International Handbook Of Psychiatry: A Concise Guide For Medical Students, Residents, And Medical Practitioners

A Concise Guide for Medical Students, Residents, and Medical Practitioners

Laura Weiss Roberts, Joseph B Layde, Richard Balon

• Publisher: WSPC
• Year: 2013
• ISBN:
  9789814405621
• Topic: Biological Sciences
• Subtopic: Science General
• Index: Biological Sciences

This handbook will be a concise guide to important topics in psychiatry with an international focus. It constitutes a précis of the field of psychiatry with emphases on the therapeutic approach to the patient and on the proper diagnosis of major psychiatric disorders.

All psychiatric diagnoses are encoded using both the US Diagnostic and Statistical Manual (DSM) and the International Statistical Classification of Diseases and Related Health Problems (ICD). Treatment options for psychiatric disorders will include approaches used in developed nations in North America, Europe, Asia, as well as in the developing world. Furthermore an invaluable brief history of psychiatry allows readers to trace the beginnings of their chosen field and gain awareness of the ethical and legal contexts.

This handbook will provide a comprehensive introduction to psychiatry appropriate for students, trainees, and practitioners seeking an international approach.

Contents:

• Impact of Mental Illness (Laura Weiss Roberts, Richard Balon and Joseph B Layde)
• International Issues in Psychiatry (Richard Balon and Cyril Höschl)
• Psychiatric Diagnosis (Stephanie Bagby-Stone, Jessica Nittler and John Lauriello)
• Psychiatric Genetics (Bhanu Prakash Kolla and David Mrazek)
• Psychiatric Interviewing: What to Do, What Not to Do (Mara Pheister)
• Psychological and Neuropsychological Testing (Jennifer Niskala Apps and Jonathan E Romain)
• Psychiatric Disorders in Childhood and Adolescence (Michael Koelch and Joerg M Fegert)
• Schizophrenia and Other Psychotic Disorders (Peter F Buckley, Adriana Foster and Scott Van Sant)
• Mood Disorders (Sandra Rackley and J Michael Bostwick)
• Anxiety Disorders (Leanne Parasram and Dan J Stein)
• Substance Use Disorders (Nidal Moukaddam and Pedro Ruiz)
• Cognitive Disorders (Alana Iglewicz, Ipsit V Vahia and Dilip V Jeste)
• Somatoform Disorders (Christina L Wichman)
• The Dissociative Disorders (Jean M Goodwin)
• Sleep Disorders in Psychiatry (Oludamilola A Salami)
• Eating Disorders (Athena Robinson and W Stewart Agras)
• Sexual Disorders (Richard Balon)
• Adjustment Disorder (Mauro Giovanni Carta, Maria Carolina Hardoy and Matteo Balestrieri)
• Personality Disorders (Joel Paris)
• Geriatrics (Randall Espinoza)
• Emergency Psychiatry (Divy Ravindranath, Mark Newman and Michelle Riba)
• Outpatient Psychiatry (Ondria Gleason, Aaron Pierce and Bryan Touchet)
• General Hospital Psychiatry (Jen Alt McDonald and Mark T Wright)
• Psychiatric Education (Linda Gask and Michelle B Riba)
• Residency Training (Sanjai Rao and Sidney Zisook)
• Methods of Psychiatric Research (Elizabeth Burgess, Nicolas Ramoz and Philip Gorwood)
• World Suicide (Morton M Silverman)
• AIDS Psychiatry (Mary Ann Cohen)
• Pharmacogenomic Variability Associated with Psychotropic Medication Response (David Mrazek and Bhanu Prakash Kolla)
• Ethics in Psychiatry (Kristi Estabrook)
• The Culturally Competent Psychiatric Assessment (Ajoy Thachil and Dinesh Bhugra)
• Traditional Healing for Psychiatric Disorders (Roger M K Ng, Zhang-Jin Zhang and Wendy Wong)
• International Perspective on Homelessness (Belinda Bandstra, Anthony Mascola and Daryn Reicherter)
• Mental Health Consequences of War and Political Conflict (Daryn Reicherter and Rena Sugarbaker)
• Stigma (Travis Fisher)
• Legal Aspects of Psychiatry (Joseph B Layde)

Readership: Psychiatry students, trainees, and practitioners.

Chapter 1

Impact of Mental Illness

Laura Weiss Roberts, Richard Balon
and Joseph B. Layde

1. INTRODUCTION

The suffering associated with neuropsychiatric diseases is severe and yet remains poorly understood. Most of these conditions emerge relatively early in life, or have clear antecedents, and recent advances in neuroscience make the biological contributions to neuropsychiatric disease increasingly evident. The personal experience of mental illness redefines the lives of those affected by these diseases as well as all who love and care for them. People with mental illness, by definition, have deficits in the spheres of life that bring fulfillment and social good. These deficits affect personal and family relationships and employment or other forms of meaningful work. Beyond the effects on individuals, families, and communities, it is clear that the burden of disease — as measured in death, disability, lost productivity, and direct and indirect societal costs — throughout the world is devastating.

Understanding and providing care for people living with neuropsychiatric diseases involve a special set of professional attitudes and expertise. This work entails a respectful, empathic, and compassionate approach to individuals who have serious, disabling, and stigmatizing conditions. This work also requires foundational knowledge of the biomedical and social sciences, of clinical therapeutics, and of different models and systems of care. It involves attention to prevention, early identification, effective and time- sensitive interventions, and, when necessary, chronic disease management. It also involves being well informed about legal considerations that influence mental health care practices and financial resources that may be of help to ill individuals who often start with, or end up with, disproportionate economic difficulties. Ideally, and most excitingly, being prepared to work with people with mental illness involves an eye to the future — being aware of emerging discoveries at the basic science level as well as innovations at the community and national levels.

In this book we have endeavored to provide a balanced introduction that touches upon all of these topics in order to help prepare early career clinicians for their work with people with neuropsychiatric diseases. We have organized the book so that it will have value for generalists in primary care, medical specialists and subspecialists, including in psychiatry, and psychologists and mental health clinicians in diverse international settings. The book is informed by psychiatry in the United States, but seeks to encompass perspectives and approaches that are multinational and international in context. Special attention has been given to educational issues, such as how psychiatry residency training is organized in the United States, as well as special topics of importance such as suicide, HIV, homelessness, and legal issues. This book has been written at a time of heightened awareness of the impact of neuropsychiatric disease globally and rapid change in the diagnostic system and interventional methods of psychiatry. As psychiatry evolves, we have sought to help the early career clinician with this transition by incorporating the insights of the past with what we expect to occur in the near future in this robust field. In this introductory chapter, we will characterize the societal/ global impact of mental illness, and we will supplement an overview of the evolving understanding of phenomenology in the field of psychiatry to provide valuable context for understanding its significance and complexity.

2. SOCIETAL IMPACT OF MENTAL ILLNESS

Societies around the world deal with the extraordinary consequences of mental illness. The personal suffering of individuals with psychiatric diseases and the public health ramifications of their disorders place a heavy burden on all cultures in all countries. The role of psychiatrists in ameliorating mental illness is a crucial part of the overall role of physicians in decreasing the burden of disease around the globe.

2.1. Illness burden

The World Health Organization (WHO) calculates the disability-adjusted life year (DALY) burden of diseases globally. The DALY is a measure that combines the years of life lost due to premature mortality and the years lived in less-than-good health by people suffering from illnesses. In 2004, unipolar depressive disorders ranked behind only lower respiratory infections and diarrheal diseases as a leading cause of the burden of disease in the world. The WHO estimates that as improved sanitation decreases the incidence of infectious disease in the developing world, unipolar depressive disorders will be ranked as the leading cause of the burden of disease globally by 2030.⁴

Another reflection of the burden of disease is years lived with disability (YLD), a measure of the number of years of healthy life lost by those who suffer from chronic illnesses. Because so many psychiatric conditions are long-lasting, and because they do not necessarily cause the immediate death of those individuals suffering from them, the statistics collected by the WHO on YLD due to mental diseases are even more impressive than those on DALY. In 2004 among men globally, unipolar depressive disorders was ranked first among disease in years of healthy life lost due to disability, alcohol use disorders was second, and schizophrenia and bipolar disorder were also ranked in the top seven diseases. Among women globally, unipolar depressive disorders as a group were also ranked first in terms of YLD, while schizophrenia, bipolar disorder, and Alzheimer and other dementias were also listed among the top 10 diseases in 2004.⁴

No country is spared of the illness burden associated with neuropsychiatric disease. The WHO also reports that in 2004, people living in low- and middle-income countries suffered enormously from psychiatric illness, as did those living in high-income countries. Unipolar depressive disorders were noted to be the leading cause of YLD in both low- and middle-income countries and high-income countries, while alcohol use disorders, schizophrenia, and bipolar disorder were also among the top ten diseases in terms of YLD in low- and middle-income countries, and alcohol use disorders, Alzheimer and other dementias, and drug use disorders were among the top ten diseases in terms of YLD in high-income countries. What is more, neuropsychiatric disorders are the most important causes of disability in all regions, accounting for about a third of YLD in adults aged 15 and older globally.⁴

Alcohol and drug use disorders are also a significant problem worldwide. For example, in the United States, recent data indicated that 32% of adults had five or more alcoholic drinks on one day in the past year; 23 million people in the United States currently use illegal drugs.⁵ The effects of drug abuse carry over to the workplace, with significant economic fallout. Roughly 14% of workers in the United States report having used at least one illicit drug in the past year, and 3% reported having done so at work.¹

2.2. Economic burden

The economic cost of mental illness globally is a huge, although poorly recognized, problem. The economic costs of mental illness include both the direct costs associated with treating mental illness and the indirect costs associated with the disability from mental illness — including, for instance, lost employment. The direct cost of mental illness is a small percentage of its total economic cost; a recent study estimated that the direct medical cost of mental illness in Canada represents only 9.8% of the total economic burden of mental illness in that country.³

The WHO reports that although good data are not available for all countries, estimates of the cost of mental illness in the United States and the European Union range from 2.5% to 4% of the Gross National Product (GNP) in those countries. Psychosis was estimated in 1996 to be the single most expensive chronic condition treated by the National Health Service (NHS) of the United Kingdom, followed by neurosis.⁶ Although the economic costs of psychiatric disorders are tremendous in all countries, developing nations are least able to pay the huge costs of mental disease.

2.3. Unmet need

The treatment of mental disorders globally is complicated by the shortage of mental health workers, especially psychiatrists, and by their uneven distribution in the world. According to the WHO, the median number of psychiatrists per 100,000 population in low income countries is 0.05, rising to 0.54 in lower-middle income countries, 2.03 in upper-middle income countries, and 8.59 in high income countries. Almost half the people in the world live in countries with less than one psychiatrist per 200,000 residents.⁷ The availability of psychiatric hospital beds and of psychiatric medication also varies tremendously throughout the world, with lower income countries having substantially fewer such resources available than higher income countries. Even in high income countries, the uneven distribution of mental health resources often means that some mentally ill patients have very poor access to care; the unmet need for caring mental health care is truly a global one.

Psychiatrists around the world spend their professional lives dealing with the suffering of people with mental illness. The illness and cost burdens of neuropsychiatric disease are immense, and the world is poorly positioned to respond to the problem of unmet need for psychiatric services. This handbook places the diagnosis and treatment of psychiatric illness in a global perspective, recognizing the ubiquity of the problem of mental disorders and the variety of approaches to the problem used by psychiatrists around the world in their attempts to improve the lives of their patients with mental illness.

3. EVOLVING APPROACHES TO PHENOMENOLOGY IN PSYCHIATRY

The first step in recognizing and addressing neuropsychiatric disease is appreciating the nature of mental illness as distinct from other medical conditions and other sources of burden in society. This first step is not an easy one to take, however, given that mental illness has not been well understood across time or nations. Indeed, throughout history, the nature of mental illness has been the focus of interest, exploration, and debate of psychiatrists, psychologists, philosophers, anthropologists, sociologists, and many others, including people suffering from mental illness and their families. In different societies and cultures, even at the present time, mental illness has been understood in terms of magic, curse, God’s punishment for a sin, and other supranatural forces. Contemporary science views mental illness in terms of disorder of the brain.

In the past, attempts to classify mental disorders have been based in various theoretical models of mental illness and in presumable etiology of mental illness. These models included psychosocial (JCA Heinroth), psychodynamic (S. Freud and followers, with the emphasis on presumed etiology in form of a psychological conflict), behavioral (IP Pavlov, JB Watson and BF Skinner), and organic (W. Griesinger). As none of these models was satisfying, psychiatry gradually accepted the pragmatic, atheoretical, clinical approach to classification, based on the observations and work of a German psychiatrist, Emil Kraepelin. He recognized that psychoses, for example, could be observed to fit into certain common patterns, and, further, that the unfolding course of psychotic illnesses across the lives of affected individuals fit into certain common patterns. While he believed that eventually the underlying roots of all mental illnesses will be discovered, Kraepelin strongly advanced a non-etiology- based classification of mental illness. This descriptive, phenomenological, and atheoretical approach has been reluctantly embraced in the modern, global society that prefers causally based or etiologically driven explanations for disease.

The work of psychiatry is certainly not finished and our diagnostic system is far from perfect. As Kendler et al.² wrote, “… the task of developing reliable and valid psychiatric diagnosis, will.. .remain central to the clinical and research mission of psychiatry for the foreseeable future.” The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, represents a substantial advancement in characterizing the patterns of neuropsychiatric diseases and related conditions. This iteration in the evolving effort to accurately characterize and classify mental disorders differs from past work in that it seeks to incorporate insights from genetics and emerging neurosciences, to be of practical utility in widely varying settings, to enhance the recognition of different developmental pathways in neuropsychiatric disease, and to illuminate how gender and sociocultural factors may shape the experience and manifestation of illness. These efforts reaffirm what the father of psychiatric phenomenology, Karl Jaspers, suggested long ago: studying the patient’s symptoms and signs should help us understand the patient’s inner experience. Moreover, the terms we use to characterize this experience should have meaning and serve as the basis for clinically astute and compassionate treatment.

In sum, mental illnesses are the source of immense suffering and give rise to poorly recognized but nearly overwhelming health burden throughout the world. These diseases emerge through a complex interplay of biological, psychological, social, and cultural factors, and we are only beginning to understand the nature of these factors and their relationships and interactions. Contemporary science sees mental illness as brain disease or dysfunction, and yet that is an overly simplistic view of the fulsome experience and contributors to mental illness and related conditions. It is our sense that, in time, improved understanding of the biological, developmental, psychological, social, and cultural features and influences that shape mental illness will help us better categorize mental disorders and, ultimately, improve and refine their treatment. Also in time, the capacity to better categorize mental disorders as they become manifest in large populations will lead to better systemic interventions and diminished burdens and costs of disease.

On the road to developing a reliable and valid approach to diagnosis in psychiatry, it is nevertheless valuable to remember Kendler’s caution that “our. criteria, however detailed, never contain all the important features of psychiatric illness that we should care about.” In other words, the abstract conceptualization and classification of neuropsychiatric diseases should never blind us to the reality of what it is like to endure each day with these devastating conditions.

4. HANDBOOK ORGANIZATION

This handbook is organized around several core knowledge domains: approaching the field of psychiatry, the initial assessment of the patient, psychiatric disorders, treatment settings, psychiatric education and research, and special topics. It is our hope that this handbook will help the clinician to progress from the starting point of recognizing the possible or likely diagnosis to the more important insights that come with understanding of their patients’...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• Contents
• Abbreviations List
• Contributors List
• Chapter 1 Impact of Mental Illness
• Chapter 2 International Issues in Psychiatry
• Chapter 3 Psychiatric Diagnosis
• Chapter 4 Psychiatric Genetics
• Chapter 5 Psychiatric Interviewing: What to Do, What Not to Do
• Chapter 6 Psychological and Neuropsychological Testing
• Chapter 7 Psychiatric Disorders in Childhood and Adolescence
• Chapter 8 Schizophrenia and Other Psychotic Disorders
• Chapter 9 Mood Disorders
• Chapter 10 Anxiety Disorders
• Chapter 11 Substance Use Disorders
• Chapter 12 Cognitive Disorders
• Chapter 13 Somatoform Disorders
• Chapter 14 The Dissociative Disorders
• Chapter 15 Sleep Disorders in Psychiatry
• Chapter 16 Eating Disorders
• Chapter 17 Sexual Disorders
• Chapter 18 Adjustment Disorder
• Chapter 19 Personality Disorders
• Chapter 20 Geriatrics
• Chapter 21 Emergency Psychiatry
• Chapter 22 Outpatient Psychiatry
• Chapter 23 General Hospital Psychiatry
• Chapter 24 Psychiatric Education
• Chapter 25 Residency Training
• Chapter 26 Methods of Psychiatric Research
• Chapter 27 World Suicide
• Chapter 28 Aids Psychiatry
• Chapter 29 Pharmacogenomic Variability Associated with Psychotropic Medication Response
• Chapter 30 Ethics in Psychiatry
• Chapter 31 The Culturally Competent Psychiatric Assessment
• Chapter 32 Traditional Healing for Psychiatric Disorders
• Chapter 33 International Perspective on Homelessness
• Chapter 34 Mental Health Consequences of War and Political Conflict
• Chapter 35 Stigma
• Chapter 36 Legal Aspects of Psychiatry
• Index