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Ethnicity and Psychopharmacology addresses the most relevant theoretical and clinical aspects of ethnopsychopharmacology, with the aim of advancing this growing field well into the twenty-first century. Detailed are the pharmacogenetic, pharmacokinetic, and pharmacodynamic mechanisms involved in differing responses to drug treatment among various ethnic groups living in the United States. Readers will learn an integrative approach in which ethnic and cultural diversity and biological diversity are taken into account and treatment is tailored to specific individual characteristics.Dr. Ruiz's extensive research experience and years of leadership in public psychiatry along with his distinguished panel of contributors combine to make this book an authoritative resource. Psychiatric practitioners, educators, and investigators, as well as other mental health professionals, primary care physicians and medical students, will gain a better understanding of treating patients from different cultures.

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Today, 25% of Americans smoke and 50% of smokers die from tobacco-related illnesses. Meanwhile, little attention has been given to implementing cessation therapies for our patients who smoke.Nicotine in Psychiatry: Psychopathology and Emerging Therapeutics examines this timely subject. The book's contributors, subject matter experts in the growing field of nicotine neurobiology andclinical pharmacology, cover the latest knowledge on   The pharmacokinetics and pharmacodynamics of nicotine The effect of nicotinic receptors on the central nervous system (CNS), the recent advances made in understanding the normal function of these receptors, and how this knowledge transfers to the clinical treatment of many CNS disorders Behavioral factors influencing the effects of nicotine and nicotine's addictive capacity The association between smoking and specific mental disorders and the association between nicotine and mood Clinical applications of nicotine as a potential therapeutic agent for a variety of disorders, such as attention deficit, Alzheimer's and Parkinson's diseases, epilepsy, inflammatory bowel disease, schizophrenia, and Tourette's syndrome Nicotine replacement therapies and various smoking-cessation strategies This book makes fascinating reading for anyone interested in the recent tobacco public policy debates, as well as clinicians and researchers looking for current information on nicotine and its clinical applications.

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Childhood Onset of 'Adult' Psychopathology

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Age at onset studies have been an important approach to understanding disease across all medical specialties. Over the last few decades, genetic research has led to the identification of unique genes and, in some cases, physiologically different disorders. These advances bring us closer to identifying genetic vulnerability and implementing prevention programs for psychopathology.Childhood Onset of "Adult" Psychopathology: Clinical and Research Advances provides an understanding of the childhood onsets of adult psychiatric disorders, including when and in what sequence psychiatric disorders begin in childhood, and how these disorders evolve over the life span. This book examines   Studies on the growing volume of data on very early forms of depression, criminality, alcoholism, schizophrenia, and anxiety Genetics, evolution, and the significance of age at onset in terms of individual variability and the course of disease The biological manner in which early-onset disorders progress New insights into the disease etiology of schizophrenia and the neurodevelopmental hypothesis The long-debated subject of whether depressive disorder in preadolescent children is the same as depressive disorder in adults and studies of individuals at risk for disorders of anxiety and depression The implications for prevention of adult psychiatric disorders, alcoholism, and antisocial personality disorder Complete with extensive references and tables, this text provides practitioners with a better understanding of adult psychopathology and insight into early detection and prevention methods.

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Ethics, Culture, and Psychiatry: International Perspectives is a textbook that explores the best ways to promote the use of the Declaration of Madrid, which outlines ethical standards for psychiatric practice throughout the world. The book is written with two questions in mind, both easy to pose and difficult to answer:   Is it possible to formulate a set of principles that will be valid for all psychiatrists, regardless of the cultures to which they belong or in which they live and practice, or are there as many sets of ethical principles as there are cultures? If there is such a set of principles, what should we do to ensure that psychiatry as a discipline makes a significant contribution to societal good without helping the evil? To facilitate the exploration of this territory, 15 experts from a variety of cultures examine the most pressing ethical issues prevalent within the current practice of psychiatry. Many of the dilemmas probed in this book are routinely encountered by clinicians who work in increasingly multicultural societies. The text covers issues that are broadly relevant to clinical practice and research, including:   An overview of ethics and societies around the world Discussions of ethical practices and dilemmas specific to various cultural regions Transcultural debate on overarching issues, such as incompetent patients, informed consent, and mental health law reform The complete copy of The Declaration of Madrid printed in the appendix Readers will find that this is a textbook that stimulates and supports, rather than closes, the debate on ethical aspects of professional psychiatric behavior. Ethics, Culture, and Psychiatry: International Perspectives is much more than just a book on ethics -- it is a major contribution to understanding the impact of culture and history on the ethical practice of medicine around the world, and a continuous search for a consensus on how to live together and make contributions to the well-being of people with mental illness, their families, and the family of humans on our planet.

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Norman Sartorius, Ahmed Okasha, Julio Arboleda-Florez

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Complementary and Alternative Medicine and Psychiatry

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Complementary and Alternative Medicine and Psychiatry will start psychiatrists and other mental health professionals on the journey toward a more complete understanding of the most common CAM treatments in use today.The alternative therapies discussed in this book pre-date our own conventional treatments by hundreds and even thousands of years. These therapies have been "conventional" medicine for hundred of millions of people who have used them throughout the centuries, and people continue to use them today.One of the few texts that provides an academic and practical review of complementary and alternative medicine, the book is written from the perspective of clinicians who practice in both traditional and alternative medicine. The book covers the major areas in CAM, including herbal medicine and nutrients, acupuncture, meditative therapies, and yoga. It provides the most important and up-to-date scientific data along with controversies that exist in the field. With all of the chapters extensively referenced, the book will serve as a tremendous resource for those interested in exploring these areas in greater depth.As evidenced by the statistics, patients today are taking increasingly active roles in managing their health care. They are using CAM therapies in the medical setting along with or in place of conventional treatment. They are using them for promoting wellness; for chronic conditions which they feel do not respond well to conventional approaches; and for more serious illnesses, as evidenced by the large number of inquiries being sent to the National Center for Complementary and Alternative Medicine at the National Institutes of Health. Complementary and Alternative Medicine and Psychiatry contains a thorough review of problems that may be encountered by the physicians treating these patients, and it also serves as a guide in advising patients who are seeking out CAM therapies.This book will appeal to a wide audience of professionals including psychiatrists, psychologists, social workers, nonpsychiatric physicians, and residents by providing a guide for treatment with nutrients and botanical preparations and the foundation for the use of meditation, acupuncture and yoga along with traditional psychiatric treatment.

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Elements of Clinical Research in Psychiatry

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Clinical research is often thought of as a dry and somewhat arcane pursuit.Not so, assert the editors of Elements of Clinical Research in Psychiatry. The editors, all actively engaged in clinical research, bring this topic to life by combining a boundless enthusiasm for their chosen field with a depth of knowledge rarely seen in the literature. They show that clinical research can be rewarding not only because the research results contribute to improving the welfare of psychiatric patients, but also because the research process itself is exciting.Arguably the definitive guidebook on clinical psychiatric research, this volume discusses   Careers in clinical mental health research -- Describes what clinical psychiatric researchers do and how to get started on this career path. Research design, measurement, and assessment -- Covers all aspects of research design, defines and evaluates measurement types, and details various assessment methods (from interviews and questionnaires to lab tests and brain images). Descriptive and inferential statistics -- Shows how statistics are used to analyze and summarize measurement data. Research support -- Provides a roadmap for those seeking research support in the U.S. (more than 90% is funded via NIH), detailing how to write grants from the ground up. Use of human subjects (the Institutional Review Board [IRB]) and ethics and misconduct -- Demystifies the often intimidating process of seeking and receiving IRB approval, with tips on how to work with the IRB and complete its consent forms; uses a series of practical scenarios, including a highly publicized case of alleged misconduct, to illustrate complex ethics and misconduct issues. Writing journal articles, reviewing manuscripts, and giving scientific presentations -- Presents the nuts and bolts of publishing journal articles; gives step-by-step advice for reviewing manuscripts and giving oral presentations, symposia, poster sessions, and colloquia. Carefully chosen appendixes provide readers with additional information they can use right away, augmented by an index and detailed reference list for further investigation.Anyone considering clinical psychiatric research as a career option will find in this succinct and eminently practical volume the single source they need. Practicing psychiatrists interested in specific areas of clinical research, such as human subject use or biomedical ethics, will also find much of interest here. Replete with useful information, these stimulating discussions provide the building blocks for embarking upon -- and enhancing -- a successful career in clinical psychiatric research.

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David E. Adson, James E. Mitchell, Stephen A. Wonderlich, Ross D. Crosby

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American Psychiatry After World War II (1944-1994)

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The history of psychiatry is complex, reflecting diverse origins in mythology, cult beliefs, astrology, early medicine, law religion, philosophy, and politics. This complexity has generated considerable debate and an increasing outflow of historical scholarship, ranging from the enthusiastic meliorism of pre-World War II histories, to the iconoclastic revisionism of the 1960s, to more focused studies, such as the history of asylums and the validity and efficacy of Freudian theory. This volume, intended as a successor to the centennial history of American psychiatry published by the American Psychiatric Association in 1944, summarizes the significant events and processes of the half-century following World War II. Most of this history is written by clinicians who were central figures in it.In broad terms, the history of psychiatry after the war can be viewed as the story of a cycling sequence, shifting from a predominantly biological to a psychodynamic perspective and back again -- all presumably en route to an ultimate view that is truly integrated -- and interacting all the while with public perceptions, expectations, exasperations, and disappointments.In six sections, Drs. Roy Menninger and John Nemiah and their colleagues cover both the continuities and the dramatic changes of this period. The first four sections of the book are roughly chronological. The first section focuses on the war and its impact on psychiatry; the second reviews postwar growth of the field (psychoanalysis and psychotherapy, psychiatric education, and psychosomatic medicine); the third recounts the rise of scientific empiricism (biological psychiatry and nosology); and the fourth discusses public attitudes and perceptions of public mental health policy, deinstitutionalization, antipsychiatry, the consumer movement, and managed care. The fifth section examines the development of specialization and differentiation, exemplified by child and adolescent psychiatry, geriatric psychiatry, addiction psychiatry, and forensic psychiatry. The concluding section examines ethics, and women and minorities in psychiatry.Anyone interested in psychiatry will find this book a fascinating read.

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Lithium, the treatment of choice for mania since its usefulness was first reported, has been shown to have varied effects on multiple biological systems, including electrolyte flux and neurochemistry. Recent advances in cellular and molecular biology promise to provide clinicians with a better understanding of the etiology of bipolar disorder and new options for treatment.Bipolar Medications: Mechanisms of Action presents the treatment and prophylaxis of bipolar disorder. More than 40 investigators share research and insight into the neurobiological mechanisms that help to explain the powerful effects of new antibipolar drugs. This comprehensive text   Examines valproic acid, lamotrigine, inositol monophosphatase inhibitors, and protein kinase C inhibitors that have the potential to revolutionize clinical practice and provide new hypotheses on the etiology of bipolar disorder Presents the current understanding of the cellular mechanisms of action of mood-stabilizing agents Discusses the emergence of valproate as a powerful lithium alternative and examines the preliminary indications that lamotrigine will be an effective option Examines the issue of withdrawal rebound, which can make lithium ineffective or even counterproductive, and reviews inositol monophosphatase inhibitors that mimic lithium action in patients Compares lithium, carbamazepine, and valproate and their differential mechanisms, which could form the basis of a "rational polypharmacy" of manic depressive illness Examines behavioral models important in the screening of new antibipolar compounds and the effects of antibipolar compounds on immediate early genes Complete with extensive references, tables, and figures, this text is essential reading for any clinician who treats patients with bipolar disorder. It thoroughly documents the latest in psychopharmacology, as well as projecting future advances in the treatment of bipolar disorder.

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Charles L. Bowden, Husseini K. Manji, Robert H. Belmaker

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Psychiatric Management in Neurological Disease

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Much of the vast terrain of neurological brain disorders lies beyond our understanding, waiting to be discovered. Complicating our knowledge of and ability to treat these disorders is that they often bring with them a daunting array of psychiatric illnesses. Into this uncharted territory comes Psychiatric Management in Neurological Disease, a practical guide written with the busy clinician in mind. Its wealth of information is organized for ease of use. This comprehensive volume sets forth management principles for a broad range of key representative neurological disorders, each of which presents a distinct psychiatric profile and requires a specific management approach tailored to the nature of the illness and the level of the nervous system affected. Readers will find:   Reviews of recent research findings in specific neurological disorders Discussions of diagnostic principles and disease aspects relevant to psychiatrists Surveys of current pharmacological and psychotherapeutic approaches, with explicit information on how to contact and refer patients to support groups Practical recommendations for helping patients' families cope with the impact of neurological illnesses. Written by leading practitioners, this concise yet through guide will appeal to a wide audience. General psychiatrists, neuropsychiatrists, and neurologists; geropsychiatrists, gerontologists, and nurses; and physical and occupational therapists and social workers will all find that this timesaving reference pays significant dividends in the quality of care they can offer their patients.

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Pharmacotherapy for Mood, Anxiety, and Cognitive Disorders

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Our limited knowledge of the pathophysiology underlying mood disorders contrasts sharply with the efficacy of the treatment modalities developed over the past decades. There has been an explosion of new antidepressant and anxiolytic medications, as well as mood stabilizers and compounds that aim to improve cognition. Although treatment success is still not optimal, pharmacotherapy for mood disorders and cognitive disorders is effective and is improving. Pharmacotherapy for Mood, Anxiety, and Cognitive Disorders takes a critical look at the medications available for treating mood, anxiety and cognitive disorders; their relevance to pathobiology and underlying mechanisms; and their limitations. Its 90 distinguished contributors, many of them pioneers in the development of treatment modalities, provide background and rationale in understanding the underlying mechanisms of frontline treatments for these disorders. This book reviews   Effective new alternatives in mood stabilizers and antidepressant interventions Advances in the study of the pathobiology of anxiety disorders as well as available treatment choices, including anxiolytic medications Several treatment approaches to dementia and other age-related cognitive impairments Gender differences in the treatment of depression and anxiety and the different responses to pharmacotherapy New treatments for social phobia and pharmacological strategies for cognitive disorders Providing both a broad overview and detailed reviews of pharmacotherapy, this resource is essential reading for any practitioner who wants to understand the rationale and background for the drugs he or she prescribes and to assess medications that are currently under development. It is a great reference and ancillary text for students and residents during their clinical years.

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There is an increased awareness that learning disorders affect many areas of both child and adult functioning. It is of utmost importance, therefore, that professionals have the most up-to-dateLearning Disabilities: Implications for Psychiatric Treatment information on how learning disabilities are being identified, the effectiveness of current treatments, and their long-term outlook.Although more people have been identified as having a learning disabilities in the past 20 years, there is no agreement as to how widespread the disorders actually are. This is due to the fact that there is still no agreed on definition of learning disabilities, or objective criteria with which to identify them.The contributors to Learning Disabilities: Implications for Psychiatric Treatment, all experts in the field, go a long way toward mapping out the current terrain. The authors highlight the shortcomings of certain definitions of learning disability; they illuminate the connections between disorders; they point out the suspected biological underpinnings; and they direct our attention to some of the most significant studies on the long-term consequences of these disabilities. With all of the chapters extensively referenced, this book serves as an important resource for those interested in exploring in greater depth this critical subject.The contributors present clear and irrefutable evidence as to the role learning disabilities play in the lives of people who have been diagnosed with them. Over and over again, we are shown the importance of early identification and intervention in preventing long-term failure and demoralization that can be associated with these disorders.Edited by Laurence L. Greenhill, M.D., a distinguished authority in the field, Learning Disabilities: Implications for Psychiatric Treatment will prove useful to professionals of many backgrounds, and provides practical guidance to psychiatrists, psychologists, students and residents, and to individuals and families whose lives have been touched by the presence of these disabilities.

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Psychoneuroimmunology has emerged as a discipline advancing our knowledge of the relationships among psychosocial factors, the central nervous system, the immune system, and disease. The growing volume of evidence suggests that psychological states, including exposure to stressors and the presence of depressive states, may influence health and disease by altering immunologic states.Psychoneuroimmunology, a collaborative work of 50 international experts, expands on the American Psychiatric Association's symposium on this topic to present never-before-compiled scientific research from this evolving field. Maintaining a clinical focus, this book illustrates clinical effects by examining relevant research studies and models including   Psychoneuroimmunological factors involved in specific illnesses such as cervical cancer, breast cancer and HIV/AIDS  The role psychoneuroimmunology plays in carcinogenesis and the progression of established tumors, as well as findings on the progression of cancer that have general clinical relevance The effects of specific psychotropic medications; the effects of life stressors, bereavement, and and social support; the response to those stressors; and stress management and psychosocial predictors of disease The impacts of gender-specific factors, diurnal variation, and behavioral genetics on the immune function The Stressor-Support-Coping model, which integrates existing psychoneuroimmunology findings and lays the groundwork for use in support group intervention This book is a first step toward organizing psychoneuroimmunology findings into coherent theoretical models and concludes with a look at future clinical applications. Complete with charts, references, and a detailed index, it is the most comprehensive source on psychoneuroimmunology.

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Defined by stable, long-term, subjective distress and/or social impairment, personality disorders affect up to 18% of the population. Social impairment and health care usage are far more prevalent among people with personality disorders than among people with major depressive disorders. Personality disorders are highly prevalent, variable, and notoriously difficult to treat, and they continue to challenge the therapeutic community and represent a formidable public health concern.This volume ably addresses personality disorders as one of the top priorities of psychiatry for the new millennium, offering a thorough and updated review and analysis of empirical work to point up the issues central to developing a therapeutic model for treatment as well as current research challenges. A review of extant research yields the heartening conclusion that psychotherapy remains an effective treatment for people with personality disorders. An examination of psychodynamic treatment for borderline personality disorder speaks to its efficacy. An analysis of the rationale for combining psychotherapy and psychopharmacology emphasizes the importance of identifying temperament and target conditions. A well-documented and reasoned treatise on antisocial personality disorder makes the crucial point that clinicians must acquire a depth of understanding and skill sufficient to determine what the cut-off point is for treatable versus nontreatable gradations. With the caveat that evidence supporting the efficacy of cognitive treatments for personality disorders is slight and that such approaches require tailoring, a strong case is made for their validity.This timely volume both answers and reframes many stubborn questions about the efficacy of psychotherapy for treating personality disorders.

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Gender and Its Effects on Psychopathology

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Starting in embryonic development, gender has profound influences on us. Endocrine receptors in the brain affect cognition, mood, and behavior differently in males and females, and gender roles inevitably affect our psychosocial experiences. It should be no surprise that men and women have differences in vulnerability for developing many forms of psychopathology, in expression of symptoms and in response to treatment.Gender and Its Effect on Psychopathology examines the gender differences in psychopathology, including susceptibility to psychiatric disorders, the timing of their onset, their course, and their response to treatment. Dr. Ellen Frank and colleagues show how studying these differences helps clinicians in predicting patients' responses to treatment. This book reviews   The types of depression to which women are prone, the hormonal basis of mood disorders in women, and the specific clinical phenomenology of reproduction-related depressions Findings on how gender difference in socialization affect the development and symptoms of psychiatric disorders Studies hormonal and pubertal changes that may explain the rise in rates for depression among females relative to males between ages 10 and 15 years Epidemiological findings on the prevalence of depression among women and discusses plausible explanations for these findings Gender differences in antisocial and borderline personality disorders, anxiety disorders, schizophrenia, and substance dependence A synopsis of current research on gender differences, Gender and Its Effects on Psychopathology provides practitioners with invaluable insight into understanding and treating patients with a variety of psychiatric disorders.

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Understanding and Treating Violent Psychiatric Patients

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One of the major challenges for mental health professionals today is to successfully treat violent patients. The mental health professional is obligated to go beyond containment and control to provide understanding, complete assessment and accurate diagnosis, and humane and effective treatment.Understanding and Treating Violent Psychiatric Patients is a one-of-a-kind, comprehensive guide to assessment, management, understanding, and treatment of violent patients. The first section encompasses practical guides to treatment for both children and adults. It discusses commonly encountered problems in the treatment of violent adult inpatients and includes a brief guide to pharmacological treatments. A chapter is devoted to the treatment of abnormal aggression in children and adolescents. The second section delves into a more conceptual and broadly focused approach to understanding violent patients. It covers the relationship between dissociation and violence, as well as the relationship between psychiatric disorders and violence, and addresses impulse control and the treatment of impulsive patients.Heavily researched and clinically focused, this new title is a "must read" for psychiatrists, psychologists, psychiatric social workers, psychiatric nurses, or any mental health professional needing a better approach to understanding and treating violent patients.

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A Self-Study Guide for Treatment Planning, Documentation, and Communication

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In today's environment of managed care, practitioners face more daunting challenges than ever: treatment authorizations are becoming more difficult to obtain, as are referrals to other healthcare practitioners, which are increasingly performance based.Into this competitive environment comes Casebook for Managing Managed Care: A Self-Study Guide for Treatment Planning, Documentation, and Communication. Dedicated to helping mental healthcare practitioners clearly articulate and prove the value of what they provide patients within the managed care system, this foundational text uniquely fills a gap in the literature by providing a user-friendly, self-contained tutorial for the Patient Impairment Profile (PIP) documentation method. The PIP combines impairment terminology, the impairment profile, and the various treatment plan components to create a common language for describing behavior-based patient dysfunction and communicating the clinical rationale for treatment.As a model for treatment plan development, the PIP system trains the practitioner (or treatment team) in the "must-have" skills needed for todays managed care environment. Here practitioners will find explicit instructions about how to   Communicate treatment needs convincingly Distinguish effectively between goals, objectives, and interventions Track progress over time Document treatment summaries efficiently Using clear language and a wide array of case vignettes, the Casebook demonstrates how using PIPS can streamline the documentation, communication, and decision-making processes.The Casebook continues the groundbreaking tradition of its predecessors: Managing Managed Care: The Mental Health Practitioner's Survival Guide (Goodman et al. 1992) and Managing Managed Care II: A Handbook for Mental Health Professionals, Second Edition (Goodman et al. 1996). It is uniquely valuable both as a stand-alone instructional text and as a companion to the second edition, which introduced the Patient Impairment Lexicon and the PIP system itself. The Casebook's updates to the Impairment Lexicon definitions that first appeared in Managing Managed Care II are based on the authors' ongoing psychometric evaluation and research.This practical text will find its way onto the bookshelves of mental healthcare practitioners and managed care personnel alike. Psychiatrists, clinical psychologists, clinical social workers, marriage and family therapists, and psychiatric nurses -- especially those participating as managed care providers -- and case managers and utilization reviewers within managed care organizations, regardless of background, will find a framework for success within these pages. The Casebook's broad appeal also extends to both students in healthcare disciplines and the graduate programs that train them, and to psychiatric/behavioral healthcare organizations and facilities (inpatient, outpatient, and residential), where it will be used for treatment planning.

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Janet Brown, Michael Goodman, Jeffrey P. Bjorck

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Manual of Nursing Home Practice for Psychiatrists

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The shifting demographic toward a "graying" population -- coupled with today's reality of managed care -- makes the need for high-quality, cost-effective psychiatric services within the nursing care setting more urgent than ever. As we increase the number of our years, it is also imperative that we enhance the quality of those years.The product of the American Psychiatric Association's (APA's) Council on Aging and its Committee on Long-Term Care and of the Elderly, the Manual of Nursing Home Practice for Psychiatrists stands out because it focuses on the "how" -- not the "why" -- of nursing home care. Of exceptional importance is its detailed discussion of the Minimum Data Set (MDS), a structured assessment required by both Medicare and Medicaid for all residents of skilled nursing facilities.Divided into six sections, this "how to" volume contains practical information readers can use right away, from getting reimbursed by insurance companies to handling nursing facility politics:   Clinical -- History; evaluation and management of psychiatric problems in long-term care patients; an overview of the MDS; sexuality within the nursing home care setting Regulatory -- Introduction to the Nursing Home Reform Act of 1987 (part of OBRA-87) and its implications for psychiatric care; details about the Resident Assessment Instrument (RAI), which includes the MDS, the Resident Assessment Protocols (RAPs), and Utilization Guides specified in the State Operations Manual (SOP) Financial -- Documentation, reimbursement, and coding; what to look for when contracting with nursing homes Legal and ethical -- The dehumanizing effect of diagnostic labels and the ethical issues inherent in regulating daily schedules (e.g., bed, meal, and bath times); nursing home placement; competence and decision-making ability; comfort care for end-stage dementia; coping with Alzheimer's disease; and the role of caregivers Summary and Future Perspectives -- A detailed vision about how psychiatrists can improve the diagnosis and treatment of nursing home patients Appendixes and bibliography -- Staffing recommendations and assessment instruments Edited by a distinguished authority and former chair of the APA's Committee on Long-Term Care and Treatment of the Elderly, this comprehensive volume will appeal to a wide audience of professionals: from general psychiatrists, nurse practitioners, and clinical nurse specialists, to primary care physicians and residents.

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Psychological Aspects of Women's Health Care

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The Interface Between Psychiatry and Obstetrics and Gynecology

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In the decade since the first edition of this work was published, an incredible array of reproductive technologies and associated issues has emerged. Obstetricians and gynecologists are hard-pressed to deal with the startling breadth and depth of these issues, which require mastery over a daunting combination of ever-increasing scientific knowledge, technical skills, long hours, legal liability, and exposure to clinical situations of overwhelming emotional intensity.Psychiatrists have a vital role to play in helping obstetricians and gynecologists cope with a host of problems whose resolutions require not just technical skill, but also knowledge of biology, psychology, sociology, anthropology, ethics, and law. For example, to design and implement strategies to reduce the transmission of HIV, psychiatrists could work with public health workers to incorporate the psychology, sociology, and anthropology of female reproductive behavior. Psychiatrists could likewise improve the diagnosis and treatment of breast and pelvic malignancies by elucidating the factors that deter women from self-examination and regular medical screening and enhance treatment compliance.Divided into three sections, this clinical and theoretical sourcebook addresses every major area of contemporary concern.   Pregnancy covers topics from the psychology of normal gestation to physical and psychiatric complications during and after pregnancy, including new prenatal diagnostic techniques and the dynamic issues that emerge when abnormalities are detected, and the use of psychotropic drugs and electroconvulsive therapy in pregnant and lactating patients. Gynecology discusses not only common gynecologic problems but also more controversial issues such as induced abortion and the new reproductive technologies, including the role of the menstrual cycle in exacerbating and precipitating psychologic symptoms, the psychiatric aspects of menopause, the assessment and management of chronic pelvic pain, the psychosocial concomitants of gynecologic malignancies and the emotional demands on the oncology team, and the special implications of HIV/AIDS. General Issues offers a broad, balanced view of topics rarely found in the literature, such as men's reactions to women's reproductive events, substance abuse and eating disorders, sexual and physical abuse (often part of the histories of patients with personality disorders and posttraumatic stress disorders), ethical and legal issues, and health care for lesbian patients. Of special significance is Dr. Stotland's chapter on how consultation-liaison services are provided to obstetrics and gynecology services.  This practical and scholarly volume is exceptionally useful as a teaching reference for medical and other health care students and residents in psychiatry and obstetrics and gynecology. It also provides a valuable resource for the clinician working to improve the psychological well-being of women patients.

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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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New Concepts for a Changing Behavioral Health System

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Today's practice of psychiatric administration is totally different from that in past years because of the vast changes sweeping the health care and behavioral health care sectors. Reflecting these changes, this completely revamped second edition contains all-new chapters by 68 contributors (most new to this edition).This definitive textbook provides the practitioner and student of administration in behavioral healthcare with an up-to-date compendium focused on five central issues that represent the framework of the debate that will guide the evolution of behavioral health care during the next few years   An overview of the evolving behavioral health system, from the rich legacy of the community mental health movement mandated by federal legislation in the 1960s to today's paradigm, which is instead driven by the marketplace phenomena of managed care, information systems, and consumer empowerment. Core and new administrative psychiatry concepts and new roles for behavioral health players, including organizational theories, leadership requirements, planning models, and information system solutions, as well as new models of program evaluation and quality management and innovations in training and human resource development. How selected behavioral health systems are changing and the trend toward integrated systems, addressing the challenge of delivery system configuration and integrated service delivery as the system evolves from cost-based fee for service to managed care settings, as well as important new roles for psychiatric administrators in behavioral health network establishment and maintenance, staffing, capitated financing, population-based care, and outcome management. A comprehensive overview of the current system, from hospitals (including VA and military services) to county mental health departments, child and family service agencies, and HMOs, with new roles for everyone -- psychiatrists, administrators, and mental health clinicians as well as consumers and their families -- in the consumer-focused health care systems of the future. Law and ethics, which includes prisons and civil law issues and considers the special challenge of working within a field where innovation, science, and the marketplace are running well ahead of the legal and bioethics communities. Offering an in-depth study of areas never before covered, this extensively referenced volume concludes with a discussion of future issues in administrative psychiatry, as the "disruptive technologies" that forced the restructuring of banking, automobile manufacturing, consumer electronics, and other industries start to have an impact on health care.Broad in appeal as well as scope, this unique reference will find a worldwide audience -- from administrators facing the challenges of designing and administering a cost-efficient, effective care system to trainees studying for certification, and nearly everyone in between: from social workers to medical directors, staff psychiatrists, nurses, and middle managers of private and public psychiatric hospitals and behavioral health managed care organizations.