bluuebunny/crossref_metadata_2025_split huggingface dataset:
From science to practice
Authors: Geddes John R. 
Published: January 2013

AbstractClinicians 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

AbstractThe 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

AbstractAttention 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

AbstractPsychiatry 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

AbstractDavid 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

AbstractPsychoanalysis 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

AbstractDespite 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

AbstractPsychodynamic 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

AbstractLewy 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

AbstractApproximately 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

AbstractSome 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.
Services for alcohol use disorders
Authors: Drummond D. Colin 
Published: January 2013

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

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