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Evidence-Based Practices in Mental Health Care

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As the first attempt to synthesize the movement toward widespread implementation of evidence-based mental health practices, this groundbreaking collection articulates the basic tenets of evidence-based medicine and shows how practices proven effective by clinical services research could improve the lives of many people.Intended to stimulate much-needed public discussion, these remarkable contributions cover both general issues, such as   Implementing practices in routine mental health settings, including strategies for disseminating evidence-based practices to staff members Ensuring that efforts to implement such practices are informed by the knowledge and experience of administrators, clinicians, patients, and advocates Integrating evidence-based practices with the recovery model and focusing on guidelines and algorithms for pharmacologic treatment of people with severe mental illness Identifying the policy implications of the movement, particularly in public-sector settings, and describing eight courses of action for addressing the gap between science and practice and specific practices, such as   Describing critical components of practices for which substantial evidence exists, such as supported employment, dual diagnosis services, and assertive community treatment Developing an evidence base for particular populations, such as children and adolescents and geriatric patients; and for clinical subgroups, such as patients with severe mental illness and posttraumatic stress disorder-and implementing a range of practices for each population Debate in public forums is critical to explaining the benefits of evidence-based care and allaying the fears of patients, practitioners, administrators, policy makers, and vested interest groups that evidence-based care excludes them from the decision-making process. Patients need to know that their individual characteristics, preferences, and autonomy are highly valued and won't be discounted by rigid adherence to the particular treatments. Practitioners need to know about the credibility of the evidence base and about new techniques and responsibilities and to understand that their favorite practices won't necessarily be excluded during initial attempts to implement evidence-based practices. Administrators and policy makers need to know about financing, organizing, implementing, and sustaining new practices. Finally, vested interest groups need to know that the introduction of evidence-based practices doesn't mean that what they do now is ineffective.This unique and densely informative volume will be welcomed by mental health care professionals and by lawmakers, planners, administrators, and others who are charged with the responsibility of providing effective care to vulnerable populations.

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What is hypnosis? Despite widespread misconceptions, hypnosis is not a treatment in itself; instead, it is a facilitator -- a useful diagnostic tool that can help the practitioner choose an appropriate treatment modality and accelerate various primary treatment strategies.The second edition of this remarkable work (first published 25 years ago) is written to provide both beginning and seasoned practitioners with a brief, disciplined technique for mobilizing and learning from an individual's capacity to concentrate. Putting to rest both exaggerated fears about hypnosis and overblown statements of its efficacy, this compelling volume brings scientific discipline to a systematic exploration of the clinical uses and limitations of hypnosis.The challenge was to develop a clinical measurement that could transform a fascinating amalgam of anecdotes, speculations, clinical intuitions and observations, and laboratory advances into a more fruitful and systematic body of information. Thus was born the authors' Hypnotic Induction Profile (HIP), a crucial 10-minute clinical assessment procedure that relates the spectrum of hypnotizability to personality style, psychopathology, and treatment outcome.Structured to reflect the flow of a typical evaluation and treatment session and highlighted by case examples throughout, this remarkable synthesis describes how to use the HIP, reviews relevant literature, and details principles and short- and long-term treatment strategies for smoking control; eating disorders; anxiety, concentration, and insomnia; phobias; pain control; psychosomatic disorders and conversion symptoms; trichotillomania; stuttering; and acute and posttraumatic stress disorders and dissociation. Meticulously referenced and indexed, this in-depth work concludes with an appendix on the interpretation and standardization of the HIP.This unique work stands out in the literature because   It is written both as an introduction for practitioners new to hypnosis and as an in-depth guide for practitioners with wide experience in hypnosis. Unlike current clinical works, it emphasizes the importance of performing a systematic assessment of hypnotizability to identify, measure, and utilize a given patient's optimal therapeutic potential -- a process that, until now, has been relegated to clinical intuition. It describes human behavior phenomenologically as it relates to hypnosis in a probable rather than an absolute fashion. It reviews only specific portions of the literature that are particularly relevant to the important themes presented by the authors. Wherever possible, the authors apply statistical methods to test their hypotheses. The realm of scientific investigation encompassing hypnosis and psychological dysfunction is comparatively new. This exceptional volume, with its profusion of systematic data, will spark controversy and interest among scientific students of hypnosis everywhere, from psychiatrists, psychologists, and psychoanalysts to physicians, dentists, and other interested clinicians.

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Guidelines for Clinically Based Risk Management

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Patient suicide is an unavoidable occupational hazard of psychiatric practice. Indeed, it is the rare clinician who does not struggle, even agonize, over the complex task of assessing and managing the risk of suicide in patients. Patient suicides account for the greatest number of malpractice suits filed against psychiatrists and for the greatest number of settlements and verdicts covered by professional liability insurers.In this book, written by a clinician for clinicians, Dr. Simon, an established expert in psychiatry and law, offers   A solid, easy-to-understand review of how medical malpractice law applies to patient suicides. He discusses the standards of care physicians must meet, the conditions associated with malpractice liability, and how best to minimize risks of litigation.  Extensive references to peer-reviewed literature on suicide and recent malpractice cases, including those triggered by patient suicides, which give insight into the latest developments in both the scientific community and the courts.  Much-needed practical advice, including advice on working with suicide risk assessments and suicide prevention contracts, on treating suicidal patients in various settings (outpatient, inpatient, collaborative, and emergency), and on coping with issues arising in the aftermath of a patient's suicide (documentation, confidentiality, and survivor care).  Clearly defined risk management guidelines that will help clinicians avoid litigation or establish a sound legal defense if sued for malpractice.  Numerous case examples that make the theoretical discussions and clinically based risk management guidelines that follow come alive. Rich in advice that draws on the author's more than 40 years of clinical experience, this book serves as an essential aid to clinicians.

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Clinical Manual for the Treatment of Autism

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Reflecting tremendous gains over the past decade in our understanding of the causes of autism, Clinical Manual for the Treatment of Autism meets the increasing need for clear, up-to-date, and evidence-based treatment. Internationally known researchers -- who are also skilled in treating patients with autism -- share treatment approaches they have either developed or thoroughly tested for safety and efficacy.The book describes in a straightforward manner how to diagnose autism, recognizing that patients may vary greatly in intelligence, language ability, disruptive behavior, and presence of comorbid disorders. It outlines the appropriate instruments to use for particular patients, providing examples and guidelines for evaluation and testing of individuals of all ages and levels of functioning, with a focus on initial diagnostic evaluation. It also evaluates the appropriate role of various medications for specific target symptoms and individuals: SSRIs and antidepressants, focusing on the rationale for their use and clinical trials in autism; anticonvulsants and mood stabilizers used to treat disruptive behaviors and mood instability; conventional and atypical antipsychotics, emphasizing studies using random assignment to active and control treatments; cholinesterase inhibitors, focusing on cholinergic mechanisms and treatment experience in autism; and stimulants and nonstimulants for the treatment of pervasive developmental disorder accompanied by hyperactivity, distractibility, and impulsiveness. In addition to pharmacological approaches, the book presents psychosocial treatments and includes well-accepted psychoeducational models for which there is sufficient evidence to recommend their use. In these chapters, the book:   Covers the use of applied behavior analysis, the DIR/Floortime approach, and peer relationship interventions. Presents educational approaches, based on the experience of the TEACCH program in North Carolina, describing how its fundamental principles are utilized across the age spectrum. Describes complementary and alternative treatments -- such as therapies targeting gastrointestinal function or the immune system or the use of nutritional supplements -- with an eye toward helping parents make informed choices. Explores promising new avenues of treatment to address issues related to cognition and social and language deficits, focusing particularly on the potential of medications that target the glutamate and oxytocin brain systems. Clinical Manual for the Treatment of Autism is an essential resource for a broad range of professionals, including psychiatrists, pediatricians, neurologists, psychologists, educators, and behavioral, speech, and occupational therapists. It is a state-of-the-art compendium of treatments that will help advance the care that people with autism receive.

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Kate Kirk, Mario Cossa, Sue Jennings, Eric Hollander, Annie Huntington, Evdokia Anagnostou, Anne Bannister

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A Clinical Guide to Diagnosis and Treatment for Health and Mental Health Professionals

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This new edition of Dr. Larry Silver's groundbreaking clinical book incorporates recent research findings on attention-deficit/hyperactivity disorder (ADHD), covering the latest information on diagnosis, associated disorders, and treatment, as well as ADHD in adults. Providing a broad overview of the continuum of neurobiologically based conditions, Attention-Deficit/Hyperactivity Disorder thoroughly reviews disorders often found to be comorbid with ADHD, including specific learning disorders, anxiety disorders, depression, anger regulation problems, obsessive-compulsive disorder, and tic disorders. Dr. Silver emphasizes that ADHD is a life disability that affects not only school performance but also family life, peer interactions, and successful participation in sports and other activities. For about half of the individuals with this disorder, it is also a lifetime disability -- thus, interventions must be considered for each phase of life. Addressing day-to-day management issues faced by physicians and mental health professionals who see patients with ADHD, this guidebook discusses such practical concerns as how to make a differential diagnosis, work with children and families in a multimodal treatment setting, manage a medication regimen, and explain ADHD to parents. Covering ways to work with the school system as well as new and controversial therapies, this up-to-the-minute book is essential reading for all who care for individuals with ADHD.

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An Approach to Moral Issues in Mental Health Treatment

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Here is the first practical guide for dealing with the moral issues that regularly confront clinicians in their work. Written for all mental health professionals, Doing the Right Thing: An Approach to Moral Issues in Mental Health Treatment offers a framework both for making moral decisions concerning the treatment of patients and for helping patients deal with their own moral concerns. Drawing on current thinking in several disciplines, Doing the Right Thing introduces the concept of moral functioning as a basis for therapeutic influence. Numerous case examples illustrate how to   Assess patients' ability to function morally -- Learn how six basic capacities needed for moral functioning develop, and how identifying problems in an individual's moral functioning can help guide the formulation of a treatment plan. Treat patients with problems functioning morally -- Appreciate when it is time to set aside neutrality as a therapeutic stance in favor of a more direct approach to helping patients make moral commitments, decisions and self-assessments and develop moral character. Deal with the moral aspects of clinical decision-making -- Develop a framework for making moral choices in planning the direction of treatment, confronting resistance and addressing problems in caring effectively.  Help patients address moral challenges -- Learn how to take into account your own and the patient's values in reasoning through moral dilemmas. Understand more clearly how to help patients deal with unfair pain caused by others, as well as the guilt and shame caused by their own moral failures. Employ the therapeutic potential of moral growth, transformation, and integration -- Discover the role of a clinician in helping demoralized patients reformulate their ideals for better outcomes. Recognize where a moral paradigm is useful in improving the delivery of mental health care. Concise, clear, and clinically relevant, Doing the Right Thing is a valuable, thought-provoking guide for both new and seasoned mental health practitioners who live and work in a morally complex environment. It is also an excellent supplementary text for courses dealing with the practice of psychotherapy and the ethical aspects of mental health care.

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Anxiety disorders are among the most prevalent, persistent, disabling, and costly psychiatric disorders, yet they are often underdiagnosed and undertreated. Fortunately, there have been major advances in understanding and treating these conditions in recent years; this is one of the most exciting areas in modern medicine.This clinical manual has earned its place in the literature as one of just a few volumes that covers all of the major anxiety disorders and presents integrated contributions from both psychopharmacologists and psychotherapists -- all in one compact work written for busy clinicians.Though concepts of anxiety have long enjoyed a central position in philosophical and psychoanalytic theories, empirical research on anxiety disorders has a relatively short history. Here, 16 experts discuss advances in diagnosis, assessment (including relevant rating scales), pharmacotherapy, and psychotherapy.This volume begins by reviewing recent important diagnostic, epidemiological, neurobiological, and treatment findings -- all of which have significant implications for clinicians. Subsequent chapters cover   Panic disorder and agoraphobia -- Laboratory studies of fear have significantly advanced our understanding of the neurocircuitry and neurochemistry of panic. Furthermore, panic disorder is now readily treated with both medications and psychotherapy.  Specific phobia -- Viewed for many years as mild and even trivial, this common disorder is now recognized for its very real associated distress and impairment. Exposure therapy is the treatment mainstay, though pharmacotherapy should be considered particularly when there is comorbidity. Social phobia (or social anxiety disorder) -- In the past few years, the first FDA-approved medications for this disorder have been made available. Cognitive-behavioral therapy is also effective for the treatment of this underdiagnosed and undertreated condition. Obsessive-compulsive disorder (OCD) -- OCD was the first disorder where it was shown that both specific medications and cognitive-behavioral techniques resulted in normalization of activity in particular brain structures. It is now possible to provide patients with integrated treatment approaches. Posttraumatic stress disorder (PTSD) -- Once viewed as a normal reaction to trauma, PTSD is increasingly understood as a pathological response, characterized by specific psychobiological dysfunctions. Again, there have been exciting advances in the treatment of this disorder, with the release of the first FDA-approved agents for PTSD. Generalized anxiety disorder (GAD) -- For a number of years GAD was thought of as a residual disorder occasionally seen in combination with more primary conditions. Nowadays, we know that GAD is an independent condition that is prevalent, persistent, and disabling. Busy residents and psychiatrists in active clinical practice, psychologists, primary care practitioners, and other mental health professionals will find this clinical manual -- with its integrated approach of both pharmacotherapy and psychotherapy -- a valuable tool in their everyday practices.

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During the 20th century, catatonia all but dropped off the agenda of mainstream psychiatric research. However, several dedicated research groups, represented in this volume, continued to report original data highlighting catatonia as a relevant and ideal subject for clinical study. This book, which exemplifies the unparalleled breadth of the knowledge gained, will benefit clinicians managing catatonic phenomena as well as researchers interested in pursuing further investigations. This book covers in great detail the psychopathology and neurobiology of catatonia, focusing on the history, epidemiology, etiology, diagnosis and treatment of the disorder. This comprehensive volume   Offers a wide representation of the historical and worldwide literature on the many variants of catatonia in a single, well-organized text.  Includes work presented by the original investigators, many of whom work outside the United States and have had their previous studies published only in non-English journals.  Covers alternative opinions and perspectives on catatonia, contributing novel and illuminating perspectives on the syndrome.  Addresses areas of controversy -- including disagreements over treatment and the nosologic status of catatonia -- head-on, in a balanced, evidence-based presentation.  Balances practical clinical material with the underlying neurobiology, presenting clinical aspects in the context of history, epidemiology, cross-cultural perspectives, and neurobiological findings and highlighting the richness and intellectual attraction of the study of the disorder. Catatonia is unique in offering a diverse, international group of contributors and such a comprehensive, up-to-date review of the clinical and scientific literature, spanning the breadth of contemporary understanding about the nature, meaning, and importance of the syndrome.

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Mary Baginsky, Brigid Daniel, Enid Hendry, Ken McCulloch, Simon Hackett, Ann Raymond, Lyn Tett, Graham Music, Susan McGinnis, Emma Westcott, Felicity Fletcher-Campbell, William Baginsky, John Guest, David Miller, Abigail Taylor, Yvonne Coppard, Louise Laskey, Andrew Francis, Stanley N. Caroff, Gregory L. Fricchione, Stephan C. Mann, Mary Baginsky

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Traumatic Dissociation: Neurobiology and Treatment offers an advanced introduction to this symptom, process, and pattern of personality organization seen in several trauma-related disorders, including acute stress disorder, posttraumatic stress disorder (PTSD), and the dissociative disorders. Our understanding of traumatic dissociation has recently been advanced by neuroimaging technology, empirically-based investigation, and an acknowledgment of its importance in psychopathology. The authors of this volume tie these findings together, tracking the condition from its earliest historical conceptualization to its most recent neurobiological understanding to provide even greater insight into traumatic dissociation and its treatment.Bringing together for the first time theoretical, cognitive, and neurobiological perspectives on traumatic dissociation, this volume is designed to provide both empirical and therapeutic insights by drawing on the work of many of the main contributors to the field. Opening chapters examine historical, conceptual, and theoretical issues and how other fields, such as cognitive psychology, have been applied to the study of traumatic dissociation. The following section focuses specifically on how neurobiological investigations have deepened our understanding of dissociation and concluding chapters explore issues pertinent to the assessment and treatment of traumatic dissociation. The interacting effects of traumatic experience, developmental history, neurobiological function, and specific vulnerabilities to dissociative processes that underlie the occurrence of traumatic dissociation are among some of the key issues covered. The book's significant contributions include   A review of cognitive experimental findings on attention and memory functioning in dissociative identity disorder An appreciation of how the literature on hypnosis provides a greater understanding of perceptual processing and traumatic stress Ascertaining symptoms of dissociation in a military setting and in other situations of extreme stress An outline of key issues for planning assessment of traumatic dissociation, including a critique of its primary empirically supported standardized measures An examination of the association between child abuse or neglect and the development of eating disorders, suggesting ways to therapeutically deal with negative body experience to reduce events that trigger dissociation A description of neuroendocrine alterations associated with stress, pointing toward a better understanding of the developmental effects of deprivation and trauma on PTSD and dissociation A review of the relation of attachment and dissociation A discussion of new research findings in the neuroimaging of dissociation and a link between cerebellar functioning and specific peritraumatic experiences Useful as a clinical reference or as ancillary textbook, Traumatic Dissociation reorganizes phenomenological observations that have been overlooked, misunderstood, or neglected in traditional training. The research and clinical experience described here will provide the basis for further clinical and theoretical formulations of traumatic dissociation and will advance empirical examination and treatment of the phenomenon.

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Eric Vermetten, David Spiegel, Martin J. Dorahy

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Research Advances in Genetics and Genomics

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Research Advances in Genetics and Genomics: Implications for Psychiatry introduces mental health professionals to exciting breakthroughs in endophenotypes, animal models, microarrays, and genetic mapping, as well as general strategies for identifying the genetic mechanisms of mental illnesses.Uniquely valuable both as summary and signpost, this concise volume provides a fascinating overview of recent cutting-edge developments in the application of molecular genetics, genomics, and proteomics to the study of psychiatric populations. By reading Research Advances in Genetics and Genomics, you will gain a better understanding of    Psychiatric Genetics -- Reviews and assesses the major research paradigms that have emerged in the field of psychiatric genetics over the several past decades, exploring the major conceptual and philosophical issues they pose and the value of their integration. Molecular Structure of Nucleic Acids -- An overview of the double-helix discovery and provides a context for current endeavors, the original one-page April 1953 Nature paper by Watson and Crick, which sparked a revolution in the life sciences. Psychiatry in the Genomics Era -- Posits that one of the most important consequences of genomics will be the development of individualized treatments that allow a clinician to tailor therapy on the basis of the unique genotype of each patient rather than on the mean responses of groups of unrelated patients.  The Genomics Revolution -- Details the implications of the genome for future medical practice, including the potential for developing methods and tools to better understand, treat, and prevent major mental disorders. The Endophenotype Concept in Psychiatry -- Explains the etymology and strategy behind the use of endophenotypes in neuropsychiatric research and, more generally, in research on other diseases with complex genetics, such as schizophrenia. The Genes and Brains of Mice and Men -- Shows why a detailed assessment of brain function in mice is so important for advancing psychiatric research in humans. Humans and mice share numerous features-in fact, for an estimated 99% of human genes a mouse version may be identified-of brain organization and behavioral responses to many pharmacological agents. Microarray Technology -- Asserts that microarrays present a methodology for identifying genes or pathways for new and unique potential drug targets, determining premorbid diagnosis, predicting drug responsiveness for individual patients, and, eventually, initiating gene therapy and prevention strategies. Meticulously referenced, this volume is exceptionally useful as a starting point for understanding the impact of genetics and genomics on psychiatry, serving to introduce psychiatrists, psychologists, neurologists, and geneticists to this exciting field.

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Sleep and wakefulness are fundamental behavioral and neurobiological states that characterize all higher animals, including human beings. Concise yet comprehensive, Sleep Disorders and Psychiatry, the latest volume in American Psychiatric Publishing's popular Review of Psychiatry Series, presents the cumulative experience of 12 experts who talk about what sleep is and why sleep is essential to maintaining good health, summarizing the major categories of sleep disorders and detailing how virtually every psychiatric disorder and a wide variety of medical illnesses adversely affect sleep.Sleep Disorders and Psychiatry is the ideal companion to busy psychiatric clinicians because it is   Comprehensive, covering all information of particular relevance to psychiatric clinicians.  Enhanced by numerous tables and illustrations that make it easy to understand and reference while "on the go" during everyday practice. Clearly structured and easy to understand, with chapters organized according to the major categories of sleep disorders most likely to be encountered in psychiatric clinical practice. The fascinating introduction discusses the functions of sleep and the consequences of sleep deprivation, including the complex neurobiology of circadian rhythms, sleep and wakefulness, the clinical assessment and management of sleep and circadian rhythm disorders, and the pros and cons of tools for taking an accurate history. Each of the six subsequent chapters in Sleep Disorders and Psychiatry follows the same format by detailing the definitions and clinical description, epidemiology, etiology and pathogenesis, and treatment for a major category of sleep disorder: insomnia, sleep apnea, narcolepsy and syndromes of central nervous system-mediated sleepiness, restless legs syndrome, parasomnias, and circadian rhythm sleep disorders.Further, Sleep Disorders and Psychiatry provides psychiatrists with the tools necessary to embark upon exciting collaborations with specialists from other areas of clinical medicine (psychologists, pulmonologists, neurologists and surgeons). Given the importance of behavioral and psychopharmacologic interventions in managing sleep disorders, psychiatrists can often make valuable contributions to the care of medically ill patients with these conditions.Abundantly referenced and illustrated, Sleep Disorders and Psychiatry is the ultimate practical resource for busy clinicians interested in the broad and growing field of sleep disorders.

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Daniel J. Buysse, John M. Oldham, Michelle B. Riba

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Recognition and Prevention of Major Mental and Substance Use Disorders

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Recognizing that favorable clinical outcomes are associated with earlier initiation of treatment -- and even more ideally with prevention -- this volume addresses the current status of early intervention in, and prevention of, major mental and substance use disorders. A team of distinguished participants addresses this problem at many levels -- from the DNA molecule to public policy -- in order to show how prevention efforts should be informed by a better understanding of etiology and by a knowledge of indicators of vulnerability.In considering the current standing of etiological knowledge, Recognition and Prevention of Major Mental and Substance Use Disorders addresses issues that are critical precursors to the prevention of mental disorders and offers an understanding of factors that contribute to the disorders' development. The contributors review genetic methodologies and current findings in mental disorders, with an emphasis on schizophrenia, and then show how biological and psychosocial environmental variables may affect vulnerability. Chapters devoted specifically to lessons in prevention drawn from recent research into schizophrenia discuss the implications of prodromal studies and relationships between stress, critical periods, and the development of the disorder. The book includes contributions from NIH representatives on how basic scientific understanding of mental disorders can be translated into public policy. It also features chapters that describe cutting-edge projects in prevention research for Alzheimer's disease, drug dependence, antisocial behavior, and posttraumatic stress disorder -- each providing compelling accounts of how existing knowledge can be adapted to promising prevention efforts. Among the volume's contributions:   New data on the role of substance abuse -- particularly marijuana and psychostimulants -- in increasing vulnerability to schizophrenia Review of vulnerability factors for several relevant disorders, examining stress and its concomitant psychobiological responses and the contribution of cognitive factors to vulnerability to depression Intriguing approach for translating successful treatment methods for schizophrenia into efforts to prevent the transition from the prodrome of the disorder to the full-blown illness Program for prevention of antisocial behavior that can be implemented as early as the first grade Secondary prevention efforts for posttraumatic stress disorder, with a focus on pharmacological interventions Each chapter reviews clinical implications of the research presented, contributing to a volume that will benefit clinicians and researchers who share the goal of preventing these debilitating conditions. This multidimensional, interdisciplinary work represents a major step toward cutting the social costs of these disorders -- and, more important, their untold cost in human suffering.

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American Psychopathological Association, Ming T. Tsuang, William E. Stone, Michael J. Lyons

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Seeking to integrate the large volume of clinical research on relational processes and mental health disorders with other scientific advances in psychiatry, Relational Processes and DSM-V builds on exciting advances in clinical research on troubled relationships. These advances included marked improvements in the assessment and epidemiology of troubled relationships as well the use of genetics, neuroscience, and immunology to explore the importance of close relationships in clinical practice. Advances in family-based intervention, and prevention are also highlighted to help practitioners and researchers find common ground and begin an empirically based discussion about the best way to revise the DSM. Given the overwhelming research showing that relationships play a role in regulating neurobiology and genetic expression and are critical for understanding schizophrenia, conduct disorder, and depression among other disorders, relational processes must be a part of any empirically based plan for revising psychiatric nosology in DSM-V. The chapters in this book counter the perspective that we can safely discard the biopsychosocial model that has guided psychiatry in the past. The contributors examine the relevance of close relationships in such issues as the basic psychopathology of mental disorders, factors influencing maintenance and relapse, sources of burden for family members, and guiding family-based interventions. By tying relational processes to basic research on psychopathology, they demonstrate the value of integrating basic behavioral and brain research with a sophisticated understanding of the self-organizing and self-sustaining characteristics of relationships. Coverage includes:   research linking relational processes to neuroscience, neurobiology, health outcomes, intervention research, prevention research, and genetics consideration of specific circumstances, such as promoting healthy parenting following divorce and relational processes in depressed Latino adolescents optimal approaches to the assessment of relational processes with clinical significance, such as child abuse, partner abuse, and expressed emotion. a simple introduction to the methodology of taxometrics, offering insight into whether key relational processes are distinct categories or continuously distributed variables an overview of the links between relational processes and psychiatric outcomes, providing a theoretical foundation for the discussion of links to psychopathology Together, these contributions seek to develop a shared commitment among clinicians, researchers, and psychopathologists to take seriously the issue of relational processes as they relate to diagnoses within DSM-and to encourage mental health care workers at all levels to harness the generative and healing properties of intimate relationships and make them a focus of clinical practice. It is a book that will prove useful to all who are interested in integrating greater sensitivity to relational processes in their work.

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Marianne Z. Wamboldt, Nadine J. Kaslow, Richard E. Heyman, Lynn G. Underwood, Steven R. Beach, Michael B. First, David Reiss

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Determining the amenability of personality disorders to psychotherapy -- a patient's capacity to benefit from verbal approaches to treatment -- is important in helping clinicians determine the treatability of cases. Michael Stone here shares the factors he has observed over long years of practice that can help practitioners evaluate patients, stressing the amenability of the various disorders to amelioration. By focusing on which patients are likely to respond well to therapeutic intervention and which will prove most resistive, his book will help therapists determine with what kinds of patients they will most likely succeed and with which ones failure is almost a certainty. Stone establishes the attributes that affect this amenability -- such as the capacity for self-reflection, motivation, and life circumstances -- as guidelines for evaluating patients, then describes borderline and other personality-disordered patients with varying levels of amenability, from high to low. This coverage progresses from patients belonging to the DSM "anxious cluster," along with the depressive-masochistic character and the hysteric character, to patients who demonstrate an intermediate level of amenability to psychotherapy. He introduces the interrelationship between borderline personality disorder and dissociative disorders and discusses treatability among certain patients in Clusters "A" and "C," as well as others with narcissistic, histrionic, depressive disorders. Final chapters address the most severe aberrations of personality and the limitations they impose on the efficacy of therapy. Personality-Disordered Patients is filled with practical, clinically focused information. This guideline structured book:   Covers all personality disorders-including ones not addressed in the latest DSM such as sadistic, depressive, hypomanic, and irritable-explosive Identifies both attributes necessary for treatability and factors associated with low treatability Pays particular attention to borderline disorders, which represent the most discussed conditions and are among the most challenging to psychotherapists Reviews personality traits whose presence, if intense-even if unaccompanied by a definable personality disorder-creates severe problems for psychotherapy Numerous case studies throughout the book provide examples that will help therapists determine which of their own patients are most likely to benefit from their efforts and thereby establish their own limits of effectiveness. By alerting practitioners to when therapy is likely to fail, these guidelines can help them avoid the professional disappointment of being unable to reach the most intractable patients.

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Mood and Anxiety Disorders During Pregnancy and Postpartum

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Mood and Anxiety Disorders During Pregnancy and Postpartum earns its important place in the literature by detailing our current understanding of the course, diagnosis, and treatment of psychiatric illness during pregnancy and postpartum, including breast-feeding -- a top priority today because we now know that active maternal psychiatric illness during pregnancy and postpartum can exert long-term negative effects on child development and cause significant morbidity for the mother.In just five concise richly informative chapters, the nine distinguished contributors to Mood and Anxiety Disorders During Pregnancy and Postpartum dispel prevailing beliefs and offer invaluable guidance in treating women during pregnancy and postpartum:   Course of Psychiatric Illness During Pregnancy and the Postpartum Period -- Despite the enduring belief that pregnancy is a time of emotional well-being for women, emerging data show that pregnancy is instead a time of increased vulnerability to psychiatric illness. Diagnosis and Treatment of Mood and Anxiety Disorders During Pregnancy -- Though the use of psychotropic medications during pregnancy and postpartum raises concerns, the accumulating data support the use of certain SSRIs/tricyclic antidepressants, especially when balanced against the risk to both mother and child of depression during pregnancy. Management of Bipolar Disorder During Pregnancy and the Postpartum Period: Weighing the Risks and Benefits -- Although the onset of bipolar disorder (BP) tends to occur during women's reproductive years, surprisingly little is known about the impact of the menstrual cycle, pregnancy, postpartum, breast-feeding, and menopause on the course and treatment of bipolar disorder.  Postpartum Mood Disorders -- Women experience a dramatic increase in their risk of developing severe psychiatric illness during postpartum for a full year after delivery. Often overlooked, postpartum disorders must be identified and treated as early as possible to reduce the mother's risk for recurrent and treatment-refractory illness and the child's risk for long-term development problems due to the detrimental effect of maternal depression. Use of Antidepressants and Mood Stabilizers in Breast-feeding Women -- This expanded clinical appraisal of the literature on antidepressant and mood stabilizer use in breast-feeding women shows that additional detailed pharmacokinetic investigations are urgently needed to enhance our understanding of nursing infant exposure and the role(s) of pharmacogenomics in determining infant exposure. Meticulously referenced and remarkably succinct, Mood and Anxiety Disorders During Pregnancy and Postpartum provides critical information about the course of illness during pregnancy and postpartum to help guide effective individualized treatment decisions-decisions that are ultimately based on the patient's wishes.

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Ruta M. Nonacs, Lee S. Cohen, John M. Oldham, Michelle B. Riba

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Organized for ease of use by today's busy mental health clinicians, Menopause: A Mental Health Practitioner's Guide describes the latest knowledge and clinical recommendations associated with menopause in a single, concise guide that is clearly written and comprehensive in scope.Menopause is about change -- but it is also a normal life stage traversed by most women with little or no difficulty. Not all women have symptoms as they transition to menopause, and women with symptoms experience them in different combinations and levels of intensity.The management of perimenopause and menopause is also rapidly changing. The past 5 years have seen truly dramatic changes in our scientific knowledge of and medical recommendations for perimenopause and menopause. For example, until recently, hormone replacement therapy was highly advocated as an essential aspect of care for women in perimenopause and menopause.Even the definitions used to describe the different time periods and stages associated with natural (i.e., nonsurgical) menopause have changed over time and can be confusing. Thus, Menopause: A Mental Health Practitioner's Guide uses the 1994 World Health Organization Scientific Group on Research in the Menopause terminology, augmented by more recent refinements made by the Stages of Reproductive Aging Workshop.The essential Menopause: A Mental Health Practitioner's Guide sheds light on the complexity and constant change integral to the study and treatment of menopause, bringing together the current work of 14 internationally recognized menopause experts in psychiatry, neuroscience, gynecology, and internal medicine. After an introductory chapter sets the contexts of midlife in women, subsequent chapters in Menopause: A Mental Health Practitioner's Guide cover the following topics:   The basic physiology of the menopausal transition and menopause. The effects of gonadal hormones on the central nervous system, and in particular, depression, anxiety, and irritability during the menopausal transition and midlife. New research findings and clinical advice about the effect of gonadal hormones and menopause on psychotic illness in women. An examination of the medical aspects of and the gynecologic aspects of perimenopause and menopause. A look beyond menopause to the psychopathology and psychotherapy of older women in various cultures. The timely information contained in Menopause: A Mental Health Practitioner's Guide will help mental health professionals to formulate current, best understanding and treatment for the psychological problems that some women experience as they traverse perimenopause and menopause.

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Medical and Psychiatric Comorbidity Over the Course of Life

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Compiled from presentations given at the 2004 American Psychopathological Association (APPA) annual meeting, Medical and Psychiatric Comorbidity Over the Course of Life reviews the comorbidity of mental and chronic physical syndromes in an epidemiological and life course context, offering fresh insights and identifying crucial clues -- gleaned from the overlapping areas or areas of mutual pathogenesis linking disparate realms of knowledge -- to the etiology and nosological distinctiveness of both physical and mental disorders.Once relatively ignored, the study of lifetime comorbidity has the potential to suggest etiological clues and to advance our ability to prevent secondary disorders by increasing our knowledge about the course and pathology of the primary disease. The etiologically relevant period, beginning with the earliest causal action and ending with diagnosis, helps us understand this potential and thus is vital to the study of comorbidity. Divided into five main sections (epidemiology, risk factors, mood disorders, emotions and health, and schizophrenia), Medical and Psychiatric Comorbidity Over the Course of Life discusses critical aspects of the life course characteristics of the etiologically relevant period:   It can be long, e.g., temperament, a relatively enduring emotional predisposition, may situate an individual more or less permanently at high risk, culminating in irreversibility only after decades of induction. The action of identical genes produces different disorders that may occur at different stages of life, such as the comorbidity of panic disorder and cystitis. It may involve critical stages, i.e., relatively narrow periods during development, such as fetal growth and puberty, to which the action of a given cause is limited. Critical periods of varying durations may exist throughout the course of life. It may have a cumulative quality to it, in which years or even decades of accumulation are required to reach the point of irreversibility, e.g., the years-long burden of lower class life, or of increased allostatic burden, for the causal nexus to reach sufficiency. It may involve multiple causes, representing different disciplines and different spheres of action spread throughout the life course. Medical and Psychiatric Comorbidity Over the Course of Life will prove invaluable for practitioners in general and consultation-liaison psychiatry, family practice and internal medicine, and psychosomatics, behavioral medicine, and health psychology.

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American Psychopathological Association, William W. Eaton

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Brain Stimulation in Psychiatric Treatment

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The past two decades have seen rapid progress in new and less invasive ways to stimulate the brain to study and treat psychiatric disorders. This authoritative reference provides an introduction to this emerging field of brain stimulation in psychiatry. Eight recognized experts present the latest research and results -- and future challenges -- for new techniques to electrically stimulate the central nervous system, including transcranial magnetic stimulation (TMS), magnetic seizure therapy (MST), deep brain stimulation (DBS), and vagus nerve stimulation (VNS). This is the first book to both review these new techniques and place them in the context of existing somatic therapies in psychiatry.Unlike electroconvulsive therapy (ECT, the standard choice for patients with treatment-resistant depression), these breakthrough methods enable us to affect selectively higher cognitive processes and mood systems by electrically stimulating -- directly or indirectly -- focal regions of the cortex and subcortical structures in the brain.    The effectiveness of TMS and MST (MST is a higher-dosage, convulsive form of magnetic stimulation) is being studied worldwide. Results are encouraging: TMS has been reported to reduce the frequency of auditory hallucinations when administered to brain regions that show abnormal hyperactivity during hallucinations, and both TMS and MST induce far less electricity and stimulate more focal cortical regions than ECT, thus incurring fewer cognitive side effects. Although DBS -- in which an electrode is implanted in a location relevant to the illness in question -- is more invasive than other modalities, it is able to reach deeper structures in a highly focal way, which may be important for illnesses like obsessive-compulsive disorder, whose circuitry relies heavily on subcortical structures. VNS is less invasive than DBS but more invasive than TMS or MST. Efficacy of VNS is uncertain. Improvement appears to build over time, and the hope is that months or years after implantation patients may show dramatic improvements. Claims of enhanced efficacy with time have never been tested directly, and controlled, randomized trials are needed to determine whether VNS has a role in the treatment of major depression. Its effects are limited to the neuroanatomical connectivity of the vagus nerve. Enriching our knowledge base in this exciting new field means more choices and therapeutic strategies for patients with conditions that resist conventional treatments. This fascinating work is a key reference for the promising future of brain stimulation in psychiatric treatment and is a "must read" for clinicians and residents alike.

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Handbook of Spirituality and Worldview in Clinical Practice

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This refreshing new work is a practical overview of religious and spiritual issues in psychiatric assessment and treatment. Eleven distinguished contributors assert that everyone has a worldview and that these religious and spiritual variables can be collaborative partners of science, bringing critical insight to assessment and healing to treatment. Unlike other works in this field, which focus primarily on spiritual experience, this clearly written volume focuses on the cognitive aspects of belief -- and how personal worldview affects the behavior of both patient and clinician. Informative case vignettes and discussions illustrate how assessment, formulation, and treatment principles can be incorporated within different worldviews, including practical clinical information on major faith traditions and on atheist and agnostic worldviews.The book's four main sections give concise yet comprehensive coverage of varying aspects of worldview:   Conceptual Foundation -- The Introduction explains the significance of worldview and its context in the development of psychiatry; reviews misunderstandings about spirituality and worldview and how they can be resolved in contemporary practice; and discusses Freud's significant influence on psychiatry's approach to religion and spirituality. Clinical Foundations -- Three chapters review how clinicians can integrate spiritual and religious perspectives in the basic clinical processes of assessment (gathering a religious or spiritual history); diagnosis and case formulation (including religious and spiritual factors); and treatment (including a review of ethical issues). Patients and Their Traditions -- Six chapters discuss Catholic and Protestant Christians, Hindus, Buddhists, Muslims, Jews, and secularists (atheists and agnostics), including a brief history, clinical implications of core beliefs, and variations of therapeutic encounters (both where patient and clinician share the same faith and where they do not) for each faith tradition. Worldview and Culture -- A concluding chapter reviews issues of a global culture where faiths once rarely encountered in North America are increasingly seen in clinical practice. This well-organized text sheds much-needed light on an area too often obscure to many clinicians, fostering a balanced integration of religion and spirituality in mental health training and practice. Bridging several disciplines in a novel way, this thought-provoking volume will find a diverse audience among mental health care students, educators, and professionals everywhere who seek to better integrate the religious and spiritual aspects of their patients' lives into assessment and treatment.

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Concise Guide to Evidence-Based Psychiatry

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Concise Guide to Evidence-Based Psychiatry (EBP) is a must-have resource for informed decision-making in psychiatric practice today. This single, easy-to-use reference will enable practitioners to find answers to clinical questions, critically appraise articles, and apply the results of their findings to patients. This practical handbook provides quick access to EBP theories, tools, and methods. Concise Guide to Evidence-Based Psychiatry is a one-stop reference for using the literature to improve patient outcomes. Features include:   Practical -- Filled with how-to information, Concise Guide to Evidence-Based Psychiatry outlines the latest techniques for accessing, assessing, and interpreting the literature. Easy to use -- Includes many tables of essential websites for finding reliable information on the Internet, best-practice strategies for searching the medical literature. Concise Guide to Evidence-Based Psychiatry fills an important role as the first EBP text for teaching residents, who are now required to develop such skills to meet the ACGME "practice-based learning and improvement" core competency. Special features for pedagogical use include suggestions for teaching EBP in residency programs, profuse examples from the psychiatric literature, and worksheets for the critical appraisal of clinical trials, diagnostic tests, epidemiologic studies, studies of prognosis, and more.Whether for self-study or use in residency programs, Concise Guide to Evidence-Based Psychiatry is the best resource available to help practitioners apply current research findings to their work with patients.