bluuebunny/crossref_metadata_2025 huggingface dataset:
Medical ophthalmology
Authors: Hughes Edward , Stanford Miles
Published: January 2013

The chapter begins with an introduction to uveal anatomy. The following areas of clinical knowledge are then discussed: anterior uveitis, intermediate uveitis, posterior uveitis, specific non-infectious posterior uveitides, viral infectious uveitis, parasitic infectious uveitis, fungal infectious uveitis, bacterial infectious uveitis, HIV-related disease, the systemic associations of uveitis, scleritis and episcleritis, systemic treatment of ocular inflammatory disorders, biological agents and periocular treatments of ocular inflammatory disorders, intraocular treatments of ocular inflammatory disorders, rheumatological disease, vasculitis, cardiovascular disease and the eye, endocrine diseases in ophthalmology, and respiratory and skin diseases in ophthalmology. Practical skills are also addressed, namely orbital-floor injection, posterior sub-Tenon injection, and intravitreal injection. The chapter concludes with a case-based discussion on scleritis.
Glaucoma
Authors: Huntbach Julie , Alwitry Amar
Published: January 2013

The chapter begins by discussing optic nerve head anatomy and aqueous fluid dynamics, before covering the key clinical skills, namely optic nerve head assessment in glaucoma, tonometry and pachymetry , gonioscopy, and perimetry. It also covers the key areas of clinical knowledge, including ocular hypertension, primary open-angle glaucoma, acute angle closure, normal-tension glaucoma, steroid-induced glaucoma, traumatic glaucoma, inflammatory glaucomas, pseudoexfoliative and pigmentary glaucoma, neovascular glaucoma, malignant glaucoma, iridocorneal endothelial syndrome and iridocorneal dysgenesis, ocular hypotensive agents, laser therapy for glaucoma, and glaucoma surgery. The chapter concludes with three case-based discussions, on open-angle glaucoma, angle closure glaucoma, and steroid glaucoma.
Orbit
Authors: Daniel Claire , Sundaram Venki , Uddin Jimmy
Published: January 2013

This chapter begins by discussing orbital anatomy and orbital history and examination, before covering the key clinical knowledge, namely orbital infections, orbital inflammatory disease, orbital vascular malformations, orbital tumours, thyroid eye disease, orbital fractures and trauma, and orbital surgery. The chapter concludes with five case-based discussions, on childhood proptosis, non-axial proptosis, traumatic proptosis, orbital pain, and diplopia following trauma.
Professional skills and behaviour
Authors: Gardiner Matthew , Sundaram Venki
Published: January 2013

This chapter discusses the key professional skills, including good medical practice, communication, judgement and decision-making, clinical governance and patient safety, audit, appraisal, and revalidation, consent and confidentiality in the UK, education, training, and research, child protection in the UK, NHS structure and economics, and the Ophthalmic Trainees’ Group, as well as the key clinical skills, breaking bad news and dealing with complaints.
Oxford Case Histories in TIA and Stroke
Authors: Pendlebury Sarah T. , Schulz Ursula G. , Malhotra Aneil , Rothwell Peter M.
Published: January 2013

Based around the core curriculum for specialist trainees, Oxford Case Histories in Stroke features 51 well-structured, peer-reviewed cases from the Oxford Hospitals giving detailed coverage of the specialty, including diagnostic and management dilemmas.
Motor Neuron Disease
Authors: Talbot Kevin , Turner Martin R. , Marsden Rachael , Botell Rachel
Published: January 2013

Written and designed to provide comprehensive, easily accessible advice for all healthcare professionals involved in the care of patients with this challenging condition, this resource addresses the entire care pathway from presentation to diagnosis to symptom management and end of life issues.
Symptomatic therapy
Authors: Glassock Richard J.
Published: January 2013

Patients with glomerular diseases develop a wide variety of biochemical disturbances and pathophysiologic alterations leading to overt clinical manifestations (Remuzzi, 1993; Glassock et al., 1995, Remuzzi and Bertani, 1998; Schrier and Fassett, 1998; Vaziri, 2003; Floege and Feehally, 2007; Kim et al., 2007; Haraldsson et al., 2008). These occur as a direct result of injury to the capillary wall and disturbances in normal glomerular function, including loss of filtration capacity and excessive transfer of erythrocytes and/or plasma proteins from blood to tubular lumina eventuating in hematuria and/or proteinuria. Proteinuria—which is believed to be the consequence of disturbed glomerular capillary wall permselectivity (Haraldsson et al., 2008) —when substantial, can lead to hypoproteinemia and thereby to a reduction in plasma oncotic pressure. Changes in the synthesis, turnover, and plasma concentration of various proteins and lipids develop and can lead to an imbalance of pro-thrombotic and anti-thrombotic factors promoting a ‘thrombophilic’ state (Vaziri, 2003; Crew et al., 2004; Glassock, 2007) Disturbances in the renal handling of sodium chloride (NaCl) and water are often associated with edema formation and/or hypertension (Perico and Remuzzi, 1993; Schrier and Fassett, 1998). Finally, the rapid or slow loss of the glomerular filtration capacity (glomerular filtration rate, GFR) due to damage of single nephrons (perhaps mediated by filtered proteins and their reabsorption) as well as by the ‘drop out’ of functioning nephrons from the overall population of nephrons in the two kidneys is responsible for ultimate progression to end-stage renal disease (ESRD) in many, but not all, of the primary glomerular disorders (Drummond et al., 1994; Remuzzi and Bertani, 1998; Squarer, et al., 1998; Floege and Feehally, 2007).

Collectively these abnormalities give rise to ‘syndromes’ of glomerular disease. These ‘syndromes’ can be arbitrarily, but usefully, grouped into five categories which may overlap to some degree; namely, the acute nephritic syndrome, rapidly progressive glomerulonephritis, the nephrotic syndrome, ‘symptomless’, haematuria and/or proteinuria, and slowly progressive ‘chronic’ nephritis (Glassock et al., 1995). The cardinal features of these syndromes and the diseases to which they are most closely associated are discussed in this monograph. This monograph will deal largely with those glomerular diseases which primarily affect the kidneys and in which the extra-renal manifestations are the consequence of the impairment or disturbance of kidney function itself (the so-called primary glomerular diseases).
Evaluation of observational and controlled trials of therapy
Authors: Glassock Richard J. , Cattran Daniel C.
Published: January 2013

The literature on the subject of treatment of glomerular disease is immense (over 15,000 articles in PubMed as of July, 2008). Negotiating this broad and complex panorama can be a difficult task, especially in relationship to the evaluation of the best evidence for a particular treatment strategy for a specific disease entity occurring in an individual patient. Perfection is not attainable in clinical trials of therapy and every report has some pitfall or limitation. Some studies, however, stand out as excellent examples of design and execution. Unfortunately, in the field of treatment of glomerular disease such studies are relatively uncommon. The good news is that well designed and executed studies of treatment of primary glomerular disease are being reported with increasing frequency in recent years. This has occurred in part because of increased collaboration among groups interested in furthering knowledge in this important area of inquiry, but also because of better recognition of the deficiencies of past efforts to study treatment of glomerular disease in clinical trials. Many interinstitutional collaborative studies have been aided by improvements in trial design and by more complete descriptions of the natural history of untreated disease. One of the main weaknesses of clinical studies of therapy in primary glomerular disease is the small numbers of subjects studied in individual reports. This increases the risks of confounding and of both false positive and false negative results.

The purpose of this chapter is to provide a concise analysis of the strengths and weakness of the various approaches to the study of therapeutic efficacy and safety of agents used in primary glomerular disease. The focus will be on observational studies, controlled clinical trials, and meta-analyses of published reports. The specific aims are to equip the discerning reader for improved understanding of the evidence-base for therapy of primary glomerular disease. The details of the specific reports and how they can be integrated into an
‘evidence-based’ approach to therapeutic decision-making are dealt with in the chapters devoted to specific disease entities which follow.
Minimal change nephropathy
Authors: Coppo Rosanna , Ponticelli Claudio
Published: January 2013

Minimal change nephropathy (MCN), also called ‘minimal change disease’ in the USA, is chiefly characterized by episodes of nephrotic syndrome—presenting with massive proteinuria, hypoalbuminemia, generalized edema, hyperlipidemia—and no lesions or only minimal glomerular abnormalities in the renal biopsy examined by light microscopy.
Membranous nephropathy
Authors: Passerini Patrizia , Ponticelli Claudio
Published: January 2013

Membranous nephropathy (MN) is a glomerular disease which is characterized histologically by uniform thickening of the glomerular capillary due to the presence of immunoglobulin-containing deposits on the outer or subepithelial aspect of the glomerular basement membrane (GBM). It exists in idiopathic (etiology unknown) or secondary (causally associated with another disorder) forms. Differentiation of the idiopathic membranous nephropathy (IMN) from secondary forms of MN may be difficult. It is a frequent cause of the nephrotic syndrome in adults. It is also characterized by a tendency for spontaneous remission in some patients and by persistence of proteinuria and slow progression to end-stage renal disease (ESRD) in others. Those patients with severe and un-remitting nephrotic syndrome may also suffer from disabling and even life-threatening extra-renal complications, such as thromboembolic events.
Heart failure
Authors: Kaski Juan Carlos
Published: January 2013

Introduction 4

Chronic heart failure with reduced LVEF (systolic heart failure) 6

Pharmacological management of chronic heart failure 8

Non-pharmacological management of chronic heart failure 18

Chronic heart failure with preserved LVEF (diastolic heart failure) 20

Acute heart failure 22

Clinical trials 26

Heart failure (HF) is a complex condition that results from cardiac functional and/or structural abnormalities that affect the ability of the heart to pump blood, and is often defined as the inability of the heart to adequately perfuse the organs of the body. Symptoms of HF vary depending on several factors but the most common manifestations of HF are dyspnoea and fatigue. Of importance, HF is not necessarily associated with a reduced ejection fraction (EF) (systolic HF), as up to 50% of cases occur in the presence of a preserved systolic function (diastolic dysfunction)....
Coronary artery disease: Acute coronary syndrome
Authors: Kaski Juan Carlos
Published: January 2013

Background 46

Management of ST elevation myocardial infarction (STEMI) 48

Non-ST elevation myocardial infarction (NSTEMI) 52

Unstable angina 52

Therapeutic agents 56

Drugs for secondary prevention therapy after ACS 66

Further reading 70

Acute coronary syndrome (ACS) encompasses a spectrum of disorders resulting from severe acute myocardial ischaemia. The most common pathogenic mechanism is acute intracoronary thrombosis resulting from atheromatous plaque disruption or erosion. Platelet activation, thrombosis, and coronary vasoconstriction are all important pathogenic mechanisms in ACS....
Coronary artery disease: Prevention of cardiovascular disease
Authors: Kaski Juan Carlos
Published: January 2013

Prevention of cardiovascular disease 72

Treatment 76

Cardioprotective agents 80

Trials supporting current recommendations 84

Further reading 86

The aim of prevention is to improve life expectancy and quality of life by reducing cardiovascular events in high-risk patients.

Prevention is often described as primary, involving subjects who are at risk of developing cardiovascular disease (CVD) but are currently asymptomatic and have no evidence of CVD, or ...
Coronary artery disease: Post-PCI management
Authors: Kaski Juan Carlos
Published: January 2013

Antiplatelet therapy 88

Antiplatelet therapy in patients on warfarin 90

Renal impairment 92

Secondary prevention 92

Clinical trials 93

One of the most important measures following PCI and stenting is dual antiplatelet therapy. All patients should be prescribed aspirin 75mg and clopidogrel 75mg after loading prior to PCI....
Systemic hypertension
Authors: Kaski Juan Carlos
Published: January 2013

Background 96

Definition and long-term complications 96

Causes 98

Clinical assessment 100

Classification of hypertension 101

General management principles 102

Treatment targets 105

Acute presentation of hypertension 105

Management of hypertension 106

Management of hypertension in specific clinical circumstances 110

Prevalence estimates of systemic hypertension are 1 billion worldwide, contributing to 4.5% of global disease burden, 64 million DALYs (disability adjusted life-years), and 7.1 million premature deaths. Analyses by the World Health Organization (WHO) indicate that about 62% of CVD and 49% of ischaemic heart disease are attributable to suboptimal BP levels (SBP >115mmHg)....
Infective and inflammatory cardiac conditions
Authors: Kaski Juan Carlos
Published: January 2013

Infective endocarditis 192

Treatment of endocarditis 194

Enterococcal endocarditis 204

Endocarditis caused by HACEK organisms 210

Fungal endocarditis 212

Culture-negative endocarditis 214

Antimicrobial prophylaxis 218

Pericarditis 220

Myocarditis 223

Infective endocarditis is an infection of the endocardium which usually involves the heart valves. In current clinical practice, endocarditis encompasses a heterogeneous collection of infections that may involve native cardiac tissues, prosthetic valves, pacing systems, and a variety of intracardiac implants. Endocarditis is mainly caused by bacteria, but fungi are occasionally implicated....
Cardiovascular drugs in pregnancy and breastfeeding
Authors: Kaski Juan Carlos
Published: January 2013

Cardiac disease in pregnancy 226

Hypertension 228

Arrhythmias 238

Prosthetic heart valves 244

Valvular heart disease 248

Congenital heart disease 249

Antibiotic prophylaxis peripartum 250

Cardiomyopathy 251

Ischaemic heart disease 253

Cardiac disease is the leading cause of mortality in pregnancy, although overall only small numbers of women are affected. ...
Drugs in adult congenital heart disease
Authors: Kaski Juan Carlos
Published: January 2013

Introduction 278

Part 1: General information for the management of patients with congenital heart disease 280

Part 2: Information specific to each type of congenital heart disease 284

This chapter has been subdivided into: Part 1, which contains general information for the management of adult patients with congenital heart disease (ACHD), and ...
Cardiac manifestations of inborn errors of metabolism and infiltrative cardiac disease
Authors: Kaski Juan Carlos
Published: January 2013

Introduction 298

Table 10.1 Cardiac manifestations of inborn errors of metabolism 299

Inherited metabolic disorders cause heart disease through the accumulation or infiltration of abnormal metabolic products. They generally cause diastolic impairment, with different degrees of systolic impairment and arrhythmias. The particular importance of these conditions is that some cases can be treated with enzyme-replacement therapy....
Aortic and peripheral vascular disease
Authors: Kaski Juan Carlos
Published: January 2013

Peripheral arterial disease 316

Aortic aneurysms 320

Aortic dissection 322

Large-vessel vasculitis 324

Peripheral arterial disease (PAD)—sometimes termed peripheral vascular disease—refers to atherosclerosis, usually of the lower limbs, with obstruction to blood supply. This usually gives rise to intermittent claudication and may progress to critical limb ischaemia characterized by rest pain, ulceration, and gangrene. Symptoms may become acutely worse due to atherothrombosis or acute embolization. PAD is increasingly recognized as a marker of arterial disease in other vascular beds as atherosclerosis is usually widespread....
Drugs in Palliative Care
Authors: Dickman Andrew
Published: January 2013

Providing an overview of pharmacology and prescribing advice, this second edition contains over 160 drug monographs, presented in an A-Z format. Fully revised and updated, this detailed yet concise resource will appeal to all healthcare professionals involved in the provision of palliative care and medicines information.
H
Authors: Dickman Andrew
Published: January 2013

This chapter includes drugs beginning with the letter H
N
Authors: Dickman Andrew
Published: January 2013

This chapter includes drugs beginning with the letter N
V
Authors: Dickman Andrew
Published: January 2013

This chapter includes drugs beginning with the letter V
The patient's perspective
Authors: Jamison Kay Redfield , Wyatt Richard Jed , Kaplin Adam Ian
Published: January 2013

It is difficult to be a psychiatric patient, but a good doctor can make it less so. Confusion and fear can be overcome by knowledge and compassion, and resistance to treatment is often, although by no means always, amenable to change by intelligent persuasion. This chapter provides an overview of the patient's perspective.
Public attitudes and the challenge of stigma
Authors: Thornicroft Graham , Brohan Elaine , Kassam Aliya
Published: January 2013

If we deliberately shift focus from stigma to discrimination, there are a number of distinct advantages. First attention moves from attitudes to actual behaviour, not if an employer would hire a person with mental illness, but if he or she does. Second, interventions can be tried and tested to see if they change behaviour towards people with mental illness, without necessarily changing knowledge or feelings. The key candidates as active ingredients to reduce stigma are: (i) at the local level, direct social contact with people with mental illness; and (ii) social marketing techniques at the national level. Third, people who have a diagnosis of mental illness can expect to benefit from all the relevant anti-discrimination policies and laws in their country or jurisdiction, on a basis of parity with people with physical disabilities. Fourth, a discrimination perspective requires us to focus not upon the ‘stigmatized’ but upon the ‘stigmatizer’. In sum, this means sharpening our sights upon human rights, upon injustice, and upon discrimination as actually experienced by people with mental illness.
Values and values-based practice in clinical psychiatry
Authors: Fulford K. W. M.
Published: January 2013

Values-based practice is a new skills-based approach to working more effectively with complex and conflicting values in health and social care. This chapter illustrates some of the ways in which combining values-based with evidence-based approaches supports the day-to-day practice of the clinical psychiatrist, particularly in the context of multidisciplinary teamwork.
Descriptive phenomenology
Authors: Sims Andrew
Published: January 2013

Psychopathology is the systematic study of abnormal experience, cognition, and behaviour. It includes the explanatory psychopathologies, where there are assumed causative factors according to theoretical constructs, and descriptive psychopathology, which precisely describes and categorizes abnormal experiences as recounted by the patient and observed in his behaviour. Therefore the two components of descriptive psychopathology are the observation of behaviour and the empathic assessment of subjective experience. The latter is referred to by Jaspers as phenomenology, and implies that the patient is able to introspect and describe what these internal experiences are, and the doctor responds by recognizing and understanding this description. Descriptive phenomenology, as described here, is synonymous with pheno-menological psychopathology, and involves the observation and categorization of abnormal psychological events, the internal experiences of the patient, and consequent behaviour. The attempt is made to observe and understand this psychological event or phenomenon so that the observer can, as far as possible, know what the patient's experience must feel like.
Cognitive assessment
Authors: Powell Graham E.
Published: January 2013

Psychometric methods based on classical test theory have permitted the development of reliable and valid tests assessing a wide range of intellectual and cognitive functions. Test results assist in formulation and diagnosis, guide rehabilitation and management, provide baseline measures to detect change, and generally assist clinical decision-making regarding such issues as capacity. Tests and assessment procedures are being further developed so as to improve their ecological validity, enabling better prediction of real-life behaviour and functioning.
Neurotransmitters and signalling
Authors: Sharp Trevor
Published: January 2013

By the end of the 19th century it was recognized that signalling from one neurone to the next occurs at specialized contacts – Sherrington coined the term ‘synapse’. It took another 50 years for scientists to accept that information passes between neurones principally through the movement across synapses of chemicals and not electrical current. Today changes in chemical transmission at brain synapses are accepted as being key to the successful drug treatment, and cause, of many forms of psychiatric illness. This article focuses on general aspects of chemical transmission and describes some recent advances relevant to psychiatry that point the direction of future research. Otto Loewi identified the first chemical neurotransmitter, acetylcholine, in 1921. Today evidence suggests that there are many tens if not hundreds of molecules in the brain that have neurotransmitter properties. These molecules include not only the three major classes of neurotransmitters—amines, amino acids and neuropeptides—but also specific purines, trophic factors, inflammatory mediators (chemokines and cytokines), lipids, and even gases. Examples of molecules that serve neurotransmitter functions in the brain are listed in Table 2.3.4.1. This list is not exhaustive and more are likely to be discovered.
Functional magnetic resonance imaging
Authors: Bullmore E. T. , Suckling J.
Published: January 2013

Functional magnetic resonance imaging (fMRI) is a relatively new technique for measuring changes in cerebral blood flow. The first fMRI studies, showing functional activation of the occipital cortex by visual stimulation and activation of the motor cortex by finger movement, were published in the early 1990s. In the years since then, fMRI has been used to investigate the physiological response to a wide variety of experimental procedures in both normal human subjects and diverse patient groups. In the next 10 years, fMRI will probably establish a role for itself in radiological and psychiatric practice; currently the clinical role of fMRI is limited to specialized applications such as assessment of hemispheric dominance prior to neurosurgery. The outstanding advantage of fMRI over alternative methods of imaging cerebral blood flow, such as positron emission tomo-graphy (PET) and single-photon emission computed tomography (SPECT), is that it does not involve exposure to radioactivity. This means that a single subject can safely be examined by fMRI on many occasions, and that the ethical problems of examining patients are minimized. Functional MRI also has superior spatial resolution (in the order of millimetres) and temporal resolution (in the order of seconds) compared with PET and SPECT. In this chapter, we provide an introduction to technical issues relevant to fMRI data acquisition, study design, and analysis. An introduction to the basic physical principles of magnetization and nuclear magnetic resonance, and the technology, is given in Chapter 2.3.7. Many excellent specialist texts covering all aspects of functional magnetic resonance imaging are available for the reader seeking more detailed treatment of the issues.
Psychoneuroimmunology
Authors: Dantzer Robert , Kelley Keith W.
Published: January 2013

Mind-body literature, in the form of magazines and self-help books on stress and healing, is full of definitive claims for the existence of powerful influences of emotions and psychosocial stressors on the immune system, leading to onset or progression of cancers or infectious diseases. This literature often makes explicit reference to research in psychoneuroimmunology to support these claims. Psychoneuroimmunology is a multi-disciplinary field that has grown rapidly during the last three decades at the crossroads of immunology, behavioural neurosciences, neuroendocrinology, and psychology. It studies mechanisms and functional aspects of bidirectional relationships between the brain and the immune system. Although still controversial, there is evidence that psychological events including emotions can and do influence the outcome of infectious, autoimmune, and neoplastic diseases via modulation of cells of the immune system. A surprising finding has been that immune events occurring in the periphery also affect mood, behaviour, and metabolism by modulating brain functions, thereby providing a biologically important link between the immune system and brain. The original discovery that activation of the innate immune system in the periphery causes clinical signs of sickness that are processed in the brain is now being extended to the involvement of the immune system in depressive disorders. This new information has solidified the idea that neurotransmitters, neuropeptides, neural pathways, and immune-derived signals such as cytokines are the minimal essential elements that permit the immune system and brain to communicate with one another. These new data offer the unexpected conclusion that the immune system is likely to be involved in not only how emotions affect health but also how immune events regulate the development and expression of emotions.
Developmental psychology through infancy, childhood, and adolescence
Authors: Yule William , Woolgar Matt
Published: January 2013

Taking a developmental perspective to mental health issues should apply across the lifespan. Psychiatrists working with adults need to understand where their clients are coming from and where they are going to. They need to understand the pleasures and pressures that children bring to their parents, and where appropriate they should be considering the impact of parental illness on the children. The institutionalized separation of child and adult psychiatry (in terms of service delivery) should not lead to a separation in ways of considering the developmental context of presenting problems. This chapter has shown that there are many small, focused models of development that deal with discrete areas of development. Stage theories emphasize differences at different stages; social learning theories emphasize continuities on processes of development. As long as practitioners are aware that when they say a child is at a particular stage, this is but a rough guide to describing the child, which may be fine. It is when such models are taken literally, that oversimplification leads to poor practice. There is no one overarching theory of child development and while this may be inconvenient for examiners, it truly reflects the rich diversity of human development. By paying more attention to the interactions between biological, social, and psychological factors, a better understanding of healthy, normal development will emerge. Empirical studies will help identify risk and protective factors which in turn will lead to better mental health promotion and more effective interventions when mental disorders manifest.
Psychology and biology of memory
Authors: Meyer-Lindenberg Andreas , Goldberg Terry E.
Published: January 2013

Memory is the ability to store, retain, and retrieve information. This cognitive function plays a key role in psychiatry. Dementia and the amnesic disorders have memory dysfunction as a defining feature. Intrusive and recurrent emotional memories are one of the most distressing symptoms in post-traumatic stress disorder. Although not as obvious, problems with memory are also commonly revealed on testing in schizophrenia. Remembered episodes are often a focus in psychotherapy, as is the acquisition of new habits and response patterns. An ability to understand and assess memory is therefore important for the practising psychiatrist. In this chapter, basic neurobiological and psychological information on memory will be reviewed. We have tried to cover a very broad field in a concise manner and give the interested reader a sense of the key memory systems and subsystems that are thought to be important for human information processing in health and in disease. We have emphasized the conceptual over the theoretical and key findings over the experimental details where possible. At times, we have not carefully separated the cognitive and neuroanatomical levels of analysis, both because they are sometimes almost inextricably bound and because it made our explanations clearer not to do so. Necessarily but not happily, we have omitted many important and active areas of investigation.
The contribution of epidemiology to psychiatric aetiology
Authors: Henderson Scott
Published: January 2013

The epidemiology of psychiatric disorders has shown the extent to which these are present in all human populations. It has also provided a large body of knowledge about aetiology. Now that biological including genetic information can be added to data on environmental exposures, opportunities for further advancement carry much promise.
Dementia: Alzheimer's disease
Authors: Lovestone Simon
Published: January 2013

Alzheimer's disease (AD) and other dementias incur huge costs to society, to the families of those affected, and to the individuals themselves. Costs to society include both direct costs to health and social services and indirect economic costs in terms of lost productivity, as carers are taken out of the workplace, and the economic costs to those families caring for or funding the care of their relative. Increasingly, as treatments become available, these costs are targets for change and are part of the cost–benefit analysis of new compounds, especially the largest single direct cost, that of the provision of nursing and other forms of continuing care. Apart from the financial cost to families there is the emotional impact resulting in distress and psychiatric morbidity. As the population ages, these costs pose substantial social and economic problems. Although lifespan itself has remained static, the numbers of elderly in both developed and developing societies is increasing rapidly. In the developed world the sharpest projected growth is in the very elderly cohort—precisely the one that is at most risk of AD. Within the developing world, the total number of elderly people is projected to rise substantially, reflecting to a large part better child health and nutrition. For countries in South America and Asia, with large and growing populations, the costs involved in caring for people with dementia in the future will become an increasing burden on health and social services budgets. In the absence of such services families will inevitably shoulder the main part of providing care, although the very process of development is associated with increasing urbanization and, to some degree, a diminution of the security provided by extended family structures.
Frontotemporal dementias
Authors: Gustafson Lars , Brun Arne
Published: January 2013

Nosological classification of organic dementia is based on current knowledge and theories of aetiology, including genetics, clinical picture, the pathological substrate, and the predominant location of brain damage. This chapter is concerned with dementia syndromes caused by a degenerative disease primarily affecting the frontal and temporal lobes, named frontal-lobe dementia or frontotemporal dementia (FTD). The terminology should be viewed from a historical perspective. The relationship between localized cortical atrophy in dementia and symptoms of aphasia was first reported by Pick in 1892. The pathological account of this lobar degeneration by Alzheimer in 1911 described ‘ballooned’ neurones (Pick cells) and argentophilic globes (Pick bodies), and the clinicopathological entity was named Pick's disease. In the 1980s, attention was drawn to a larger group of frontal-lobe dementias associated with frontotemporal cortical degeneration. The Lund–Manchester consensus of 1994 delineated the prototypical clinical syndrome of FTD with three neuropathological constituents, frontal lobe degeneration of non-Alzheimer type (FLD), (alternatively designated ‘dementia lacking distinctive histology’), Pick's disease, and motor neurone disease (MND) with dementia (FTD-MND). The 1998 consensus on clinical diagnostic criteria for frontotemporal lobar degeneration (FTLD) encompassed two additional dementia syndromes; progressive non-fluent aphasia (PA), and semantic dementia. Corticobasal degeneration (CBD) and progressive supranuclear palsy (PSP) have also been associated with FTLD. A changing clinical classification is shown in Fig. 4.1.3.1. The addition of important genetic and histochemical characteristics has further added to the complex classification of FTD and FTLD with a risk of developing numerous and partly competing definitions. FTLD may be further subclassified into forms positive or negative for tau and ubiquitin. The ubiquitinated form will be referred to as FTD-U, which is synonymous to FLTD-U.
Prion disease
Authors: Collinge John
Published: January 2013

The human prion diseases, also known as the subacute spongiform encephalopathies, have been traditionally classified into Creutzfeldt–Jakob disease (CJD), Gerstmann–Sträussler syndrome (GSS) (also known as Gerstmann–Sträussler–Scheinker disease), and kuru. Although rare, affecting about 1–2 per million worldwide per annum, remarkable attention has been recently focused on these diseases. This is because of the unique biology of the transmissible agent or prion, and also because bovine spongiform encephalopathy (BSE), an epidemic bovine prion disease, appears to have transmitted to humans as variant CJD (vCJD), opening the possibility of a significant threat to public health through dietary exposure to infected tissues. The transmissibility of the human diseases was demonstrated with the transmission, by intracerebral inoculation with brain homogenates into chimpanzees, of first kuru and then CJD in 1966 and 1968, respectively. Transmission of GSS followed in 1981. The prototypic prion disease is scrapie, a naturally occurring disease of sheep and goats, which has been recognized in Europe for over 200 years and which is present in the sheep flocks of many countries. Scrapie was demonstrated to be transmissible by inoculation in 1936 and the recognition that kuru, and then CJD, resembled scrapie in its histopathological appearances led to the suggestion that these diseases may also be transmissible. Kuru reached epidemic proportions amongst the Fore linguistic group in the Eastern Highlands of Papua New Guinea and was transmitted by ritual cannibalism. Since the cessation of cannibalism in the 1950s the disease has declined but a few cases still occur as a result of the long incubation periods in this condition, which may exceed 50 years. The term Creutzfeldt–Jakob disease was introduced by Spielmeyer in 1922 bringing together the case reports published by Creutzfeldt and Jakob. Several of these cases would not meet modern diagnostic criteria for CJD and indeed it was not until the demonstration of transmissibility allowed diagnostic criteria to be reassessed and refined that a clear diagnostic entity developed. All these diseases share common histopathological features; the classical triad of spongiform vacuolation (affecting any part of the cerebral grey matter), astrocytic proliferation, and neuronal loss, may be accompanied by the deposition of amyloid plaques.
Dementia in Parkinson's disease
Authors: Mindham R. H. S. , Hughes T. A.
Published: January 2013

Parkinson's disease has been regarded as a neurological condition mainly affecting motor function and arising from specific lesions in the brain stem. The recognition of dementia in Parkinson's disease is of importance in management but the possibility that motor and cognitive functions may be located in the same region of the brain is of theoretical importance.
Dementia due to Huntington's disease
Authors: Folstein Susan , Margolis Russell L.
Published: January 2013

Huntington's disease (HD) was first described in 1872 by an American physician living on Long Island, New York. His father and grandfather practised medicine in the same community, so he had access to case notes from several generations of families who lived there. This long period of record keeping allowed him to document a hereditary form of chorea, similar to ‘common (Sydenham's) chorea’, but progressing over many years to death. Its sufferers had a tendency to insanity and suicide. Huntington's brief essay, which also included a clear description of autosomal dominant inheritance, remains one of the classical descriptions of a medical disorder.
Alcohol-related dementia (alcohol-induced dementia; alcohol-related brain damage)
Authors: Marshall Jane
Published: January 2013

Long-term heavy alcohol consumption causes significant brain abnormalities and impairs cognitive functioning. A number of terms have been used to describe these effects, including: ‘alcohol-related dementia’, ‘alcohol-induced dementia’, and ‘alcoholic dementia’. The more pragmatic umbrella term ‘alcohol-related brain damage’ (ARBD) is also used. The literature is beset with limitations, in particular the lack of a diagnostic gold standard, and the difficulty in making a clinical diagnosis. Many individuals labelled as having an alcohol-related dementia are, in fact, suffering from the Wernicke–Korsakoff syndrome (WKS). (This is a specific neuropathological disease caused by thiamine deficiency, which can occur secondary to alcohol misuse. It is considered in Chapter 4.1.12.) When considering the topic of ‘alcohol-related dementia’ it is probably sensible to take a broad clinically-based diagnostic view that includes both WKS and other cases of ‘dementia’ that appear to be alcohol-related. Alcohol-related dementia should be recognized as a preventable condition. However, identification is hampered by a lack of clarity in terminology, and a lack of standardized and specialized screening instruments and assessment procedures. These individuals make repeated use of Accident and Emergency Departments, general medical, and long stay wards. Early identification would reduce their need for these services. Abstinence is the key to recovery. Treatment services should be integrated and flexible.
Pharmacological and psychological aspects of drugs abuse
Authors: Nutt David J. , Law Fergus D.
Published: January 2013

Drug abuse, misuse, and addiction are major issues in society because of their enormous personal, social, and economic costs and their important psychiatric components. Many drug treatment programmes are run by psychiatrists, and the evidence strongly supports the notion that a significant proportion of severe drug abusers are psychiatrically ill. Moreover, drug misuse appears to be becoming more frequent in patients with other psychiatric disorders, where it can lead to problems in treatment and poorer outcomes. It is therefore essential for all psychiatrists and related health professionals to have a good understanding of the basis of drug misuse.
Alcohol and psychiatric and physical disorders
Authors: Mann Karl F. , Kiefer Falk
Published: January 2013

This chapter covers the clinical symptoms of alcohol intoxication, withdrawal (without complications and with perceptual disturbances, grand mal seizures, delirium tremens, and alcoholic hallucinosis), and psychiatric disorders, including alcohol-induced mood disorders and alcohol-induced anxiety disorders. The effects of alcohol on the brain are covered in detail, including Wernicke’s encephalopathy, Korsakoff’s syndrome, cerebellar degeneration, hepatocerebral degeneration, and foetal alcohol syndrome, as are the effects on the body, including malnutrition and vitamin deficiency, peripheral neuropathy, effects on the muscle, liver, pancreas, skin, and heart, and the relationship between alcohol and hypertension and cancer.
Schizophrenia: a conceptual history
Authors: Andreasen Nancy C.
Published: January 2013

We know that psychotic disorders have been present and publicly recognized at least since classical times because of their portrayals in literature: the madness of Medea, the frenzied behaviour in The Bacchae, or the paranoia of Othello. Perhaps the most ‘valid’ portrayal from a modern clinical perspective is the feigned madness of ‘Poor Tom’ in King Lear. However, the definition and delineation of schizophrenia as a discrete disorder is a relatively recent phenomenon. This chapter covers the founding fathers of the concept: Kraepelin and Bleuler, Schneiderian symptoms, psychosis, and the dominance of diagnostic criteria, and the concept of positive and negative symptoms, finishing with a look present and future developments.
Treatment and management of schizophrenia
Authors: Owens D. G. Cunningham , Johnstone E. C.
Published: January 2013

The above might be interpreted as inferring that nothing much has changed in the treatment and management of schizophrenia, which remains a somewhat pessimistic, even unrewarding, area of therapeutic endeavour: one that is regressing far less moving on. This is far from our experience and the opposite of the impression we wish to create. Certainly, as far as drug treatments are concerned, no single agent or type of agent now seems more satisfactory across the board than any other, but the challenge to ‘atypicality’ as a valid subgrouping of antipsychotics does not limit options—rather it broadens them, restoring to the treatment repertoire the wide range of choices that is the key to individualized care planning. With psychosocial interventions, there does remain more work to be done in proving absolute efficacy and/or effectiveness and the relative place of each, but in service development and care planning, risk:benefit appraisal is sophisticated enough to encompass what has qualitative value as well as what is quantitatively proven. As in all branches of medicine where chronic and relapsing disease is encountered, restoring order on chaos, fostering engagement and lighting a way forward when none may be obvious are for the highest levels of skill, in which evidence-based practice can provide the direction but not yet the specific path. We are fortunate in now having available to us the greatest ever range of interventions to bring to the care of those who suffer from this most complex and fell disorder. None is comprehensive, all have limitations, but if we wish to provide quality care, care that accounts for the multifarious manifestations patients present, it is our duty to apply not only the experience of others but of ourselves too. There is no ‘quick fix’ in gaining competence in the treatment and management of schizophrenia—and, as yet, no curative ‘holy grail’ either. But there is, more than ever, the opportunity for clinicians to demonstrate real expertise in moulding the range of therapeutics now at our disposal. If that is not reason for medical optimism, what is!
Schizoaffective and schizotypal disorders
Authors: Tsuang Ming T. , Stone William S. , Faraone Stephen V.
Published: January 2013

This chapter focuses on two disorders in the schizophrenia ‘spectrum’: schizoaffective disorder and schizotypal personality disorder. The emphasis includes the clinical features, classification, diagnosis, epidemiology, aetiology, course, prognosis, and possibilities for prevention for each disorder. Some aspects will be underscored to reflect controversial issues, such as the heterogeneity apparent in each condition. Such issues relate to the accurate classification of the disorders, which is important for at least two reasons. First, it is essential to develop reliable and valid diagnostic criteria in order to study the aetiology of the disorders and then utilize that knowledge to develop rational and testable intervention strategies. Heterogeneity adds variance to the process that reduces both the reliability of diagnosis and also the statistical power of experimental designs to detect intervention/treatment effects. Second, the development of newer generations of psychopharmacological treatments holds the promise of matching more appropriate and efficacious medications with specific syndromes or types of symptoms. This trend underscores the importance of differential diagnosis in determining what treatment a patient will receive. Heterogeneity within a diagnostic category complicates achievement of this goal. Another area to be emphasized involves the goal of early interventions, in addition to palliative treatments for these disorders. In contrast, other areas such as the genetic aetiology of schizoaffective disorder and schizotypal personality disorder, and treatments for schizoaffective disorder, will receive less emphasis here, to avoid redundancies with other chapters in this volume. Each disorder will be considered separately, starting with a review of schizoaffective disorder, the more severe of the two spectrum conditions.
Introduction to mood disorders
Authors: Geddes John R.
Published: January 2013

The concept of mood is difficult to define. In psychiatry, it has come to mean a pervasive emotional tone varying along an axis from happiness to sadness—and perhaps anxiety. The boundaries between normal and abnormal mood are equally difficult to define. Nonetheless, there is usually no doubt about the most extreme manifestations of low mood, depression, or elevated mood, mania. This chapter begins by discussing the early history and subsequent development of modern psychiatric nosology. It then covers the distinction between unipolar and bipolar disorders, modern diagnostic systems and the birth of diagnostic criteria, subgroups of unipolar and bipolar disorder, and likely future developments in the classification of mood disorders.
Clinical features of mood disorders and mania
Authors: Bech Per
Published: January 2013

The clinical spectrum of the states of depression and mania has been described in Fig. 4.5.2.1 by the symptomatic dimensions of severity as validated by clinician-rated scales. Thus, symptom severity is a key issue of the spectrum of mood states. The spectrum of mood polarity disorders covering the longitudinal diagnosis of manic and depressive episodes is shown in Fig. 4.5.2.2. Recent research has demonstrated how important it is to recognize subthreshold states of mania and depression, as they can have a major impact on both social functioning and quality of life, since many patients with mood disorders spend much time in subthreshold disorders, i.e. cyclothymia, dysthymia, or neuroticism. While the severity spectrum of the states of mania and depression has been accepted as evidence-based, we still lack a validation of the mood polarity spectrum in long-term follow-up studies.