LITMIR.BIZ

Beset by contradictions, somatoform and factitious disorders have an unusually long, rich, and colorful historical and clinical tradition. Yet, some of them have received only limited empirical investigation.This book continues that rich tradition by offering a broad and scholarly synthesis of the current knowledge – and controversies – about somatoform and factitious disorders. Here you'll find up-to-date, clinically focused overviews of these intriguing and often difficult-to-treat disorders.Recognized experts present the latest findings along with insightful recommendations and illustrative case studies on Somatization disorder – The evolution and problems of diagnostic criteria (e.g., its focus on symptom counting), epidemiology, clinical features, etiologic considerations, differential diagnosis (e.g., contrasted with depressive and anxiety disorders), evaluation (use of questionnaires), and treatment considerations (psychotherapy, psychotropic medications). Hypochondriasis – History, clinical features, theoretical models (psychodynamic, cognitive-behavioral, and physiologic), research studies, and practical techniques for treatment (from pharmacotherapy to cognitive behavioral therapy to alternative treatments such as relaxation therapy). Body dysmorphic disorder – History and prevalence, clinical features, treatment (including surgery and nonpsychiatric medical treatment), etiology and pathophysiology (its relationship to obsessive-compulsive, depressive, and eating disorders), and diagnosis and misdiagnosis. Conversion disorder – Diagnostic criteria and clinical subtypes, history and definitions, models of symptom generation, functions served by conversion symptoms, associated features, epidemiology, demographic and disease course, comorbidity, differential diagnosis, and treatment (best done in collaboration with an internist, primary care physician, or neurologist). Factitious disorders (widely known as Munchausen syndrome, its most extreme subtype) – Empirical evidence related to epidemiology and etiology; diagnosis, clinical description, prevalence, and associated costs; limitations of current approaches; the reliability and usefulness of differential diagnoses; comorbidity, etiology, and management. Both concise and thorough, this extensively annotated volume clarifies the issues surrounding these fascinating disorders and offers practical guidance and recommendations, highlighting the pressing need for further research to improve patient care. As such, it will prove compelling reading for practicing psychiatrists and other physicians in any clinical setting who want to better understand the baffling complexities of these distressing disorders.

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Constituting nearly 12 percent of the US population, Latinos (a term used interchangeably with the term Hispanic throughout the text) are expected to become the second-largest race ethnic group (after non-Hispanic whites) by 2010. This growth emphasizes the increasing importance of understanding the cultural factors affecting the psychiatric treatment of Latino patients.Integrating culture-specific treatments, such as the services of a folk healer (called a santero in Cuba and a curandero in Mexico), with more traditional interventions, such as medication and case management services, is crucial to achieving successful outcomes for Latino patients.This unique book helps mental health professionals acquire the knowledge, skills, and – most important – the cultural sensitivity necessary for treating Latino patients in the United States. The book can aid clinicians in learning to appreciate the importance of language, culture, religion, gender, sexual orientation, race, and ethnicity in psychiatric evaluation and care.The editors of this insightful, wide-ranging text have structured the work of 20 distinguished contributors into three major sections: Section I, Overview, presents an overview and brief history of Latinos in the United States, including demographic data and statistics on their physical and mental health. Variables include language, religion, geographical origin, class, race, degree of acculturation, gender, education, and sexual orientation. Of particular interest here is practical guidance on conducting culturally sensitive psychiatric evaluations of Latino patients. Section II, Individual Countries, highlights the fascinating differences among the major Latino subgroups in the US, including Colombia, Cuba, the Dominican Republic, El Salvador, Mexico, Nicaragua, Peru, and Puerto Rico, and details their distinct characteristics (from cuisine, music, and literature to dialects and traditions) so that clinicians may better understand these patients and incorporate this knowledge into their practices. Section III, Special Issues, discusses today's the pressing realities of Latino life in the United States – such as socioeconomic status, the gender roles of machismo (qualities of the strong, powerful, active man) and marianismo (the qualities of the submissive, obedient woman), and cultural ideals such as familismo (strong loyalty and duty to family) – and how these factors affect treatment. Discussions span women's issues, substance abuse, and violence in Latino populations. Of broad interest to students, residents, and practicing clinicians, this informative volume adds a singularly valuable tool needed to understand, evaluate, and treat Latino patients by viewing their original culture and belief system as integral parts of who they are.

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Suicide remains all too common in the United States. As the ninth leading cause of death – responsible for 30,000 deaths annually – it is also one of the more preventable causes of deathIncreasingly, mental health clinicians must care for suicidal patients within managed care systems. Managed care's cost-driven focus on rapid assessment and triage, narrowly restrictive hospital admission criteria, and abbreviated inpatient stays have resulted in poorer clinical care and increased opportunities both for adverse outcomes such as suicide and for clinician liability.Bringing together a unique mix of clinicians, authorities, and administrators from private practice and managed care, Treatment of Suicidal Patients in Managed Care offers practical guidance on how to improve care and reduce risk for suicidal patients. Contributors explore a wide range of topics: Hospitalization – Emphasizes the increased importance of the initial assessment when managed care systems shorten or deny hospitalization for suicidal patients and of knowing whom to call within the managed care system. Includes alternative programs from acute residential care to cognitive-behavioral strategies and dialectical behavior therapy for the suicidal patient in crisis Suicide risk among adolescents and the elderly – For adolescents, emphasizes the value of multiple levels of care when admissions are too short and too often followed by distressing and costly readmissions. For the elderly, offers preventive interventions for primary care physicians who are uncomfortable discussing depression and suicidal ideation and intention with their elderly patients Suicide and substance abuse – Details the role of case managers in providing continuity of care in a disorder known to be chronic and relapsing Pharmacotherapy of depression and suicidality – Discusses the effects of managed care and raises questions about the expertise of the prescriber, especially relevant now that more primary care physicians are treating patients with uncomplicated unipolar depression Risk management issues – To counter the perception that managed care companies profit from withholding care, emphasizes the crucial importance today of documenting the reasons for treatment decisions Helping those affected by the aftermath of a suicide – A step-by-step process: 1) anticipating a suicide, 2) announcing or sharing the news of a suicide, 3) assessing those affected by a suicide, and 4) seeing what can be learned from reviewing the patient's treatment This clinical guide will aid understanding of clinical, administrative, and risk management issues relevant to the care of suicidal patients. Psychiatrists, psychologists, nurse clinical specialists, social workers, administrators, and primary care physicians will also rely on it as they cope with the mounting pressures of managed care while maintaining the quality of their care for these vulnerable and patients.

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In sharp contrast to the prevailing belief during the past century that schizophrenia inevitably results in a progressive deteriorating clinical course, research since the early 1980s shows that early intervention can significantly improve the long-term outcome of this complex illness. With very early treatment, many affected individuals can achieve an excellent recovery.This research has set off an explosion of interest in – and optimism about – early intervention in what was once thought to be an intractable illness. The work of 19 top experts in the field of schizophrenia research is available in this single, powerful volume that introduces the concept of early intervention and describes the clinical approaches most likely to facilitate the fullest degree of recovery. Contributors review the clinical and epidemiological evidence that supports the importance of comprehensive and optimal treatment during the early stages of schizophrenia – treatment that must encompass emotional, family, and vocational as well as pharmacological needs of affected individuals. This rich overview is organized into three major parts: Early Intervention, Epidemiology, and Natural History of Schizophrenia, which presents an overview of important concepts in early intervention and reviews our current understanding of the outcome from a first episode of schizophrenia, including which features predict the onset of first-episode psychosis Management of the Early Stages of Schizophrenia, which reviews the critical management issues in providing specialized and optimal care to this complex patient group and their families, including meeting the patient's emotional needs Neurobiological Investigations of the Early Stages of Schizophrenia, which describes important specialized topics that contribute to our understanding of the first episode of schizophrenia, including schizophrenia in childhood and adolescence and cognitive dysfunction in the early stages of schizophrenia This ground-breaking volume provides reason for new optimism about the treatment and outcome of schizophrenia. With its dramatically different perspective on the potential long-term outcome of a still-baffling illness, this volume is a must-read for mental health practitioners and educators, psychiatry residents, and family members of affected individuals.

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In recent years, considerable research, as well as clinical guidelines based on study findings, has been published on the treatment of posttraumatic stress disorder (PTSD). A gap remains, however, between the controlled environments and protocols used in intervention research and the more complex and often imperfect settings and situations that clinicians must navigate in daily practice. Moreover, clinicians routinely see patients whose comorbid substance abuse, self-destructive behavior, or medical illness would likely exclude them from research studies. In short, although the extensive literature is certainly helpful in articulating the various treatment modalities available to clinicians, the strength of the evidence for the efficacy of the treatments, and the recommendations and personal preferences of experts, the literature does not address the real-life dilemmas that clinicians face in attempting to treat trauma survivors.What is needed is a way to bridge the gap between research and practice – to «translate» study findings into everyday clinical realities. Treating Trauma Survivors With PTSD answers that need. Its authors, experienced researchers and clinicians who are at the forefront of conceptual discourse on trauma and PTSD, are uniquely qualified to offer guidance on these issues. Among the specific topics covered are the following: Diagnosis and assessment of and treatment planning for trauma survivors with PTSD, including clinical presentations related to trauma exposure and PTSD and the implications of comorbid symptoms and disorders Treatment matching in clinical practice – how treatment outcome findings can be used to develop profiles for predicting which patients are most likely to respond to which treatments Medications useful in the treatment of PTSD and the strength of the empirical evidence for their efficacy Trauma in children and the efficacy of various treatments, including a discussion of how treatment for children differs from that for adults Assessment and treatment of multiply traumatized patients – those with both recent trauma and a history of childhood trauma or abuse Treatment of trauma survivors in the acute aftermath of traumatic events, including a review of some of the exciting developments in the field regarding risk factors (e.g., normal vs. pathological coping responses) that influence which individuals are most likely to develop PTSD after such events. These topics have never been more relevant than now, in the wake of the attacks that shook our country on September 11, 2001. It is the authors' hope that by reading this book, mental health practitioners will gain more confidence in applying the specialized techniques described in empirical studies to their own practices and clinical realities.

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Every clinician today needs a basic understanding of what causes violent behavior. The second edition of Neurobiology of Violence synthesizes current research on the origins of violence and reveals its implications for managing aggressive patients and minimizing risk.Author Jan Volavka, currently Chief of Clinical Research at the Nathan S. Kline Institute, spent time in a Nazi prison as a child and has devoted much of his career to studying violence in humans. In Neurobiology of Violence, Second Edition, he brought together research and clinical data from many diverse disciplines in a single-authored volume with a unified voice that is clearly written and interesting to read.Neurobiology of Violence, Second Edition, will give you a firm grounding in a complex subject that will help you diagnose, manage, and predict violent behavior. In the first part of the book you'll examine the basic science of the origins of violence in humans, such as Factors in animal aggression that have parallels in human aggression, including the relationship between serotonin and aggression The genetic and environmental factors that interplay from conception to adulthood to result in violence. In the latter part, you'll develop new insights and strategies for working with violent patients in discussions of the latest clinical science, including Major mental disorders and violent behaviors, including behaviors expressed in the community and those in psychiatric hospitals Alcohol and various drugs and the tendencies of each type of abuse to predispose people to violence Current psychopharmacological approaches to managing violent behavior in patients. With more than 1000 updated references, the second edition of Neurobiology of Violence is a seminal resource for clinicians. It is an important tool for psychiatrists, neurologists, psychologists, and all other clinicians who struggle to understand and treat violent patients.

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Countless studies have demonstrated the power of early intervention to permanently alter the course of a child's life. Yet – heightened by the past decade's research breakthroughs in genetics – the nature vs. nurture controversy rages on.This volume dispels some of the persistent myths surrounding this controversy. Unlike largely theoretical texts that describe infant behavioral and emotional difficulties and other psychosocial challenges affecting young children, this eminently practical guide illustrates what to do in numerous clinical situations with actual patients. Written by clinicians who work with infants and children and their families every day, this reality-based approach addresses the most common and important problems in infant psychopathology (e.g., trauma, sleep, feeding, excessive crying, attachment disruptions), covering models of intervention from pregnancy through infancy, attachment issues, and transgenerational themes. Here, you'll find topics rarely addressed elsewhere: The theoretical and clinical implications of trauma during early childhood and its effects on emotional regulation, cognition, and attachment, including potential disruptions of attachment – a topic widely overlooked in the life of young children, perhaps because of the distress it produces in adults to think that infants can be subject to violence, witness major traumatic events, and experience consequences from such events Techniques, such as multimodal parent-infant psychotherapy, for working effectively with families – once considered «unreachable» – who are under severe stress and have endured multiple disruptions, disappointments, and marginalization A timely discussion of a rarely addressed problem on the importance of early intervention and the effects of day care for infants, from the point of view of the infant exposed to multiple caretakers, addressing the very difficult questions of the effects on infants of changes in caretakers How young children use their bodies and its functions to manifest their difficulties, focusing on sleeping, crying, and eating with practical suggestions that can be widely applied by health care professionals Unique commentaries on two case examples by a diverse international panel of clinicians and researchers – from countries such as Argentina, Canada, France, Japan, Mexico, Switzerland, the UK, and the U.S. – illustrating the differences of opinion, approaches, and perspectives that together generate more effective assessment and treatment This thought-provoking clinical reference is a «must read» for developmental, child, and adolescent psychiatry educators and practitioners – and nurses, pediatricians, occupational therapists, and clinical social workers – as they help the youngest members of our community through theoretical understanding and practical intervention.

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In today's world of managed care – characterized by limited mental health resources, emphasis on accountability, concerns of third-party payers, and consumer need – the demand for mental health professionals to use briefer therapeutic approaches is on the rise. Fully 84% of all clinicians are doing some form of planned brief therapy (6-20 sessions per year per patient). Yet despite clinical advances and outcome data that demonstrate the effectiveness of short-term therapy, many therapists – in fact, 90% of those whose theoretical orientation is psychodynamic rather than cognitive-behavioral – are reluctant to learn briefer interventions, seeing value only in long-term, depth-oriented work. The second edition of this Concise Guide is intended to help educate both beginning and experienced clinicians in the strategies and techniques of time-attentive models and to foster more positive and optimistic attitudes toward using these important therapies. The seven therapeutic models presented here – including an entirely new chapter on time-limited group therapy – highlight the importance of the interpersonal perspective. The seven models, one per chapter, represent well-established short-term approaches to clinical issues that therapists commonly encounter in their clinical practices. These models also have clearly defined intervention techniques and formulation strategies and can be used within the 10- to 20-session time frame of most managed care settings. The first part of each chapter dealing with a therapeutic model lists the various presenting problems the authors deem most suitable for treatment by that particular approach. The authors discuss the overall framework of each model, selection criteria, goals, therapeutic tasks and strategies, empirical support, and relevance for managed care, with clinical cases to illustrate the application of each model. The authors include updated chapters on supportive, time-limited, and interpersonal therapies; time-limited dynamic psychotherapy; short-term dynamic therapy for patients with posttraumatic stress disorder; brief dynamic therapy for patients with substance abuse disorders; an entirely new chapter on time-limited group therapy; and a final chapter on the reciprocal relationship between pharmacotherapy and psychotherapy. Meant to complement the more detailed information found in lengthier psychiatric texts, this Concise Guide (it is designed to fit into a jacket or lab coat pocket) is a practical and convenient reference for psychiatrists, psychiatric residents, and medical students working in a variety of treatment settings, such as inpatient psychiatry units, outpatient clinics, consultation-liaison services, and private offices.

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Over the last three decades, the visibility – and public acceptance – of self-identified lesbian women and gay men and bisexual and transgender individuals has increased dramatically, making it more important than ever to understand the dynamics of their relationships.This timely work, part of Volume 21 in the Review of Psychiatry series, offers compelling facts and insights in a concise yet comprehensive format, bringing together the latest research and clinical practice in this rapidly evolving field. Chapter 1 details normal adolescent development and the extra challenges imposed by the development of a sexual identity that is different from that of most of their peers, including the lack of lesbian, gay, bisexual, and transgender role models. Chapter 2 presents a rare discussion about theoretical models (managing a concealable stigma, minority stress and resilience, and coping with multiple minority statuses) and empirical data on aging as a stigmatized sexual minority, including the similarities and differences of aging between the sexual minority communities and the heterosexual community and special issues in working with aging ethnic minority gay men, lesbians, and bisexual persons. Chapter 3 breaks new ground by detailing the expanding role of the psychiatrist or other mental health professional as forensic expert and therapist – requiring not only an in-depth understanding of lesbian and gay mental health issues, but also the often-daunting task of encouraging and teaching judges and juries to better understand these issues as they relate to discriminatory laws in child custody/visitation, workplace harassment/other discrimination, domestic violence, and immigration/asylum. Chapter 4 covers both the three types of etiological theories on homosexuality presented in the scientific literature and an historical overview of clinical attitudes toward homosexuality, from early modern theories (Karl Ulrichs, Krafft-Ebing, and Freud) to the present day, reporting on some adverse side effects of sexual conversion treatment that have been either overlooked or ignored in the reparative therapy literature and raising important clinical and ethical concerns. Chapter 5 examines the public and professional evolution of thinking toward U.S. African race and toward sexual orientation with regard to the reevaluation of the psychiatric diagnosis and treatment of gender identity disorder. Among other topics, the author presents a fascinating discussion of differences between sexual orientation and gender (e.g., anatomical, social, hormonal, psychological, legal, or political), and distinctions between transgenderism and homosexuality, including an illuminating case example. Thought-provoking and informative, this compact volume will be welcomed by residents, clinicians, and students alike as they continue to look for ways to better differentiate health from pathology and successfully treat these remarkably diverse individuals.

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In the 1960's and 1970's, personality and mental illness were conceptualized in an intertwined psychodynamic model. Biological psychiatry for many un-weaved that model and took mental illness for psychiatry and left personality to psychology. This book brings personality back into biological psychiatry, not merely in the form of personality disorder but as part of a new intertwined molecular genetic model of personality and mental disorder. This is the beginning of a new conceptual paradigm!!This breakthrough volume marks the beginning of a new era, an era made possible by the electrifying pace of discovery and innovation in the field of molecular genetics. In fact, several types of genome maps have already been completed, and today's experts confidently predict that we will have a smooth version of the sequencing of the human genome – which contains some 3 billion base pairsSuch astounding progress helped fuel the development of this remarkable volume, the first ever to discuss the brand-new – and often controversial – field of molecular genetics and the human personality. Questioning, critical, and strong on methodological principles, this volume reflects the point of view of its 35 distinguished contributors – all pioneers in this burgeoning field and themselves world-class theoreticians, empiricists, clinicians, developmentalists, and statisticians.For students of psychopathology and others bold enough to hold in abeyance their understandable misgivings about the conjunction of «molecular genetics» and «human personality,» this work offers an authoritative and up-to-date introduction to the molecular genetics of human personality. The book, with its wealth of facts, conjectures, hopes, and misgivings, begins with a preface by world-renowned researcher and author Irving Gottesman. The authors masterfully guide us through Chapter 1, principles and methods; Chapter 4, animal models for personality; and Chapter 11, human intelligence as a model for personality, laying the groundwork for our appreciation of the remaining empirical findings of human personality qua personality. Many chapters (6, 7, 9, 11, and 13) emphasize the neurodevelopmental and ontogenetic aspects of personality, with a major emphasis on the receptors and transporters for the neurotransmitters dopamine and serotonin. Though these neurotransmitters are a rational starting point now, the future undoubtedly will bring many other candidate genes that today cannot even be imagined, given our ignorance of the genes involved in the prenatal development of the central nervous system. Chapter 3 provides an integrative overview of the broad autism phenotype, and as such will be of special interest to child psychiatrists. Chapters 5, 8, and 10 offer enlightening information on drug and alcohol abuse. Chapter 14 discusses variations in sexuality. Adding balance and mature perspectives on how all the chapters complement and sometimes challenge one another are Chapter 2, written by a major figure in the renaissance of the relevance to psychopathology of both genetics and personality; Chapters 15-17, informed critical appraisals citing concerns and cautions about premature applications of this information in the policy arena; and Chapter 18, a judicious contemplation by the editors themselves of this promising – and, to some, alarming – field. Clear and meticulously researched, this eminently satisfying work is written to introduce the subject to postgraduate students just beginning to develop their research skills, to interested psychiatric practitioners, and to informed laypersons with some scientific background.

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