a range of thoughts, feelings, and behaviours at any given point in time. As a result, our personality traits frequently vary within that range and occasionally change by moving beyond the previous range in response to particular internal and external events. Understanding the course of a person's development during his life is what allows the psychiatrist to understand him as a unique person.
Questionnaire, rating, and behavioural methods of assessment
Authors: Hall John N.
Published: January 2013

The earliest forms of psychiatric assessment were based on direct interviews with patients, on reported observations by those who knew the patient, and on direct observations by attendants—later nurses—in the care setting. Attempts to codify these forms of assessment had begun over 90 years ago, as illustrated by the ‘Behavior Chart’ of Kempf. The present range of structured psychiatric assessment methods grew from the 1950s in association with the introduction of neuroleptic medication and the development of psychiatric rehabilitation programmes. The two most frequently used types of systematic and structured assessment used in both clinical practice and research continue to be questionnaires and ratings. Their value lies in the systematic coverage of relevant content, and the potential for comparing scores across individuals and groups and over time. This section covers assessment methods that are appropriate for both self-report by patients and others—questionnaires—and observations and judgements made by others about the patient and their immediate circumstances—rating methods. This section will also briefly describe behavioural approaches to assessment of clinical relevance. Questionnaires offer the respondent a preset range of written questions covering the area of clinical interest, such as depression. The questions are usually completed by marking one of a set of provided response categories (forced-choice questions), but may be completed by the patient writing their own response in free text. Self-report and ‘self-monitoring’ methods are similar to the latter form of questionnaire, in that the patient completes a diary or pre-marked sheets. These are more open-ended, and any associated thoughts of the patient may be included. Self-report measures are used widely in cognitive behavioural interventions. Ratings are judgements about the quality or characteristics of a defined attribute or behaviour, completed subjectively, or on the basis of direct observation of the behaviour in question. While questionnaires are usually self-completed, ratings may be completed by one person with respect to another person. In psychiatric practice, ratings include those made by professional staff, often a nurse or care worker, or by a family member or informal carer, about a patient. Ratings and behavioural measures have a special use in the assessment of disturbed or bizarre behaviour, where the patient may have little insight or knowledge of the nature or degree of their disturbance, which may pose a major ongoing management problem, or a barrier to their placement in the community. An example of such a measure is the Aberrant Behavior Checklist. This is a 58-item behavioural rating scale completed by an informant, with the content covering five subscales: irritability, agitation, and crying; social withdrawal and lethargy; stereotyped behaviour; hyperactivity and non-compliance; and inappropriate speech.
From science to practice
Authors: Geddes John R.
Published: January 2013

Clinicians need accurate and up-to-date information about emerging knowledge on assessment and treatment as well as other developments in practice. The presentation of this knowledge needs to be timely, accurate, and unbiased. In an ideal world, every psychiatrist would have instantaneous access to the original scientific articles. As this is not feasible because clinicians are busy and the skills needed for an adequate systematic search, critical appraisal, and interpretation of research articles are not routinely available. Further, the volume of research articles is staggering: about 2 million papers are published in 20 000 biomedical journals every year, and even if a psychiatrist restricted her reading to those clinical psychiatry journals it would be necessary to read about 5500 papers each year—equivalent to 15 papers every day. Clearly, a strategy is required for efficient and timely identification of research that is both methodologically sound and clinically relevant. A coherent set of strategies designed as a clinical tool to link the best available evidence directly to the care of individual patients was first formulated at McMaster University in Canada—an approach called evidence-based medicine. Evidence-based medicine is problem-based and splits the process of linking research to practice into five stages (formulating a structured clinical question, finding evidence and advances in the organization of clinical knowledge, using a systematic approach to searching for the best available evidence, applying the evidence to the clinical problem, and assessing and improving the process) plus the identification of clinical questions in need of more research. To make evidence-based practice feasible in real-life clinical practice, a number of problems need to be solved at each stage of the process.
Neuroanatomy
Authors: Pearson R. C. A.
Published: January 2013

The symptoms, signs, and syndromes of psychiatry, whether organic or biological psychiatric disease or not, in the main reflect alterations in functions which reside in the cerebral cortex, including the limbic lobe, and those structures and pathways closely related to the cortex. These cortical manifestations of psychiatric disease include alterations in thought, language, perception, mood, memory, motivation, personality, behaviour, and intellect. Therefore, this brief account of brain structures and pathways that are important in psychiatry will concentrate on the cerebral cortex and related structures and pathways. Readers who require a fuller account of central nervous system anatomy are referred to the many standard texts, which give a more complete coverage of the subject. Broadly speaking, neuroanatomy can be subdivided into two parts—the topographical organization of the brain and spinal cord, and the anatomical connections forming functional pathways in the central nervous system. The former is of vital importance clinically, since pathologies rarely respect the boundaries of functional systems, and knowledge of the spatial relationships of different brain structures is increasingly useful as modern imaging methods more accurately visualize detailed brain structure in vivo. However, it is the second subdivision of the subject which makes the greater contribution to understanding the biological basis of psychiatric disease, and it is this that will be at the centre of the present account.
Psychology of attention
Authors: Coulthard Elizabeth , Husain Masud
Published: January 2013

Attention is generally taken to be the process by which people are able to concentrate on certain information or processes, while ignoring other events. It appears to be a fundamental attribute of human brain processing, although difficult to pin down in terms of mechanism. Psychologists have attempted to fractionate attention in many different ways, using ingenious behavioural paradigms. In this section we, too, will consider different aspects of attention: selective, phasic and sustained, divided and executive control of attention. However, it would be fair to say that all these aspects of attention do not normally operate in isolation. Instead they interact, and deficiencies in one aspect of attention, for example, in a patient population, often to do not occur in isolation. Functional imaging and lesion studies of attention have proliferated in recent years, attempting to place a neurobiological framework to these varied processes. In general, these studies also tend to confirm the view that attention is likely an emergent property of widespread brain networks, with a special emphasis on frontal and parietal regions of the human brain (Fig. 2.5.2.1). In this discussion we illustrate several aspects of attention with examples particularly from literature on visual attention, which is the most widely studied area, but it should be appreciated that many of the concepts discussed here extend to other domains. In fact, there is a good deal of evidence to suggest that several aspects of attention operate at a supra- or cross-modal level allowing integration of information from different sources. Recent studies suggest there are two fronto-parietal networks: (Fig. 2.5.2.1) a dorsal parieto-frontal network involving the superior parietal lobe (SPL) and dorsal frontal regions such as the frontal eye field (FEF); and a ventral network involving the inferior parietal lobe (IPL), temporoparietal junction (TPJ) and inferior frontal gyrus (IFG). In addition, dorsomedial frontal areas, including the anterior cingulate cortex (ACC) and pre-supplementary area (pre-SMA) may play a key role in flexible control of attention for strategic behaviour.
Neuropsychological basis of neuropsychiatry
Authors: Clark L. , Sahakian B. J. , Robbins T. W.
Published: January 2013

Psychiatry is the science of psychopathology, and as such, the measurement of behaviour and cognition is central to its theory and methodology. Neuropsychology provides such measures, which can be used to augment the psychiatric interview and other clinical instruments, as well as to provide an interface with other important approaches including functional brain imaging (see Dolan, this volume), functional genomics, and clinical psychopharmacology. Clinical neuropsychology has developed via the need to assess brain-damaged patients, whereas in most neuropsychiatric disorders, such damage is much less well defined if it is present at all. Thus, whilst there is growing information about specific brain abnormalities in many forms of neuropsychiatric disorder, the lesion model is not necessarily the most appropriate. Moreover, some of the deficits in disorders such as depression and anxiety involve subtle interactions between specific emotional and attentional mechanisms with cognitive function. Therefore, the study of neuropsychiatric patients has also enriched our understanding of clinical neuropsychology. We predict that these aspects of the discipline will develop considerably in the next few years, particularly in combination with data from other domains such as functional brain imaging and pharmacogenetics. Indeed, the specification of specific neural systems implicated in core behavioural or cognitive processes may well aid the enterprise of psychiatric genetics by providing more precise definitions of phenotypes (or endophenotypes) than are currently feasible in nosology (e.g. as defined by the Diagnostic and Statistical Manual).
Medical sociology and issues of aetiology
Authors: Brown George W.
Published: January 2013

David Mechanic, in his pioneering textbook, Medical Sociology, views human activity within an adaptive framework—as a struggle of human beings to control their environment and life situation. While this view informs the research to be outlined, there are a number of ways it differs in emphasis from much medical sociology. First, by its concern with particular disorders defined in medical terms. Second, by its use of the investigator rather than respondent to characterize phenomena—to decide, for example, whether an incident should be classified as a life event. Third, by the importance placed on context. In order, for example, for an investigator to make a judgement about the likely meaning of an event such as a loss of a job it is essential to know whether it cast the person in a bad light; its impact on the person's family; her chance of getting another job, and so on. It is such circumstances surrounding an event that usually give it meaning via the emotion they create. Finally, by recognizing that where appropriate such emotion should be taken into account: ‘A world experienced without any affect would be a pallid, meaningless world, and it is what gives us feedback about what is what is good or bad about our lives’.
Psychoanalysis: Freud's theories and their contemporary development
Authors: Kernberg Otto F.
Published: January 2013

Psychoanalysis is: 1 A personality theory, and, more generally, a theory of psychological functioning that focuses particularly on unconscious mental processes; 2 A method for the investigation of psychological functions based on the exploration of free associations within a special therapeutic setting; 3 A method for treatment of a broad spectrum of psychopathological conditions, including the symptomatic neuroses (anxiety states, characterological depression, obsessive–compulsive disorder, conversion hysteria, and dissociative hysterical pathology), sexual inhibitions and perversions (‘paraphilias’), and the personality disorders. Psychoanalysis has also been applied, mostly in modified versions, i.e. in psychoanalytic psychotherapies, to the treatment of severe personality disorders, psychosomatic conditions, and certain psychotic conditions, particularly a subgroup of patients with chronic schizophrenic illness. All three aspects of psychoanalysis were originally developed by Freud whose theories of the dynamic unconscious, personality development, personality structure, psychopathology, methodology of psychoanalytic investigation, and method of treatment still largely influence the field, both in the sense that many of his central ideas continue as the basis of contemporary psychoanalytic thinking, and in that corresponding divergencies, controversies, and radical innovations still can be better understood in the light of the overall frame of his contributions. Freud's concepts of dream analysis, mechanisms of defence, and transference have become central aspects of many contemporary psychotherapeutic procedures. Freud's ideas about personality development and psychopathology, the method of psychoanalytic investigation, and the analytic approach to treatment gradually changed in the course of his dramatically creative lifespan. Moreover, the theory of the structure of the mind that he assumed must underlie the events that he observed clinically changed in major respects, so that an overall summary of his views can hardly be undertaken without tracing the history of his thinking. The present overview will lead up to summaries of his final conclusions as to the structure of the mind and how this is reflected in personality development and psychopathology. Psychoanalysis will then be described as a method of treatment, as seen from the point of view of resolution of conflict between impulse and defence, and from that of object-relations theory. We shall explore significant changes that have occurred in all these domains, and conclude with an overview of contemporary psychoanalysis, with particular emphasis upon the presently converging tendencies of contemporary psychoanalytic approaches, and new developments that remain controversial.
Object relations, attachment theory, self-psychology, and interpersonal psychoanalysis
Authors: Holmes Jeremy
Published: January 2013

Despite many splits and schisms, dating back to Adler and Jung's early break with Freud, there has been an enduring attempt within psychoanalysis to hold to a central psychodynamic vision and to find common ground between differing theoretical and clinical approaches. The aim of this chapter is to describe the work of some of the major figures who have extended and developed Freud's ideas, pointing to areas of both conflict and convergence, and, wherever possible, to relate their concepts to the everyday practice of psychiatry.
Current psychodynamic approaches to psychiatry
Authors: Gabbard Glen O.
Published: January 2013

Psychodynamic psychiatry is broadly defined today. In fact, the term psychodynamic is now used almost synonymously with psychoanalytical. Freud originally used the term psychodynamic to emphasize the conflict between opposing intrapsychic forces: a wish was opposed by a defence, and different intrapsychic agencies, such as ego, id, and superego, were in conflict with one another. Indeed, for much of the twentieth century psychoanalytical theory was dominated by the drive-defence model, often referred to as ego psychology. A set of time-honoured basic principles, all derived from psychoanalytical technique and theory, define the overall approach of the dynamic psychiatrists, and these are discussed here. Another key component of the psychodynamic approach is that the clinician treats the person and not just the illness. In practice, that perspective means taking the personality into account in every case, and development of personality is discussed here, as is dynamic pharmacotherapy, multiple-treater settings, two-person context of treatment, and psychodynamic psychotherapy for specific disorders. Finally future directions are discussed.
Dementia with Lewy bodies
Authors: McKeith I. G.
Published: January 2013

Lewy bodies are spherical neuronal inclusions, first described by the German neuropathologist Friederich Lewy while working in Alzheimer's laboratory in Munich in 1912. In 1961, Okazaki published case reports about two elderly men who presented with dementia and died shortly after with severe extrapyramidal rigidity. Autopsy showed Lewy bodies in their cerebral cortex. Over the next 20 years, 34 similar cases were reported, all by Japanese workers. Lewy body disease was thus considered to be a rare cause of dementia, until a series of studies in Europe and North America, in the late 1980s, identified Lewy bodies in the brains of between 15 and 20 per cent of elderly demented cases reaching autopsy. Dementia with Lewy bodies (DLB) is unlikely to be a newly occurring disorder, since re-examination of autopsy material collected from elderly demented patients in Newcastle during the 1960s, reveals cortical Lewy bodies in 17 per cent of cases. The recent recognition of DLB as the second most common form of degenerative dementia in old age is largely due to the widespread use of improved neuropathological techniques, initially antiubiquitin immunocytochemistry, and more recently specific staining for alpha-synuclein which is a core constituent of Lewy bodies and related lesions.
Aetiology of alcohol problems
Authors: Negrete Juan C. , Gill Kathryn J.
Published: January 2013

Approximately 8 out of every 10 persons living in Europe and the Americas would report consuming alcoholic beverages in their lifetime, and the norm is for drinking to start in adolescence: in 2003 the average age of first drink in the United States was 14 years old. Also in the year 2003, 79.3 per cent of persons aged 15 years or more in Canada reported to be current users of alcohol, and 22.6 per cent admitted to having exceeded the country's safe drinking guidelines (i.e. no more than 14 units/week for males and 12 units/week for females). The same survey elicited a rate of ‘hazardous drinkers’ of 13.6 per cent, defined as all respondents who scored 8+ on the AUDIT screening questionnaire.Epidemiological data in the United States indicates that roughly one in seven persons who start drinking will develop an alcohol dependence disorder in the course of their lives. The figure is higher among men when compared to women. Of course it is also higher if other clinical forms of alcohol misuse (i.e. alcohol abuse/harmful drinking) are included in the rates in addition to dependence. A moderate level of alcohol use appears to be relatively harmless; and there exist public health guidelines on ‘safe’ drinking practices. The recommendations vary considerably from country to country, but they all assume a greater vulnerability to alcohol effects in the female gender. In the United Kingdom, for instance, hazardous drinking is thought to start at 21 units/week for men and 16 units/week for women; and in the United States the equivalent guidelines are 14 and 7 drinks per week. It is among alcohol users who exceed such guidelines that the prevalence of dependence is the highest; up to 40 per cent of the more frequent violators. The expression ‘alcohol problems’ encompasses a wide range of untoward occurrences, from maladaptive, impaired, or harmful behaviour, to health complications and the condition of alcohol dependence. Alcohol problems are not incurred just by chronic excessive drinkers, but also by persons who drink heavily on isolated occasions (e.g. accidents, violence, poisoning, etc.). Given their high frequency and social costs, these consequences of acute inebriation represent the most significant public health burden of drinking. This section focuses rather on the causes of problems of a clinical nature, the ones presented by individuals who engage in patterns of repeated excessive drinking, i.e. ‘alcohol dependence’ and ‘alcohol abuse’ (DSM-IV nomenclature) or ‘harmful drinking’ (ICD-10 nomenclature).
Treatment of alcohol dependence
Authors: Chick Jonathan
Published: January 2013

Some people repeatedly put themselves or others at risk by drinking. One view is that such people could drink sensibly if they were more considerate and used more will power. Another increasingly accepted view is that many such individuals are in a state, existing in degrees of severity, in which the freedom to decide whether to change their drinking, and to adhere to that decision, is reduced compared with other drinkers. This state partly depends on perceived pay-offs for changing, and on acquired dispositions, which are less accessible to conscious control. Such persons become aware of a wish, or urge, to drink, which overcomes rational thought. They may then make up an explanation, for example, ‘No wonder I feel like a drink, I've had a hard day’. Such individuals benefit from help to unlearn those patterns, and to learn different approaches to problems. Discussion, care, and encouragement from others can bolster their will to do so. Assistance to set-up controls within or from outside themselves may help. Some people can do this without external help, and others with the help of Alcoholics Anonymous (AA) alone. This approach argues that dependence on alcohol should be managed like other relapsing disorders, such as diabetes and asthma, by using long-term monitoring coupled with intermittent or continuous treatment. Research into alcoholism spanning 50 years has shown that the attitudes of the agency and the therapist influence patients’ outcome, as they may do for many illnesses. The therapeutic alliance is a strong predictor of outcome in the treatment of alcohol dependence. However, agencies must also be prepared to set limits on drunken behaviour at the clinic and telephone calls when intoxicated. And for patients who repeatedly relapse, resumption of treatment should sometimes be made conditional on complying with a new treatment plan, such as supervision of medication. Showing respect, enhancing dignity, conveying accurate empathy, adopting objective and not moral criteria, involving the family, and reducing hurdles to seeking help have been shown to improve compliance, and often outcome, for alcohol dependence.