Somatization and somatoform disorders

Disorders presenting with functional physical symptoms and somatization 'Functional' somatic symptoms with no obvious organic explanation are frequent in childhood. Children have a limited vocabulary for expressing their emotions and often communicate their worries by means of physical symptoms. In a number of cases functional symptoms may be an expression of somatization, namely the somatic presentation of psychological distress leading to a degree of impairment resulting in help-seeking...

Levels of homovanillic acid and 5hydroxyindoleacetic acid in cerebrospinal fluid

Suicide attempts represent a more varied type of behaviour than completed suicides, yet neurobiological studies of suicide attempters have shown a remarkable consistency in pointing to a serotonergic dysfunction. In a meta-analysis, which included 20 research reports, Lester (15) concluded that there is strong evidence of decreased cerebrospinal fluid levels of 5-HIAA in subjects who had previously made a suicide attempt compared to diagnostically matched non-attempters. Moreover, in three out...

Multiaxial assessment

ICD-10 recommends that multiaxial assessment be carried out for children and adolescents, while DSM-IV suggests it for all ages. In both systems Axis 1 is used for psychiatric disorders which have been discussed above. The last three axes in both systems cover general medical conditions, psychosocial problems, and level of social functioning, respectively these topics will be alluded to below under aetiology. In the middle are two axes in ICD-10, which cover specific (Axis II) and general (Axis...

Population strategies

Reducing availability of means for suicide This is the most widely discussed population strategy.(25) It is based on evidence that if the availability and or danger of a popular method for suicide changes then this tends to have an impact on suicide rates. The general principles of prevention through reducing availability of means are, first, that many suicidal acts occur impulsively and therefore if a dangerous means is available this is more likely to result in death and, secondly, that the...

Cognitivebehaviour therapies for children and adolescents

Cognitive, ,d e,v,e opffie n., asocial, context Conduct, .disorder, and, .aggression Attentiondeficitandhype ractivity initial formulation Education and. .engagement. ofthe ch ildand family Problem-solving Ciore ciognitiveM .techniques Core behavioiural technigues Severity of disorder Social.context Combinatio,n With .other, interventions Length, of, .treatment and fo,l low UP Attention de.ficit,and hyperactivity Training .and disseminatio.n Chapter., References

Determinants of suicide

Usually, suicide has no single cause. It is the endpoint of an individual process, in which several interacting determinants or risk factors can be identified ( Table , and TableJ). Risk factors are by their nature cultural, social, situational, psychological, biological, and even genetic. Table 1 Risk factors for suicide sociodemographic variables *-r ITTFll. -Urt lOTKIkptK i-il-l'IT t*< h-H f*if. AW. nwr -HLA+11. Table 2 Clinical determinants of suicide Culture defines basic attitudes...

Further reading

Advisory Council on the Misuse of Drugs (1995). Volatile substance abuse. HMSO, London. Flanagan, R.J., Streete, P.J., and Ramsey, J.D. (1997). Volatile substance abuse practical guidelines for the analytical investigation of suspected cases and interpretation of results. United Nations Drug Control Programme, Vienna. Ives, R. (1995). Problems with solutions a manual for work with solvent sniffers and other young drug users (pack and video). Institute for the Study of Drug Dependence, London....

Conclusion

Brief dynamic psychotherapy is an important treatment for numerous disorders, primarily the adjustment, anxiety, and mood disorders. Both alone and in combination with medication brief dynamic psychotherapy is an effective part of the treatment armamentarium. Clinicians should be trained in the brief as well as the longer-term treatments and their use as brief, intermittent, and maintenance treatments. Skill in the longer-term psychotherapies is important to developing skill in the brief...

Delusions clinical aspects

A delusion may be defined very loosely as a mistaken idea which is held unshakeably by the patient and which cannot be corrected. As will be seen, this is not a satisfactory definition, although it may be a useful starting-point for clinical recognition of a delusional process. This brief exposition is concerned to facilitate clinical recognition rather than to dwell on psychopathological theories which are dealt with in detail elsewhere in this book. It is a widely held view that delusions are...

Ketamine

Ketamine, a non-barbiturate anaesthetic analgesic structurally related to phencylidine was developed in the 1960s when it was promoted as an anaesthetic. Unlike inhalational and opiod anaesthetics which work via supresssion of the reticular activating system, ketamine causes functional and electrophysiological dissociation between the thalamocortical and limbic systems. The dissociation results in higher centres being prevented from perceiving auditory, visual, or painful stimuli, i.e. 'a lack...

Chapter References

Mental heath law (4th edn). Sweet and Maxwell, London. 2. Bean, P. (1986). Mental disorder and legal control. Cambridge University Press. 3. Roth, M. and Bluglass, P. (1986). Psychiatry, human rights and the law. Cambridge University Press. 4. United Nations (1991). General Assembly, Res. 46 119. 5. Kennedy, I. and Grubb, A. (ed.) (1998) Principles of medical law, pp. 109-279. Oxford University Press. 6. Malette v. Shuman (1988), 47 Dominion Law Reports (4th) 18. 7. Re T...

Psychogenic excoriation Clinical description

Psychogenic excoriation (also called neurotic excoriation, pathological or compulsive skin picking, and dermatotillomania) is excessive scratching, picking, gouging, or squeezing of the skin sometimes in response to an itch or other skin sensation or to remove a lesion on the skin (for example acn excor ).(353 and 37) Most patients use fingernails to excoriate the skin, but the teeth and instruments (for example tweezers, nail files, pins, or knives) are also used. Psychogenic excoriation...

Psychological treatments Debriefing

Critical incident stress debriefing is a widely practised intervention that has the goal of promoting adaptation to traumatic events. Debriefing is generally conducted in a group within 24 to 72 h of the trauma. However, these parameters have been modified to permit more flexible interventions. Mitchell (43> proposes that debriefing comprises seven phases 1. an initial outline of the purpose and benefits of debriefing 2. the fact phase, in which participants relate what happened to them 3. a...

The Present State Examination

The Present State Examination (PSE)(62> is a semistructured procedure, based upon an interview schedule containing items that are rated as the interview proceeds. The content of the PSE has always been more or less comprehensive and it contains a number of symptoms, such as worry, muscular tension, restlessness, etc., that are not associated with particular diagnoses. These symptoms are included because they are often clinically obvious and also important to the patient (see comments below on...

Assessments of index problem and psychiatric diagnosis

The task of assessment is to identify those factors that might have predisposed, precipitated, and may now be maintaining the index problem (e.g. aggressive behaviour). This is done through detailed history taking from both the person him- or herself and an informant, a mental state examination and where indicated a physical examination, direct observation, and detailed record keeping by care staff over time. Assessments should include a description of the behaviour as well as an attempt to...

Assessment and treatment

The key to successful handling of psychiatric and psychological problems in trauma patients is a thorough psychological assessment. Semistructured interviews (e.g. the Mini International Diagnostic Interview), questionnaires, and rating scales (e.g. the Montgomery Asberg Depression Rating Scale ( MADRS)) may be helpful, but cannot replace a clinical assessment. General questionnaires, such as the General Health Questionnaire or Symptom Checklist, perform as well as accident-specific...

Disorders of sleep Sleep complaints

The starting point for the clinician is the patient's sleep complaint. They are of three basic types not enough sleep or unrefreshing sleep (insomnia) sleeping too much (excessive daytime sleepiness) disturbed episodes during or otherwise related to sleep (parasomnias) The detailed accounts later in this section are organized in relation to these main types of sleep complaint insomnias ( Chapiei.4.14., 2), excessive daytime sleepiness (Chapter.4.14.3), and parasomnias (Chapter 4.14.4). In...

Social phobia

Social phobia only recently became an official diagnostic category. In the first and second editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM),(12) all phobias were grouped together. However, in 1966, Marks and Gelder(3) observed that various phobias had different ages of onset and surmised that they might be distinct disorders, providing the initial impetus for the inclusion of social phobia in DSM-III. (4) Nevertheless, research into the nature and treatment of social...

Drugs used to treat psychiatric disorders

Antidepressants such as tricyclics, monoamine oxidase inhibitors, and others (trazodone, fluoxetine, bupropion, ritenserin, and lithium) may cause sleep disruption, alter sleep architecture, and suppress REM sleep. Sedative antidepressants (e.g. amitryptiline (Elavil ( )), doxepin, and trazodone) may be used to treat insomnia, especially if associated with depression. Most tricyclic antidepressants may cause daytime sedation. Monoamine oxidase inhibitors have alerting properties and so they...

Practical implications

Neuropsychological function has been related to various indices of outcome and predictors of rehabilitation success. In a thorough review of the literature, Green (39 concluded that the most consistent finding was that verbal memory was associated with all types of functional outcome so that deficits in this function could limit the level of outcome. Vigilance was related to social problem solving and skill acquisition, while card sorting predicted the quality of more general functioning in the...

Cognitivebehaviour therapy for eating disorders

The cognitive-behavioural account of anorexia nervosa and bulimia.nervosa Evidence forth . .c.o.gp. tjy -beha.Yi.o.u.ra.l account implications .of th.e .c.oflnitive-be.ha.vio.ura . account The cognitive-behavioural treatment of, bulimia., nervosa Stage , Explainingthe, .cognitivein view ofthe main.te.n.a.nce of, bulimia. .nervosa Adviceregarding eating,. vomiting, . .and the. .misuse, oLlaxativesand .diuretics StageJ Addressing concerns a,b,o,ut e,ati,n,g,,,.sh,ape,n and. weight Tack,lin,g...

Medication for children and adolescents

General., guidelines. . for . drug treatmentin c.h.ildren and adolescents Central stimulants other. iMndi,ca.tions io.r central stimulant. .treatment Schiz.o.ph rs n.ia and othsLfsrHs .ofBsychosss .i,n. ad.o ,es.c,e.n,c.e Tou rette'ssyndrome and. other .tic disprders Serotonergic drugs including. .tricyc ic ntid.ep.re.ssa.nts other. anxietydisorders including sch,o,ol. phobia . a.n,d se ective .mutism Tourett.e s Synd.rome and. .pther. tic. .disorders Anorexia. nervosa,. b1u.liml a nervosa,,...

Experimental design

The basic principle of experimental design in fMRI is to manipulate the subject's experience or behaviour in some way that is likely to produce a functionally specific neurovascular response. It is usually important that the experiment should be designed to allow some other measure of response, for instance a button press, to be monitored simultaneously. We shall illustrate these and other principles by considering how one might design an experiment to identify the regions of the brain that are...

Anxiety obsessional and stressrelated neuroses

After excessively painful labours, some women suffer insomnia, nightmares, and repetitive daytime intrusion of images and memories, similar to those that occur after the harrowing experiences of war and natural disaster. (53> If they become pregnant, the symptoms may return, especially in the last trimester. They may develop a secondary tocophobia. This disorder can be treated by ventilation and cognitive-behavioural psychotherapy. Tocophobia is an indication for elective Caesarean section....

Reduplicative paramnesia

Perhaps the delusion that is most pathognomonic of brain injury, and which is also associated with postictal confusional states, is reduplicative paramnesia. The term reduplicative paramnesia covers a range of phenomena, which are often observed concurrently. Pick (42> , who introduced the term, used it to describe a patient who believed she had visited a duplicate hospital. Other phenomena covered by the term include the following any delusion involving duplication, for example that events...

Medicationrelated sleepwake disturbances

Many medications cause sleep-wake disturbances .,10 (Table, ). Drup ULT Li-I.n Ji. irrwrjIrmzdiiJI'ii-.urLkn ArtMlirtMH. UIMflWXL Jri(bUftlifl- 0'h4< U Hl(rtM i> hhm fi-otoiifi brottoNjun. dw hH. ipptixc Jufptutw. Ltetptf A Orup uuil tie (TMt pipchiitnc iiinrdrn HsilUnriiiii apvnli (iuji at dull ind jlcuhul) iPftfllMH (Oil Lit. I* **, -u-in.4nt. tans' Niul dtto+< Kir i. rtfi-i pJh Table 1 Medications causing sleep-wake disorders

Measurement and meanings

The original version of the Life Events and Difficulties Schedule was developed to study schizophrenic episodes (29,,30) and there has since been a large amount of research dealing with psychotic patients.(31) An early achievement was to make clear that the amount of change in activity as such brought about by a life event appears to be irrelevant and that the impact of events results from their meaning. (32> It has also been clear that some attention needs also to be given to ongoing...

Indications

Tables lists conditions where some antidepressant drugs have been found to be effective. Not all drugs are equally effective in each condition and very few clinical trials of the different compounds in each of the conditions have been conducted. Since the efficacy of antidepressant drugs is in part related to the dose administered and or blood levels, it is difficult to be certain of the relative efficacy of one compound versus another when only single fixed doses are used. The expense and...

Classification

A clinically important classification controversy is whether delusional and non-delusional BDD are the same or different disorders. Whereas BDD is classified as a somatoform disorder, its delusional variant is classified as a type of delusional disorder (formerly known as monosymptomatic hypochondriacal psychosis). DSM-IV, however, allows delusional patients to be diagnosed with both BDD and delusional disorder. This reflects the available data suggesting that the non-delusional and delusional...

Cornelia de Lange syndrome

This syndrome, also known as Brachmann-de Lange syndrome, was first described by de Lange in 1933 as a multisystem disorder which includes congenital malformation, growth retardation, and developmental delay.(31) A similar syndrome associated with additional finding of upper limb deficiency was described earlier by Brachmann in 1916.(32) Around 87 per cent of the affected subjects have an IQ below 60 (IQ ranges between 30 and 86 with an average of 53) and the quoted prevalence of this condition...

Treatment and management of schizophrenia

Johnstone Drugjre,atm,e,,n,t 'Positive features 'Negativelfsalures Behaviour Maintenance Treatment resistance Psychosocial interventions Social, .skillsJ.rain.ina .and Mil,lnMe,ss self-m,an,a.gemeot, .programmes Principles. pftreatmentand. management Preliminaries Low- o,tencyM.regimens ,High.-p,ote,n,c,y. regimens TheMmaintenance phase Psychiatric emergencies ppPLresponsenandM.tlreatmenlt. resistance Second-lineadiunctiyetreatments Psychosocial .interventions...

Angelman syndrome

This syndrome, also known as 'happy puppet syndrome', was first described by Angelman in 1965. The syndrome is characterized by severe mental retardation, jerky limb movements associated with abnormal gait, and inappropriate bouts of laughter, features which give the syndrome its name. This is a rare condition which affects between 1 in 20 000 and 1 in 30 000 people. In around 60 to 75 per cent of cases a deletion in the long arm of chromosome 15 (q11q13) could be detected. Whereas in...

Analytical psychology Jung

He.ro m.yt.h,s Anima,, animus, aM.shadow Jung's contributions to. psychotherapy Dreamsand .the self-re.gu.l.ating.psyche Psychological types The process of. individuation Summary 'Analytical Psychology' was the name given by C.G. Jung to his variety of psychodynamic theory in order to distinguish it from Freud's 'Psychoanalysis'. Jung's background and early work Jung was born on 26 July 1875, the son of a pastor in the Swiss Reformed Church who was also an Oriental and classical scholar. He...

Hemispheric shape and the formation of gyri

The spherical shape of the early fetal hemisphere is transformed into the adult shape by differing rates of growth in the various regions of the telencephalon ( Fig 1). The future insular lobe grows less than other telencephalic regions, so that by the eighth month it is covered by the frontal, parietal, and temporal lobes. In the adult brain the insula is completely buried in the depth of the lateral fissure. The extensive growth of the parieto-occipito-temporal association cortex leads to a...

The stress diathesis model

A parsimonious model meeting the above criteria has been proposed by our group. (1) (Fig, 1) It is based on the following key observations. Fig. 1 A stress diathesis model of suicide. Fig. 1 A stress diathesis model of suicide. 1. Over 90 per cent of suicides occur in the context of a psychiatric disorder. 2. The overwhelming majority of persons with psychiatric disorders do not make suicide attempts. 3. The objective severity of symptoms is not predictive of suicidal behaviours. 4. In a factor...

Definitions of impulse control disorders

Historically, impulse control disorders have been defined as harmful behaviours performed in response to irresistible impulses. (1.) In DSM-IV, an impulse control disorder is defined as the failure to resist an impulse, drive, or temptation to commit an act that is harmful to the individual or to others. (2.,3) DSM-IV also stipulates that for most impulse control disorders, the individual feels an increasing sense of tension or arousal before committing the act and then experiences pleasure,...

Indications and contraindications

Controlled trials confirm that valproate is effective in the treatment of multiple seizure types, including complex partial, simple and complex absence, generalized tonic-clonic, and myoclonic seizures.(3) Valproate is also effective in the prophylaxis of migraine headaches. At least seven controlled studies indicate efficacy in the treatment of the manic phase of bipolar disorder. Ml 1 and 12 No controlled studies have been conducted in patients with bipolar depression. Other conditions for...

Models of counselling

Specific models of counselling are usually differentiated by their theoretical base or traditions. The most relevant models for psychiatry are information-giving, reflective or client-centred, problem-solving, cognitive-behavioural, interpersonal, and psychodynamic counselling. Each of these will be described in turn. Giving information is an important part of contemporary psychiatric practice. This reflects a more open and collaborative approach to treating patients, and the ethical...

Peptic ulcer disease

Peptic ulcer disease occurs when the balance between stomach acid and mucosal defence factors is disrupted. Gastric acid, Helicobacter pylori, and non-steroidal anti-inflammatory drugs are the most important risk factors in the development of peptic ulcers. (49> The majority of patients with peptic ulcer disease present with epigastric pain that begins 1 to 3 h after eating. Treatment is aimed at reducing gastric acid (e.g. using cimetidine and ranitidine), improving mucosal defences (with,...

Assessment of the problem

It is important to obtain a detailed appraisal of the extent and amount of gambling occurring, as well as a detailed history of the development of the gambling from its early beginnings. Since the history is often chequered, a more accurate account can usually be obtained if the person being assessed provides the information by means of a detailed written narrative. This can subsequently be amplified and used as the basis of discussion. In addition, an attempt should be made to obtain some...

Course and prognosis

The natural history of pathological gambling is one characterized by exacerbations and remissions, often related to life events. Important elements in this are relationships within the family, especially with the spouse partner. An example of this is the not infrequent sequence of an exacerbation of heavy gambling in the husband, coterminous with the wife's first pregnancy. The outlook in pathological gambling is usually determined by the integrity of the underlying personality. In those in...

Developmental psychopathology

Developmental psychopathology emerged in the 1980s to bridge the rift between academic and clinical child psychology. (2, ,21) 'The developmental psychopathologist is concerned with the time course of a given disorder, its varying manifestations with development, its precursors and sequelae, and its relation to non-disordered patterns of behaviour.'(21) Developmental psychopathologists, like social learning theorists, look to normal development to illuminate pathological development. They are...

Reliability of evidence

Questions may arise about whether statements and confessions made by suspects are reliable. It is recognized that particular care should be exercised by the police in dealing with suspects who are psychologically vulnerable, and under the Police and Criminal Evidence Act 1984 police should ensure that juveniles and the mentally disordered should only be interviewed in the presence of an independent 'appropriate adult'. Nonetheless, it is clinically accepted that false confessions are sometimes...

Neurogenetic syndromes with behavioural phenotypes

Particular patterns of behaviour, temperament, and psychopathology may be associated with specific chromosomal and genetic disorders. (256) The term 'behavioural phenotype' was introduced by Nyhan in 1972(7) to describe patterns of unusual behaviour that are so characteristic that they suggest a specific neurogenetic disorder. He described stereotypical patterns of behaviour occurring in syndromic fashion in sizeable numbers of affected individuals with a given syndrome, and observed that these...

Interventions for parents and families a developmental psychopathology perspective

Stormshak Prenatal and early childhood family interventions Family interventions in the preschool years Family interventions in the school-aged years Family interventions involving adolescents Cultural issues m.family interventions Conclusions Chapter, References Several decades ago, a chapter on the types of treatment available for psychological disorders of childhood and adolescence would probably have been quite fragmented. The diversity of observed...

Psychiatry and abnormal behaviours

Psychiatry is the study of mental disorders. In this chapter we consider how and up to what point personality disorders should be considered as psychiatric disorders. Descriptions of individuals with behavioural characteristics of a negative moral or social value exist in every culture. At times, most societies have stablished institutions in which all types of marginalized people have been confined, as recorded by Foucault in his Histoire de la Folie l' ge ClassiqueA1 In 1575, the first...

Child neglect

Neglect refers to the underprovision of the child's basic needs, both physical and psychological. Most incidents comprise omissions of care by parents and others in the parental role. However, institutional neglect also occurs, mainly in the form of collective caretaking failure for example, residential children's homes in the United Kingdom, orphanages and nurseries in Eastern Europe, and neglect of care by educational establishments and outdoor pursuit centres. Definition problems include...

Kurt Schneider

Schneider is listed as the third major alienist in the history of schizophrenia, for example by Hoenig. (32) Study of Schneider's writings shows that there is a discontinuity between his views on schizophrenia and those proposed by Bleuler. For Schneider, the 'first-rank symptoms' were not pathognomonic but suggested a diagnosis of schizophrenia only if there was no evidence of any other organic psychoses. The 11 first-rank symptoms only gain meaning when sought in the context of three...

Syndromal mental retardation

Molecular analysis of syndromal mental retardation has identified numerous genes, but has not cast much light on the pathogenesis of the condition. A division into conditions due to mutations in a single gene and those due to chromosomal rearrangements is helpful for descriptive purposes, but this probably does not reflect a major distinction in pathogenesis. Perhaps the most disappointing result comes from the cloning of the FMR1 gene, mutations in which give rise to the fragile X syndrome, a...

Cultural variants

Other forms of acute psychoses have been observed in both traditional and developing countries, with high prevalence in Asia, Africa, and Latin America. These brief psychotic episodes are culture-bound syndromes, often with immediate precipitating stress or life events. (25> There is disorganized behaviour, delusions, thought disorders, confusion, and mood disorders, usually with full recovery and no relapse in a 1-year follow-up. The culture-specific disorders'26) and their potentially...

Psychiatric morbidity

Psychiatric morbidity is not increased in the early stages of the disease when patients present with isolated neurological symptoms (e.g. optic neuritis), (28) and purely psychiatric presentations without accompanying neurological symptoms do not occur.(29) Depressive symptoms (irritability, poor concentration, low mood, and anxiety) are commonly reported. In cross-sectional studies they are present in about 50 per cent of patients.(28> The lifetime prevalence for depression is also around 50...

Children with psychiatric disorder

High rates of sleep disturbance have been described in child psychiatric groups compared with other children (2,25. and 26 and in specific psychiatric disorders. Various sleep problems, including panic attacks, have been described in anxious children in general including those with panic disorders. Similarly, many types of sleep problem (including nightmares and other disturbed nocturnal episodes, excessive daytime sleepiness, and bedwetting) have been reported to be particularly frequent in...

The condensation and recording of information Summary and formulation

The skills required to produce summaries and formulations should be acquired early on in professional training, since they are central to the process of getting the information about the patient into a form which facilitates the making of decisions and the allocation of priorities for actions. Useful preliminaries to the writing of both summary and formulation are the preparation of a problem list and a lifechart how to prepare these should also be covered in the early stages of training. The...

Predisposing factors

In the presence of social pressures, predisposed individuals are propelled towards pathological gambling. Some of the factors involved in this predisposition are discussed below. Since gambling is a type of risk-taking, it lends itself to be used by those who, for reasons related to their personality, have a high need for risk. They spend large sums of money on the intangible commodity of risk, which may easily pass unnoticed because it is fleeting. This morbid propensity to take risks shows...

Borderline personality disorders

These patients form a significant proportion of the caseloads of many therapists. Working with them can pose difficult clinical problems based on their 'stable instability' including inability to form a stable therapeutic alliance, mood oscillations, poor impulse control, limited reflective ability, painful states of psychic emptiness followed by self-destructive acting-out, including self-destructive gestures and self-mutilation, violence, substance abuse, sexual acting-out, and eating...

Biological substrates of personality and personality disorders

Many investigators have concluded that there appears to be a high genetic component in the aetiology of schizoid, depressive, psychopathic, and introversive traits. Personality disorders and major psychiatric disorders Personality disorders have been considered as belonging to the spectrum of major psychiatric disorders. However, it must be remembered that external events, such as brain damage (organic personality disorders), or the psychological impact of a catastrophic event may also lead to...

Comorbidity

Pain disorder is commonly associated with anxiety and depression, and an additional diagnosis of anxiety disorder or mood disorder can be made if the criteria for both diagnoses are satisfied. This dual diagnosis can be useful if, for example, a depressive disorder develops in the presence of a long-standing pain disorder. Any temporal relationship can occur, however, with pain onset preceding, developing simultaneously, or following the onset of a mood disorder. Other common comorbid diagnoses...

Scope of developmental neuropsychiatry

The scope of developmental neuropsychiatry is broad(2) and includes the following. 1. Neurodevelopmental disorders that are described in other chapters of this book, including attention-deficit and hyperactivity disorders ( Chapter 9.2.3), pervasive developmental disorders and childhood-onset schizophrenia ( Chapter 9.2.2), obsessive- compulsive disorder and Tourette's syndrome (Chapter .9.2.6), and specific developmental disorders (Chapter 9.2.1). 2. Neurogenetic disorders with behavioural...

Schizophrenia and other psychotic disorders Studies between 1898 and 1975

Subsequently to Alzheimer, Southard reported cortical atrophy in schizophrenia and mentioned that association areas of the cerebral cortex were most affected in this disorder 10,) Buscaino(U> described various histopathological changes, mainly in the basal ganglia, which he assumed to be responsible for catatonia-like and stereotyped behaviour. Another approach to the neuropathology of psychiatric diseases had been made by Vogt and Vogt and their coworkers, who reported cellular alterations...

Formulation of definitions of alcohol dependence 19481974

From the time of its inception in 1948, WHO played a major role in formulating public health definitions of 'alcoholism', 'addiction', and 'dependence' through a series of expert committees. Early definitions stressed the sociological rather than the physical aspects of dependence. (7) 'Alcoholics' were defined as (7) those excessive drinkers whose dependence upon alcohol has attained such a degree that it shows a noticeable mental disturbance or an interference with their bodily and mental...

Archetypes and the collective unconscious

Jung's research into schizophrenia led him to conclude that there was a myth-making substratum of mind common to all men a 'collective unconscious' which lay beneath the merely personal, and which was responsible for the spontaneous production of myths, visions, religious ideas, and certain types of dream which were common to various cultures and different periods of history. Jung was widely read in history and comparative religion. He referred to the images of the collective unconscious as...

Explaining the development of offending

In explaining the development of offending, a major problem is that most risk factors tend to coincide and tend to be interrelated. For example, adolescents living in physically deteriorated and socially disorganized neighbourhoods disproportionally tend also to come from families with poor parental supervision and erratic parental discipline and tend also to have high impulsivity and low intelligence. The concentration and co-occurrence of these kinds of adversities makes it difficult to...

Structure process and content the dynamic elements of a group

Regardless of the therapist's method, people usually start in groups with a form of serial monologue. Out of this arise the capacities to talk and to listen which are often undeveloped or even non-existent at the outset of therapy but which are its core constituents. From talking and listening comes self-disclosure, and out of this emerges identification which, in due course, leads to dialogue and differentiation. Therefore the conductor must give a place to monologue whilst, at the same time,...

Diagnosis and differential diagnosis

The most cost-effective method of diagnosing paraphilias is to conduct a comprehensive psychiatric history, to use psychophysiological assessment methods to determine sexual interest, and to differentiate organic or psychiatric disorders that can impact on an individual's sexual interest and activity. Interviewing the potential paraphiliac, especially a paraphiliac who has been involved in felonies, requires a non-judgemental clinician. The first step in the interview process is to obtain a...

Legal control of recreational drugs

Until the middle of the nineteenth century there was a free market in drugs in Europe and the United States, with access to everything from alcohol to opium and coca restricted only by the depth of one's pocket. Two developments did much to upset the status quo. In 1805, a pharmacist's apprentice separated a chemical from raw opium and named it morphine after the Greek god of dreams. Isolation of codeine, thebaine, and papaverine soon followed. Then in 1858 a Scottish surgeon invented a device...

Modelling normal sexual functionthe sex survey

One obvious way of describing normal sexual function is to ask people what they do. Two classic sex surveys were conducted by Kinsey and his coworkers who reported the results of interviews with 12 000 males in 1948 (19 and 8000 females in 1953.(11) Their technique of sampling was to interview everyone in specific cooperating groups (clubs, hospital staff, universities, police force, school teachers, etc.). This gave samples of convenience but not a valid sampling of the population. Despite...

Demand and utilization

Need must be distinguished from demand and utilization demand is an economic term, a measure of the quantity of services consumers seek to obtain. Demand is more dynamic than need, in the sense that it is influenced by many factors, including system-level factors such as the cost to the consumer (price), available alternatives and their prices, and individual factors such as education, the effects of advertising, distances, and social pressures including stigma. A simplified economic model of...

Bodily preoccupations

Individuals with BDD are preoccupied with the idea that some aspect of their appearance is unattractive, deformed, or 'not right' in some way. Concerns usually focus on the face or head but can involve any body area. (5,10> The skin, hair, and nose are most often disliked (e.g. acne, scarring, lines, or pale skin, hair thinning, or a large or crooked nose). Concern with bodily asymmetry (e.g. 'uneven' buttocks) is common. Although the concern usually focuses on specific areas, it may involve...

Why do negative thoughts and beliefs persist

If the world is not as dangerous as anxiety disorder patients assume, why do they not notice this and correct their thinking For many patients with chronic anxiety disorders, the persistence of their fears can seem strangely irrational, at least at first glance. Consider, for example, panic disorder patients who think during their panic attacks that they are having a heart attack. Before they come for treatment they may have had several thousand panic attacks, in each one of which they thought...

Sibling rivalry disorder

This disorder should only be diagnosed if there is a degree of emotional disturbance, usually following the birth of an immediately younger sibling, which is both unusual in degree and associated with abnormalities of social interaction. Clinically, the child shows abnormally intense negative feelings towards an immediately younger sibling characterized by two or more symptoms of regression tantrums sleep difficulties dysphoria oppositional or attention-seeking behaviour with one or both...

Speech and language disorders

A common question asked of clinicians in general practice, child health, and child psychiatry concerns the long-term consequences of delayed speech and language development in the early years of life.(1) A previously held view was that most young children with speech and language problems would eventually develop normally. But this is an optimistic view it is more likely to be true of children without major mental and physical handicaps. Allied questions which have to be addressed are whether...

Psychological factors Personality

It is now widely accepted that alcoholics do not present a homogeneous premorbid personality profile. However, some distinctive trait clusters have been identified which seem to characterize different types of alcoholics.(35) One such group (type 1) tend to score low in novelty seeking and high in harm avoidance and reward dependence. Another group (type 2) is formed by the natural thrill seekers, who appear to ignore harmful consequences and punitive responses. This latter cluster, which...

Physical sequelae of crime

Apart from the immediate direct physical injuries caused by crime, there are often indirect negative health consequences. In general, people who have experienced crime have a poorer perception of their physical health, more limitations on their physical functioning, and more chronic medical conditions. (23) Physical and sexual assault are associated with increased cigarette consumption, alcohol and other drug abuse, health-care neglect, risky sexual behaviour, and eating disorders. (24)...

Comorbidity and differential diagnosis

Social phobia may increase the risk for other psychiatric disorders. (9,2 21.> In the National Comorbidity Survey (NCS), 81 per cent of persons with primary social phobia met the criteria for at least one other lifetime psychiatric disorder.(22) Odds ratios for other DSM-IIIR disorders given social phobia were 7.75 for simple phobia, 7.06 for agoraphobia, 4.83 for panic disorder, 3.77 for generalized anxiety disorder, 2.69 for post-traumatic stress disorder, 3.69 for major depression, 3.15...

Diagnostic subtypes of mood disorders in DSMIV

Major depressive (unipolar) disorder is characterized by depressive episodes without any hypomanic or manic states the patient is either depressed or average in mood, but experiences no mania. 2. Bipolar disorder is characterized by manic or hypomanic states the patient is either depressed, euthymic (normal in mood), or hypomanic manic. Bipolar disorder differs from unipolar disorder by including manic states. No matter how many times a patient is depressed, only one manic hypomanic episode is...

Limitations of the psychoanalytic approach

A series of limitations render child psychoanalysis vulnerable to being seen as impractical, non-scientific, and uneconomical 1. lack of operationalization in most descriptions of technical interventions, with the effectiveness of interventions supported almost entirely by evocative case illustrations 2. inadequate specificity regarding technical interventions appropriate for children with a particular diagnosis or clinical presentation 3. limited evidence of efficacy, particularly evidence...

Why do people take drugs

A very common misconception is that drug misuse is simply a search for fun. In fact, people take drugs for many reasons other than to get the buzz or high. Indeed, studies have shown that straightforward pleasure seeking is the primary reason for initiation of drug use in fewer than 20 per cent of individuals. While the high or buzz is the most obvious pleasurable effect, many people also describe using drugs to feel comfortably numb, pleasantly drowsy, or full of energy and confidence. Many...

Diagnosis classification and differential diagnosis of schizophrenia

The diagnosis of schizophrenia Diagnostic criteria Basis of classification Athepretica Schneider's. .first. ranK sympto.ms Differential. diagnosis Otherpsychiairic .disorders The presence of imo,o,d, i,n,,c,o,,ng,r,ue,n,t delusions. (lOlr lha. .U.C,i.n.ati.0.n.S) Thei d1u,r,ati,o,n a,n,d, a,c,ute,n,e,ss, o,f. .onset criteria Social, and occ.upati.o.n.aLd.ist.urha.n.ce The diagnostic process Chapter References

Clinical features Hair pulling sites

Scalp hair is pulled out in approximately 80 per cent of cases, resulting in diverse patterns of bald patches and or hair thinning. (3) One pattern of hair loss, tonsure ( 1), is characterized by a circular denuded patch over the top of the scalp. Fig. 1 Tonsure pattern of hair loss in trichotillomania. Most patients pull from multiple hair sites. The most common sites, in descending order of frequency, are the scalp, eyelashes, eyebrows, pubis, face, and the extremities.(4) Rarely, hair is...

The influence of psychodynamic theories

Research has shown that psychoanalysis, in the form originally promulgated by Freud and his followers, is no more effective in relieving neurotic symptoms than other less demanding and less expensive forms of psychotherapy. Freud's theory of dreams, which he himself considered to embody his deepest insight, has not stood the test of time. Nor have his views on religion, anthropology, and art. Although many of his psychopathological interpretations are open to question, he was a great clinical...

Psychological mutism

There are two forms of psychological mutism traumatic and selective 3 32) Both are dramatic and rare. Traumatic mutism has an acute onset following a psychological shock or injury. Some consider it to be a hysterical phenomenon as it is not associated with any disorder of the structures subserving speech functioning (lips, tongue, palate, or vocal cords). Furthermore, the patient is able to cough normally. The literature suggests that it is common, but a wide clinical survey has attested to its...

Bipolar disorders Diagnostic issues

While classical bipolar disorder with episodes of euphoric mania interspersed with episodes of depression is one of the clearest clinical syndromes in psychiatry, the boundaries of bipolar disorder remain contested. As case definition is central to epidemiology, all the contested boundaries of bipolar disorder could influence prevalence rates and our understanding of risk factors. Some of the major boundary issues for bipolar disorder include the overlap of bipolar disorder with psychotic...

Why knowledge of causation is important

Mental retardation is a confusing concept. Mentally retarded people have more differences than common features. Developmental delay may appear in different ages and with different degrees of severity in different children. The age and severity vary both between and within different aetiologies. The development of a child can come to a stop or can even regress. There is a multitude of confirmed causes of mental retardation. Single aetiologies are rare and the clinical picture within the same...

Normal psychological response to cancer diagnosis

The diagnosis of cancer for most people results in a predictable psychological pattern of distress over several weeks. The meaning of cancer is usually that of possible death, with pain, possible disability or disfigurement from treatment, loss of independence and self-esteem, and possible loss of significant relationships due to changed appearance or disability. This normal response is characterized by three phases initial denial, an acute turmoil phase, and a period of adaptation. (7) It is...

The principles of clinical assessment in general psychiatry

Cooper and Margaret Oates Introduction assessment effects. on activities Ca. ,ego.r.i,e.s oJE informationi .subjective, obie,C.i.v.e, a,n.d , scientific The diagnostic process . disorders. and diagnoses The sequence synthesistand review From. complaints formulation Psychodynamics and. the life story Contextual infl.U.ence.S on , assessment Assessment as a. .mul i.d,iscipl .inary, .activity Leadership Key worke,rs, and, c,are. rogra,mEes Reasons .forthe development of structured...

Specific developmental disorder of motor function Clinical features and classification

Many children to whom this category applies, were previously diagnosed as having 'minimal brain dysfunction'. This term is no longer used. The essential clinical features of the disorder include the following (ICD-10). An impairment of motor co-ordination that is significantly below the expected level on the basis of age and general intelligence assessed by an individually administered and standardized test. The difficulties in co-ordination should already have been present early in...

Managing anxiety and other emotional sequelae resulting from impaired cognition

Anxiety and depression are frequently seen in memory-impaired people. Kopelman and Crawford (29> found depression in over 40 per cent of 200 consecutive referrals to a memory clinic. Evans and Wilson (39 found anxiety to be common in attenders of a weekly memory group. Dealing with these emotional problems should be an integral part of memory rehabilitation. Obviously, listening, trying to understand, and providing information are key factors in encouraging families to cope with their...

Can we identify patients for whom immediate medication prescription may be unnecessary

A common design feature is a 7- to 10-day single-blind initial placebo run-in period ( IPR) prior to a double-blind phase. The purpose of the IPR is to remove patients with an increased chance of placebo effect. Typically, much improved patients do not enter a double-blind phase, but minimally improved patients continue into the double-blind phase. We found that patients minimally improved during a single-blind placebo period had a better prognosis whether subsequently assigned to drug or...

Epilepsy and epilepsyrelated behaviour disorders among people with mental retardation

Diagnosis., and differential diagnosis of epilepsy Epilepsy.and., epileptic. .s.yn.d.ro.me.s at. .different ages Infancy Later .c.hiild.h.o.o,d a,n.d adolescence Adulthood .andold age Behavioural disorders due to epilepsy Occurrence of epilepsy related to menta retardation Aetiology.and. pathogenesis. ofepilepsy Treatment. ofepilepsy Antiepilepticdrugtherapy Behavioural disorders caiused by an1tiepileRtic drufls Prognosis Conclusions Chapter. References Epilepsy is defined as two or more...

Specific developmental disorders of scholastic skills

'Specific developmental disorders of scholastic skills' (ICD-10) or 'Learning disorders' (DSM-IV) include disorders characterized by one or more significant impairments in acquisition of reading, spelling, or arithmetical skills. ICD-10 suggests that the category 'Mixed disorder of scholastic skills' (F81.3) be used as an ill-defined, but necessary, category in which arithmetical and reading or spelling skills are significantly impaired, although not because of general mental retardation or...

Lesch Nyhan syndrome

This X-linked recessive condition, which almost exclusively affects boys, was first described in 1964 by William Nyhan. (24) Although often described as a rare condition, the incidence rate quoted for this condition varies widely between 1 in 10 000 and 1 in 380 000 live births. The usual mode of inheritance is from a carrier mother to her affected son. The syndrome is caused by an inborn error of purine metabolism, resulting in an abnormally high level of xanthine and uric acid in the blood of...

Cognitivebehaviour therapy for anxiety disorders

HistoricaldeveloRment ofcognitive-behaviour therapy Cognitivecontentof. .anxiety, disorders Generalized anxiety d1is,ordsr Obse,ssjye,-som u, s,ive disorder Post-traumatic. . .stress. .disorder Why do. .negative. thoughts. . and belie.fs.fiersist Avoidance,, escape and safety-se.eking be.hayiours Attentional. deployment SRlo,ntaneou,s, y.l occurring .images Emotional .reasoning Memory processes Rumination Treatment Developing. .an. .j,d.i,os.yncrat,ic mpd.ei, of the patient,,s pro,b,lem...

Introduction history of ideas

Two different approaches may be discerned in the conceptualization of anorexia nervosa. 1. The medicoclinical approach defines the illness in terms of its clinical manifestations the main landmarks were the descriptions by William Gull in 1874 (. > and Charles Lasegue in 1873.(2) 2. The sociocultural approach is unlike the more empirical clinical approach and takes causation into account by viewing the illness as a response to prevailing social and cultural systems. This was best argued by...

Hypersomnia associated with infectious disorders

Excessive sleepiness occurring during the acute phase of a bacterial or viral infection, without any other symptom of central nervous system involvement, is commonplace in medicine. Its mechanism may involve certain cytokines. There are other conditions, also presenting with excessive sleepiness, which may be life threatening. The most frequent of these is African trypanosomiasis (sleeping sickness) caused by the haemoflagellate Trypanosoma brucei. The incubation period of the parasite lasts...

Complications of the hyperthymic temperament History

Although well described by classical German psychiatrists (e.g. Schneider(20)), the hyperthymic type appears neither in DSM-IV nor in ICD-10. A lifelong disposition, hyperthymia must be distinguished from short-lived hypomanic episodes. Alternatively, this disposition can be characterized as trait hypomania. It derives from the ancient Graeco-Roman sanguine temperament, believed to represent the optimal mixture of behavioural traits. They are full of zest, fun-loving, and prone to lechery their...

Pharmacokinetics

Nicotine is absorbed through the skin, and through the lining of the mouth and nose, the rate of absorption being enhanced in an alkaline environment and reduced in an acidic environment. Because of the large surface area of the lungs the mildly acidic smoke of cigarettes is absorbed almost immediately and completely on inhalation, giving rise to high concentration arterial nicotine boli which reach the brain in less than 10 s. (17) Nicotine has a distributional half-life of about 15 min and a...

Personality change

Personality change after head injury results in more suffering than any other single sequel. (3,33) In general, the personality change goes hand in hand with cognitive impairment. However, a severe personality change is occasionally found in somebody with almost no impairment of cognitive function. Normal test scores for memory and intellect do not rule out brain injury as a cause of personality change after head injury. It is not easy to predict who will develop a change in personality after...

Culturally related syndromes

The, concept .of 'culture-bound, syndromes', or, l'clU t.U.re.-SPeCifi,C, , .d,i.S.Orde.rS, Locallfolk idioms, pf distres.s Susto.,. espantotMedo Culturally stereotyped reactions to extreme environmental conditions. .('arctic hysteria') Syndromes.related to a cultural emphasis.on fertility .a.n.d firocrea.tion .'.G.enit.al.shrinking.'. syndrome koro, suo-vang). 'Semen losslsyndroms., shen-kluelLd& Mi., Mryan, , sukra., prameha Syndrpmes re ated., to.,a, .cultural em.p.hasis pn le.arnt.,...

Abstinence or controlled drinking

Harmful or hazardous use of alcohol without severe dependence can sometimes revert to risk-free drinking. Patients with social supports (family and job) and without impulsive personalities and many social problems are most likely to succeed. For others, including most of those dependent on alcohol, the goal of abstinence is better. In patients attending specialized outpatient clinics, the proportion who can sustain problem-free drinking for at least 1 year is small 5 per cent is a typical...

Biological predisposition

Compared to controls, a significantly larger percentage of men with family history of alcoholism present a lesser physiological response to alcohol in terms of both subjective sensations and objective measurements (postconsumption plasma cortisol levels and body sway). A lower sensitivity is assumed to lead to heavier drinking and predicts the eventual development of alcoholism. The authors of this prospective follow-up study concluded that the 'innate' low response to alcohol is an independent...