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Covering the range of clinical presentations, treatments, and levels of care, Borderline Personality Disorder: A Clinical Guide, Second Edition, provides a comprehensive guide to the diagnosis and treatment of borderline personality disorder (BPD). The second edition includes new research about BPD's relationship to other disorders and up-to-date descriptions of empirically validated treatments, including cognitive-behavioral and psychodynamic approaches. Compelling new research also indicates a much better prognosis for BPD than previously known.A pioneer in the field, author John Gunderson, M.D., director of the Borderline Personality Disorder Center at McLean Hospital, draws from nearly 40 years of research and clinical experience. The guide begins with a clear and specific definition of BPD, informed by a nuanced overview of the historical evolution of the diagnosis and a thoughtful discussion of misdiagnosis. Offering a complete evaluation of treatment approaches, Dr. Gunderson provides an authoritative overview of the treatment options and describes in-depth each modality of treatment, including pharmacotherapy, family therapy, individual and group therapy, and cognitive-behavioral therapies. Unlike other works, this book guides clinicians in using multiple modalities, including the sequence of treatments and the types of changes that can be expected from each mode. The discussion of each treatment emphasizes empirically validated therapies, helping clinicians choose modalities that work best for specific patients. In addition, Borderline Personality Disorder: A Clinical Guide, Second Edition, also outlines therapeutic approaches for multiple settings, such as hospitalization, partial hospitalization or day hospital programs, and levels of outpatient care. Complementing the well-organized treatment guide are a series of informative and intriguing sidebars, providing insight into the subjective experience of BPD, addressing myths about therapeutic alliances in BPD, and questioning the efficacy of contracting for safety. Throughout the book, Dr. Gunderson recommends specific do's and don'ts for disclosing the diagnosis, discussing medications, meeting with families, starting psychotherapy, and managing suicidality.A synthesis of theory and practical examples, Borderline Personality Disorder: A Clinical Guide, Second Edition, provides a thorough and practical manual for any clinician working with BPD patients.

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Robert Simon's Bad Men Do What Good Men Dream: A Forensic Psychiatrist Illuminates the Darker Side of Human Behavior is that rare title that is both essential reading for the mental health professional and accessible in style and content to the fascinated lay reader. In twelve powerful and provocative chapters, the author introduces readers to a psychological perspective on evil, character and destiny, as well as the making of good men and women. Simon also illuminates the psychology of psychopaths, serial killers, rapists and all manner of evil characters who appall and challenge us by their very existence. He rejects the common belief that his subjects are «monsters» with nothing in common with the more «normal» among us. Simon posits that if we deny our dark side, it can only obscure our understanding of violent offenders and impede our ability to both know ourselves and control our own, at times, unacceptable impulses.The author is among the foremost experts in forensic psychiatry. He is Director of the Program in Psychiatry and Law at Georgetown University School of Medicine. Author or co-author of more than two dozen books and editions, including the foundational Textbook of Forensic Psychiatry, Simon has made important contributions to the field of forensic psychiatry for more than 30 years. He is also an eloquent writer with a dramatic, yet nuanced, narrative style that takes the reader inside the mind of the evildoer.The first edition of this groundbreaking work garnered uniformly superlative reviews and was translated into several languages. This updated version retains Simon's engrossing portrayals and keen insight, while offering a number of key enhancements. The highlights include: Explorations of the Internet and violence, «corporate» psychopaths, cyberstalkers, perpetrators of school violence, and a new cast of serial killers, terrorists, and other evildoers. A psychological perspective on evil, serial killers, and us. Updates on the neuroscience and genetics of deviant behaviors. Reflections on empathy, character, and destiny: the making of good men and women. A new foreword by Thomas G. Gutheil, M.D., Professor of Psychiatry and Co-Founder, Program in Psychiatry and the Law at Harvard Medical School, that illuminates Simon's thesis and grounds it in historical context. Graphic but never sensational, unsparing but never cold, Simon's writing transcends the theoretical and achieves that most difficult of aims: leading readers to discover, contain, and transform the darkness within us all, to the betterment of our human condition.

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Evaluating and treating patients with violent ideations and behaviors can be frustrating, anxiety-provoking, and even dangerous, as errors in judgment can lead to disastrous consequences. Fortunately, there is the Textbook of Violence Assessment and Management, the first and only comprehensive textbook on assessing the potentially violent patient for mental health clinicians on the front lines of patient care. Uniquely qualified to produce this comprehensive volume, the editors have assembled a distinguished roster of contributors who, in 28 practical chapters, combine evidence-based medicine with expert opinion to address the topic of patient violence in all its diversity of presentation and expression. Dr. Simon is Director of the Program in Psychiatry and Law at Georgetown University School of Medicine, as well as the author or co-author of more than two dozen books. Dr. Tardiff, Professor of Psychiatry and Public Health at the Payne Whitney Clinic, The New York Hospital – Cornell Medical Center, is the author of The Concise Guide to Assessment and Management of Violent Patients, an introduction to aggression management now in its second edition.Violence is both endemic to our society and epidemic in our age. Skilled assessment and management of violence is therefore critical for mental health professionals involved in patient care. The Textbook of Violence Assessment and Management includes many features designed to instruct and support these clinicians. For example: It is the first comprehensive textbook to take the mental health professional from evaluation and assessment to treatment and management of patients who are or may become violent. The 28 chapters address the diversity of clinical settings, patient demographics, psychopathology and treatment modalities, making this work useful as both a textbook and a reference that clinicians can consult as needed for particular cases. End-of-chapter «Key Points» highlight the most important concepts and conclusions, allowing students to review and consolidate their learning and practicing professionals to locate critical information quickly. Clinical case examples abound, providing rich and nuanced perspectives on patient behavior, evaluation and management. The textbook includes a separate chapter on evaluating patients from different cultures, a competency that becomes more crucial as patient populations become more diverse. Increasing numbers of veterans are diagnosed with PTSD and traumatic brain injury. Campus tragedies such as Virginia Tech are fresh in our collective memory. This text is both timely and necessary – not just for mental health professionals and their patients, but for the families and communities whose safety depends upon competent professional judgment.

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Solomon Snyder has been instrumental in the establishment of modern psychopharmacology – as a pioneer in the identification of receptors for neurotransmitters and drugs and in the explanation of the actions of psychotropic agents. Science and Psychiatry is a collection of some of his best scientific papers, publications ranging over forty years that represent important advances in psychopharmacology and molecular biology. Audacious and unanticipated when they first appeared, these papers opened up new areas of understanding and revolutionized the modern study of the brain. Republished here, they show why fundamental research into the «messengers of the mind» is as essential for clinicians as for researchers.Many of these papers have clear clinical relevance, offering insight into modern neuroscience to help make sense of the bewildering array of available psychotropic medications and point the way toward more effective and safer agents. Others describe the underpinnings of psychopharmacology that practitioners need to know, especially regarding the role of receptors in drug action. Each of the nine groups of research articles is accompanied by a commentary by a well-known authority, putting the discoveries in perspective and providing a broad overview of subjects ranging from characterization of the enkephalins to serotonin receptor subtypes. The final set of papers focuses on apoptosis, the general process of cell suicide, where Snyder's work with bilirubin holds promise for treating neurodegenerative disorders. And in a closing piece, «The Audacity Principle in Science,» Snyder speculates about factors conducive to creativity and efficacy in scientific discovery.The articles particularly describe four groups of extraordinary discoveries for which Snyder is widely recognized: Identification of opiate receptors, providing keys to understanding pain perception Characterization of the IP3 receptor, exploring its role as a target for lithium treatment in manic-depressive disorders Establishment of nitric oxide as a transmitter in the brain, radically transforming conceptualizations of neurotransmission Discovery that D-serine is the normal stimulus for the glycine site of the NMDA receptor, providing new insight into the regulation of the receptor important for learning and memory Hailed as one of the preeminent scientists of the past twenty years, Snyder is a consummate researcher who confesses to remaining obsessed with the need to «think thoughts no one else has thought before.» Science and Psychiatry clearly shows how that urge accounts for the diversity of challenges he has taken on as it conveys the origins of modern psychopharmacologic practice.

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Windows to the Brain is the only book to synthesize neuroanatomical and imaging research as it pertains to selected neuropsychiatric diseases, containing all of the «Windows to the Brain» papers published from 1999-2006 in the Journal of Neuropsychiatry and Clinical Neurosciences. These reader-friendly summaries by more than sixty contributors present modern imaging techniques that assist in the diagnosis of neuropsychiatric illness, enhanced by easily understood color graphics of the neuroanatomical circuits of behavior, memory, and emotion. They provide a basic understanding of how to apply a variety of imaging techniques to the study of adult neuropsychiatric disease and how to use neuroimaging to assist in diagnostic work-ups for conditions ranging from sleep disorders to epilepsy to borderline personality.Integrated, color-coded graphics present functional anatomical information in a manner that promotes understanding and use in clinical practice, while the text encompasses a wide range of diseases and injuries across the adult lifespan. The book is organized into four sections that will help readers increase their appreciation of the wide range of research and clinical applications for imaging in neuropsychiatry: chapters on imaging techniques discuss underlying principles, strengths and weaknesses, and applications; chapters on specific diseases demonstrate a range of investigative techniques; anatomy/circuit chapters focus on particular brain structures or functional neuropsychiatric circuits; and final chapters present image-based approaches to understanding or selecting treatment options. Some of the applications described are: Use of fMRI in posttraumatic stress disorder to reveal the delicate balance between the structures of the emotion and memory tracks; Use of high-resolution MRI and nuclear imaging to distinguish between panic disorder and simple partial seizure disorder; Use of functional imaging studies to detect corticobasal degeneration, as a means of better understanding dementia; Use of newer imaging techniques in identifying progressive multifocal leukoencephalopathy, to enable more rapid and reliable tailoring of individual therapy for HIV; Use of functional neuroimaging in the study of fear, in order to better understand and treat anxiety-based psychiatric disorders; Use of neuroimaging studies in conversion disorder, showing implications for the disruption of selfhood in dissociative identity disorder and schizophrenia; Use of FDG-PET scans to look for predictors of treatment response in childhood-onset obsessive-compulsive disorder. Windows to the Brain can help bring less-experienced readers up to speed on advanced imaging and anatomical details that pertain to the modern practice of neuropsychiatry. It is must-reading for specialists in neuropsychiatry and cognitive/behavioral neurology, or for general psychiatrists with an interest in neuroimaging.

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A major benchmark in the understanding of psychiatric illness in children and adolescents, Developmental Psychopathology and Wellness reports on progress in identifying genetic and environmental influences on emotional-behavioral disorders. A team of 22 international authorities presents work that changes the way child psychiatry and clinical psychology are conceptualized, debunking misconceptions about depression, antisocial behavior, and other conditions to enhance our understanding of the causes of child psychopathology – and improve the ways we treat these disorders. Coverage of basic principles describes the influence of genomic medicine, as explained by trailblazers in the field who demonstrate the importance of the developmental perspective. Chapters on gene-environment interaction review the important concepts of personality and temperament, cognition, and sex – including findings from molecular genetic investigations on adolescent cognition, temperament, and brain function. Disorder-based examples show how emotional-behavioral illness and wellness attest to the interaction of genetic and environmental factors over time, providing new insight into the study of anxious depression, ADHD, autism, and antisocial personality disorders. And in considering how we can bridge the gap between research and clinical applications, Dr. Hudziak describes his family-based gene-environment approach as a means of better understanding etiopathology and treatment. Among the other significant contributions: Thomas Achenbach focuses on the importance of culture in understanding the genetic and environmental impact on children, with insights into measuring these sources of influence. Joan Kaufman reports on her seminal work on the genetic and environmental modifiers of risk and resilience in child abuse, relating maltreatment to other forms of environmental risk, genetic mediation, and reactivity. D. I. Boomsma describes the genetic architecture of childhood worry, presenting data from an extraordinary sample of 30,000 twin pairs. Frank Verhulst draws on a 14-year study to detail the advantages of the developmental perspective in understanding antisocial behavior. Stephen Faraone offers guidelines for moving beyond statistics to document the functional significance of DNA variants associated with psychopathology. As the contributors ably demonstrate, these new approaches to the care and treatment of at-risk children are applicable to daily practice, teaching, and research. Developmental Psychopathology and Wellness shows that these psychopathologies are not a matter of nature versus nurture or genes versus environment, but rather an intertwining web of them all.

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As more patients seek information about family risks of psychiatric illness – an interest likely to increase as gene-identification studies are publicized – most psychiatrists agree it is their role to discuss these issues but admit they are ill-prepared to do so. Psychiatric Genetics addresses that need as the first book to focus on clinical applications of genetics in psychiatry. It covers issues involved in genetic counseling, the interpretation of familial and genetic information for clinical use, information regarding risks associated with specific psychiatric disorders, risk/benefit considerations related to medication use during pregnancy, and the ethical and social implications of psychiatric genetic knowledge and research – including the prospects for genetic testing.While other books have been written for the genetics community, this volume is addressed to practitioners: a clinically relevant resource that can help them understand the often bewildering flood of information about genetics – information difficult to interpret, let alone integrate into practice – and enable them to respond to patients' requests to predict the risk of recurrence of psychiatric illness or provide information about reproductive and pregnancy-related issues. Experts from psychiatry, genetic epidemiology, molecular genetics, genetic counseling, cognitive psychology, and ethics focus on issues that have received little attention elsewhere yet are of increasing importance to clinicians. Written at a level that assumes no particular expertise in genetics, the book features these immediately applicable benefits: It offers a framework for understanding and critically evaluating the psychiatric genetic research literature, enabling clinicians to better understand the meaning and limitations of genetic discoveries when patients raise questions about media reports. It provides a resource for clinicians who would like more information about the role and content of genetic counseling, outlining a typical counseling session while demonstrating how risks are estimated and discussed. It summarizes genetic aspects of major psychiatric conditions – from childhood-onset disorders through psychotic, mood, and anxiety disorders to dementia – as well as neuropsychiatric manifestations of other genetic disorders. It alerts clinicians to risk/benefit considerations related to medication use during pregnancy. It covers the ethical, legal, and social implications of genetic research and counseling, illustrating the dilemmas that arise with new advances. Whether used as a clinical guide, reference, or ancillary text, this book sets the standard for the application of psychiatric genetic knowledge in everyday practice. Psychiatrists, mental health clinicians, and genetic counselors will find it an essential resource for all patient encounters in which genetic issues arise.

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Because physicians are shaped by the expectations and responsibilities of their profession and are especially susceptible to stress and illness, professionals treating them need to be attuned to a host of demands and considerations not applicable to other patients. The Physician as Patient meets that need by combining the perspectives of two seasoned psychiatrists who have been assessing and treating physicians for more than 30 years. Drs. Myers and Gabbard pool their career-long dedication to physician health, counseling, and risk management to demonstrate that, through accurate diagnosis and state-of-the-art treatment, most impaired physicians can recover and return to practice.As the most current sourcebook available on this subject, The Physician as Patient not only discusses common illnesses and problems seen in doctors but also outlines the many biopsychosocial treatments that are indicated – always with an emphasis on integrated care. It considers such issues as the reluctance of physicians to assume the role of patient and the uniqueness of the physician's psychological makeup that facilitates or impedes diagnosis and treatment. It describes the most common medical and psychiatric illnesses in physicians – including addictions – and addresses personality disorders and the increasingly important subject of boundary violations. And it helps readers determine what can be done about doctors behaving badly or out-of-character, or what strategies are useful in treating physicians to assure accuracy while also diminishing morbidity and relieving suffering. Among other key issues raised are: The importance of considering sociocultural customs and values when treating the increasing number of minority and International Medical Graduate physicians Addressing the many clinical, humanistic, ethical, and legal dimensions of the psychiatric evaluation of physicians Distinguishing between long-standing patterns of personality disorders that manifest as disruptive behaviors and those patterns that lead to burnout and depression Assessing amenability to rehabilitation in cases of sexual boundary violation, including an awareness of alcohol or drug abuse as contributing factors Utilizing a physician's predisposition as a learner and pragmatist to enter into cognitive behavior therapy The success of early diagnosis and treatment in lowering the occurrence of suicide, for which physicians are notoriously at risk Brimming with case examples, The Physician as Patient adopts a reader-friendly style that facilitates quick grasp of concepts, while an extensive list of references and websites provides an entrée for additional support. This book is an indispensable resource for all mental health professionals who take caregivers into their care.

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This first book of its kind for the medical profession brings the real-world translation of ethics to the care of patients, conduct of protocols, and training of professionals. An interactive, case-oriented approach to mental health ethics, Professionalism and Ethics: Q & A Self-Study Guide for Mental Health Professionals consists of questions and answers developed by the authors and fourteen contributors from backgrounds as diverse as family medicine, research ethics, social psychology, and public health. They draw on personal experience in the care of people with mental illness, in mental health research, and in clinical training to generate scenarios that pose ethical questions. Some questions are narrow and to the point, such as responding to a suspicion of child abuse; others require a more nuanced approach, such as dealing with conflict of interest posed by a pharmaceutical company. They then resolve these questions in alignment with an understanding of ethical principles, the standards of their fields, the law, and the expectations of mental health professionals. The brief case descriptions that frame each ethical question echo the real-life complexities of clinical practice and are presented in single-answer, multiple-choice format modeled after key medical licensure and specialty certification organizations. Following an overview of ethics and professionalism, questions cover four broad areas: core concepts, clinical care, medical research, and interactions with colleagues and trainees. Explanations following the questions offer background information about relevant ethical concepts and related legal and clinical considerations. A subsequent section features another set of questions for self-assessment, followed by answers with citations to appropriate references. The book's overall approach is geared to underscore the following areas of concern: Essential ethical skills, such as understanding how personal values affect patient care, recognizing high-risk situations in which ethical problems arise, and building ethical safeguards Core ethical principles, including nonmaleficence, beneficence, autonomy, respect, justice, veracity, fidelity, and privacy Key clinical ethics issues, including maintaining therapeutic boundaries, patient non-abandonment, informed consent and treatment refusal, alternative decision making and advance directives, confidentiality, reporting colleague misconduct, and caring for difficult patients. Trainees and experienced clinicians alike will be richly rewarded by considering the dilemmas posed here. Developed with an extensive review process, reference verifications, and iterative crosschecks, this book facilitates professionalism as a core competency in medicine as it instills the need for ongoing consideration of ethical behaviors and principles in the daily practice of psychiatry.

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Cultural diversity has always been a fact of life, nowhere more so than in the unique melting pot of U.S. society. Respecting and understanding that diversity is an important – and challenging – goals. Culture and Psychotherapy: A Guide to Clinical Practice brings us closer to that goal by offering a fresh perspective on how to bring an understanding of cultural diversity to the practice of psychotherapy to improve treatment outcomes.This remarkable work presents the nuts and bolts of incorporating culture into therapy, in a way that is immediately useful and practical. Illustrated by numerous case studies that demonstrate issues, techniques, and recommendations, the topics in this wide-ranging volume focus not on specific race or ethnicity but instead on culture. Introduction – Summarizes the influence of culture (an abstract concept defined as an entity apart from race, ethnicity, or minority) on the practice and process of psychotherapy while offering a broadened definition of psychotherapy as a special practice involving a designated healer (or therapist) and identified client (or patient) to solve a client's problem or promote a client's mental health Case Presentations and Analysis – Illustrates distinctive cultural issues and overtones within psychotherapy, such as the traditional Japanese respect for authority figures, the Native American concept of spirit songs, the clash of modern values with traditional Islamic codes, and the effects of the conflict between Eastern values of dependence and group harmony and Western values of independence and autonomy Specific Issues in Therapy – Discusses lessons from folk healing, the cultural aspects of the therapist-patient relationship, and the giving and receiving of medication as part of therapy Treating Special Populations – Presents issues and trauma faced by African Americans, Hispanic veterans, Southeast Asian refugees, adolescents, and the ethnic minority elderly Special Models of Therapy – Shows the interplay between cultural issues and specific models of therapy, including marital therapy for intercultural couples and group therapy with multiethnic members The relevance of cultural diversity will only grow stronger in the coming years as our definition of community expands to embrace global – not just local – issues. With its balanced combination of clinical guidance and conceptual discussion highlighted by fascinating case studies, this volume, authored by national and international experts, offers psychotherapists, psychiatrists, psychologists, psychiatric residents, psychiatric nurses, and mental health social workers – both in the U.S. and abroad – an expansive focus and richness of content unmatched elsewhere in the literature.

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