BOOK
Massachusetts General Hospital Handbook of General Hospital Psychiatry E-Book
Theodore A. Stern | Oliver Freudenreich | Felicia A. Smith | Gregory L. Fricchione | Jerrold F. Rosenbaum
(2017)
Additional Information
Book Details
Abstract
For generations of practitioners, the Massachusetts General Hospital Handbook of General Hospital Psychiatry has been and is the "gold standard" guide to consultation-liaison psychiatry and psychosomatic medicine. The fully updated 7th Edition, by Drs. Theodore A. Stern, Oliver Freudenreich, Felicia A. Smith, Gregory L. Fricchione, and Jerrold F. Rosenbaum, provides an authoritative, easy-to-understand review of the diagnosis, evaluation, and treatment of psychiatric problems experienced by adults and children with medical and surgical conditions.
Covers the psychological impact of chronic medical problems and life-threatening diseases, somatic symptom disorders, organ donors and recipients, pain, substance abuse, and polypharmacy, including a thorough review of drug actions and interactions, metabolism, and elimination.
- Features DSM-5 updates throughout, as well as case studies in every chapter.
- Contains practical tips on how to implement the most current and effective pharmacological therapies as well as cognitive-behavioral approaches.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Massachusetts General Hospital Handbook of General Hospital Psychiatry | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Preface | vii | ||
| Table Of Contents | ix | ||
| Contributing Authors | xiii | ||
| 1 Beginnings | 1 | ||
| Psychosomatic Medicine | 1 | ||
| History | 1 | ||
| The Consultation Service | 3 | ||
| Patient Care | 3 | ||
| Teaching | 3 | ||
| Research | 4 | ||
| Recent Directions | 4 | ||
| Summary | 5 | ||
| References | 5 | ||
| References | 5.e1 | ||
| 2 Approach to Psychiatric Consultations in the General Hospital | 7 | ||
| Categories of Psychiatric Differential Diagnosis in the General Hospital | 7 | ||
| Psychiatric Presentations of Medical Conditions | 7 | ||
| Psychiatric Complications of Medical Conditions or Treatments | 7 | ||
| Psychological Reactions to Medical Conditions or Treatments | 8 | ||
| Medical Presentations of Psychiatric Conditions | 8 | ||
| Medical Complications of Psychiatric Conditions or Treatments | 8 | ||
| Co-morbid Medical and Psychiatric Conditions | 8 | ||
| The Art of Psychiatric Consultation in the General Hospital | 8 | ||
| Clinical Approach | 8 | ||
| Environment | 9 | ||
| Style of Interaction | 9 | ||
| Use of Language | 9 | ||
| The Process of Psychiatric Consultation in the General Hospital | 10 | ||
| Speak Directly With the Referring Clinician | 10 | ||
| Review the Current and Pertinent Past Records | 10 | ||
| Review the Patient’s Medications | 10 | ||
| Gather Collateral Data | 11 | ||
| Interview and Examine the Patient | 11 | ||
| Formulate a Diagnosis and Management Plan | 11 | ||
| Write a Note | 12 | ||
| Speak Directly Again With the Referring Clinician | 12 | ||
| Provide Periodic Follow-up | 12 | ||
| Principles of Psychiatric Treatment in the General Hospital | 12 | ||
| Biological Management | 12 | ||
| Pharmacokinetic Profiles | 12 | ||
| Drug–Drug Interactions | 13 | ||
| Adverse Effects | 14 | ||
| Psychological Management | 14 | ||
| Social Management | 14 | ||
| Summary | 14 | ||
| References | 14 | ||
| References | 14.e1 | ||
| 3 The Doctor–Patient Relationship | 15 | ||
| Overview | 15 | ||
| Unique Aspects of the Doctor–Patient Relationship in the General Hospital | 15 | ||
| The Optimal Healing Environment: Patient-Centered Care | 16 | ||
| Physician Practice in Patient-Centered Care | 17 | ||
| Collaboration Around History-Taking | 17 | ||
| Effective Clinical Interviewing | 17 | ||
| Planning the Path Forward: Creating a Clinical Formulation | 19 | ||
| Treatment Planning | 20 | ||
| Obstacles and Difficulties in the Doctor–Patient Relationship | 21 | ||
| Conclusion | 22 | ||
| References | 22 | ||
| References | 22.e1 | ||
| 4 The Psychiatric Interview | 23 | ||
| Overview | 23 | ||
| Lessons From Attachment Theory, Narrative Medicine, and Mindful Practice | 24 | ||
| The Context of the Interview: Factors Influencing the Form and Content of the Interview | 25 | ||
| The Setting | 25 | ||
| The Situation | 26 | ||
| The Subject | 26 | ||
| The Significance | 27 | ||
| Establishing an Alliance and Fostering Effective Communication | 27 | ||
| Building the Relationship and Therapeutic Alliance | 28 | ||
| Data Collection: Behavioral Observation, the Medical and Psychiatric History, and Mental Status Examination | 29 | ||
| Behavioral Observation | 29 | ||
| The Medical and Psychiatric History | 29 | ||
| Presenting Problems | 29 | ||
| Past Psychiatric History | 31 | ||
| Past Medical History | 31 | ||
| Review of Systems | 31 | ||
| Family History | 32 | ||
| Social and Developmental History | 32 | ||
| Use of Collateral Information | 32 | ||
| The Mental Status Examination | 32 | ||
| Sharing Information and Preparing the Patient for Treatment | 33 | ||
| The Evaluation of Children and Adolescents | 34 | ||
| Difficulties and Errors in the Psychiatric Interview | 34 | ||
| Dealing With Sensitive Subjects | 34 | ||
| Disagreements About Assessment and Treatment | 35 | ||
| Errors in Psychiatric Interviewing | 35 | ||
| Conclusion | 35 | ||
| References | 35 | ||
| References | 35.e1 | ||
| 5 Functional Neuroanatomy and the Neurologic Examination | 37 | ||
| Functional Neuroanatomy | 37 | ||
| The Neurologic Examination | 38 | ||
| Input | 38 | ||
| Peripheral Sensory Examination | 39 | ||
| In Addition, Complex Associative Sensory Modalities of Clinical Relevance Include | 39 | ||
| Sensory (I, II, VIII) and Sensorimotor (V, VII, IX, X) Cranial Nerves | 39 | ||
| Olfactory Nerve (Cranial Nerve I) | 39 | ||
| Optic Nerve (Cranial Nerve II) | 39 | ||
| Trigeminal Nerve (Cranial Nerve V) | 40 | ||
| Facial Nerve (Cranial Nerve VII) | 40 | ||
| Acoustic Nerve (Cranial Nerve VIII) | 40 | ||
| Glossopharyngeal and Vagus Nerves (Cranial Nerves IX and X) | 40 | ||
| Integration and Evaluation | 40 | ||
| Reflexes | 40 | ||
| The Mental Status Examination | 41 | ||
| Executive Function and Attention | 41 | ||
| Language | 41 | ||
| Memory | 41 | ||
| Visual–Spatial Skills | 41 | ||
| Output | 41 | ||
| Motor (III, IV, VI, XI, XII) and Sensorimotor (V, VII, IX, X) Cranial Nerves | 41 | ||
| Motor Examination | 42 | ||
| Coordination | 42 | ||
| References | 42 | ||
| References | 42.e1 | ||
| 6 Limbic Music | 43 | ||
| Introduction | 43 | ||
| Why Limbic Music? | 43 | ||
| What Is Limbic Music? | 44 | ||
| Where Does Limbic Music Come From and What Does It Want? | 46 | ||
| The Polyvagal Theory | 47 | ||
| Microexpressions | 48 | ||
| Implicit Bias | 48 | ||
| Clinical Examples | 49 | ||
| Conclusion | 49 | ||
| References | 49 | ||
| References | 49.e1 | ||
| 7 Psychological and Neuropsychological Assessment | 51 | ||
| Overview | 51 | ||
| Psychological Assessment | 51 | ||
| Assessment of Intellectual Functioning | 52 | ||
| Tests of Personality, Psychopathology, and Psychological Function | 53 | ||
| Neuropsychological Assessment | 54 | ||
| An Overview of Neuropsychological Assessment Methods | 55 | ||
| Attention and Executive Functions | 56 | ||
| Language | 56 | ||
| Higher-Order Visual Functions | 56 | ||
| Learning and Memory | 56 | ||
| Higher-Order Sensory and Motor Functions | 57 | ||
| Statistical Analysis and Interpretation | 57 | ||
| Neuropsychological Screening Instruments | 57 | ||
| Integration With Psychological Assessment Tools | 57 | ||
| Common Neuropsychological Assessment Referral Questions for Psychiatrists | 57 | ||
| Obtaining and Understanding Test Reports | 58 | ||
| References | 58 | ||
| References | 58.e1 | ||
| 8 Diagnostic Rating Scales and Laboratory Tests | 59 | ||
| Diagnostic Rating Scales | 59 | ||
| General Psychiatric Diagnostic Instruments | 59 | ||
| Mood Disorders | 59 | ||
| Psychotic Disorders and Related Symptoms | 60 | ||
| Anxiety Disorders | 60 | ||
| Attention Disorders | 61 | ||
| Substance Abuse Disorders | 61 | ||
| Cognitive Disorders | 61 | ||
| Laboratory Tests | 62 | ||
| Routine Screening | 62 | ||
| Psychosis and Delirium | 62 | ||
| Mood Disorders and Affective Symptoms | 63 | ||
| Anxiety | 64 | ||
| Care of the Geriatric Population | 64 | ||
| Substance Abuse | 64 | ||
| Eating Disorders | 64 | ||
| Pharmacogenomic Testing | 65 | ||
| The Electroencephalogram | 66 | ||
| Neuroimaging | 67 | ||
| Computed Tomography | 67 | ||
| Magnetic Resonance Imaging | 67 | ||
| Positron Emission Tomography/Single Photon Emission Computed Tomography | 68 | ||
| Conclusion | 68 | ||
| References | 68 | ||
| References | 68.e1 | ||
| 9 Depressed Patients | 69 | ||
| Overview | 69 | ||
| Making the Diagnosis of Depression | 70 | ||
| Major Depression | 70 | ||
| States Commonly Mislabeled as Depression | 72 | ||
| Excluding Organic Causes of Depression | 73 | ||
| Stroke | 73 | ||
| Dementia | 74 | ||
| Subcortical Dementias | 74 | ||
| Choice of an Appropriate Antidepressant Treatment | 74 | ||
| Prescribing Antidepressants for the Medically III | 74 | ||
| Orthostatic Hypotension | 76 | ||
| Anticholinergic Effects | 76 | ||
| Cardiac Conduction Effects | 76 | ||
| Myocardial Depression | 78 | ||
| Other Side Effects (Specific to Each Antidepressant Class) | 78 | ||
| Antidepressant Discontinuation Syndrome | 79 | ||
| Hepatic Metabolism | 79 | ||
| Thioridazine | 79 | ||
| Other DSM-5 Diagnoses of Depression | 79 | ||
| Persistent Depressive Disorder (Formerly Dysthymic Disorder) | 79 | ||
| Adjustment Disorder With Depressed Mood | 79 | ||
| Bereavement | 79 | ||
| Despondency Consequent to Serious Illness | 79 | ||
| Management of the Acute Phase of Despondency | 80 | ||
| Management of Post-Acute Despondencies: Planning for Discharge and After | 80 | ||
| References | 81 | ||
| References | 81.e1 | ||
| 10 Delirious Patients | 83 | ||
| Diagnosis | 83 | ||
| Differential Diagnosis | 84 | ||
| The Examination of the Patient | 87 | ||
| Specific Management Strategies for Delirium | 89 | ||
| Drug Management | 89 | ||
| Delirium in Specific Diseases | 92 | ||
| Conclusion | 92 | ||
| References | 93 | ||
| References | 93.e1 | ||
| 11 Patients With Neurocognitive Disorders | 95 | ||
| Epidemiology | 95 | ||
| Diagnosis | 96 | ||
| Neurocognitive Disorder Due to Alzheimer’s Disease | 96 | ||
| Vascular Neurocognitive Disorder | 97 | ||
| Neurocognitive Disorder With Lewy Bodies | 98 | ||
| Frontotemporal Neurocognitive Disorder | 98 | ||
| Neurocognitive Disorder Due to Another Medical Condition | 99 | ||
| Substance/Medication-Induced Neurocognitive Disorder | 99 | ||
| Neurocognitive Disorders Due to Multiple Etiologies | 99 | ||
| Evaluation of Neurocognitive Disorders | 99 | ||
| History | 99 | ||
| Medical and Neurologic Examination | 101 | ||
| Laboratory Examination | 101 | ||
| Mental Status Examination | 101 | ||
| Bedside Neurocognitive Assessment | 102 | ||
| Standardized Cognitive Testing | 103 | ||
| Treatment Considerations | 103 | ||
| Medical and Surgical Interventions | 103 | ||
| Behavioral Interventions | 105 | ||
| Pharmacotherapy | 105 | ||
| Cognitive Symptoms | 105 | ||
| Neuropsychiatric Symptoms | 106 | ||
| Conclusion | 107 | ||
| References | 107 | ||
| References | 107.e1 | ||
| 12 Psychotic Patients | 109 | ||
| Diagnostic Evaluation | 109 | ||
| Clinical Pictures and Corresponding Problems on the Medical Ward | 113 | ||
| The Paranoid or Delusional Patient | 113 | ||
| The Disorganized Patient | 114 | ||
| The Patient With Negative Symptoms or Neurocognitive Deficits | 114 | ||
| The Manic Patient | 114 | ||
| The Psychotic Depressed Patient | 115 | ||
| The Elderly Psychotic Patient | 115 | ||
| Management of Psychotic Patients | 115 | ||
| General Considerations | 115 | ||
| Drug Selection | 115 | ||
| First-generation Antipsychotics | 116 | ||
| Extrapyramidal Side Effects and Tardive Dyskinesia | 116 | ||
| Second-generation Antipsychotics | 117 | ||
| Treating Agitation | 118 | ||
| Neuroleptic Malignant Syndrome | 118 | ||
| Drug Interactions With Antipsychotic Agents | 118 | ||
| Working With the Patient and the Family | 119 | ||
| More Problems in the Care of Psychotic Patients | 119 | ||
| Assessment of Dangerousness | 119 | ||
| Pain Threshold in Schizophrenia | 119 | ||
| Psychogenic Polydipsia (Water Intoxication) | 119 | ||
| Medical Co-morbidities | 120 | ||
| Cigarette Smoking | 120 | ||
| Conclusion | 120 | ||
| Medication Adherence and Insight Into Illness | 120 | ||
| References | 121 | ||
| References | 121.e1 | ||
| 13 Anxious Patients | 123 | ||
| Overview | 123 | ||
| The Nature and Origin of Anxiety | 123 | ||
| Anxiety in the Medical Setting | 125 | ||
| Anxiety From Failure to Cope | 126 | ||
| PTSD Resulting From Traumatic Procedures | 126 | ||
| Anxiety That Interferes With Evaluation or Treatment | 127 | ||
| Medical Illnesses That Mimic Anxiety Disorder | 128 | ||
| Anxiety That Mimics Medical Illness | 130 | ||
| Panic Disorder Associated With Medical Illness | 132 | ||
| Primary Anxiety Disorders | 132 | ||
| Panic Disorder | 132 | ||
| Generalized Anxiety Disorder | 133 | ||
| Specific Phobias | 133 | ||
| Social Phobia (Social Anxiety Disorder) | 133 | ||
| Post-traumatic Stress Disorder | 133 | ||
| Obsessive–Compulsive Disorder | 134 | ||
| Other Psychiatric Disorders | 134 | ||
| Treatment | 134 | ||
| Pharmacologic Treatment of Panic Disorder | 135 | ||
| Antidepressants | 135 | ||
| Benzodiazepines | 136 | ||
| Pharmacologic Treatment of Generalized Anxiety | 137 | ||
| Choice of Benzodiazepine | 137 | ||
| Precautions in Prescribing | 138 | ||
| Pharmacologic Alternatives to Benzodiazepines | 138 | ||
| Cognitive-behavioral Therapy | 139 | ||
| References | 139 | ||
| References | 139.e1 | ||
| 14 Patients With Alcohol Use Disorder | 141 | ||
| Overview | 141 | ||
| Screening for Alcohol Use Disorder | 142 | ||
| Acute Intoxication and the Psychiatric Sequelae of Alcohol Use | 142 | ||
| Alcohol Withdrawal Syndrome: Identification and Management | 143 | ||
| Types of Alcohol Withdrawal Syndromes | 144 | ||
| Treatment of Alcohol Withdrawal | 145 | ||
| Wernicke–Korsakoff Syndrome | 146 | ||
| Wernicke’s Encephalopathy | 146 | ||
| Korsakoff’s Psychosis | 146 | ||
| Treatment | 146 | ||
| Pharmacotherapy for Alcohol Use Disorder | 146 | ||
| Psychosocial Treatment of Alcohol Use Disorder | 147 | ||
| References | 148 | ||
| References | 148.e1 | ||
| 15 Patients With Substance Use Disorders | 149 | ||
| Overview | 149 | ||
| Stimulants | 150 | ||
| Cocaine | 150 | ||
| Pharmacology and Mechanism of Action | 150 | ||
| Psychiatric Sequelae of Cocaine Use | 151 | ||
| Management | 151 | ||
| Amphetamines and Other CNS Stimulants | 152 | ||
| Pharmacology and Mechanism of Action | 152 | ||
| Psychiatric Sequelae of Amphetamine Use | 152 | ||
| Management | 152 | ||
| Hallucinogens | 153 | ||
| Pharmacology and Mechanism of Action | 153 | ||
| Psychiatric Sequelae and Management | 154 | ||
| Cannabis and Synthetic Cannabinoids | 154 | ||
| Pharmacology and Mechanism of Action | 154 | ||
| Psychiatric Sequelae of Cannabis Use | 154 | ||
| Management | 155 | ||
| Heroin and Other Opioids | 155 | ||
| Pharmacology and Mechanism of Action | 155 | ||
| Management of Opioid Intoxication and Withdrawal | 155 | ||
| Pharmacotherapy for Maintenance of Opioid Use Disorder | 156 | ||
| Opioid Agonist Treatment | 156 | ||
| Opioid Antagonist Treatment | 157 | ||
| Benzodiazepines and Other Sedative Hypnotics | 157 | ||
| Benzodiazepines | 157 | ||
| Pharmacology and Mechanism of Action | 158 | ||
| Psychiatric Sequelae of Benzodiazepine Use | 158 | ||
| Benzodiazepine Withdrawal Management | 158 | ||
| Sedative–Hypnotics | 159 | ||
| Pharmacology and Mechanism of Action | 159 | ||
| Withdrawal Management | 159 | ||
| References | 159 | ||
| References | 159.e1 | ||
| 16 Psychosomatic Conditions | 161 | ||
| Overview | 161 | ||
| Somatic Symptom and Related Disorders | 162 | ||
| Somatic Symptom Disorder | 162 | ||
| Illness Anxiety Disorder | 163 | ||
| Conversion Disorder | 164 | ||
| Psychological Factors Affecting Medical Illness | 164 | ||
| Factitious Disorders | 165 | ||
| Psychiatric Differential Diagnosis | 165 | ||
| Depressive Disorders | 165 | ||
| Anxiety Disorders | 165 | ||
| Substance Use Disorders | 165 | ||
| Psychotic Disorders | 165 | ||
| Organic Mental Disorders | 166 | ||
| Personality Disorders | 166 | ||
| Functional Somatic Syndromes | 166 | ||
| Systemic Exertion Intolerance Disease | 167 | ||
| Fibromyalgia | 167 | ||
| Irritable Bowel Syndrome | 168 | ||
| Multiple Chemical Sensitivity | 168 | ||
| Treatment of the Somatic Symptom Disorders | 168 | ||
| Prognosis and Treatment | 168 | ||
| Somatic Symptom Disorder | 168 | ||
| Conversion Disorder or Functional Neurologic Symptoms | 169 | ||
| Illness Anxiety Disorder | 169 | ||
| Deception Syndromes | 170 | ||
| Factitious Disorders | 170 | ||
| Diagnostic Approach | 172 | ||
| Malingering | 172 | ||
| Management of Deception Syndromes | 173 | ||
| Three Shared Parameters of Psychosomatic Conditions | 173 | ||
| Manifestation | 174 | ||
| Production | 174 | ||
| Gratification | 175 | ||
| Conclusion | 175 | ||
| References | 175 | ||
| References | 175.e1 | ||
| 17 Patients With an Eating Disorder | 177 | ||
| Overview | 177 | ||
| Epidemiology | 177 | ||
| Onset and Course | 177 | ||
| Differential Diagnosis and Initial Assessment of Eating Disorders | 178 | ||
| Clinical Detection of an Occult Eating Disorder | 178 | ||
| Differential Diagnosis | 178 | ||
| Weight Assessment | 179 | ||
| Interventions | 179 | ||
| Engaging the Reluctant Patient | 179 | ||
| Considerations in Initiating Treatment | 180 | ||
| Medical Intervention for Eating Disorders | 181 | ||
| Treatment of Patients With Anorexia Nervosa | 182 | ||
| Nutritional Rehabilitation | 182 | ||
| Psychological Therapies | 183 | ||
| Pharmacologic Management | 184 | ||
| Treatment of Patients With Bulimia Nervosa | 184 | ||
| Psychological Therapies | 184 | ||
| Pharmacologic Management | 185 | ||
| Treatment of Patients With Binge-Eating Disorder | 185 | ||
| Psychological Therapies | 186 | ||
| Pharmacologic Management | 186 | ||
| Summary | 186 | ||
| References | 187 | ||
| References | 187.e1 | ||
| 18 Pain Patients | 189 | ||
| Overview | 189 | ||
| Pathophysiology of Pain | 189 | ||
| Pain Terminology | 191 | ||
| Pain Measurement | 193 | ||
| The Psychiatry Consultant as Pain Physician | 194 | ||
| The Psychiatrist’s Role | 194 | ||
| Gathering Important Preliminary Information | 194 | ||
| Physical Examination | 194 | ||
| Psychiatric Examination | 194 | ||
| Depression | 194 | ||
| Anxiety Disorders | 196 | ||
| Somatic Symptom Disorders | 196 | ||
| Functional Neurologic Symptom Disorder | 196 | ||
| Factitious Disorder With Physical Symptoms | 197 | ||
| Malingering | 197 | ||
| Dissociative States | 197 | ||
| General Principles of Pain Therapy | 198 | ||
| Pain Is Not Psychological by Default | 198 | ||
| Care Does Not Only Involve Symptom Management | 198 | ||
| Caveats in Using Placebos | 198 | ||
| Deafferentation Surgery Is Usually Not the Answer | 198 | ||
| Talking and Listening | 199 | ||
| Medication for Pain: Analgesia and Adjuvants | 199 | ||
| Non-Steroidal Antiinflammatory Drugs | 200 | ||
| Side-Effects | 200 | ||
| Special Features | 200 | ||
| Opioids | 201 | ||
| Opioid Potencies | 201 | ||
| Principles of Opioid Administration | 201 | ||
| Potency and Administration | 201 | ||
| Oral Potency | 201 | ||
| Avoid As-Needed Dosing | 202 | ||
| Toxicity | 202 | ||
| Are Opioids the Drugs of Choice in Our Case? | 203 | ||
| Dosing | 203 | ||
| Drug Delivery | 203 | ||
| Tolerance or Excessive Sedation | 203 | ||
| Mixed Agonists and Antagonists | 203 | ||
| Addiction | 203 | ||
| Opioid Adjuvants | 203 | ||
| Guidelines for Opioid Maintenance Adjuvants | 203 | ||
| Analgesic Adjuvants | 204 | ||
| Antidepressants for Pain | 204 | ||
| Reviews of Efficacy | 206 | ||
| Anti-Epileptic Drugs | 207 | ||
| Sympathetically Maintained Pain | 208 | ||
| Treatment of Central Neuropathic Pain States | 208 | ||
| Treatment of Pain Behavior and the Use of Multidisciplinary Pain Clinics | 209 | ||
| Guidelines | 209 | ||
| Reasons for Referral to an Inpatient Multidisciplinary Pain Clinic | 210 | ||
| Hypnosis | 210 | ||
| Rehabilitation | 210 | ||
| Education | 210 | ||
| Cognitive and Behavioral Therapies | 210 | ||
| Coping and Psychotherapy | 211 | ||
| References | 211 | ||
| References | 211.e1 | ||
| 19 Patients With Seizure Disorders | 213 | ||
| Overview | 213 | ||
| The Management of Psychiatric Symptoms in Patients With Seizure Disorders | 213 | ||
| Ictal Neuropsychiatric Phenomena | 214 | ||
| Peri-ictal Neuropsychiatric Phenomena | 215 | ||
| Inter-ictal (Chronic) Neuropsychiatric Phenomena | 216 | ||
| Non-Epileptic Seizures | 218 | ||
| Clinical Considerations | 219 | ||
| Summary | 220 | ||
| References | 221 | ||
| References | 221.e1 | ||
| 20 Patients With Cerebrovascular Disease and Traumatic Brain Injury | 223 | ||
| Cerebrovascular Disease | 223 | ||
| Cognitive Impairment and Delirium | 224 | ||
| Post-Stroke Depression | 224 | ||
| Post-Stroke Apathy | 225 | ||
| Other Post-Stroke Psychiatric Phenomena | 226 | ||
| The Management of Patients With Traumatic Brain Injury | 227 | ||
| Epidemiology | 227 | ||
| Pathophysiology | 227 | ||
| Clinical Presentation | 228 | ||
| Cognitive Impairment | 228 | ||
| Personality Changes | 228 | ||
| Mood and Anxiety Disorders | 228 | ||
| Psychosis | 229 | ||
| Treatment | 229 | ||
| Pharmacology | 229 | ||
| Behavioral, Cognitive, and Social Interventions | 230 | ||
| Conclusion | 230 | ||
| References | 230 | ||
| References | 230.e1 | ||
| 21 Patients With Abnormal Movements | 231 | ||
| Overview | 231 | ||
| Patient History and Physical Examination | 231 | ||
| Idiopathic Movement Disorders | 232 | ||
| Parkinson’s Disease | 232 | ||
| Huntington’s Disease | 233 | ||
| Tourette’s Syndrome | 234 | ||
| Wilson’s Disease | 234 | ||
| Restless Legs Syndrome (Willis–Ekbom Disease) | 235 | ||
| Tremors | 235 | ||
| Drug-Induced Movement Disorders | 235 | ||
| Drug-Induced Tremors | 235 | ||
| Antipsychotic-Induced Extrapyramidal Symptoms | 236 | ||
| Acute Dystonic Reaction | 236 | ||
| Akathisia | 236 | ||
| Parkinsonism | 237 | ||
| Tardive Dyskinesia | 237 | ||
| Functional Movement Disorders | 238 | ||
| References | 239 | ||
| References | 239.e1 | ||
| 22 Patients With Infectious or Inflammatory Neuropsychiatric Impairment | 241 | ||
| Overview | 241 | ||
| Potential Etiologies of Acute and Sub-Acute Neuropsychiatric Impairment | 241 | ||
| Encephalitis Versus Encephalopathy | 241 | ||
| Causes of Encephalopathy | 241 | ||
| Work-Up for Encephalopathy | 241 | ||
| Encephalitic Neuropsychiatric Impairment | 242 | ||
| Clinical Features of Infectious Encephalitis | 242 | ||
| Clinical Features of Autoimmune Encephalitis | 242 | ||
| Work-Up for Infectious and Inflammatory Causes | 243 | ||
| Bloodwork | 243 | ||
| Neural Autoantibody Testing | 243 | ||
| Intracellular Versus Cell Surface-Targeted Neural Autoantibodies | 243 | ||
| Overlap Syndromes: Parainfectious Autoimmune Encephalitis | 245 | ||
| CSF Analysis | 245 | ||
| Electroencephalography | 245 | ||
| Brain Imaging | 246 | ||
| Malignancy Screening | 246 | ||
| Illustrative Autoimmune Encephalitic Syndromes Manifesting With Neuropsychiatric Impairment | 246 | ||
| NMDAR Encephalitis | 246 | ||
| Limbic Encephalitis | 247 | ||
| LGI-1 Encephalitis | 247 | ||
| Treatment Strategies for Patients With Infectious or Inflammatory Causes of Encephalitic Neuropsychiatric Impairment | 248 | ||
| Treatment of Infectious Encephalitis or Meningitis | 248 | ||
| Treatment of Autoimmune Encephalitis | 249 | ||
| Identification of Objective Measures to Follow Over Time | 249 | ||
| General Treatment Goals | 249 | ||
| Treatment Strategies | 249 | ||
| Paraneoplastic Disorders | 249 | ||
| Psychiatric Considerations in the Treatment of Patients With Infectious or Inflammatory Neuropsychiatric Impairment | 250 | ||
| Remaining Questions on Autoimmune Encephalitides | 250 | ||
| What About Low-Titer Autoantibodies? | 250 | ||
| What About Late Diagnoses? | 250 | ||
| What Is Hashimoto’s Encephalitis and Does It Truly Exist? | 250 | ||
| Are Antibody Subtypes Important? | 251 | ||
| Conclusion | 251 | ||
| References | 251 | ||
| References | 251.e1 | ||
| 23 Catatonia, Neuroleptic Malignant Syndrome, and Serotonin Syndrome | 253 | ||
| Overview | 253 | ||
| Catatonia | 253 | ||
| Definition | 253 | ||
| Epidemiology, Risk Factors, and Potential Etiologies | 254 | ||
| Subtypes of Catatonia | 255 | ||
| Clinical Features and Diagnosis | 256 | ||
| Neuropathophysiology | 256 | ||
| Management and Treatment | 259 | ||
| Prognosis and Complications | 261 | ||
| Neuroleptic Malignant Syndrome | 261 | ||
| Epidemiology and Risk Factors | 262 | ||
| Clinical Features and Diagnosis | 262 | ||
| Serotonin Syndrome | 263 | ||
| Definition | 263 | ||
| Epidemiology | 263 | ||
| Clinical Features and Diagnosis | 263 | ||
| Pathophysiology | 264 | ||
| Management and Treatment | 264 | ||
| Prognosis and Complications | 265 | ||
| References | 265 | ||
| References | 265.e1 | ||
| 24 Patients With Disordered Sleep | 267 | ||
| Overview | 267 | ||
| Sleep Stages and Normal Sleep | 267 | ||
| Polysomnography | 267 | ||
| Sleep Cycle and Architecture | 268 | ||
| Sleep Across the Life Span | 268 | ||
| Neuroanatomic Basis for Sleep | 268 | ||
| Sleep Disorders | 269 | ||
| Insomnia | 269 | ||
| Diagnosis | 269 | ||
| Treatment | 269 | ||
| Sleep-Related Breathing Disorders | 270 | ||
| Diagnosis | 270 | ||
| Treatment | 270 | ||
| Narcolepsy and Hypersomnias of Central Origin | 271 | ||
| Narcolepsy | 271 | ||
| Hypersomnias of Central Origin | 271 | ||
| Circadian Rhythm Sleep Disorders | 271 | ||
| Parasomnias | 272 | ||
| Arousal Disorders | 272 | ||
| REM Sleep Disorders | 272 | ||
| Sleep-Related Movement Disorders | 273 | ||
| Sleep Disorders Related to Another Medical Condition | 273 | ||
| Mood Disorders | 273 | ||
| Psychotic Disorders | 274 | ||
| Anxiety Disorders | 274 | ||
| Medical Disorders | 274 | ||
| Substance-Induced Sleep Disorder | 274 | ||
| Approach to the Patient With Disordered Sleep | 275 | ||
| References | 277 | ||
| References | 277.e1 | ||
| 25 Sexual Disorders or Sexual Dysfunction | 279 | ||
| Overview | 279 | ||
| Epidemiology and Risk Factors | 279 | ||
| Pathophysiology | 279 | ||
| Clinical Features and Diagnosis | 280 | ||
| Approach to Sexual History-Taking | 280 | ||
| Physical Examination and Laboratory Investigation | 282 | ||
| Diagnostic Criteria of Specific Sexual Disorders | 282 | ||
| Male Disorders of Sexual Function | 282 | ||
| Erectile Disorder | 282 | ||
| Delayed Ejaculation | 282 | ||
| Premature (Early) Ejaculation | 283 | ||
| Male Hypoactive Sexual Desire Disorder | 284 | ||
| Female Disorders of Sexual Function | 284 | ||
| Female Sexual Interest/Arousal Disorder | 284 | ||
| Female Orgasmic Disorder | 284 | ||
| Genito–pelvic Pain/Penetration Disorder | 284 | ||
| Sexual Dysfunction Disorders Affecting Both Genders | 284 | ||
| Substance/Medication Induced-Sexual Dysfunction | 284 | ||
| Other Specified and Unspecified Sexual Dysfunction | 284 | ||
| Paraphilic Disorders | 284 | ||
| Gender Dysphoria | 284 | ||
| Differential Diagnosis of Sexual Disorders | 285 | ||
| Treatment | 285 | ||
| Organically Based Treatment | 285 | ||
| Psychotropic Medication-induced Sexual Dysfunction | 285 | ||
| Antidepressants | 285 | ||
| Antipsychotics | 286 | ||
| Premature Ejaculation | 286 | ||
| Erectile Dysfunction | 286 | ||
| Female Sexual Dysfunction | 288 | ||
| 26 The Psychiatric Management of Patients With Cardiac Disease | 291 | ||
| Overview | 291 | ||
| Anxiety in the Cardiac Patient | 291 | ||
| Epidemiology | 291 | ||
| Anxiety Among Cardiac Patients | 291 | ||
| Anxiety Disorders in Cardiac Patients | 291 | ||
| Association Between Anxiety and Cardiac Illness | 292 | ||
| Differential Diagnosis of Anxiety in the Cardiac Patient | 293 | ||
| Psychopharmacologic Issues in the Anxious Cardiac Patient | 293 | ||
| Benzodiazepines. | 293 | ||
| Antidepressants. | 293 | ||
| Antipsychotics. | 293 | ||
| Other Agents. | 294 | ||
| Approach to the Anxious Cardiac Patient | 294 | ||
| Consider a Broad Differential Diagnosis for the Patient’s Distress. | 294 | ||
| Evaluate Sources of Anxiety and Assess How the Patient Has Dealt With Difficult Situations in the Past. | 294 | ||
| Recommend Appropriate Behavioral and Therapeutic Interventions. | 294 | ||
| Intelligently Use Psychiatric Medications for Specific Target Symptoms. | 294 | ||
| Return Frequently to See the Patient. | 295 | ||
| Depression in the Cardiac Patient | 295 | ||
| Depression in Patients With Established Cardiac Illness | 295 | ||
| Depression as a Risk Factor for Cardiac Disease | 295 | ||
| Differential Diagnosis of Depression in the Cardiac Patient | 296 | ||
| Psychopharmacologic Issues in the Depressed Cardiac Patient | 297 | ||
| Other Treatment Modalities for the Depressed Cardiac Patient | 298 | ||
| Approach to the Management of the Depressed Cardiac Patient | 298 | ||
| Routine Screening. | 298 | ||
| Consider Appropriate Psychiatric and Medical Differential Diagnoses. | 298 | ||
| Attempt to Identify the Patient’s Coping Style and the Triggers for Depressive Symptoms. | 298 | ||
| Make Use of Existing Social Supports or Help Develop a Network. | 298 | ||
| Carefully Consider the Use of Antidepressant Medication. | 299 | ||
| Delirium in Cardiac Patients | 299 | ||
| Epidemiology | 299 | ||
| Delirium and Cardiac Disease | 299 | ||
| Delirium and Medical Outcome | 299 | ||
| Differential Diagnosis of Delirium in the Cardiac Patient | 299 | ||
| Psychopharmacologic Issues in the Delirious Cardiac Patient | 300 | ||
| The Practical Management of the Delirious Cardiac Patient | 301 | ||
| Make an Informed Diagnosis of Delirium, and Carefully Consider Potential Etiologies. | 301 | ||
| Aggressively Treat All Potential Etiologies of Delirium. | 301 | ||
| Use Non-Pharmacologic Strategies to Minimize Confusion and Ensure Safety. | 301 | ||
| Use Antipsychotic Medications to Reduce Agitation and Psychotic Symptoms and Regulate the Sleep–Wake Cycle. | 301 | ||
| References | 302 | ||
| References | 302.e1 | ||
| 27 Patients With Renal Disease | 303 | ||
| Overview | 303 | ||
| Patients With Normal Kidney Function | 303 | ||
| Clearance of Toxins and Homeostasis | 303 | ||
| Volume Control | 303 | ||
| Endocrine Function | 303 | ||
| Kidney Disease | 303 | ||
| Epidemiology and Risk Factors | 304 | ||
| Lithium and Kidney Disease | 304 | ||
| Complications of Kidney Disease | 304 | ||
| Therapeutic Options for Advanced Kidney Disease | 304 | ||
| Dialysis | 305 | ||
| Kidney Transplantation | 305 | ||
| Psychiatric Disorders in ESRD | 306 | ||
| Depression and Anxiety | 306 | ||
| Cognitive Impairment | 306 | ||
| Treatment Considerations | 307 | ||
| Neurologic Complications in Renal Failure | 307 | ||
| Central Nervous System Complications | 307 | ||
| Peripheral Nervous System Complications | 308 | ||
| Pediatric Populations | 309 | ||
| Psychopharmacologic Considerations | 309 | ||
| Antidepressants | 309 | ||
| Benzodiazepines | 311 | ||
| Mood Stabilizers | 311 | ||
| Antipsychotics | 311 | ||
| References | 312 | ||
| References | 312.e1 | ||
| 28 Patients With Gastrointestinal Disease | 313 | ||
| Introduction | 313 | ||
| Disorders of the Oropharynx, Esophagus, Stomach, and Upper Intestines | 313 | ||
| Xerostomia | 313 | ||
| Dysphagia | 313 | ||
| Globus Hystericus | 313 | ||
| Gastroesophageal Reflux Disease | 313 | ||
| Nausea and Vomiting | 314 | ||
| Gastroparesis | 315 | ||
| Gastric Bypass | 315 | ||
| Disorders of the Lower Gastrointestinal Tract | 316 | ||
| Constipation | 316 | ||
| Diarrhea | 316 | ||
| Irritable Bowel Syndrome | 317 | ||
| Inflammatory Bowel Disease | 318 | ||
| Psychiatric Issues Related to Cancers of the Upper and Lower Intestines | 319 | ||
| GI Cancer | 319 | ||
| Liver Disorders | 320 | ||
| Hepatitis C | 320 | ||
| Hepatic Encephalopathy | 321 | ||
| Disorders of the Pancreas | 321 | ||
| Pancreatic Cancer | 321 | ||
| Pancreatitis | 322 | ||
| Medication Considerations in Gastrointestinal Illness | 322 | ||
| SSRI-Related Upper GI Bleeding | 323 | ||
| Medication Considerations in Liver Disease | 324 | ||
| References | 326 | ||
| References | 326.e1 | ||
| 29 Organ Failure and Transplantation | 327 | ||
| Overview | 327 | ||
| Psychiatric Evaluation of the Transplant Patient | 328 | ||
| Pre-Transplant Psychiatric Evaluation | 329 | ||
| Psychiatric Considerations in Patients With End-Organ Failure | 330 | ||
| Psychiatric Care of the Pre-Transplant Patient | 330 | ||
| Care of the Post-Transplant Patient | 331 | ||
| Short-Term Care | 331 | ||
| Long-Term Care | 332 | ||
| Pediatric Transplantation | 333 | ||
| Pre-Transplant Evaluation | 333 | ||
| Post-Transplant Care | 334 | ||
| Conclusion | 334 | ||
| References | 334 | ||
| References | 334.e1 | ||
| 30 Patients With Human Immunodeficiency Virus Infection and Acquired Immunodeficiency Syndrome | 335 | ||
| Overview | 335 | ||
| Epidemiology | 335 | ||
| Medications for HIV Infection | 336 | ||
| Nucleoside (and Nucleotide) Reverse Transcriptase Inhibitors | 337 | ||
| Non-nucleoside Reverse Transcriptase Inhibitors | 337 | ||
| Protease Inhibitors | 337 | ||
| Integrase Inhibitors | 337 | ||
| Entry Inhibitors | 337 | ||
| Fusion Inhibitors | 338 | ||
| HIV Infection and the Central Nervous System | 338 | ||
| HIV-Associated Neurocognitive Disorders (HAND) | 338 | ||
| HIV-associated Dementia | 338 | ||
| HIV-associated Mild Neurocognitive Disorder | 339 | ||
| Asymptomatic Neurocognitive Impairment | 339 | ||
| HAND in the Era of HAART | 339 | ||
| CSF Viral Escape | 339 | ||
| Differential Diagnosis of Psychiatric Distress | 339 | ||
| Mental Disorder Due to Another Medical Condition | 339 | ||
| Delirium | 340 | ||
| Depression | 340 | ||
| Fatigue | 340 | ||
| Bereavement | 340 | ||
| Suicide | 341 | ||
| Anxiety | 341 | ||
| Mania | 341 | ||
| Psychosis | 341 | ||
| Sleep | 341 | ||
| Substance Use | 341 | ||
| Pain | 342 | ||
| Approach to Psychiatric Care | 342 | ||
| Screening and Prevention | 342 | ||
| Collaboration | 343 | ||
| Adherence | 343 | ||
| Treatment | 344 | ||
| Non-pharmacologic Treatments | 344 | ||
| Case Management | 344 | ||
| Groups | 344 | ||
| Individual Psychotherapy | 344 | ||
| Pharmacologic Treatment | 344 | ||
| Drug–Drug Interactions | 344 | ||
| Depression | 344 | ||
| Serotonin–Norepinephrine Re-Uptake Inhibitors | 345 | ||
| Bupropion | 345 | ||
| Trazodone | 345 | ||
| Mirtazapine | 345 | ||
| Tricyclic Antidepressants | 346 | ||
| Monoamine Oxidase Inhibitors (MAOIs) | 346 | ||
| Psychostimulants | 346 | ||
| Anxiety | 346 | ||
| Anxiolytic Antidepressants | 346 | ||
| Benzodiazepines | 346 | ||
| Buspirone | 346 | ||
| Antipsychotics | 346 | ||
| Bipolar Disorder | 346 | ||
| Psychosis | 347 | ||
| Substance Use Disorders | 347 | ||
| Pain | 347 | ||
| Conclusion | 348 | ||
| References | 348 | ||
| References | 348.e1 | ||
| 31 Patients With Cancer | 349 | ||
| Overview | 349 | ||
| Denial and “Middle Knowledge” | 349 | ||
| Hope and the Doctor–Patient Relationship | 349 | ||
| Medical Choices | 349 | ||
| Distress | 349 | ||
| Screening | 352 | ||
| Psychosocial Interventions | 353 | ||
| Anxiety Syndromes | 353 | ||
| Nausea and Vomiting | 353 | ||
| Depression | 353 | ||
| Fatigue | 354 | ||
| Diagnosis | 355 | ||
| Treatment | 355 | ||
| Exercise | 355 | ||
| Behavioral Interventions | 355 | ||
| Stimulants | 355 | ||
| Confusion and Cognitive Impairment | 355 | ||
| Hypercalcemia | 355 | ||
| Hyponatremia | 356 | ||
| Brain Tumors | 356 | ||
| Leptomeningeal Disease | 356 | ||
| Delirium in Hematopoietic Stem Cell Transplantation (HSCT) | 356 | ||
| Hyperviscosity Syndrome | 356 | ||
| Idiopathic Hyperammonemia (IHA) | 357 | ||
| Cushing’s Syndrome | 357 | ||
| Paraneoplastic Limbic Encephalitis (PLE) | 357 | ||
| Toxic Leukoencephalopathy | 357 | ||
| Chemotherapy-Related Cognitive Impairment (CRCI) | 357 | ||
| Effects of Hormonal Therapy in Cancer Patients | 357 | ||
| Survivors of Childhood Cancer | 358 | ||
| Conclusion | 358 | ||
| References | 358 | ||
| References | 358.e1 | ||
| 32 Burn Patients | 359 | ||
| Overview | 359 | ||
| History | 359 | ||
| Epidemiology | 359 | ||
| Types of Burns | 360 | ||
| Risk Factors | 360 | ||
| Pre-Burn Psychopathology | 361 | ||
| Assessment and Management of Patients With Burns | 361 | ||
| Diagnosis and Developmental Assessment | 361 | ||
| Developmental Stage and Burns: Case Examples | 362 | ||
| Infancy (Birth to 2.5 Years Old) | 362 | ||
| Pre-School Age (2.5 to 6 Years Old) | 362 | ||
| School-Age (7 to 12 Years Old) | 362 | ||
| Adolescence | 363 | ||
| Young Adulthood | 363 | ||
| Elderly | 363 | ||
| Acute Phase: Assessment and Treatment | 363 | ||
| Survival Fear During the Acute Phase After Injury | 364 | ||
| Search for Meaning During the Acute Phase After Injury | 364 | ||
| Burn-Induced Delirium | 364 | ||
| Acute Stress Disorder and Post-Traumatic Stress Disorder | 364 | ||
| Pain Assessment | 364 | ||
| Psychological Treatment of Pain | 365 | ||
| Pharmacologic Treatment of Acute Burn Patients | 365 | ||
| Drug Side Effects, Toxicity, and Adverse Interactions | 366 | ||
| Intermediate Phase | 367 | ||
| Psychological Interventions | 367 | ||
| Body Image and Plastic and Reconstructive Surgery | 367 | ||
| Acute Burns | 368 | ||
| Long-Term Phase and Outcomes | 368 | ||
| General Outcomes | 368 | ||
| Post-Traumatic Stress Disorder (PTSD) | 369 | ||
| Depression | 369 | ||
| Chronic Pain | 370 | ||
| End-of-Life Care | 370 | ||
| Staff Support, Staff Stress | 370 | ||
| Ethical Considerations | 370 | ||
| References | 370 | ||
| References | 370.e1 | ||
| 33 Chronic Medical Illness and Rehabilitation | 371 | ||
| Overview | 371 | ||
| Diagnostic Considerations | 371 | ||
| Phases of Rehabilitation | 371 | ||
| Developmental Factors | 374 | ||
| Symptom Type and Intensity | 374 | ||
| Symptoms That Interfere With the Goals of Rehabilitation | 374 | ||
| Psychiatric Look-Alikes | 374 | ||
| Aphasia | 374 | ||
| Agitation | 374 | ||
| Pseudobulbar Affect | 375 | ||
| Aprosodia | 375 | ||
| Sensory Abnormalities | 375 | ||
| Temporal Lobe Symptomatology | 376 | ||
| Abulia | 376 | ||
| Diagnosis Is Critical to Treating the Patient With a Somatic Symptom Disorder | 376 | ||
| Treatment Strategies | 376 | ||
| Addressing Denial | 376 | ||
| Anxiety and Depression | 377 | ||
| Agitation | 377 | ||
| Managing Sexual Dysfunction After Spinal Cord Injury | 378 | ||
| Co-Morbid Medical and Psychiatric Conditions | 378 | ||
| References | 379 | ||
| References | 379.e1 | ||
| 34 Intensive Care Unit Patients | 381 | ||
| The Intensive Care Unit Setting | 381 | ||
| The Psychiatrist in the Intensive Care Unit | 381 | ||
| Conclusion | 384 | ||
| References | 384 | ||
| References | 384.e1 | ||
| 35 Patients With Genetic Syndromes | 385 | ||
| Overview | 385 | ||
| Varied approaches to Understanding Psychiatric Genetics | 385 | ||
| Epidemiology of Psychiatric Disorders | 385 | ||
| Gene-by-Environment Interactions | 386 | ||
| Advances in Identification of Genetic Mutations that Underlie Psychiatric Disorders | 386 | ||
| Assessment of the Patient for Genetic Syndromes | 388 | ||
| Selected Genetic Disorders | 388 | ||
| Disorders Due to Chromosomal Abnormalities and Microdeletions | 388 | ||
| Velocardiofacial Syndrome/DiGeorge Syndrome | 388 | ||
| Smith–Magenis Syndrome | 389 | ||
| Williams Syndrome | 389 | ||
| Prader–Willi Syndrome | 390 | ||
| Down’s Syndrome | 390 | ||
| Turner’s Syndrome | 390 | ||
| Klinefelter’s Syndrome | 390 | ||
| 47,XYY | 390 | ||
| Autosomal Dominant Single-gene Disorders | 391 | ||
| Huntington’s Disease | 391 | ||
| Tuberous Sclerosis | 391 | ||
| Neurofibromatosis Type I | 391 | ||
| X-linked Dominant Disorders | 391 | ||
| Fragile X Syndrome | 391 | ||
| Rett Syndrome | 391 | ||
| Metabolic Disease | 392 | ||
| Assessment of the Patient for Metabolic Illness | 392 | ||
| Selected Metabolic Disorders With Psychiatric Features | 392 | ||
| Autosomal Dominant Disorders | 393 | ||
| Porphyrias/Acute Intermittent Porphyria | 393 | ||
| Autosomal Recessive Disorders | 393 | ||
| Homocystinuria | 393 | ||
| Wilson’s Disease | 393 | ||
| Metachromatic Leukodystrophy | 394 | ||
| Niemann–Pick Disease, Type C | 394 | ||
| GM2 Gangliosidosis (Tay–Sachs Disease, Late-onset Type) | 394 | ||
| X-linked Disorders | 394 | ||
| X-linked Adrenoleukodystrophy | 394 | ||
| Urea Cycle Defects—Ornithine Transcarbamylase Deficiency | 395 | ||
| Lesch–Nyhan Syndrome | 395 | ||
| Mitochondrial Disorders | 395 | ||
| Teratogen Exposure | 395 | ||
| Fetal Alcohol Spectrum Disorders | 395 | ||
| Conclusion | 396 | ||
| References | 396 | ||
| References | 396.e1 | ||
| Suggested Reading | 396 | ||
| 36 Coping With Illness and Psychotherapy of the Medically Ill | 397 | ||
| What Exactly Is Coping? | 397 | ||
| Who Copes Well? | 398 | ||
| Who Copes Poorly? | 398 | ||
| What Interferes With Our Ability to Adapt to Illness? | 398 | ||
| The Role of Religion | 399 | ||
| The Medical Predicament—Bringing It All Together | 399 | ||
| Coping and Social Support | 399 | ||
| Courage to Cope | 400 | ||
| Assessment of Vulnerability | 400 | ||
| How to Find Out More About Coping | 401 | ||
| How to Be a Better Coper | 402 | ||
| Additional Psychotherapeutic Techniques in the Medically Ill Population | 403 | ||
| References | 403 | ||
| References | 403.e1 | ||
| 37 Electroconvulsive Therapy and Neurotherapeutics | 405 | ||
| Overview | 405 | ||
| Transcranial Magnetic Stimulation | 405 | ||
| Technique | 405 | ||
| Indications | 406 | ||
| Safety | 406 | ||
| Electroconvulsive Therapy | 406 | ||
| Technique | 407 | ||
| Indications | 407 | ||
| Safety | 408 | ||
| Cognitive | 408 | ||
| Other CNS Adverse Effects | 408 | ||
| Cardiovascular | 409 | ||
| Respiratory | 409 | ||
| Pregnancy | 409 | ||
| Vagus Nerve Stimulation | 409 | ||
| Technique | 409 | ||
| 38 Psychopharmacology in the Medical Setting | 413 | ||
| Overview | 413 | ||
| Principles of Psychopharmacologic Practice | 413 | ||
| Initiating Treatment | 414 | ||
| Selecting and Administering Medication | 415 | ||
| Approach to Treatment Failure | 416 | ||
| Diagnosis | 416 | ||
| Dosage | 416 | ||
| Drugs | 416 | ||
| Disruptions | 417 | ||
| Combined Therapy | 417 | ||
| Discontinuing Medications | 417 | ||
| Pharmacokinetics | 418 | ||
| Absorption | 418 | ||
| Distribution | 419 | ||
| Metabolism | 419 | ||
| Excretion | 420 | ||
| Drug Interactions | 422 | ||
| Antipsychotic Drugs | 423 | ||
| Mood Stabilizers | 425 | ||
| Lithium | 425 | ||
| Valproic Acid | 426 | ||
| Lamotrigine | 427 | ||
| Carbamazepine and Oxcarbazepine | 427 | ||
| Other Anticonvulsants | 428 | ||
| Topiramate | 428 | ||
| Zonisamide | 428 | ||
| Gabapentin and Pregabalin | 428 | ||
| Antidepressants | 428 | ||
| SSRIs and Other Newer Antidepressants | 429 | ||
| Cytochrome P450 2D6 | 430 | ||
| Cytochrome P450 3A4 | 430 | ||
| Cytochrome P450 2C | 430 | ||
| Cytochrome P450 1A | 430 | ||
| Additional Interactions | 430 | ||
| Tricyclic Antidepressants | 430 | ||
| Monoamine Oxidase Inhibitors | 431 | ||
| Hypertensive Crisis | 432 | ||
| Serotonin Syndrome | 432 | ||
| St. John’s Wort | 432 | ||
| Psychostimulants and Modafinil | 433 | ||
| Psychostimulants | 433 | ||
| Modafinil/Armodafinil | 433 | ||
| Benzodiazepines | 433 | ||
| Psychiatric Uses of Non-Psychiatric Medications | 434 | ||
| Medications for Psychotropic Drug Side Effects | 434 | ||
| α1-Adrenergic Antagonists | 435 | ||
| α2-Adrenergic Agonists | 435 | ||
| β-Blockers | 435 | ||
| References | 436 | ||
| References | 436.e1 | ||
| 39 Psychopharmacologic Management of Children and Adolescents | 437 | ||
| Overview | 437 | ||
| Issues in Clinical Management | 437 | ||
| Medical Precautions and Contraindications | 438 | ||
| Emergency Interventions: Treatment of Acute Agitation or Aggression | 439 | ||
| Delirium | 439 | ||
| Childhood Anxiety Disorders | 439 | ||
| Akathisia | 440 | ||
| Attention Deficit Hyperactivity Disorder | 440 | ||
| FDA-Approved Treatments for ADHD | 441 | ||
| Stimulants | 441 | ||
| Methylphenidate | 442 | ||
| Amphetamines | 442 | ||
| Guidelines on the Use of Stimulants in Children | 443 | ||
| Side Effects of Stimulants | 443 | ||
| Medication Interactions With Stimulants | 443 | ||
| Atomoxetine | 444 | ||
| Alternative (Non-FDA-Approved) Treatments for ADHD | 444 | ||
| Bupropion Hydrochloride (Wellbutrin, Zyban) | 444 | ||
| Tricyclic Antidepressants | 444 | ||
| α-Adrenergic Agonists | 444 | ||
| Clonidine | 444 | ||
| Guanfacine (Tenex) | 445 | ||
| Novel Treatments for ADHD | 445 | ||
| Modafinil/Armodafinil | 445 | ||
| Mood Disorders | 445 | ||
| Depression | 445 | ||
| Pharmacotherapy of Depression | 446 | ||
| Update on Antidepressant-Associated Suicidality | 446 | ||
| Pharmacokinetics of Antidepressants in Children and Adolescents | 447 | ||
| Clinical Use of SSRIs | 447 | ||
| Side Effects and Complications | 448 | ||
| Bipolar Disorder | 448 | ||
| Pharmacotherapy | 448 | ||
| Lithium | 448 | ||
| Carbamazepine | 449 | ||
| Oxcarbazepine | 449 | ||
| Valproic Acid | 449 | ||
| Atypical Antipsychotics | 449 | ||
| Risperidone | 449 | ||
| Aripiprazole | 450 | ||
| Olanzapine | 450 | ||
| Quetiapine | 450 | ||
| Ziprasidone | 450 | ||
| Asenapine | 450 | ||
| Alternative Anticonvulsants | 450 | ||
| Developmental Disorders | 450 | ||
| Intellectual Disability | 450 | ||
| Autism Spectrum Disorders | 451 | ||
| Psychotic Disorders | 451 | ||
| Combined Agents | 453 | ||
| References | 453 | ||
| References | 453.e1 | ||
| 40 Mind–Body Medicine | 455 | ||
| Overview | 455 | ||
| Stress Physiology | 455 | ||
| Definition of Stress and Distress | 455 | ||
| Autonomic Nervous System | 456 | ||
| Hypothalamic–Pituitary–Adrenal Axis | 456 | ||
| Appraisal | 457 | ||
| Immune System | 457 | ||
| Specificity of the Stress Response | 457 | ||
| Allostasis, Allostatic Loading, and NF-κB | 457 | ||
| Resiliency | 458 | ||
| The Mind–Body Medicine Hypotheses | 458 | ||
| Use and Efficacy of Mind–Body Techniques | 459 | ||
| Conclusions | 460 | ||
| References | 460 | ||
| References | 460.e1 | ||
| 41 Chronic Disease and Unhealthy Habits | 461 | ||
| Overview | 461 | ||
| Healthy Habits and Disease Prevention and Management | 461 | ||
| Transtheoretical Model of Change | 462 | ||
| Pre-contemplation | 463 | ||
| Contemplation | 463 | ||
| Preparation | 463 | ||
| Action | 463 | ||
| Maintenance | 463 | ||
| Behavior Modification Counseling: the “5 As” | 463 | ||
| Assess | 464 | ||
| Advise | 464 | ||
| Agree | 464 | ||
| Assist | 464 | ||
| Arrange | 464 | ||
| A Five-Step Cycle for Coaching Patients to Adopt Healthy Habits | 464 | ||
| Smoking Prevalence and Characteristics of Smokers | 467 | ||
| Quitting Cigarette Smoking | 468 | ||
| Smoking Cessation Behavioral Treatments | 468 | ||
| Cognitive-Behavioral Therapy Approaches | 468 | ||
| Mind-Body Approaches or Mindfulness | 468 | ||
| Smoking Cessation Medications | 468 | ||
| References | 469 | ||
| References | 469.e1 | ||
| 42 Complementary Medicine and Natural Medications | 471 | ||
| Overview | 471 | ||
| Efficacy and Safety | 471 | ||
| Mood Disorders | 471 | ||
| Anxiolytics and Hypnotics | 473 | ||
| Premenstrual and Menopausal Symptoms | 474 | ||
| Cognition and Dementia | 474 | ||
| Non-Medication Therapies | 474 | ||
| Conclusion | 475 | ||
| References | 475 | ||
| References | 475.e1 | ||
| 43 Difficult Patients | 477 | ||
| Overview | 477 | ||
| Types of Difficult Patients | 477 | ||
| Antisocial and Narcissistic Personality Disorders | 478 | ||
| Borderline Personality Disorder | 478 | ||
| Difficult Behavior and the Consultee | 480 | ||
| Helping the Consultee | 481 | ||
| Consultant’s Role | 483 | ||
| Medication | 484 | ||
| Psychiatrist’s Work With the Patient | 485 | ||
| Differential Diagnosis | 485 | ||
| Suicide Assessment | 486 | ||
| Assessment of Potential for Violence | 486 | ||
| Substance Abuse | 486 | ||
| Brief Tactical Psychotherapy | 487 | ||
| Termination | 488 | ||
| References | 490 | ||
| References | 490.e1 | ||
| 44 Care of the Suicidal Patient | 491 | ||
| Overview | 491 | ||
| Epidemiology and Risk Factors | 491 | ||
| Epidemiology | 491 | ||
| Psychiatric Risk Factors | 492 | ||
| Medical Risk Factors | 493 | ||
| Familial and Genetic Risk Factors | 494 | ||
| Social Risk Factors | 494 | ||
| Past and Present Suicidality | 494 | ||
| Contact With Physicians | 495 | ||
| Pathophysiology | 495 | ||
| Clinical Features and Diagnosis | 495 | ||
| Treatment of Suicide Risk | 497 | ||
| Difficulties in the Assessment of Suicide Risk | 500 | ||
| References | 500 | ||
| References | 500.e1 | ||
| 45 Emergency Psychiatry | 501 | ||
| Introduction | 501 | ||
| Demographics | 501 | ||
| Types of Delivery Models | 501 | ||
| The Psychiatric Interview | 502 | ||
| The Medical Evaluation | 503 | ||
| The Safety Evaluation | 504 | ||
| Psychiatric Symptoms and Presentations | 504 | ||
| Depression | 504 | ||
| Mania | 504 | ||
| Anxiety | 504 | ||
| Psychosis | 505 | ||
| Personality Disorders | 505 | ||
| Catatonia | 505 | ||
| Trauma | 505 | ||
| Intoxication or Withdrawal | 505 | ||
| Alcohol | 505 | ||
| Benzodiazepines and Barbiturates | 506 | ||
| Opiates | 506 | ||
| Cocaine | 506 | ||
| Crystal Methamphetamine | 506 | ||
| Phencyclidine | 506 | ||
| Marijuana | 506 | ||
| Substance Intoxication and the Safety Assessment | 506 | ||
| Change in Mental Status | 507 | ||
| Management of Acute Symptoms | 507 | ||
| Environmental Intervention | 508 | ||
| Psychological Intervention | 508 | ||
| Pharmacologic Intervention | 508 | ||
| Management of Agitation | 508 | ||
| Restraint and Seclusion | 509 | ||
| Disposition | 510 | ||
| Emergency Assessment of Children | 510 | ||
| Demographics | 510 | ||
| Basic Principles | 510 | ||
| The Evaluation | 510 | ||
| Management | 511 | ||
| Legal Responsibilities of the Emergency Psychiatrist | 511 | ||
| Capacity Evaluation | 511 | ||
| Confidentiality and Release of Information | 512 | ||
| Civil Commitment | 512 | ||
| Mandatory Reporting | 512 | ||
| Conclusion | 512 | ||
| References | 512 | ||
| References | 512.e1 | ||
| 46 Care at the End of Life | 513 | ||
| Goals of Treatment | 513 | ||
| The Role of the Psychiatrist | 514 | ||
| Depression | 514 | ||
| Desire to Hasten Death | 514 | ||
| Anxiety | 514 | ||
| Personality Considerations | 515 | ||
| Delirium and Cognitive Changes | 515 | ||
| Pain | 515 | ||
| Psychosocial Considerations | 515 | ||
| Challenges for Care Providers | 516 | ||
| Ethics and End-of-Life Care | 517 | ||
| Principles | 517 | ||
| Limitation of Life-Sustaining Treatment | 517 | ||
| Physician-Assisted Suicide | 518 | ||
| Conclusion | 518 | ||
| References | 519 | ||
| References | 519.e1 | ||
| 47 Pediatric Consultation | 521 | ||
| Overview | 521 | ||
| The Pediatric Consultation Process | 522 | ||
| Initial Steps | 522 | ||
| Interview Techniques for Child Psychiatric Consultation | 522 | ||
| Liaison With the Medical Team | 523 | ||
| Working With Clinical Staff | 523 | ||
| Developmental and Family-Centered Approach to Consultation | 524 | ||
| Infancy | 524 | ||
| Pre-School Age | 525 | ||
| School Age | 525 | ||
| Adolescence | 525 | ||
| Family-Centered Care | 526 | ||
| Reasons for Consultation Requests | 526 | ||
| Primary Psychiatric Illnesses | 527 | ||
| Depression | 527 | ||
| Suicide | 527 | ||
| Feeding and Eating Disorders | 528 | ||
| Somatic Symptom and Related Disorders | 528 | ||
| Psychiatric Factors That Affect Medical Illness | 529 | ||
| Behavioral Factors That Affect Health Outcomes | 530 | ||
| Accidents | 530 | ||
| Non-Adherence | 531 | ||
| Behavioral Difficulties During Hospitalization | 532 | ||
| Child Maltreatment | 532 | ||
| Physical Abuse and Neglect | 533 | ||
| Sexual Abuse | 533 | ||
| Medical Child Abuse | 534 | ||
| Living With Chronic Illness | 535 | ||
| Care at the End of Life | 535 | ||
| Support for Parents With Serious Illness | 536 | ||
| The Parenting at a Challenging Time (PACT) Model | 536 | ||
| Ethical Issues | 536 | ||
| Future Considerations | 538 | ||
| References | 538 | ||
| References | 538.e1 | ||
| 48 Care of the Geriatric Patient | 539 | ||
| Overview | 539 | ||
| Consultation With Geriatric Patients | 539 | ||
| Depression | 539 | ||
| Bipolar Disorder | 540 | ||
| Delirium and Dementia | 540 | ||
| Psychosis | 542 | ||
| Substance Abuse and Withdrawal | 543 | ||
| Anxiety | 543 | ||
| Special Considerations in the Geriatric Population | 544 | ||
| Pharmacotherapy | 544 | ||
| Healthcare Decision-Making | 544 | ||
| Emergency Department Care | 544 | ||
| Elder Abuse | 545 | ||
| Families and Caregivers | 545 | ||
| References | 545 | ||
| References | 545.e1 | ||
| 49 Psychiatric Illness During Pregnancy and the Postpartum Period | 547 | ||
| Overview | 547 | ||
| Diagnosis and Treatment of Mood Disorders During Pregnancy | 547 | ||
| Antidepressants | 548 | ||
| Pharmacologic Treatment of Depression: Clinical Guidelines | 549 | ||
| Bipolar Disorder | 550 | ||
| Psychotic Disorders | 552 | ||
| Anxiety Disorders | 553 | ||
| Electroconvulsive Therapy | 553 | ||
| Breast-Feeding and Psychotropic Drug Use | 554 | ||
| Psychiatric Consultation and Postpartum Psychiatric Illness | 555 | ||
| Depression | 555 | ||
| Diagnosis | 555 | ||
| Treatment | 555 | ||
| Panic Attacks and Obsessive– Compulsive Disorder | 556 | ||
| Psychosis | 556 | ||
| Prevention | 556 | ||
| Perinatal Psychiatry: From Screening to Treatment | 557 | ||
| References | 557 | ||
| References | 557.e1 | ||
| 50 Culture and Psychiatry | 559 | ||
| Overview | 559 | ||
| Culture and Psychiatry | 559 | ||
| Cultural Differences in Illness Presentation | 559 | ||
| Cultural Assessment for Clinicians | 560 | ||
| Cultural Identity of the Individual | 560 | ||
| Cultural Conceptualizations of Distress | 560 | ||
| Psychosocial Stressors and Cultural Features of Vulnerability and Resilience | 561 | ||
| Cultural Features of the Relationship Between the Individual and the Clinician | 561 | ||
| Overall Cultural Assessment | 561 | ||
| Cultural Concepts of Distress | 561 | ||
| Acculturation and Immigration | 561 | ||
| Impact of Race/Ethnicity on Psychiatric Diagnosis and Treatment | 562 | ||
| Working With Interpreters | 562 | ||
| Recommendations When Working With Interpreters | 562 | ||
| The “Medical Ombudsman” Role | 563 | ||
| Ethnicity, Culture, and Psychiatric Medications | 563 | ||
| Cultural Factors in Psychotropic Medication Usage | 563 | ||
| Biological Aspects of Psychopharmacology | 564 | ||
| Recommendations for Optimizing Clinical Care of Diverse Populations | 567 | ||
| Helpful Techniques | 567 | ||
| Moving Beyond “Cultural Competence” and Toward “Cultural Humility” | 567 | ||
| References | 567 | ||
| References | 567.e1 | ||
| 51 Legal Aspects of Consultation | 569 | ||
| Overview | 569 | ||
| Physicians’ Rights and Obligations | 569 | ||
| Malpractice Liability | 569 | ||
| Liability and Managed Care | 570 | ||
| Confidentiality and Privacy | 570 | ||
| Refusal to Treat Patients | 571 | ||
| End-of-Life Care and Advance Directives | 572 | ||
| Rights of Patients | 573 | ||
| Informed Consent and Evaluation of Decision-Making Capacity | 573 | ||
| Civil Commitment and Restraint | 576 | ||
| Right to Refuse Treatment | 577 | ||
| Conclusion | 578 | ||
| References | 579 | ||
| References | 579.e1 | ||
| 52 Approaches to Collaborative Care and Behavioral Health Integration | 581 | ||
| Overview | 581 | ||
| Epidemiology | 582 | ||
| Barriers to Treatment | 582 | ||
| The Goals of Collaboration | 583 | ||
| Access | 583 | ||
| Treatment | 583 | ||
| Outcomes | 583 | ||
| Communication | 583 | ||
| Roles, Relationships, Expectations, and Liability | 584 | ||
| Models of Collaboration | 584 | ||
| Coordinated Care | 584 | ||
| Longitudinal Outpatient Psychiatric Care | 584 | ||
| Specialty Psychiatric Clinics | 585 | ||
| Consultation Psychiatry (Including Consult-and-Return Models) | 586 | ||
| Co-Located Care | 586 | ||
| Staff Consultant/Stepped Care Models | 586 | ||
| Parallel Care | 586 | ||
| Joint (or Collaborative) Patient Management | 587 | ||
| Primary Care in Psychiatry (“Reverse Integration”) | 587 | ||
| Collaborative (Fully Integrated) Care | 587 | ||
| The IMPACT Model | 587 | ||
| Three-Component Model | 588 | ||
| Choosing the Right Model | 588 | ||
| Conclusions | 588 | ||
| References | 589 | ||
| References | 589.e1 | ||
| 53 Physician Well-Being and Coping With the Rigors of Psychiatric Practice | 591 | ||
| Overview | 591 | ||
| Epidemiology | 591 | ||
| Etiologies for Stress and Burnout | 591 | ||
| Frequent Encounters With Distress | 591 | ||
| Ethical Dilemmas | 591 | ||
| Transference and Countertransference | 592 | ||
| The Perception of Failure | 592 | ||
| Bearing the Burden of Stigma | 592 | ||
| Controlling Affect | 593 | ||
| Responsibility and Uncertainty | 593 | ||
| Disruption of Social Relationships | 593 | ||
| Delayed Gratification | 593 | ||
| Being the Caregiver | 593 | ||
| Financial Stress | 593 | ||
| Special Situations in Psychiatry | 593 | ||
| Coping With Patient Suicide | 593 | ||
| A Profound and Enduring Effect | 593 | ||
| Reactions to Suicide | 593 | ||
| Coping | 593 | ||
| Treating Dying Patients | 594 | ||
| Coping With Boundary Crossings and Violations | 594 | ||
| Boundary Violations | 594 | ||
| Decreasing Vulnerability | 594 | ||
| Coping With Malpractice Litigation | 594 | ||
| Protecting Yourself | 594 | ||
| Coping With a Lawsuit | 594 | ||
| Coping With Residency Training | 594 | ||
| When the Cobbler’s Children Have No Shoes | 595 | ||
| Denial of Vulnerability | 595 | ||
| Negation of Personal and Familial Concerns | 595 | ||
| Deferment of Seeking Help | 595 | ||
| How to Recognize Stress in Oneself | 595 | ||
| Healing the Wounded Healer | 596 | ||
| Be Your Own Most Important Patient | 596 | ||
| Process Experiences Regularly | 596 | ||
| Set Realistic Expectations and Boundaries | 596 | ||
| Review Your Own History | 596 | ||
| Notice What Works | 596 | ||
| Decrease Vulnerability to Stress | 597 | ||
| Identify Thought Distortions and Practice Positive Expectations | 597 | ||
| Engage in Directed Fantasy | 597 | ||
| Communicate With Family and Friends About Anticipated Unavailability | 597 | ||
| Enjoy Your Achievements and Your Goals | 597 | ||
| Learn and Practice Mindfulness | 597 | ||
| Autognosis Rounds | 597 | ||
| Maintain a Pleasurable Existence | 597 | ||
| When to Seek Consultation | 598 | ||
| Types of Professional Help | 598 | ||
| Psychotherapy | 598 | ||
| Psychopharmacology | 598 | ||
| Couples Therapy | 598 | ||
| Group Therapy | 598 | ||
| Conclusion | 598 | ||
| References | 598 | ||
| References | 598.e1 | ||
| 54 Management of a Psychiatric Consultation Service | 599 | ||
| Overview | 599 | ||
| Documentation Should Reflect the Service Performed | 599 | ||
| Bill Only for Services Documented in the Medical Record | 599 | ||
| Follow the Medicare Guidelines for All Entries in the Medical Record | 599 | ||
| Obtain Preauthorization for Services Whenever Necessary | 600 | ||
| Identify the Payer | 600 | ||
| Develop a Standard Format for Writing the Consultation Note | 600 | ||
| Bill the Appropriate Code | 601 | ||
| Evaluate the Costs and Benefits of the Consultation Service | 601 | ||
| Provide Quality Assurance and Quality Improvement on the Psychiatric Consultation Service | 602 | ||
| Understand Donabedian’s Model | 602 | ||
| Use Structural Measures of Consulting Quality | 602 | ||
| Apply Process Measures of Consulting Quality | 603 | ||
| Consider Outcome Measures of the Consultant’s Quality | 603 | ||
| Follow the Guiding Principles of Quality Measurement | 603 | ||
| Conclusion | 603 | ||
| References | 604 | ||
| References | 604.e1 | ||
| Index | 605 | ||
| A | 605 | ||
| B | 608 | ||
| C | 610 | ||
| D | 614 | ||
| E | 616 | ||
| F | 618 | ||
| G | 619 | ||
| H | 620 | ||
| I | 622 | ||
| J | 623 | ||
| K | 623 | ||
| L | 623 | ||
| M | 624 | ||
| N | 626 | ||
| O | 627 | ||
| P | 628 | ||
| Q | 632 | ||
| R | 632 | ||
| S | 633 | ||
| T | 636 | ||
| U | 637 | ||
| V | 637 | ||
| W | 638 | ||
| X | 638 | ||
| Y | 638 | ||
| Z | 638 | ||
| Inside Back Cover | ibc1 |