bluuebunny/crossref_metadata_2025_split huggingface dataset:
Schizoaffective and schizotypal disorders
Authors: Tsuang Ming T. , Stone William S. , Faraone Stephen V. 
Published: January 2013

AbstractThis 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

Abstract
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

AbstractThe 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.
Genetic aetiology of mood disorders
Authors: Oswald Pierre , Souery Daniel , Mendlewicz Julien 
Published: January 2013

AbstractAdvances towards the understanding of the etiological mechanisms involved in mood disorders provide interesting yet diverse hypotheses and promising models. In this context, molecular genetics has now been widely incorporated into genetic epidemiological research in psychiatry. Affective disorders and, in particular, bipolar affective disorder (BPAD) have been examined in many molecular genetic studies which have covered a large part of the genome, specific hypotheses such as mutations have also been studied. Most recent studies indicate that several chromosomal regions may be involved in the aetiology of BPAD. Other studies have reported the presence of anticipation in BPAD and in unipolar affective disorder (UPAD). In parallel to these new developments in molecular genetics, the classical genetic epidemiology, represented by twin, adoption and family studies, provided additional evidence in favour of the genetic hypothesis in mood disorders. Moreover, these methods have been improved through models to test the gene-environment interactions. In addition to genetic approaches, psychiatric research has focused on the role of psychosocial factors in the emergence of mood disorders. In this approach, psychosocial factors refer to the patient's social life context as well as to personality dimensions. Abnormalities in the social behavior such as impairment in social relationships have been observed during episode of affective disorders, and implicated in the etiology of affective disorders. Further, gender and socio-economic status also emerged as having a possible impact on the development of affective disorders. Finally, the onset and outcome of affective disorders could also be explained by interactions between the social life context and the individual's temperament and personality. The importance of temperament and personality characteristics in the etiology of depression has been emphasized in various theories, although disagreement exists with regard to terminology and the etiology. While significant advances have been done in these two major fields of research, it appears that integrative models, taking into account the interactions between biological (genetic) factors and social (psychosocial environment) variables offer the most reliable way to approach the complex mechanisms involved in the etiology and outcome of mood disorders. This chapter will review some of the most promising genetic and psychosocial hypotheses in mood disorders that can be integrated in interactive models.
Course and prognosis of mood disorders
Authors: Angst Jules 
Published: January 2013

Abstract
Ever since Kahlbaum's monograph 1863 the course and outcome of mental disorders have played important roles as criteria and validators of psychiatric classification. The prognosis is fundamental for doctor and patient when deciding whether to start long-term prophylactic medication and, at a later stage, whether to stop a successful long-term treatment. Course is a crucial factor in estimating the social consequences, costs, suicide risk, and mortality associated with mood disorders. The description of course includes the age of onset, episode length, recurrence of episodes, residual symptoms between episodes and outcome (remission, chronicity, death). These aspects are covered in this chapter.
Normal sexual function
Authors: Levin Roy J. 
Published: January 2013

AbstractNormal human sexual function can be characterized simply by its biological mechanisms which are of obvious importance, not least to reproduction. The mechanisms have changed little over the centuries, but their expression as behaviour, when moulded by historical time, social class, ethnic grouping, religion, and society, creates the changing complex concept of human sexuality. Indeed, it has been said that human sexuality is more about fertilizing relationships than eggs! While we have increased hugely our knowledge about many of the mechanisms involved in human sexuality, the impact of a highly successful oral therapy for erectile dysfunction being an obvious example, those of the brain and spinal cord are practically unexplored. What creates human sexual desire and sexual excitement and what causes them to fade away, where in the brain is the pleasure of orgasms created, why do men have a PERT but not women, are just a few of the fascinating questions that remain to be answered.
Personality disorders: an introductory perspective
Authors: López-Ibor Jr. Juan J. 
Published: January 2013

AbstractDuring the last few decades there has been an impressive growth in research and knowledge on personality disorders. There is a strong growing evidence that they are “real” disorders that can be managed in ways similar to the rest of psychiatric disorders. There is also a growing consensus on the need for a new classification able to capture the nuances beyond the rigidity of present nosological systems. There is also a need for a clearer delimitation from normal personality variants something that will have important impacts, for instance in forensic settings or for reimbursement purposes.
Management of personality disorder
Authors: Newton-Howes Giles , Davidson Kate 
Published: January 2013

AbstractSome years ago that most sceptical of academic psychiatrists, Michael Shepherd, in referring to the contents of a book entitled Recent Advances in Psychiatry commented that the content was more accurately defined as ‘recent activities’, as ‘advances’ was too generous a word. Whilst not going quite as far as this in regard to advances in the treatment of personality disorder it is fair to add that the promise of effective therapies across the spectrum of personality dysfunction remains a long way off and we must be very careful not to oversell the evidence. The complexity of personality disorders often requires complex intervention, however, until we are confident that single treatments are effective the arguments for evaluating them in combination have to be very strong on theoretical grounds to justify the cost. We are still at the stage in which explanatory trials (ones demonstrating efficacy under optimal conditions) are at least as necessary as pragmatic ones (demonstrating benefit in conditions of ordinary practice). These need to be carried out with adequate numbers of patients (at least 50 in each treatment arm rather than an artificially derived sample size to justify a small number) and with good independent assessments carried out by research workers who are masked as much as possible from disclosure of treatment. These requirements are exacting but can be achieved. We also need better pragmatic trials of patients seen in ordinary mental health practice whose treatment and characteristics are both representative and from whom it is possible to generalize findings with confidence. Currently there are very few studies that satisfy this requirement; one recent study combining an educational intervention with problem-solving is an exception. Despite the caution of these statements these are exciting times in the management of personality disorder. We are no longer listening to the once powerful lobby that claimed that patients with these conditions should not be treated by psychiatric services, or to the pessimists that still regard these conditions as untreatable. We are in the equivalent position as those in the early 1950s who suddenly became aware of the possibility that powerful treatments for severe mental illness were ready and waiting to be used. They do indeed appear to be within reach, but we must use them wisely.
Impulse control disorders
Authors: McElroy Susan L. , Keck Jr. Paul E. 
Published: January 2013

AbstractGrowing research shows that the impulse control disorders are much more common than once thought to be. The consistency of the ‘structure’ of the irresistible impulse (a core disturbance of impulsivity and compulsivity) together with increasing research showing that it responds to certain treatments, especially cognitivebehavioural psychotherapies and medical treatments with thymoleptic or anticraving properties, regardless of its ‘content’ (the specific impulse experienced), strongly suggest that it is an important psychopathological symptom, and that impulse control disorders are legitimate mental disorders that are in fact likely to be related despite their apparent differences. This chapter first defines impulse control disorders, and then summarizes available research on the clinical features, epidemiology, psychiatric comorbidity, family studies, psychobiology, and treatment response of the most common of these conditions
Epidemiology and causes of suicide
Authors: Lonnqvist Jouko K. 
Published: January 2013

AbstractSuicidal behaviour or suicidality can be conceptualized as a continuum ranging from suicidal ideation and communications to suicide attempts and completed suicide. A developmental process which leads to suicidal ideation, suicidal communication, self-destructive behaviour, in some cases even to suicide, and its consequences to the survivors is often referred to as a suicidal process. There is no single unanimously accepted definition of suicide, although in most proposed definitions it is considered as a fatal act of self-injury (self-harm) undertaken with more or less conscious self-destructive intent, however vague and ambiguous. Since the deceased cannot testify as to his or her intent, the conclusions about this must be drawn by inference. The evidence required for this inference depends on many factors, for example the mode of death, the use of autopsy, age, gender, social and occupational status, and the social stigma of suicide in the person’s culture. The assessment of suicide intent is always based on a balance of probabilities. This chapter discusses the suicide process and the act of suicide, epidemiology and public health aspects of suicide, basic characteristics of the suicide victim, and finally mental disorders and suicide.
Biological aspects of suicidal behaviour
Authors: Mann J. John , Currier Dianne 
Published: January 2013

AbstractTo understand the biological underpinnings of multi-determined behaviours such as suicide and attempted suicide it is necessary to situate them within an explanatory model that can elaborate the causal pathways and interrelations between biological, clinical, genetic, and environmental factors that all play a role in suicidal behaviour. Where possible, such a model should be clinically explanatory, incorporate biological correlates, be testable in both clinical and biological studies, and have some utility in identifying high-risk individuals. We have proposed a stress–diathesis model of suicidal behaviour wherein exposure to a stressor precipitates a suicidal act in those with the diathesis, or propensity, for suicidal behaviour. Stressors are generally state-dependent factors such as an episode of major depression or adverse life event. The diathesis, we have hypothesized, comprises trait characteristics such as impulsive aggression, and pessimism. Uncovering the biological mechanisms relevant to the stress and the diathesis dimensions of suicidal behaviour will facilitate the identification of both enduring and proximal markers of risk, as well as potential targets for treatment. One biological correlate of the diathesis for suicidal behaviour appears to be low serotonergic activity. Abnormal serotonergic function may be the result of numerous factors including genetics, early life experience, chronic medical illness, alcoholism or substance use disorder, many of which have been correlated with increased risk for suicidal behaviour. Moreover, serotonergic dysfunction may underlie recurrent mood disorders or behavioural traits that characterize the diathesis, such as aggression and impulsivity. In terms of stress response, the noradrenergic and HPA axis have been the focus of biological studies in suicidal behaviour. This chapter gives an overview of the major neurobiological findings in suicide and attempted suicide, as well as emerging findings from studies of genes related to those systems.
Hypochondriasis (health anxiety)
Authors: Noyes Jr. Russell 
Published: January 2013

AbstractHypochondriasis is a preoccupation with the fear that one has, or may develop, serious disease despite evidence to the contrary. So defined, the disorder affects between 2 and 7 per cent of patients attending general medical clinics and is a cause of physical dysfunction and disability. It is also a reason for increased health care utilization and dissatisfaction with care received. To their physicians, patients with this disorder are an enigma and a source of frustration. Unfortunately, relatively little is known about hypochondriasis. Primary care physicians have had little interest and psychiatrists see few patients with the condition. It is a pejorative label that, even if entertained, is rarely communicated. And, even if communicated, the diagnosis would not, until very recently, have led to effective treatment.
Adjustment to illness and handicap
Authors: House Allan 
Published: January 2013

AbstractNot everybody who develops a serious physical illness will have psychiatric problems as a consequence. To understand why, it is useful to have a model of the normal process of adjustment to stress; psychiatric disorder can then be seen as arising when that process, often called coping, is either maladaptive or is adaptive but only partially successful. This chapter will start with an outline of one theory of stress and coping as it applies to physical illness, followed by a review of disorders of adjustment to illness. A distinction will be drawn between recent-onset illness, which provokes an acute response, and long-standing illness, where the challenge is more often to adjust to chronic disability.
Epilepsy
Authors: Toone Brian 
Published: January 2013

Abstract
An epileptic seizure has been defined as ‘a clinical manifestation presumed to result from an abnormal and excessive discharge of a set of neurones in the brain’. A diagnosis of epilepsy applies with the recurrence of two or more discrete and unprovoked seizures (febrile and neonatal seizures are excluded from this definition). Epilepsy is one of the more common neurological disorders. It carries with it a greater psychiatric morbidity than is to be found in other neurological disorders of comparable severity. Many of its manifestations resemble and may be confused with psychiatric phenomenology. It is often associated with learning difficulties; it may be a manifestation of acquired brain damage or disease; seizures may occur in the course of substance abuse or be caused by psychiatric treatment. For these and for many other reasons psychiatrists should be familiar with epilepsy, its manifold aetiologies, presentations, and treatment.
Psychiatric aspects of infections
Authors: Ayuso-Mateos José Luis 
Published: January 2013

AbstractNeuropsychiatric disturbances stemming from infectious diseases are widespread in both the industrialized world and developing countries. Such neuropsychiatric syndromes are not necessarily the result of infectious processes directly involving the central nervous system, they may also be complications of systemic infections. There are many microbial, viral, and parasitic agents, as well as other types of infectious substances, which can affect the central nervous system, leading to the appearance of neurological and psychiatric symptoms that may cause suffering to the patient, and even be disabling. When considering the psychiatric manifestations of infectious illness, it is important to consider clinical manifestations derived from a possible systemic infection, which can be less obvious than a direct involvement of the central nervous system. Acute organic reactions may accompany many systemic infections, especially at the extremes of life. A clear example is the delirium that frequently occurs with pneumonia in the elderly. In these clinical syndromes, several factors could be responsible for the alterations in cerebral metabolism. The mere fact of having a fever could be involved. Cerebral anoxia often appears to be responsible, or the influence of toxins derived from the infecting micro-organism. More complex metabolic disturbances or the accumulation of toxic intermediate products can also be -implicated. Likewise, infections that course as chronic or subacute illnesses are frequently accompanied by the onset of depressive syndromes. One of the factors implied in clinical depression that occurs within the context of systemic infectious illnesses (e.g. tuberculosis and infectious mononucleosis), is a sense of physical vulnerability, possibly heightened by a loss of strength and negative changes in the patient's appearance. Patients are often afraid of losing their earning capacity or even their jobs, as well as other social and occupational problems associated with the illness. Another very important factor, above all with the human immunodeficiency virus (HIV) and other sexually transmitted disease (STD), is the social stigma that these patients may suffer. Sexually transmitted disease infection implies sexual activity that historically carries connotations of illicit, casual, sexual encounters, and acquiring an STD is frequently associated with embarrassment and social stigma. In addition to the disease itself, the medications commonly used to treat infectious illnesses can have side-effects that alter patients’ behaviour, as well as their cognitive and affective functioning (Table 5.3.5.1). In this chapter we consider infections of clinical interest in the practice of psychiatry. These conditions will be dealt with briefly, and textbooks of general medicine should be consulted for further details. Prion diseases and chronic fatigue syndromes, which are also related to the subject of the present chapter, are discussed in Chapters 4.1.4 and 5.2.7, respectively.
Electroconvulsive therapy
Authors: Fink Max 
Published: January 2013

AbstractConvulsive therapy (ECT or electroshock) is an effective treatment for those with severe and persistent emotional disorders. It is safe for patients of all ages, for those with debilitating systemic illnesses and during pregnancy. It relieves symptoms in a briefer time than do psychotropic drugs. To achieve remission, treatments are usually given three times a week for two to seven weeks. To sustain recovery, treatments are continued either weekly or biweekly for several months. The overall duration of the treatment course is similar to that of the psychotropic medications frequently used for the same conditions. The treatment is severely stigmatized and its use is discouraged, even interdicted, in the belief that the electricity or the seizures irreversibly damage the brain. Few physicians are tutored in its use and facilities are limited making ECT unavailable to many who would benefit. The ease in the use of psychotropic medications, and neither greater efficacy nor greater safety, encourages their preferential use as ECT is relegated to the ‘last resort.’ In countries where psychotropic medications are expensive, ECT is prescribed, but the expense for anesthetics limits its use to its unmodified form. Despite these hurdles of stigma, expense and lack of training, its use has persisted for more than 70 years. Indeed, its use is increasing. Whole societies where it was interdicted at the end of the 20th century, as in the Netherlands, Germany, Austria, Italy, and Japan, interest and usage has increased, texts have been written or translated, and local psychiatric societies formed to encourage its use.