International Handbook of Psychiatry · A Concise Guide for Medical Students, Residents, and Medical Practitioners by Roberts, Laura Weiss -- Read -- Imperial Library of Trantor

Index

Contents Abbreviations List Contributors List Chapter 1 Impact of Mental Illness Laura Weiss Roberts, Richard Balon and Joseph B. Layde

1. INTRODUCTION 2. SOCIETAL IMPACT OF MENTAL ILLNESS

2.1. Illness burden 2.2. Economic burden 2.3. Unmet need

3. EVOLVING APPROACHES TO PHENOMENOLOGY IN PSYCHIATRY 4. HANDBOOK ORGANIZATION ACKNOWLEDGEMENT REFERENCES

Chapter 2 International Issues in Psychiatry Richard Balon and Cyril Höschl

1. INTRODUCTION 2. DIAGNOSTIC CLASSIFICATION 3. EDUCATION 4. RESEARCH 5. ETHICS 6. CULTURE AND CULTURAL PSYCHIATRY 7. PSYCHIATRIC CARE FOR VICTIMS OF MAJOR DISASTERS, VICTIMS OF TORTURE, AND REFUGEES 8. MISCELLANEOUS 9. THE ROLE OF INTERNATIONAL/NATIONAL ORGANIZATIONS 10. CONCLUSION 11. KEY POINTS 12. SELF-ASSESSMENT

12.1. Clinical trials conducted by pharmaceutical companies in the developing countries may face which of the following difficulties? 12.2. International educational activities include all of the following except

13. CASE STUDIES

13.1. Development of psychiatric service and training in Cambodia 13.2. An American training Chinese psychoanalysts 13.3. Concepts of mental illness

REFERENCES

Chapter 3 Psychiatric Diagnosis Stephanie Bagby-Stone, Jessica Nittler and John Lauriello

1. INTRODUCTION

1.1. What is a psychiatric diagnosis?

1.1.1. Significance of psychiatric diagnosis

2. SIGNS AND SYMPTOMS IN PSYCHIATRIC ILLNESS

2.1. Specificity, sensitivity, and predictive value of signs and symptoms 2.2. What information is useful in making a psychiatric diagnosis?

2.2.1. Psychiatric interview 2.2.2. Collateral information 2.2.3. Physical examination 2.2.4. Laboratory testing 2.2.5. Neuro-imaging and other studies 2.2.6. Psychological testing 2.2.7. Psychiatric rating scales and diagnostic interviews

3. HOW ARE PSYCHIATRIC DIAGNOSES CLASSIFIED?

3.1. Categorical versus etiological 3.2. Reliability and validity in psychiatric diagnosis

4. CURRENT CLASSIFICATION SYSTEMS

4.1. The international classification of diseases (ICD) 4.2. The Diagnostic and Statistical Manual of Mental Disorders

5. CULTURAL ISSUES REGARDING PSYCHIATRIC DIAGNOSIS 6. OTHER PSYCHIATRIC CLASSIFICATION SYSTEMS 7. FINAL THOUGHTS ON PSYCHIATRIC DIAGNOSIS AND ITS FUTURE 8. KEY POINTS 9. SELF-ASSESSMENT

9.1. Which of the following would be important in the evaluation of a 55-year-old woman who was brought to a hospital by her family with new onsetmanic and psychotic symptoms? 9.2. Which of the following is false regarding our current psychiatric diagnostic classification systems — the DSM-IV-TR and the ICD-10? 9.3. Which of the following are true statements regarding the function and meaning of a psychiatric diagnosis?

10. CASE STUDIES

10.1. Seeing patient and diagnosis in context 10.2. Diagnosis changes over time 10.3. A complete perspective of mental illness

REFERENCES

Chapter 4 Psychiatric Genetics Bhanu Prakash Kolla and David Mrazek

1. INTRODUCTION

1.1. Endophenotypes and intermediate phenotypes 1.2. Heritability 1.3. Twin studies 1.4. Adoption studies 1.5. Linkage studies 1.6. Association studies and genome wide association studies

2. THE GENETICS OF PREVALENT PSYCHIATRIC ILLNESS

2.1. Alzheimer’s disease 2.2. Alcohol use disorders 2.3. Autism and other pervasive development disorders 2.4. Anxiety disorders 2.5. Schizophrenia 2.6. Bipolar disorder 2.7. Attention deficit hyperactivity disorder 2.8. Anorexia nervosa 2.9. Major depressive disorder

3. CONCLUSION 4. SELF-ASSESSMENT

4.1. The parents of a four-year-old boy who was recently diagnosed with autism want to have another child and are worried about the next child also having autism. There is no family history of autism of which they are aware. The chromosomal analysis of their first child did not reveal any abnormalities. What is the best estimate of the likelihood that their second child will develop autism? 4.2. Which of the below genes is implicated in both schizophrenia and bipolar disorder?

REFERENCES

Chapter 5 Psychiatric Interviewing: What to Do, What Not to Do Mara Pheister

1. PURPOSE AND CONTEXT 2. PSYCHOTHERAPEUTIC TECHNIQUES

2.1. Process versus content 2.2. Empathic validation 2.3. Reflection 2.4. Containment 2.5. Confrontation 2.6. Interpretation 2.7. Education

3. ASKING QUESTIONS

3.1. Open versus closed questions 3.2. Transitions 3.3. Focusing a talkative patient 3.4. Eliciting information from a guarded patient 3.5. Cultural considerations in asking questions

4. STRUCTURE OF THE INTERVIEW

4.1. Opening 4.2. Middle

4.2.1. Presenting problem (history of present illness) 4.2.2. Psychiatric review of systems 4.2.3. Psychiatric history 4.2.4. Substance abuse history 4.2.5. Family history 4.2.6. Medical history 4.2.7. Social history 4.2.8. Mental status examination

4.3. Closing

5. CONCLUSION 6. KEY POINTS 7. SELF-ASSESSMENT

7.1. “It seems like you are concerned about being a burden on your family” is an example of 7.2. Which is an example of a good screening question?

8. CASE STUDY REFERENCES

Chapter 6 Psychological and Neuropsychological Testing Jennifer Niskala Apps and Jonathan E. Romain

1. INTRODUCTION 2. HISTORY OF TESTING

2.1. Classical test theory 2.2. Reliability & validity

3. STANDARDIZATION AND INTERPRETATION

3.1. Standardization processes 3.2. Normative groups

3.2.1. Age 3.2.2. Gender 3.2.3. Education

3.3. Standardized scores 3.4. Sensitivity and specificity

4. INTERNATIONAL CONSIDERATIONS

4.1. Cultural differences

4.1.1. Context 4.1.2. Administration 4.1.3. Interpretation

5. CLINICAL TESTING AND NEUROPSYCHOLOGY 6. COGNITIVE OR ATTRIBUTE TESTING

6.1. Intellectual 6.2. Additional attributes

6.2.1. Learning and memory 6.2.2. Memory loss 6.2.3. Language 6.2.4. Visual–spatial abilities 6.2.5. Motor and sensory examination 6.2.6. Attention and executive skills 6.2.7. Developmental and functional abilities 6.2.8. Effort 6.2.9. Competency 6.2.10. Personality and emotional

7. ACADEMIC ACHIEVEMENT 8. OCCUPATIONAL TESTING 9. KEY POINTS 10. SELF-ASSESSMENT

10.1. Intellectual measures yield standard scores. For the most part, when considering a standard score, the score is based on 10.2. You have been given a rating scale to review that measures apathy and notice several of the items appear more related to self-esteem and social anxiety. Concern for whether patients would believe this measure actually taps into apathy relates to 10.3. An adolescent female presents at the hospital with “memory problems” of an unknown etiology. Which of the following would raise the greatest suspicion for dissociative amnesia

11. CASE STUDIES

11.1. Neuropsychological assessment in a traumatic brain injury clinic 11.2. School failure

REFERENCES

Chapter 7 Psychiatric Disorders in Childhood and Adolescence Michael Koelch and Joerg M. Fegert

1. INTRODUCTION

1.1. Development 1.2. Specific aspects of treatment 1.3. Psychopharmacotherapy 1.4. Access to care 1.5. An international debate: Childhood bipolar disorder or combined ADHD with conduct disorder? 1.6. Categorical classification versus clinical entities

2. EPIDEMIOLOGY 3. ETIOLOGY OF PSYCHIATRIC DISORDERS IN CHILDHOOD AND ADOLESCENCE: NATURE, NURTURE, OR GENE–ENVIRONMENT INTERACTIONS?

3.1. Neurobiological aspects and risks of psychiatric disorders in childhood and adolescence 3.2. Social risk factors 3.3. Resilience

4. SPECIAL DISORDERS

4.1. Attachment disorders

4.1.1. Phenomenology 4.1.2. Treatments

4.2. Autistic syndromes

4.2.1. Phenomenology 4.2.2. Treatment 4.2.3. Prognostic factors

4.3. Attention deficit/hyperactivity disorder (ADHD)

4.3.1. Phenomenology 4.3.2. Treatment 4.3.3. Prognostic factors

4.4. Conduct disorder and oppositional defiant disorder

4.4.1. Phenomenology 4.4.2. Treatment 4.4.3. Prognostic factors

4.5. Tic disorder and Tourette syndrome

4.5.1. Phenomenology: Signs and symptoms 4.5.2. Treatments 4.5.3. Prognostic factors

4.6. Stuttering

4.6.1. Phenomenology: Signs and symptoms 4.6.2. Differential diagnoses 4.6.3. Treatment 4.6.4. Prognostic factors

4.7. Further relevant disorders and symptoms in childhood and adolescence

4.7.1. Elimination disorders: enuresis and encopresis 4.7.2. Anxiety disorders 4.7.3. Eating disorders 4.7.4. Non-suicidal self-injury 4.7.5. Depressive disorder 4.7.6. Schizophrenia 4.7.7. Sleep problems and sleep disorders

5. CONCLUSION AND FURTHER DIRECTION 6. KEY POINTS 7. CASE STUDIES

7.1. ADHD 7.2. Autism 7.3. Self-harming behavior

REFERENCES

Chapter 8 Schizophrenia and Other Psychotic Disorders Peter F. Buckley, Adriana Foster and Scott Van Sant

1. INTRODUCTION 2. EPIDEMIOLOGY 3. ETIOLOGY

3.1. Diagnosis and phenomenology

4. TREATMENT

4.1. General considerations 4.2. Medication treatments 4.3. Non-medication treatments

5. PSYCHOTIC CONDITIONS OTHER THAN SCHIZOPHRENIA 6. PROGNOSIS 7. KEY POINTS 8. SELF-ASSESSMENT

8.1. Available information on the efficacy of antipsychotic medications suggests that 8.2. In attempting to understand the relative efficacy of antipsychotic medications, which of the following is most pertinent 8.3. In attempting to understand the relative tolerability of antipsychotic medications, which of the following is most pertinent concerning the risk of tardive dyskinesia and the rates across antipsychotic classes 8.4. Optimizing the dose of an antipsychotic is a reasonable (first) alternative to switching medications once

9. CASE STUDIES

9.1. Psychotic break complicated by substance abuse 9.2. Depression or prodromal state? 9.3. Schizophrenia and suicide 9.4. Schizophrenia and pharmacology

REFERENCES

Chapter 9 Mood Disorders Sandra Rackley and J. Michael Bostwick

1. INTRODUCTION 2. EPIDEMIOLOGY OF MOOD DISORDERS 3. ETIOLOGY OF MOOD DISORDERS 4. DEPRESSIVE DISORDERS

4.1. Phenomenology of depressive disorders 4.2. Differential diagnosis of depressive symptoms 4.3. Treatments for depressive disorders 4.4. Prognostic factors

5. BIPOLAR DISORDER

5.1. Phenomenology of bipolar disorder 5.2. Differential diagnosis of manic symptoms 5.3. Treatment of bipolar disorder 5.4. Prognostic factors in bipolar disorder

6. PERSISTENT MOOD DISORDERS

6.1. Phenomenology of persistent mood disorders 6.2. Treatment of persistent mood disorders 6.3. Prognosis of persistent mood disorders

7. OTHER MOOD DISORDERS 8. CONCLUSIONS AND FUTURE DIRECTIONS 9. KEY POINTS 10. SELF-ASSESSMENT

10.1. Mrs Jones, a 62-year-old recently-widowed woman, sees her family physician with complaints of on-going sadness after her husband’s death a month ago. Which of the following symptoms is most suggestive of a depressive episode rather than bereavement? 10.2. In a patient with bipolar disorder, all of the following are associated with an increased risk of death by suicide except 10.3. Which of the following would not be considered first-line treatment for a patient with a diagnosis of a recurrent depressive disorder?

11. CASE STUDIES

11.1. A depressive episode 11.2. A manic episode

REFERENCES

Chapter 10 Anxiety Disorders Leanne Parasram and Dan J. Stein

1. INTRODUCTION 2. PANIC DISORDER AND AGORAPHOBIA

2.1. Diagnostic criteria 2.2. Clinical presentation 2.3. Differential diagnosis 2.4. Epidemiology 2.5. Pathogenesis 2.6. Neurocircuitry — the “fear network” and “false suffocation alarm” 2.7. Genetic contribution 2.8. Psychosocial factors 2.9. Course and prognosis 2.10. Assessment 2.11. Management

3. SOCIAL AND SPECIFIC PHOBIAS

3.1. Diagnostic criteria 3.2. Clinical presentation 3.3. Epidemiology 3.4. Pathogenesis 3.5. Course and prognosis 3.6. Management

4. OBSESSIVE-COMPULSIVE DISORDER

4.1. Diagnostic criteria 4.2. Clinical presentation 4.3. Epidemiology 4.4. Pathogenesis 4.5. Course and prognosis 4.6. Assessment 4.7. Management

5. POSTTRAUMATIC STRESS DISORDER AND ACUTE STRESS REACTION

5.1. Diagnostic criteria 5.2. Clinical presentation 5.3. Epidemiology 5.4. Pathogenesis 5.5. Course and prognosis 5.6. Assessment 5.7. Management

6. GENERALIZED ANXIETY DISORDER

6.1. Diagnostic criteria 6.2. Clinical presentation 6.3. Epidemiology 6.4. Pathogenesis 6.5. Course and prognosis 6.6. Assessment 6.7. Management

7. KEY POINTS 8. SELF-ASSESSMENT

8.1. With regard to anxiety disorders, please state which statement is true 8.2. With regard to panic disorder, please state which statement is true

9. CASE STUDIES

9.1. Panic attack 9.2. Social phobia 9.3. OCD 9.4. PTSD 9.5. Generalized anxiety disorder

REFERENCES

Chapter 11 Substance Use Disorders Nidal Moukaddam and Pedro Ruiz

1. INTRODUCTION 2. CONSIDERATIONS REGARDING DRUG USE EPIDEMIOLOGY 3. NEUROBIOLOGICAL CONSIDERATIONS IN SUBSTANCE USE DISORDERS 4. NICOTINE 5. CAFFEINE 6. ALCOHOL

6.1. Genetic contributions in alcohol use disorders 6.2. Mechanism of action 6.3. Identification in clinic settings 6.4. Alcohol withdrawal 6.5. Long-term management of alcohol use disorders

6.5.1. Medications to prevent alcoholism relapse

7. CANNABIS 8. OPIOIDS 9. STIMULANTS

9.1. Cocaine 9.2. Inhalants

10. HALLUCINOGENS 11. CLUB DRUGS 12. NEW DRUGS 13. TREATMENT CONSIDERATIONS IN SUBSTANCE USE DISORDERS 14. KEY POINTS 15. CASE STUDIES

15.1. A complaint of anxiety 15.2. An overdose

REFERENCES

Chapter 12 Cognitive Disorders Alana Iglewicz, Ipsit V. Vahia and Dilip V. Jeste

1. INTRODUCTION 2. DELIRIUM

2.1. Epidemiology 2.2. Etiology 2.3. Phenomenology 2.4. Treatments 2.5. Prognostic factors

3. DEMENTIAS

3.1. Age-associated memory impairment 3.2. Mild cognitive impairment

4. DEMENTIA DUE TO ALZHEIMER’S DISEASE

4.1. Epidemiology 4.2. Etiology

4.2.1. Risk factors

4.3. Phenomenology 4.4. Clinical syndromes associated with Alzheimer’s disease

4.4.1. Psychosis of Alzheimer’s disease (and other dementias)7 4.4.2. Depression of Alzheimer’s disease11

4.5. Treatments 4.6. International policy implications

5. VASCULAR DEMENTIA 6. DEMENTIA IN PICK’S DISEASE (FRONTOTEMPORAL DEGENERATION) 7. DEMENTIA IN PARKINSON’S DISEASE AND DEMENTIA WITH LEWY BODIES 8. CONCLUSION 9. KEY POINTS 10. SELF-ASSESSMENT

10.1. Which of the following features best help distinguish a delirium from a dementia? 10.2. Individuals with which type of dementia are especially sensitive to antipsychotic medications?

11. CASE STUDIES

11.1. Delirium 11.2. Dementia due to Alzheimer’s disease

REFERENCES

Chapter 13 Somatoform Disorders Christina L. Wichman

1. INTRODUCTION 2. SOMATIZATION DISORDER 3. HYPOCHONDRIACAL DISORDER

3.1. Body dysmorphic disorder

4. PERSISTENT SOMATOFORM PAIN DISORDER 5. DISSOCIATIVE (CONVERSION) DISORDERS 6. FACTITIOUS DISORDER 7. MALINGERING 8. KEY POINTS 9. SELF-ASSESSMENT

9.1. A 50-year-old woman admitted to the hospital from the neurology clinic complains in a dramatic fashion of bilateral ankle pain that she suffered while at work. Multiple physicians have been involved. Legal action for worker’s compensation is pending, but the patient does not want the medical staff to confirm this chain of events. A thorough outpatient evaluation has not revealed a clear etiology for the pain complaints. Psychiatry has been asked to evaluate for depression contributing to her pain, which was felt to be disproportionate to the injury. She denies any depression, psychosis, or anxiety symptoms or family history of psychiatric issues. Testing is negative, and she becomes increasing labile and irritable and begins to demand a more aggressive work-up to find out what is wrong. She continues to complain of 10/10 pain without appearing subjectively distressed. Given these facts, the correct diagnosis is 9.2. A 26-year-old woman presents to a plastic surgeon’s office requesting a rhinoplasty. She has had several other cosmetic procedures by other surgeons. She describes her nares as “too large” and the bridge of her nose as “too wide.” She states that she thinks about her nose several hours daily and has become more isolated lately because she fears that others are focused on the appearance of her nose. No deformity is noted by the surgeon. Which of the following issues should be addressed during the consultation?

REFERENCES

Chapter 14 The Dissociative Disorders Jean M. Goodwin

1. INTRODUCTION 2. TRAUMATIC ANXIETY AND DISSOCIATION: A SPECTRUM OF RESPONSE 3. DISSOCIATIVE IDENTITY DISORDER

3.1. Epidemiology 3.2. Etiology of dissociative disorders 3.3. Phenomenology of dissociative identity disorder 3.4. Treatment of DID: timing and techniques

4. SPECIAL ISSUES IN DISSOCIATION 5. CASE STUDY REFERENCES

Chapter 15 Sleep Disorders in Psychiatry Oludamilola A. Salami

1. INTRODUCTION 2. PHYSIOLOGY OF NORMAL SLEEP 3. STAGES OF SLEEP 4. CLASSIFICATION OF SLEEP DISORDERS 5. PRIMARY SLEEP DISORDERS

5.1. Dyssomnias 5.2. Management 5.3. Treatment 5.4. Primary or recurrent hypersomnia 5.5. Narcolepsy 5.6. Breathing related sleep disorder 5.7. Circadian rhythm sleep disorders

5.7.1. Delayed sleep-phase syndrome 5.7.2. Time zone change syndrome 5.7.3. Shift work disorder 5.7.4. Treatment

5.8. Dyssomnia not otherwise specified

5.8.1. Restless legs syndrome 5.8.2. Periodic limb movement disorder

5.9. Parasomnias

5.9.1. Nightmare disorder 5.9.2. Sleep terror disorder 5.9.3. Sleepwalking disorder 5.9.4. Parasomnia not otherwise specified

6. SPECIFIC PSYCHIATRIC SYNDROMES

6.1. Sleep and schizophrenia 6.2. Sleep and anxiety disorders 6.3. Sleep and depressive disorders 6.4. Sleep and dementia 6.5. Substance-induced sleep disorders

7. KEY POINTS 8. SELF-ASSESSMENT

8.1. Mr J, a 27-year-old construction worker, is diagnosed with major depression. His most distressing symptom is insomnia. A polysomnogram in this patient would most likely show which of the following? 8.2. Michael, a 34-year-old schoolteacher, has had difficulty falling asleep and was prescribed diazepam by his family doctor. Benzodiazepine medications are associated with which of the following?

9. CASE STUDIES

9.1. Primary sleep disorder 9.2. Circadian rhythm disorder 9.3. Parasomnia

REFERENCES

Chapter 16 Eating Disorders Athena Robinson and W. Stewart Agras

1. INTRODUCTION 2. EPIDEMIOLOGY 3. ETIOLOGY OF EATING DISORDERS 4. ANOREXIA NERVOSA

4.1. Medical complications 4.2. Problems with anorexia nervosa treatment research 4.3. Treatments for anorexia nervosa

4.3.1. Cognitive behavioral therapy for anorexia nervosa 4.3.2. Behavioral family therapy for adolescent anorexia nervosa 4.3.3. Inpatient and day hospitalization for anorexia nervosa 4.3.4. Pharmacotherapy for anorexia nervosa 4.3.5. Summary of evidence for the treatment of anorexia nervosa

5. BULIMIA NERVOSA

5.1. Medical complications 5.2. Treatments for bulimia nervosa

5.2.1. Cognitive behavioral therapy and interpersonal psychotherapy 5.2.2. Behavioral family therapy for adolescent bulimia nervosa 5.2.3. Pharmacotherapy for bulimia nervosa 5.2.4. Summary of evidence for the treatment of bulimia nervosa

6. BINGE EATING DISORDER

6.1. Treatments for binge eating disorder

6.1.1. Cognitive behavioral therapy and interpersonal psychotherapy for binge eating disorder 6.1.2. Dialectical behavior therapy for binge eating disorder 6.1.3. Self-help approaches for binge eating disorder 6.1.4. Pharmacotherapy for binge eating disorder 6.1.5. Summary of evidence for the treatment of binge eating disorder

7. OBESITY

7.1. Treatments for obesity

7.1.1. Behavioral weight loss, cognitive behavioral therapy, low calorie diets, and bariatric surgery 7.1.2. Pharmacotherapy for obesity 7.1.3. Summary of evidence for the treatment of obesity

8. PICA 9. DISORDERS OF CHILDHOOD

9.1. Selective eating 9.2. Food phobias 9.3. Food avoidance emotional disorder

10. CONCLUSIONS AND FUTURE DIRECTIONS 11. KEY POINTS 12. SELF-ASSESSMENT

12.1. On the basis of the current empirical literature, which of the following is presently the recommended treatment of choice for bulimia nervosa? 12.2. Which of the following refers to the international statistical classification of diseases and related health problems-10 and diagnostic and statistical manual of mental disorders-IV criteria for anorexia nervosa?

13. CASE STUDIES

13.1. Anorexia nervosa 13.2. Bulimia nervosa 13.3. Binge eating disorder

REFERENCES

Chapter 17 Sexual Disorders Richard Balon

1. INTRODUCTION 2. GENERAL CONSIDERATIONS

2.1. Epidemiology 2.2. Etiology 2.3. Genetics 2.4. Diagnosis and classification 2.5. Evaluation of sexual functioning in clinical practice

2.5.1. Clinical interview 2.5.2. Psychometric assessment 2.5.3. Physical examination 2.5.4. Laboratory testing

2.6. General management recommendations

3. SEXUAL DYSFUNCTIONS

3.1. Sexual desire disorders

3.1.1. Hypoactive sexual desire disorder 3.1.2. Sexual aversion disorder

3.2. Sexual arousal disorders

3.2.1. Female sexual arousal disorder 3.2.2. Male erectile disorder

3.3. Orgasmic disorders

3.3.1. Female orgasmic disorder 3.3.2. Male orgasmic disorder 3.3.3. Premature ejaculation

3.4. Sexual pain disorders

3.4.1. Dyspareunia (not due to general medical condition) 3.4.2. Vaginismus (not due to general medical condition)

3.5. Other categories

3.5.1. Sexual dysfunction due to general medical condition 3.5.2. Substance-induced sexual dysfunction 3.5.3. Sexual dysfunction not otherwise specified

4. PARAPHILIAS

4.1. Diagnostic criteria of individual paraphilias

4.1.1. Exhibitionism 4.1.2. Fetishism 4.1.3. Frotteurism 4.1.4. Pedophilia 4.1.5. Sexual masochism 4.1.6. Sexual sadism 4.1.7. Transvestic fetishism 4.1.8. Voyeurism 4.1.9. Paraphilias not otherwise specified

4.2. Treatment of paraphilias

5. GENDER INDENTITY DISORDERS

5.1. Gender identity disorder 5.2. GID not otherwise specified 5.3. Sexual disorder not otherwise specified 5.4. Treatment of GIDs

6. CONCLUSION 7. KEY POINTS 8. SELF-ASSESSMENT

8.1. Which of the following sexual disorders is not classified as paraphilia? 8.2. Bupropion may be useful in the treatment of which of the following sexual disorders?

9. CASE STUDIES

9.1. Female hypoactive sexual desire disorder 9.2. Difficulty to ejaculate 9.3. Exhibitionism

REFERENCES

Chapter 18 Adjustment Disorder Mauro Giovanni Carta, Maria Carolina Hardoy and Matteo Balestrieri

1. INTRODUCTION 2. EPIDEMIOLOGY

2.1. Prevalence 2.2. Outcome

3. ETIOLOGY 4. DIAGNOSIS 5. TREATMENTS 6. CONCLUSION 7. KEY POINTS 8. SELF-ASSESSMENT

8.1. The onset of an adjustment disorder is usually 8.2. Which of the following manifestations are not included in the ICD-10 diagnostic description of adjustment disorder?

9. CASE STUDIES

9.1. Adjustment disorder with mixed anxiety and conduct disturbances 9.2. Adjustment disorder with mixed anxiety and depression

REFERENCES

Chapter 19 Personality Disorders Joel Paris

1. INTRODUCTION 2. EPIDEMIOLOGY OF PERSONALITY DISORDERS 3. ETIOLOGY OF PERSONALITY DISORDERS 4. DISSOCIAL PERSONALITY DISORDER 5. EMOTIONALLY UNSTABLE (BORDERLINE) PERSONALITY DISORDER 6. OTHER PERSONALITY DISORDERS 7. TREATMENT 8. CONCLUSION AND FUTURE DIRECTIONS 9. KEY POINTS 10. SELF-ASSESSMENT

10.1. The following are defining criteria for dissocial personality disorder, except for 10.2. The following are defining criteria for borderline personality disorder, except for 10.3. Etiological factors in personality disorders are reflected in 10.4. The long-term outcome of most personality disorders demonstrates 10.5. Which form of psychological treatment for personality disorders has been supported by randomized clinical trials?

11. CASE STUDIES

11.1. Borderline personality disorder 11.2. Dissocial personality disorder

REFERENCES

Chapter 20 Geriatrics Randall Espinoza

1. INTRODUCTION 2. AN OVERVIEW OF GROWING OLDER

2.1. Who is old 2.2. Cognitive and psychological aging 2.3. Adjustment to growing older

2.3.1. Retirement 2.3.2. Relocation and housing 2.3.3. Institutionalization 2.3.4. Driving 2.3.5. Sexuality 2.3.6. Coping with loss and decline

3. GENERAL APPROACH TO THE OLDER PATIENT

3.1. Psychiatric interview 3.2. Medical history 3.3. Medication and supplement history 3.4. Family history 3.5. Past psychiatric history 3.6. Social history 3.7. Review of systems

3.7.1. Physical examination 3.7.2. Mental status examination 3.7.3 Laboratory studies

4. MAJOR PSYCHIATRIC DISORDERS

4.1. Geriatric psychopharmacology 4.2. Psychotherapy and other behavioral treatments 4.3. Mood disorders 4.4. Anxiety disorders 4.5. Substance abuse disorders 4.6. Psychotic disorders

5. CONCLUSION 6. KEY POINTS 7. SELF-ASSESSMENT

7.1. Which of the following is true? 7.2. General true statements about the aging world population include all the following except

8. CASE STUDIES

8.1. Depression in an older adult 8.2. Adjustment disorder in an older adult

REFERENCES

Chapter 21 Emergency Psychiatry Divy Ravindranath, Mark Newman and Michelle Riba

1. INTRODUCTION 2. APPROACH TO THE PATIENT

2.1. Building rapport 2.2. Management of agitation 2.3. Evaluation

2.3.1. General medical evaluation 2.3.2. Psychiatric evaluation 2.3.3. Culture-bound syndromes

3. RISK MANAGEMENT FOR COMMON PSYCHIATRIC EMERGENCIES

3.1. Dangerousness to self

3.1.1. Definition 3.1.2. Risk factors 3.1.3. Management

3.2. Dangerousness to others

3.2.1. Definition 3.2.2. Risk factors 3.2.3. Management

4. PSYCHOSIS

4.1. Definition 4.2. Risk factors 4.3. Management

5. MANIA

5.1. Definition 5.2. Risk factors 5.3. Management

6. ANXIETY

6.1. Definition 6.2. Risk factors 6.3. Management

7. DISPOSITION

7.1. Inpatient 7.2. Outpatient 7.3. Liaison with other providers

8. CONCLUSION 9. KEY POINTS 10. SELF-ASSESSMENT

10.1. According to a 2005 study, which of the following risk factors closely correlates with the decision to pursue inpatient hospitalization of a suicidal patient? 10.2. All of the following characteristics correlate with an anxiety aetiology, rather than a cardiac etiology, for chest pain, except

11. CASE STUDIES

11.1. At risk of self-harm 11.2. A danger to others 11.3. A patient with paranoid schizophrenia 11.4. A patient with bipolar disorder 11.5. Sudden-onset chest pain

ACKNOWLEDGEMENT REFERENCES

Chapter 22 Outpatient Psychiatry Ondria Gleason, Aaron Pierce and Bryan Touchet

1. INTRODUCTION 2. PROFESSIONALISM AND ETHICAL CONSIDERATIONS 3. THE PSYCHIATRIC INTERVIEW

3.1. Interview format

4. SAFETY IN THE OUTPATIENT SETTING 5. SUICIDE RISK ASSESSMENT 6. SUBSTANCE ABUSE SCREENING 7. EFFECT OF MEDICAL ILLNESS ON PSYCHIATRIC DISORDERS 8. DIFFERENTIAL DIAGNOSIS AND FORMULATION 9. MANAGEMENT OF THE PSYCHIATRIC PHARMACOLOGICAL MANAGEMENT VISIT 10. PSYCHOTHERAPY IN THE OUTPATIENT SETTING 11. TREATMENT ADHERENCE 12. KEY POINTS 13. SELF-ASSESSMENT

13.1. Rapport is 13.2. A 45-year-old man is brought to the psychiatric clinic after being found wandering on the street. Initial management includes which of the following

14. CASE STUDIES

14.1. A case emphasizing ethical dilemmas in outpatient practice

REFERENCES

Chapter 23 General Hospital Psychiatry Jen Alt McDonald and Mark T. Wright

1. INTRODUCTION 2. PSYCHIATRIC DISORDERS IN THE GENERAL HOSPITAL POPULATION 3. THE WORK OF GENERAL HOSPITAL PSYCHIATRISTS 4. AGITATION AND AGGRESSION IN THE GENERAL HOSPITAL 5. ANXIETY IN THE GENERAL HOSPITAL 6. DEPRESSION IN THE GENERAL HOSPITAL 7. SUICIDALITY IN THE GENERAL HOSPITAL 8. SOMATOFORM DISORDERS, FACTITIOUS DISORDERS, AND MALINGERING IN THE GENERAL HOSPITAL 9. SUBSTANCE WITHDRAWAL IN THE GENERAL HOSPITAL 10. OTHER ISSUES IN THE GENERAL HOSPITAL

10.1. Informed consent 10.2. Conflicts within the treatment team 10.3. Conflicts with families 10.4. Patient refusal to speak or eat 10.5. Privacy and stigma

11. CONCLUSION 12. KEY POINTS 13. SELF-ASSESSMENT

13.1. Which of the following factors is associated with a decrease in suicide risk? 13.2. A hospital ward nurse calls you to report a patient is agitated. The best response to this is

14. CASE STUDIES

14.1. Agitation in a general hospital patient 14.2. Depression in a general hospital patient 14.3. Parasuicidal behavior 14.4. Alcohol withdrawal

REFERENCES

Chapter 24 Psychiatric Education Linda Gask and Michelle B. Riba

1. INTRODUCTION: TEACHING AND LEARNING 2. PSYCHIATRY AND MENTAL HEALTH 3. EDUCATION AND RECRUITMENT 4. MEDICAL SCHOOL TEACHING IN PSYCHIATRY: AN INTERNATIONAL PERSPECTIVE 5. EXPERIENCE OF PSYCHIATRY IN MEDICAL SCHOOLS

5.1. Behavioral science teaching 5.2. Communication skills training 5.3. Integrated curricula and problem-based learning

6. RESIDENCY AND POSTGRADUATE TRAINING IN PSYCHIATRY ACROSS THE WORLD

6.1. Purpose and overview 6.2. International comparisons 6.3. International variation in the content of training schemes 6.4. Psychiatry, neurology and biological psychiatry 6.5. Training in psychotherapy 6.6. Involvement of service user/patients and carers in psychiatric training

7. ASSESSMENT OF PSYCHIATRIC EDUCATION

7.1. Assessing knowledge 7.2. Skills assessment 7.3. The long case 7.4. Modified long cases 7.5. The objective structured clinical examination (OSCE) 7.6. Assessment methods used internationally 7.7. Life-long learning 7.8. Developing research and teaching skills 7.9. Continuous professional development and education 7.10. CPD and the pharmaceutical industry

7.11. Re-licensing 7.12. Self-care

8. KEY POINTS 9. SELF-ASSESSMENT

9.1. In the United States, the accreditation council of graduate medical education has determined six competencies for all medical specialties, including psychiatry 9.2. The Royal College of Physicians and Surgeons of Canada organized competencies around seven specific roles of the medical professional

10. CASE STUDY REFERENCES

Chapter 25 Residency Training Sanjai Rao and Sidney Zisook

1. INTRODUCTION 2. THE PATHWAY TO PSYCHIATRY RESIDENCY IN THE US

2.1. Undergraduate education 2.2. Medical school 2.3. Psychiatry residency

3. THE ADMISSIONS PROCESS

3.1. Applications

3.1.1. Electronic Residency Application Service 3.1.2. Educational Commission for Foreign Medical Graduates 3.1.3. Maximizing the odds

3.2. Interviews

3.2.1. Scheduling and preparation 3.2.2. The interview day 3.2.3. After the interview

3.3. The match 3.4. The Supplemental Offer and Acceptance Program

4. ADMINISTRATIVE HIERARCHY FOR RESIDENCY TRAINING

4.1. Oversight of programs

4.1.1. Accreditation Council for Graduate Medical Education 4.1.2. Residency Review Committee for Psychiatry

4.2. Oversight of residents

4.2.1. American Board of Psychiatry and Neurology 4.2.2. Local Graduate Medical Education Committee 4.2.3. Residency Training Committee 4.2.4. Program director and associate program directors

5. RESIDENCY TRAINING

5.1. Clinical rotations 5.2. Postgraduate year one 5.3. Postgraduate year two 5.4. Postgraduate year three 5.5. Postgraduate year four 5.6. Didactic Curriculum

5.6.1. PGY-1 5.6.2. PGY-2 5.6.3. PGY-3 5.6.4. PGY-4

5.7. Other common seminars 5.8. Supervision 5.9. Evaluation 5.10. Core competencies 5.11. Psychotherapy 5.12. Resident evaluations 5.13. Standardized exams

6. AFTER RESIDENCY

6.1. Specialty training/ fellowships 6.2. Academic psychiatry 6.3. Community and/or private practice psychiatry

7. CONCLUSIONS REFERENCES

Chapter 26 Methods of Psychiatric Research Elizabeth Burgess, Nicolas Ramoz and Philip Gorwood

1. INTRODUCTION 2. IMAGERY

2.1. Mixing fMRI and PET 2.2. Mixing fMRI and genetics

3. GENETICS 4. COGNITIVE FUNCTIONS

4.1. Cognitive functions as endophenotypes

5. EPIDEMIOLOGICAL COHORT STUDIES

5.1. Mixing cohort studies and genetics

6. VIRUSES AND PARASITES AS ENVIRONMENTAL FACTORS 7. PHARMACOLOGY

7.1. Access to the protocol before it starts (www.clinicaltrial.gov) 7.2. The use of ‘mega trials’ 7.3. Mixing pharmacology and cognitive analyses 7.4. Mixing pharmacology and genetics

REFERENCES

Chapter 27 World Suicide Morton M. Silverman

1. INTRODUCTION 2. RISK FACTORS 3. PROTECTIVE FACTORS 4. SUICIDE ATTEMPTS 5. A PUBLIC HEALTH PERSPECTIVE 6. WORLD HEALTH ORGANIZATION STATISTICS 7. ACCESS TO MEANS 8. GENDER AS A RISK FACTOR 9. AGE AS A RISK FACTOR 10. INTERNATIONAL ACTIVITIES 11. INTERNATIONAL STUDIES ON INCREASED RISK FOR SUICIDE 12. INTERNATIONAL STUDIES ON PSYCHOPHARMACOLOGICAL INTERVENTIONS FOR MENTAL ILLNESSES ASSOCIATED WITH SUICIDAL BEHAVIORS 13. SUICIDE RISK ASSESSMENT FROM A CULTURAL PERSPECTIVE 14. RECOMMENDATIONS

14.1. Better data 14.2. Further research 14.3. Better psychiatric treatment 14.4. Environmental changes 14.5. Strengthening community-based efforts

15. CONCLUSIONS 16. KEY POINTS 17. SELF-ASSESSMENT

17.1. You have just been asked to serve as a medical consultant to the new Deputy Minister of Health for a developing country whose major economic resource is agriculture. You have been asked to consult on the suicide problem in this country. The Deputy Minister of Health wants a solution to the problem as fast as possible and has asked you for your best advice as to how to lower the suicide rates in the next 12 months. Before you agree to accept this consultation, you ask the Deputy Minister of Health for which of the following information 17.2. A 28-year-old, recently separated, intoxicated male is brought into the Emergency Department following an apparent overdose of sleeping pills after a verbal fight on the telephone with his estranged wife. He told her on the telephone that he would continue to swallow sleeping pills until she agreed to come back to live with him. Instead she hung up and called the police, who went to his apartment and brought him to the emergency room. The first course of action was to medically stabilize the patient and to ensure that he had not ingested a lethal amount of sleeping pills. The next step was to wait until he was no longer inebriated before conducting a standard mental status examination. When asked if he was thinking of killing himself, only trying to get my wife’s attention.” As the examining clinician, your next step, after completing the rest of the mental status examination, is to

REFERENCES

Chapter 28 AIDS Psychiatry Mary Ann Cohen

1. THE SCOPE OF THE AIDS PANDEMIC AND RELEVANCE TO PSYCHIATRY 2. A BIOPSYCHOSOCIAL APPROACH TO PSYCHIATRIC DIAGNOSIS IN PERSONS WITH HIV AND AIDS 3. DIAGNOSIS AND TREATMENT IN AIDS PSYCHIATRY 4. COGNITIVE DISORDERS IN HIV AND AIDS

4.1. HIV-associated neurocognitive disorder 4.2. Delirium

5. MOOD DISORDERS IN HIV AND AIDS 6. ANXIETY DISORDERS IN HIV AND AIDS: POSTTRAUMATIC STRESS DISORDER 7. CLINICAL DECISION-MAKING AND TREATMENT IN AIDS PSYCHIATRY

7.1. Clinical decision-making

7.1.1. Psychosomatic medicine and prevention of HIV transmission 7.1.2. Recognition and treatment of psychiatric disorders — diagnostic mnemonic A, B, C, D 7.1.3. Comprehensive psychiatric evaluation

8. TREATMENT ISSUES

8.1. Psychotherapeutic modalities 8.2. Psychopharmacology and AIDS psychiatry

8.2.1. General principles 8.2.2. Psychopharmacology and addictive disorders10,11 8.2.3. Psychopharmacology and other psychiatric disorders — examples of medicines and doses are listed

9. CONCLUSION 10. KEY POINTS 11. SELF-ASSESSMENT

11.1. What is the differential diagnosis of new-onset visual hallucinations in a person with late-stage AIDS? 11.2. What is the most common cause of dementia in persons under 50 years of age?

12. CASE STUDIES

12.1. Differential diagnosis of visual hallucinations 12.2. Nonadherence due to subtle cognitive impairment 12.3. A young man AIDS and severe cognitive impairment 12.4. Delirium 12.5. Depression, suicide, and HIV infection 12.6. PTSD and non-adherence to care

ACKNOWLEDGEMENT REFERENCES

Chapter 29 Pharmacogenomic Variability Associated with Psychotropic Medication Response David Mrazek and Bhanu Prakash Kolla

1. INTRODUCTION 2. ANTIDEPRESSANT MEDICATIONS

2.1. Cytochrome P450 drug metabolizing enzyme genes

2.1.1. The cytochrome P450 2D6 gene (CYP2D6) 2.1.2. The cytochrome P450 ( CYP2C19) 2.1.3. The cytochrome P450 2C9 gene (CYP2C9) 2.1.4. The cytochrome P450 1A2 gene (CYP1A2)

2.2. Target genes that affect antidepressant response

2.2.1. The catechol-O-methyltransferase enzyme gene (COMT) 2.2.2. The norepinephrine transporter gene (SLC6A2) 2.2.3. The serotonin transporter gene (SLC6A4) 2.2.4. The serotonin 1A receptor gene (HTR1A) 2.2.5. The serotonin 2A receptor gene (HTR2A)

3. ANTIPSYCHOTIC MEDICATIONS

3.1. Drug metabolizing genes associated with antipsychotic response

3.1.1. The cytochrome P450 2D6 gene (CYP2D6) 3.1.2. The cytochrome P450 2C19 gene (CYP2C19) 3.1.3. The cytochrome P450 1A2 gene (CYP1A2) 3.1.4. The cytochrome P450 3A4 gene (CYP3A4)

3.2. Target genes that affect antipsychotic response

3.2.1. The catechol-O-methyltransferase enzyme gene (COMT) 3.2.2. The norepinephrine transporter gene (SLC6A2) 3.2.3. The serotonin 1A receptor gene (HTR1A) 3.2.4. The serotonin 2A receptor 3.2.5. The serotonin 2C receptor gene (HTR2C) 3.2.6. The dopamine 2 receptor gene (DRD2) 3.2.7. The dopamine 3 receptor gene (DRD3) 3.2.8. The dopamine 4 receptor gene (DRD4)

4. MEDICATIONS USED TO TREAT ADHD

4.1. Drug metabolizing enzyme associated with response to ADHD treatment 4.2. Target genes that affect response to ADHD treatment

4.2.1. The catechol-O-methyltransferase enzyme gene (COMT) 4.2.2. The norepinephrine transporter gene (SLC6A2) 4.2.3. The dopamine transporter gene (SLC6A3) 4.2.4. The serotonin transporter gene (SLC6A4)

5. CONCLUSION 6. SELF-ASSESSMENT

6.1. A patient is a poor metabolizer of CYP2D6 and CYP2C9, but has normal metabolic capacity for CYP2C19 and CYP1A2. Which antidepressant would be the best choice as an initial medication to treat a major depression? 6.2. A patient is hospitalized with a psychotic illness and successfully treated with olanzapine. It is determined that he has an inducible form of CYP1A2. Which of the following discharge instructions is not necessary?

REFERENCES

Chapter 30 Ethics in Psychiatry Kristi Estabrook

1. INTRODUCTION 2. HISTORY OF INTERNATIONAL PSYCHIATRIC ETHICS 3. CURRENT BIOETHICAL PRINCIPLES

3.1. Autonomy 3.2. Non-maleficence 3.3. Beneficence 3.4. Justice 3.5. Professionalism

4. CULTURAL THEMES AND INTERNATIONAL PERSPECTIVES IN ETHICS 5. ESSENTIAL ETHICAL SKILLS 6. ETHICS IN PSYCHIATRY

6.1. Boundaries 6.2. Confidentiality: An Evolving Ethical Challenge 6.3. Informed consent 6.4. Dual roles 6.5. Ethics in training 6.6. Research

7. CONCLUSION 8. KEY POINTS

9. SELF-ASSESSMENT

9.1. A 35-year-old woman dies from an intentional overdose. Her husband approaches her psychiatrist of the last 10 years, devastated about her death and looking for answers as to why she might have killed herself. The patient did not sign a release of information before her death. What should the psychiatrist say to the husband? 9.2. A 19-year-old man is found wandering the street, confused and clothed only in underwear, on a very cold night. On evaluation he denies thoughts of harming himself or wanting to harm others. He insists that he was on his way to church, and he is religiously preoccupied and psychotic. The patient declines inpatient treatment and requests a cab home. The psychiatrist should

REFERENCES

Chapter 31 The Culturally Competent Psychiatric Assessment Ajoy Thachil and Dinesh Bhugra

1. INTRODUCTION 2. CULTURAL PSYCHIATRY 3. DEFINITIONS OF KEY TERMS 4. THE EPIDEMIOLOGY OF MENTAL ILLNESS ACROSS CULTURES 5. CULTURE-RELATED SPECIFIC SYNDROMES 6. PREPARING FOR A CROSS-CULTURAL PSYCHIATRIC ASSESSMENT 7. ELICITING THE PSYCHIATRIC HISTORY

7.1. Identity and worldview 7.2. Idioms of distress 7.3. Life events 7.4. Migration and acculturation 7.5. Discriminatory experiences 7.6. Personal history 7.7. Explanatory model of illness 7.8. Previous experience of services and treatment

8. THE MENTAL STATE EXAMINATION

8.1. Appearance and behavior 8.2. Impulse control and aggression 8.3. Mood 8.4. Depressive cognitions 8.5. Delusions 8.6. Perception 8.7. First rank symptoms 8.8. Cognitive assessment

9. CULTURAL FORMULATION AND DIAGNOSIS 10. MANAGEMENT 11. CONCLUSION 12. KEY POINTS

12.1. Preparing for cross-cultural assessments 12.2. Eliciting the psychiatric history 12.3. Good practice points9

13. SELF-ASSESSMENT

13.1. The WHO conducted two international studies, the IPSS and the DOSMeD. These studies 13.2. Somatic idioms of distress include

14. CASE STUDIES

14.1. Overdose 14.2. Cognitive decline

REFERENCES

Chapter 32 Traditional Healing for Psychiatric Disorders Roger M. K. Ng, Zhang-Jin Zhang and Wendy Wong

1. SHOULD WE CARE OR SHOULD WE NOT? 2. ANCIENT WISDOM ON MANAGEMENT OF MENTAL HEALTH PROBLEMS

2.1. Unani medicine in Indian sub-continent culture 2.2. Ayurvedic medicine in Indian sub-continent culture 2.3. Traditional Chinese medicine in oriental culture

2.3.1. Stagnation of liver qi 2.3.2. Stagnation of liver qi with spleen deficiencies 2.3.3. Disturbed shen (神) with phlegm

2.4. Curanderas in Mexican and Peruvian Americans 2.5. Obeah in Afro-Caribbean culture 2.6. Ubunta in African culture

3. CONCLUSION 4. KEY POINTS 5. SELF-ASSESSMENT

5.1. What are the three essential components of evidence-based medicine as suggested by Sackett?18 5.2. What are the major criticisms of the practice of traditional healing practices?

6. CASE STUDIES

6.1. Obeah 6.2. Traditional Chinese medicine

REFERENCES

Chapter 33 International Perspective on Homelessness Belinda Bandstra, Anthony Mascola and Daryn Reicherter

1. INTRODUCTION 2. DEFINITIONS 3. EPIDEMIOLOGY 4. MENTAL HEALTH AND HOMELESSNESS

4.1. Substance use disorders 4.2. Mood disorder 4.3. Anxiety disorders 4.4. Psychotic disorders 4.5. Personality disorders 4.6. Traumatic brain injury 4.7. Cognitive dysfunction 4.8. Comorbidities 4.9. Mortality and general medical health 4.10. Criminal justice systems

5. TREATMENT INTERVENTIONS PROPOSED TO ASSIST HOMELESS PERSONS AND THEIR EFFECTIVENESS

5.1. Historical context 5.2. Contemporary treatment interventions proposed for homeless persons with various health conditions

5.2.1. Intensive case management versus other forms of care 5.2.2. “High threshold interventions,” requiring substance use and mental health stabilization first before providing further assistance to homeless persons versus “low threshold, harm reduction” strategies 5.2.3. Effective interventions for homeless youth

6. SUMMARY 7. SOCIAL VARIABLES AND HOMELESSNESS

7.1. Government

8. KEY POINTS 9. SELF-ASSESSMENT

9.1. What diagnoses account for the majority of psychiatric disorders among homeless people? 9.2. A harm reduction intervention is characterized by a

10. CASE STUDIES

10.1. Chronic psychiatric symptoms 10.2. Multiple hospital admissions

REFERENCES

Chapter 34 Mental Health Consequences of War and Political Conflict Daryn Reicherter and Rena Sugarbaker

1. INTRODUCTION 2. WAR AND TRAUMA-RELATED MENTAL HEALTH DISORDERS 3. PTSD IN WAR SETTINGS 4. MENTAL HEALTH CONSEQUENCES OF CURRENT AND RECENT CONFLICTS

4.1. Afghanistan 4.2. The Balkans 4.3. Chechnya 4.4. Iraq 4.5. Israel 4.6. Lebanon 4.7. The Gaza strip 4.8. Rwanda 4.9. Sri Lanka 4.10. Somalia

5. UNMEASURED MENTAL SUFFERING FROM WAR 6. HUMAN RIGHTS VIOLATIONS PROMOTED IN CONFLICT SETTINGS

6.1. Genocide 6.2. Torture 6.3. Gender-based violence

7. HIGH RISK CONDITIONS CREATED BY CONFLICT

7.1. International issues linked to increased mental health problems 7.2. Internal issues linked to increased mental health problems

8. DEMOGRAPHICS OF POPULATIONS AT RISK IN WAR SETTINGS

8.1. Veterans 8.2. Civilians 8.3. Women 8.4. Children

9. SPECIAL CLINICAL ISSUES IN TREATING SURVIVORS OF CONFLICT

9.1. Rebuilding public mental health in post conflict settings 9.2. Refugee mental health for influx of traumatized people 9.3. Cultural variables in mental health of diverse traumatized populations 9.4. Centers for torture rehabilitation 9.5. Veterans’ mental health services

10. KEY POINTS 11. SELF-ASSESSMENT

11.1. Aside from soldiers, which populations are at risk for trauma related mental health problems in the context of war/conflict? 11.2. Will PTSD from war/conflict always present in an identical fashion, independent of culture, gender, or nationality?

12. CASE STUDIES REFERENCES

Chapter 35 Stigma Travis Fisher

1. INTRODUCTION 2. DEFINITION

2.1. Stereotype 2.2. Prejudice 2.3. Discrimination

3. THE SIGNS OF STIGMA

3.1. Personal liberty 3.2. Social opportunities

3.2.1. Housing 3.2.2. Employment 3.2.3. Treatment by the legal system 3.2.4. Marriage

3.3. Health care

3.3.1. General medical care 3.3.2. Mental health care

4. EXPLANATORY MODELS

4.1. Classical conditioning 4.2. “Just world” hypothesis 4.3. Social identity theory 4.4. Categorization 4.5. Modifi ed labeling theory

5. INTERVENTIONS

5.1. Examination of our own attitudes 5.2. Be active advocates 5.3. Increased focus on patients quality of life

6. CONCLUSIONS 7. SELF-ASSESSMENT

7.1. The just world hypothesis argues that 7.2. Which of the following is not a component of the sociologic definition of stigma?

8. CASE STUDIES

8.1. Mr A 8.2. Ms B 8.3. Mrs C 8.4. Mr F 8.5. Mr G 8.6. Mrs H

REFERENCES

Chapter 36 Legal Aspects of Psychiatry Joseph B. Layde

1. INTRODUCTION 2. LEGAL REGULATION OF PSYCHIATRIC PRACTICE 3. APPLICATION OF PSYCHIATRY TO CRIMINAL LAW 4. APPLICATION OF PSYCHIATRY TO CIVIL LAW 5. PSYCHIATRIC MALPRACTICE 6. PSYCHIATRY AS AGENCY OF SOCIAL CONTROL 7. KEY POINTS 8. SELF-ASSESSMENT

8.1. A psychiatrist is asked by a patient, a 28-year-old man who suffers from dysthymia, to fill out a form requesting medical disability insurance payments for his illness. The patient says, “You can exaggerate my symptoms a little bit, just for my sake.” Which of the following is the most appropriate response by the psychiatrist? 8.2. Which of the following is most accurate in describing the role of psychiatrists in torture?

9. CASE STUDY REFERENCES

Index

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