Contents

Preface xv

PART I: THE NATURE AND ASSESSMENT OF PSYCHIATRIC

DISORDER 1

1 Classification 3

The basis of classification 4

Reliability and validity 4

Limitations and problems of classification 5

Common terms in psychiatric classification 6

Classification systems 7

2 Causes and Prevention 11

Causation in clinical practice 11

Historical background 12

Genetics 12

Neurochemistry 14

Neuroradiology 15

Epidemiology 15

Individual life experience 18

Prevention of psychiatric disorder 19

3 Assessment 23

Circumstances of referral 23

The psychiatric interview 24

Mental state examination 28

Physical examination 32

Structured interviews and questionnaires 34

Further assessments 35

Physical investigations 36

PART II: CLINICAL SYNDROMES 39

4 Schizophrenia 41

Definition 41

Frequency 41

Epidemiology 42

Causation 42

Clinical features 48

Clinical types 55

Diagnostic criteria 58

Differential diagnosis 60

Treatment 61

Prognosis 66

5 Mood Disorders: Depressive Illness and Mania 69

Frequency 70

Epidemiology 71

Causes 71

Clinical features of depressive illness 76

Types of depressive illness 79

Diagnosis of depressive illness 85

Clinical features of mania 85

Differential diagnosis of mood disorders 86

Treatment of depressive illness 87

Treatment of mania 92

Prophylaxis of affective disorder 92

6 Anxiety and Stress-Related Disorders 95

Boundaries of anxiety disorder 96

Hierarchy of diagnosis 96

Frequency 96

Epidemiology 97

Causes 97

Clinical features 98

Differential diagnosis 100

Treatment 100

Prognosis 103

Generalized anxiety disorder (anxiety state) 104

Panic disorder 105

Agoraphobia 105

Social phobia 106

Simple phobias (specific phobias, monophobias) 106

Obsessive-compulsive disorders 106

Post-traumatic stress disorder (PTSD) 107

Adjustment disorders 111

Bereavement 111

7 Personality Disorders 113

Definition 113

Classification 113

Types of personality disorder 115

Epidemiology 117

Differential diagnosis 118

Treatment 119

Prognosis 121

Sociopathic (dissocial) personality disorder 121

8 Paranoid States 125

Definition 125

Predisposing factors 125

Differential diagnosis of paranoid states 126

Management 127

Culture-bound syndromes 127

9 Physical Symptoms and Psychiatric Disorder 129

Introduction 129

Assessing physical symptoms in psychiatric practice 130

Unexplained physical symptoms 131

Management 137

Malingering and exaggeration 139

10 Organic Brain Syndromes 143

Causes 144

Clinical features 145

Delirium 145

Dementia 147

Focal brain damage 159

11 Liaison Psychiatry 163

Psychological influences on the course of physical disease 164

The stresses of physical illness 165

Adjustment and coping 165

Clinical depression in medically ill patients 166

Management and prevention 167

Liaison psychiatric services 168

12 Drug Misuse 171

Definitions 171

Epidemiology 172

Causes 172

Psychiatric and physical complications 172

Legal aspects 173

Pharmacology 174

Prevention 174

Treatment 175

Opiates 176

Amphetamines (speed) 179

Cocaine and crack 180

Cannabis (Indian hemp, hashish, pot) 181

Lysergic acid diethylamide (LSD, acid) 182

MDMA (Ecstasy) 183

Glues and solvents 184

Tobacco 184

Caffeine 185

Barbiturates 186

Benzodiazepines 187

13 Alcohol Misuse 189

Safe limits of drinking 189

Frequency 190

Epidemiology 190

Causes 191

Effects of alcohol 192

Course of alcohol abuse 195

Recognition 195

Treatment 196

Prognosis 198

Prevention 198

14 Deliberate Self-Harm 199

Suicide 199

Non-fatal deliberate self-harm (parasuicide, attempted suicide) 205

15 Eating Disorders: Anorexia Nervosa and Bulimia Nervosa 211

Introduction 211

Anorexia nervosa 211

Bulimia nervosa 216

Obesity 217

16 Disorders of Female Reproductive Life 219

Pregnancy 219

Puerperal psychosis 220

Post-natal depression and other neurotic syndromes 222

Abortion 225

Stillbirth and perinatal death 225

Premenstrual syndrome 225

The menopause 226

Hysterectomy 226

17 Sexual Problems 227

Sexual dysfunctions 227

Sexual deviations 231

Gender-identity disorders 235

Homosexuality 236

18 Child and Adolescent Psychiatry 237

Predisposing factors 237

Classification 238

History taking and examination 239

Treatment 241

Relationship with adult disorder 241

Neurotic (emotional) disorders 242

Conduct disorders 243

Attention deficit disorder 243

Psychoses 244

Delays in development 244

Symptomatic disorders 246

Child abuse 247

Psychiatry of adolescence 249

19 Learning disability 251

Frequency 251

Causes 251

Diagnosis of learning disability 252

Associated phenomena 253

Management 254

Prognosis 255

Prevention 255

Chromosomal abnormalities 258

Gene abnormalities 259

Acquired handicap 261

Miscellaneous 261

20 Psychiatry of Old Age 263

Frequency 263

Clinical syndromes 264

Assessment 266

Specific treatments 267

Organization of services 269

21 Forensic Psychiatry 271

Offending behaviour 272

Predicting violence and dangerousness 273

Psychiatric aspects of specific offences 274

Treatment: general considerations 278

Facilities for mentally disordered offenders 279

Psychiatric reports: criminal 282

PART III: TREATMENT 287

22 Psychological Treatment 289

Historical background 289

Principles of psychotherapy today 292

Counselling 294

Cognitive-behavioural therapy (CBT) 295

Psychodynamic psychotherapy 301

Group therapy 303

Family and marital therapy 303

Recent advances 305

23 Psychopharmacology 307

General principles of using psychotropic drugs 307

Antipsychotics 310

Antidepressants 315

Antidepressants: tricyclic group 316

Antidepressants: SSRI group 319

Antidepressants: MAOI group 322

Other antidepressant drugs 323

Benzodiazepines 324

Mood stabilizers 328

Other drugs 331

24 Electroconvulsive Therapy (ECT) and Psychosurgery 333

Indications 334

Mode of action 334

Efficacy and prediction of response 335

Timing and number of treatments 335

Practicalities of treatment 335

Contraindications 336

Bilateral versus unilateral ECT 336

Unwanted effects 336

Consent for ECT 337

Myths 337

For the future 338

Psychosurgery 338

Video 339

25 Organization of Services 341

Introduction 341

Background and history 342

Community care 343

The psychiatric multidiscipLinary team 344

Psychiatry in primary care 345

Inpatient services 346

Outpatient clinics 347

Crisis and home treatment 347

Day hospitals 348

Resource centres and day centres 348

Assertive outreach teams 348

Recovery and rehabilitation 348

The care programme approach 350

Non-NHS health-care facilities 350

26 The Mental Health Act 1983 353

Introduction 353

Background 354

Compulsory admission 355

Patients already in hospital 356

Patients in the community 356

Relatives 357

Approved social workers (ASWs) 357

Police powers 358

Mentally abnormal offenders 358

Consent to treatment 359

Information for detained patients 360

Mental Health Act Commission 361

Glossary 363

Alcohol No More

Alcohol No More

Do you love a drink from time to time? A lot of us do, often when socializing with acquaintances and loved ones. Drinking may be beneficial or harmful, depending upon your age and health status, and, naturally, how much you drink.

Get My Free Ebook


Post a comment