Most clinicians endorse the combination of pharmacotherapy and psychotherapy as more effective and beneficial than each modality alone, but combining these treatments can be a complicated and highly variable process. Competency in Combining Pharmacotherapy and Psychotherapy: Integrated and Split Treatment is designed to help psychiatrists at any stage of their career achieve competency in combining and coordinating pharmacotherapeutic and psychotherapeutic treatments for the benefit of their patients. This guide, now in its updated, second edition, addresses both integrated (single clinician) and split/collaborative (multiple clinicians) treatments, discussing for each: * The selection of medication and psychotherapy* The patient evaluation and opening* Sequencing* Evaluating, monitoring, and supervising treatment* Terminating and transitioning patient care The book also offers a chapter-new to this second edition-that focuses on primary care access for mental health services in the context of integrated and split/collaborative care. The rapid transformation of clinical care models in new health systems means that competence in integrated and split/collaborative care is absolutely vital for long-established clinicians as well as for psychiatric professionals in the early stages of their careers. Competency in Combining Pharmacotherapy and Psychotherapy offers an unrivaled introduction to the complex process of combining medication and psychosocial treatments, clearly defining the competencies of combining two modalities. Psychiatric educators should note that this resource relates to all six main competencies of the Accreditation Council for Graduate Medical Education: patient care and procedural skills, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.

As many as 35-40% of patients afflicted with Major Depressive Disorder (MDD) are treatment resistant, a situation that places a massive emotional and financial burden on society and challenges the mental health profession to develop new treatment paradigms and practices. Even the most astute clinicians can be frustrated when treatment options fail to be effective or work for only a brief time, leaving them to wonder what course to pursue next. Treatment Resistant Depression: A Roadmap for Effective Care gives clinicians and their patients what they need most desperately: a sequence of steps that reflect state-of-the-art diagnostic procedures and integrates all evidence-based treatment modalities -- in short, a roadmap to wellness and recovery.

Based primarily on the experiences of the authors, all of whom are leading researchers and/or clinicians in Treatment Resistant Depression and affiliated with the University of Michigan Comprehensive Depression Center, the book also draws upon the clinical research advances and treatment innovations of programs around the world. Although the book's step-by-step organization is clear and easy to follow, its coverage, scope, and level of sophistication are anything but simplified. This book - Is comprehensive, addressing treatment options, including psychopharmacotherapy, psychotherapy, neuromodulation (ECT, transcranial magnetic stimulation, deep brain stimulation, vagus nerve stimulation), exercise, nutrition, self-management approaches to enhance adherence, behavioral sleep programs, and others- Addresses treatment resistant depression across the lifespan, reflecting the diverse demographics of depression, which knows no age, gender, or socioeconomic status- Emphasizes the authors' commitment to early intervention and provides techniques for identifying young people who are at risk for developing depression or already expressing symptoms of the disease- Recognizes the chronicity of depression, rather than focusing on only the acute stage, and in this way allows for more effective treatment over the patient's lifetime- Introduces self-management as playing a critical role in the patient's prognosis, engagement, adherence to clinical steps that help maintain recovery, and self-esteem- Promotes the development of new, personalized, and predictive biomarkers to target treatment more effectively.

Designed to be useful across disciplines and treatment modalities, the book includes a multitude of tables, graphs, and learning aids that will benefit students, instructors, and clinicians. At the same time, the book promises to be a valuable resource for patients and their families, since Treatment Resistant Depression is both difficult to live with and little understood. No other book offers so much practical guidance, sound research and hope.

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 & ldquo;on the go& rdquo; 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.

The multidisciplinary field of developmental psychobiology has uncovered new findings in behavioral progressions that have led to exciting avenues for therapeutic intervention. Developmental Psychobiology examines typical and atypical behavioral and neural development, reflecting a broad sampling of this multidisciplinary field in its five densely informative chapters. Here, ten contributors discuss early attachment, face processing, reading disability, Tourette's syndrome, and schizophrenia as a disorder of neurodevelopment -- emphasizing three fundamental topics that are especially relevant to biological and child psychiatry: - Learning and development and the methods for studying them -- Understanding normal progressions as a dynamic behavioral and neural process will have a significant impact in determining the biological substrates of clinical disorders and how we can target effective treatments and interventions for behaviors such as the waxing and waning of symptoms in Tourette's syndrome and OCD, eye contact and gaze in autism, word reading in dyslexia, and working memory in schizophrenia.- The establishment of typical and atypical developmental progressions in systems -- Both plasticity and stability are critical in the normal development of behavioral and neural systems. For example, certain behaviors are appropriate at one age but inappropriate at other ages, whereas some clinical disorders may not diminish or change with age and may be viewed instead as developmental delays or deficiencies.- The impact of methodological advances on imaging and genetics in understanding typical and atypical behavioral and neural development -- How have developments in noninvasive tools for looking into the developing, behaving human brain -- imaging, computational modeling and genetic techniques -- helped us to inform or constrain our understanding of typical and atypical development? Until now, biological psychiatry has been based on psychopharmacological work, but now, with imaging and genetic techniques, we can further characterize the biological mechanisms underlying a disorder.

With chapters that elucidate the newest research in the field, Developmental Psychobiology provides clinicians an abundance of insight that can provide practical help to patients and a richer understanding of the underpinnings of cognitive and emotional disorders.

In this authoritative volume you'll find today's most important molecular neurobiological advances and their relevance to clinicians treating patients with mental illness. Molecular Neurobiology for the Clinician, Review of Psychiatry, Volume 22, will update you on the latest findings -- and their impact on psychiatry.

You'll learn about - Discoveries with the potential to revolutionize your clinical approach by changing the ways in which you diagnose and treat patients- The effects on psychiatry of advances in the molecular basis of neuronal network function, particularly in relation to abnormalities in cognitive and emotional regulation, and the identification of novel molecular targets for drug development- How to apply these discoveries to diagnosing and treating major psychiatric disorders, including childhood- and adolescent-onset disorders, schizophrenia, drug addiction, and severe mood and anxiety disorders

Molecular Neurobiology for the Clinician is an outstanding compilation of the best research by top names in the field. Psychiatrists, psychologists, psychiatric residents, and graduate students in neuroscience, psychiatry, and psychology will gain knowledge, understanding, and techniques for better diagnosis and treatment.

Based on powerful epidemiological data such as numbers afflicted, mortality rates from suicide, personal and familial consequences, and skyrocketing fiscal costs, major depressive disorder (MDD) has the sad and ignominious distinction of being a leader among disabling disorders worldwide.

With lifetime prevalence risks of 13% for men and 21% for women, the magnitude of this crisis cannot be understated. This hard-hitting volume focuses on recurrences -- perhaps most important among the many factors (others include extreme underdiagnosis and undertreatment, genetic vulnerability, frequent recurrences, severe stigma and poor adherence with maintenance treatment, and brain tissue degenerative changes associated with recurrences and chronic depression) that contribute to MDD's high morbidity.

Following an introduction by the editor detailing the overwhelming personal and societal burden created by MDD, the distinguished authors of this volume emphasize five critical topics: - The lifetime impact of gender on recurrent MDD in women, emphasizing the clinical features, treatment, and prevention strategies of the illness during three key periods of hormone transition (adolescence, childbearing years, and middle life) and including recommendations on where future research should focus.- Treatment strategies for chronic and recurrent depression to help prevent acute episodes from developing into long-term depression, specifically addressing the continuing question of whether pharmacotherapy and psychotherapy combinations are superior to either alone.- Prevention of recurrences in bipolar patients, updating the demonstrated benefits of several new anticonvulsant mood stabilizers and integrative treatment approaches and suggesting that treatment success depends on a multifaceted approach that combines old and new pharmacotherapy.- Potential applications of new somatic treatment strategies involving minimally invasive brain stimulation that have greatly reduced the stigma but done little to advance the diagnosis and treatment of neuropsychiatric illnesses, with exciting data suggesting the efficacy of vagal nerve stimulation (VNS) and repetitive transcranial magnetic stimulation (TMS).- A "call to arms" with updated recommendations on how to ensure demonstrable, lasting progress in preventing recurrences of depression, which -- along with other chronic diseases such as diabetes, heart disease, and schizophrenia -- progresses throughout life unless actively treated.

This highly informative volume, clearly written and exceptionally well referenced, is a "must-read" for every clinician, including specialists in depression and clinical neurosciences, primary care physicians and mental health clinicians interested in learning more about how to successfully treat what remains one of our most recalcitrant, debilitating illnesses.

Beset by contradictions, somatoform and factitious disorders have an unusually long, rich, and colorful historical and clinical tradition. Yet, some of them have received only limited empirical investigation.

This book continues that rich tradition by offering a broad and scholarly synthesis of the current knowledge -- and controversies -- about somatoform and factitious disorders. Here you'll find up-to-date, clinically focused overviews of these intriguing and often difficult-to-treat disorders.

Recognized experts present the latest findings along with insightful recommendations and illustrative case studies on - Somatization disorder -- The evolution and problems of diagnostic criteria (e.g., its focus on symptom counting), epidemiology, clinical features, etiologic considerations, differential diagnosis (e.g., contrasted with depressive and anxiety disorders), evaluation (use of questionnaires), and treatment considerations (psychotherapy, psychotropic medications).- Hypochondriasis -- History, clinical features, theoretical models (psychodynamic, cognitive-behavioral, and physiologic), research studies, and practical techniques for treatment (from pharmacotherapy to cognitive behavioral therapy to alternative treatments such as relaxation therapy).- Body dysmorphic disorder -- History and prevalence, clinical features, treatment (including surgery and nonpsychiatric medical treatment), etiology and pathophysiology (its relationship to obsessive-compulsive, depressive, and eating disorders), and diagnosis and misdiagnosis.- Conversion disorder -- Diagnostic criteria and clinical subtypes, history and definitions, models of symptom generation, functions served by conversion symptoms, associated features, epidemiology, demographic and disease course, comorbidity, differential diagnosis, and treatment (best done in collaboration with an internist, primary care physician, or neurologist).- Factitious disorders (widely known as Munchausen syndrome, its most extreme subtype) -- Empirical evidence related to epidemiology and etiology; diagnosis, clinical description, prevalence, and associated costs; limitations of current approaches; the reliability and usefulness of differential diagnoses; comorbidity, etiology, and management.

Both concise and thorough, this extensively annotated volume clarifies the issues surrounding these fascinating disorders and offers practical guidance and recommendations, highlighting the pressing need for further research to improve patient care. As such, it will prove compelling reading for practicing psychiatrists and other physicians in any clinical setting who want to better understand the baffling complexities of these distressing disorders.

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.

PTSD is a recently named psychiatric condition that unknown before the publication of DSM-III in 1980. The creation of this diagnosis was intensely controversial, and there continued to be considerable reluctance to apply the term to children. The 1985 landmark volume, Posttraumatic Stress Disorder in Children, edited by Spencer Eth and Robert Pynoos, helped establish the validity of this condition during childhood. Now Spencer Eth has edited PTSD in Children and Adolescents, a work that brings the field of childhood trauma in to the new century by offering fresh insights on five major topic areas in child and adolescent PTSD: - Techniques for comprehensive evaluation -- details recently developed diagnostic instruments and rating scales that measure the variety and severity of traumatic symptoms in children and adolescents.- Forensic aspects of traumatized children -- surveys legally pertinent issues, including abuse, reliability of traumatic memories, and credibility of child victims.- Juvenile offenders and incarcerated youth -- examines the role of trauma in the lives of juvenile offenders, noting that the victimization of delinquents must be specifically addressed in order for an integrated approach to treatment to achieve effective rehabilitation.- Biological treatment strategies -- systematically reviews the important role of medications for PTSD in clinical practice, including such topics as biological dysregulation, target symptoms, and the inclusion of drugs into the biopsychosocial treatment plan.- The relationship between exposure to trauma in childhood and the development of psychiatric disorders in adulthood -- presents current research on the long-term prognosis of traumatized children and adolescents by analyzing the association between early traumatic exposure, biological substrates, and subsequent symptomatic morbidity.

Mental health practitioners and trainees, as well as attorneys, pediatricians, and school personnel, will find this thoroughly annotated volume an invaluable roadmap in their journey toward understanding PTSD and discovering more effective treatments for traumatized children and adolescents. With its eclectic perspective and interdisciplinary format, this exceptional reference will also enhance courses in developmental psychology, social work, and education.

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.

In psychiatry, clinicians recognize the influence of their own personal characteristics on the assessment and treatment of their patients. No interactions in psychiatry are entirely free of countertransference dynamics. Most major theories point to countertransference as a jointly created phenomenon involving feelings induced by the patient combined with the conflicts and preexisting self and object representations that the clinician brings to the encounter.

Countertransference Issues in Psychiatric Treatment provides an overview of theory and technique that gives the reader a detailed account of how countertransference is used in contemporary practice. This timely reference - Illustrates the usefulness of examining countertransference issues in a wide range of psychiatric settings, including pharmacotherapy, consultation-liaison settings, and forensic facilities- Explores the specific countertransference dynamics evoked when clinicians treat suicidal borderline patients and the common countertransference problems confronted when treating antisocial and violent patients- Describes the difficulties encountered in general medical settings when physician-assisted suicide is considered as an acceptable clinical intervention- Breaks new ground in considering psychiatrist's emotional reactions to the patient as an integral part of psychiatric practice and discusses some of the current controversies about countertransference- Reviews cutting-edge psychoanalytic theory involving subjectivity, projective identification, role responsiveness and countertransference enactments

Whereas most literature on countertransference is geared toward psychoanalysis and dynamic psychotherapy, this volume illustrates how countertransference issues must be considered in every clinical setting in which a psychiatrist works. It is an excellent introduction to the topic for psychiatric residents and medical students.

In the past, disruptive behavior disorders were often attributed to a lack of willpower or general & ldquo;badness& rdquo; in children and adolescents. Research now points to unique neurodevelopmental underpinnings for these disorders. Neuroimaging, genetic studies, and other neurobiological advances have furthered our understanding of these common and frequently debilitating disorders and have led to new treatment and prevention efforts.

"Disruptive Behavior Disorders in Children and Adolescents" comprehensively reviews current research and clinical observations on this timely topic. The authors look at three subtypes of attention-deficit/hyperactivity disorder (ADHD), conduct disorder, and oppositional defiant disorder, all of which are common among youths and often share similar symptoms of impulse control problems. Specifically, it covers: Cutting-edge research on the diagnostic, epidemiological, and biological aspects of ADHD and state-of-the-art pharmacological treatments The important role that biological and environmental factors play in the etiology of conduct disorders The importance of age and development in diagnosing oppositional defiant disorder as well as practical guidelines and treatment options for clinicians working with patients with this disorder The similar biopsychosocial and developmental underpinnings of disruptive behavior disorders and the comorbidity of substance abuse or aggressive behavior with disruptive behavior disorders Research connecting ADHD and bipolar disorder and discusses the possible reasons for the association of violence and mental illness in youth The etiology of disruptive behavior disorders and effective treatment approaches, including psychopharmacological interventions

Helpful in exploring the effect of comorbidity, resilience, and environmental factors, this comprehensive guide proves valuable to clinicians and families in designing effective prevention and treatment programs.

Interpersonal Psychotherapy compiles the results of several recent research studies on this popular subject. Not only has interpersonal psychotherapy (IPT) been found to be effective in treating acute major depression, but recent studies have led to the adaptation and testing of IPT for treating other diagnostic groups, including non-mood disorders.

With rising economic pressures, interpersonal psychotherapy has gained attention as a proven time-limited treatment. This reference provides an overview of interpersonal psychotherapy (IPT) and discusses important developments in IPT research and clinical practice. It covers: - The results of recent research studies, typical phases of treatments and applications for patient populations, which have seen positive results for IPT

- The concepts and techniques of IPT and its current status of IPT adaptation

- Groundbreaking research using IPT in maintenance treatments of recurrent depression

- The adaptation of IPT to treat depresses adolescents as well as bulimia patients

- The use of IPT to treat depression associated with HIV-positive patients

- The current and likely future roles of interpersonal psychotherapy in clinical practice

Complete with charted research results, this comprehensive resource provides invaluable information on recent developments in interpersonal psychotherapy.

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.

Despite works published as recently as 2002, the continuing rapid evolution of new medications and adjunctive psychosocial interventions for bipolar disorder has made the concise "Advances in Treatment of Bipolar Disorder" essential for today's clinicians who want to stay abreast of the latest developments in treating this complex and challenging mental illness.

Meticulously referenced with numerous tables and illustrations, "Advances in Treatment of Bipolar Disorder" offers a very timely and exciting perspective on new ways to treat bipolar disorder. After an overview, six succinct chapters written by experts review recent developments& mdash;emphasizing interventions supported by controlled studies& mdash;in the following areas: "Advances in treatment of patients with acute mania": discussing newer antipsychotics, which as a class are effective as primary treatments for acute mania, and have emerging potential roles in maintenance treatment, and acute bipolar depression; and anticonvulsants, some of which are effective for as primary treatments for acute mania or maintenance, and others of which although not primary treatments for bipolar disorders may provide benefits as adjuncts for comorbid conditions. "New developments in the treatment of acute bipolar depression": describing therapeutic options beyond mood stabilizers and highlighting that adjunctive use of antidepressants requires additional adequately powered controlled studies to support this common approach. "Techniques in the maintenance treatment of patients with bipolar disorder": including both medications and adjunctive psychosocial therapies, which together can help clinicians manage medication adverse effects andmaintain the therapeutic alliance, treatment adherence, and involvement of significant others to enhance outcomes. "Innovations in the treatment of rapid-cycling bipolar disorder": although no treatment has received FDA approval for the management of this challenging presentation, results of controlled trials are beginning to provide clinically relevant insights in to the treatment of patients with rapid cycling, offering hope for more effective future therapies. "The treatment of children and adolescents with bipolar disorder": no treatment has FDA approval for the treatment of pediatric patients with bipolar disorder and controlled data are limited, yet recent research is beginning to yield important new information about the diagnosis and management of children and adolescents with this illness or its putative prodromes. "Phenomenology and management of bipolar disorder in women": introducing important new information to enhance clinicians' understanding of the importance of accounting for gender differences and reproductive health in the treatment of women with bipolar disorder.

"Advances in Treatment of Bipolar Disorder" helps clinicians to better understand the utility of both older medications and important new treatment options as it highlights the need for additional research to ensure further progress in overcoming the challenges of caring for patients with bipolar disorder.

Now four decades old, cognitive-behavior therapy (CBT) is one of the most heavily researched& mdash;and effective& mdash;forms of psychotherapy, useful in treating both psychiatric and medical disorders.

In this compact, richly detailed volume, 13 distinguished contributors show how CBT's primary focus of identifying and changing maladaptive patterns of information processing and related behaviors is fully compatible with biological theories and treatments and can be combined with pharmacotherapy to optimize treatment results in clinical practice. In five chapters that illustrate the broadening reach and scope of CBT, these experts discuss "Schizophrenia"& mdash;Shows clinicians how to incorporate the strengths of CBT into their daily practices for treating patients with schizophrenia. CBT methods (e.g., thought recording, examining the evidence, activity scheduling, graded task assignments, psychoeducation) can help relieve both positive and negative symptoms, reduce the stigma associated with the illness, improve depression and anxiety, and increase social skills. "Bipolar I disorder"& mdash;Focuses on a concerted effort to educate the patient about bipolar disorder, which helps patients and families develop an "early warning" system and be prepared with interventions to forestall relapse. CBT methods also teach patients how to reduce common psychosocial stressors and adhere to their prescribed medications. "Computer-assisted CBT"& mdash;Discusses an exciting new frontier that has already found excellent levels of patient acceptance and can reduce the amount of clinician time required for successful treatment. Using virtual reality and other technologies, computer-assisted CBTenhances therapy by providing interactive methods of learning and rehearsing CBT skills and by illustrating problem-solving methods with multimedia scenarios. "CBT for treating physical illnesses"& mdash;Details the positive benefits for CBT in many different types of medical disorders, such as coronary artery disease, diabetes, and multiple sclerosis. CBT can help change negative automatic thoughts ("What's the use& #63;"), reduce anxiety and depression, and ultimately help the patient develop adaptive beliefs, identify and mobilize inherent strengths, and maximize healthy behavioral strategies. "CBT for children and adolescents"& mdash;Reviews the robust effects for CBT in children and adolescents with anxiety disorders and depression and demonstrates how these methods can be used in clinical practice. Findings from numerous studies demonstrate that CBT is effective in individual, group, and family formats and can also be used to reduce vulnerability to depression in adolescents who are at risk.

This exceptional volume enriches our understanding of the strengths of CBT and provides new opportunities for helping patients. As such, it will be welcomed by clinicians and students alike.

In our increasingly dangerous world -- brought into urgent focus by the September 11, 2001, attacks -- the need to manage the psychiatric consequences of traumatic events and disasters has never been greater. The editors of this powerful reference summarize our current understanding of the complex psychological, behavioral, and social responses to disaster, and present a compelling case for intensifying our focus on delivery and intervention efforts.

In just five chapters, 16 distinguished contributors examine the impact of trauma from the personal to the community level. This critical book - reviews the neurobiologic and neuroanatomic responses to severe traumatic events, focusing on posttraumatic stress disorder to show how an initially adaptive response becomes maladaptive by producing long-term adverse consequences.- discusses the psychiatric epidemiology of disaster, presenting a guide for clinicians in identifying and following groups at high risk for developing psychiatric disorders and an empirical blueprint for developing community interventions.- details the impact of traumatic stressors on children, using the 9/11 terrorist attacks to illustrate many points and debunking the myth that children are more resilient than adults -- thus reinforcing their assertion that we need to improve the delivery of mental health services to traumatized children.- presents material from an international consensus conference on the psychological interventions following mass violence, reviewing the psychological impact of disasters (including risk and protective factors) and acute interventions for trauma (e.g., psychological debriefing, treatment of traumatic grief, pharmacotherapy, cognitive-behavioral therapy, and interventions for children).- concludes with the special dilemmas posed by weapons of mass destruction, including chemical, biological, nuclear, radiological, and high-yield explosives, discussing the attributes that make these weapons especially effective as instruments of terror and offering recommendations on how nations can enhance preparedness against these weapons.

This volume is a must-read for educators, students, residents, clinicians, and social workers -- in short, anyone interested in helping to heal the psychological fallout from traumatic events and disasters.

In clinical settings clinicians continue to underutilize interviews and rating scales because their benefits are underappreciated and their use is perceived as too costly and time consuming. Augmenting the broad information contained in the APA's Handbook of Psychiatric Measures, this in-depth guide examines the real-world issues involved in implementing measures in actual clinical settings. This book - Asserts that the use of structured diagnostic interviews in clinical settings is justified, suggesting that it would be most cost-effective to target research assessment toward those groups most difficult to evaluate and most likely to be misdiagnosed, especially those whose misdiagnosis leads to consumption of a greater-than-expected amount of treatment resources- Focuses on the underrecognition and underreporting of diagnostic comorbidity, discussing the daunting practical issues of using comprehensive structured interviews and suggesting instead that a self-administered questionnaire be used to screen for the most common DSM-IV Axis I disorders- Considers the use of structured interviews-administered by either lay interviewers or by computer-in the diagnostic assessment of children and adolescents, making a case that using the research model (i.e., reliable measures that can be given to large numbers of subjects) in clinical settings meets the cost-efficiency requirements of understaffed clinical providers- Discusses the utility and limitations of research instruments for crucially important clinical purposes-determining suicide risk-and presents the inherent difficulties in predicting risk and explore the underlying clinical risk factors based on their proposed stress-diathesis model- Presents the issues and challenges involved in the U.S. Department of Veteran's Affairs (VA) attempt to implement a national program requiring the routine use of the GAF scale. The authors conclude with a discussion of the reasons why the Global Assessment of Functioning (GAF) scale was chosen, software and procedures, methods to ensure system compliance, and the specific measures taken by two VA networks that helped improve its implementation

It is a groundbreaking guide that details the pros and cons of using structured interviews and rating scales in clinical settings to ensure reliable and valid assessment of diagnoses, symptoms, and outcomes.

"Psychological Trauma" reviews the theory of traumatic exposure as a major factor in psychological disorders like PTSD. It also addresses the differing outcomes of such exposure as well as exciting treatment options for patients. Some highlights from this volume of the 1998 Review of Psychiatry series include: - Complete coverage of the neurological damage from exposure to trauma.- A thoughtful discussion of the reasons some rape survivors suffer from chronic PTSD.- An established connection between PTSD and anxiety disorders and depression.- New uses of pharmacotherapy for patients suffering from PTSD.

The understanding of the connection between trauma and PTSD, is a continuing challenge for physicians. While many patients suffer from the disorder, it is still not commonly understood. "Psychological Trauma" provides psychiatrists and psychologists accessible and reliable information on the topic.

The second edition of Clinical Manual of Emergency Psychiatry is designed to help medical students, residents, and clinical faculty chart an appropriate course of treatment in a setting where an incorrect assessment can have life-or-death implications. Arranged by chief complaint rather than by psychiatric diagnosis, each chapter combines the fresh insights of an accomplished psychiatry trainee with the more seasoned viewpoint of a senior practitioner in the field, providing a richly integrated perspective on the challenges and rewards of caring for patients in the psychiatric emergency department. This newly revised edition presents current approaches to evaluation, treatment, and management of patients in crisis, including up-to-date guidelines on use of pharmacotherapy in the emergency setting; suicide risk assessment; evaluation of patients with abnormal mood, psychosis, acute anxiety, agitation, cognitive impairment, and/or substance-related emergencies; and care of children and adolescents. The editors have created an accessible text with many useful features: * A chapter devoted to effective strategies for teaching, mentoring, and supervision of trainees in the psychiatry emergency service.* Chapters focused on assessment of risk for violence in patients, determination of the need for seclusion or restraint, and navigation of the legal and ethical issues that arise in the emergency setting.* Clinical vignettes that contextualize the information provided, allowing readers to envision applicable clinical scenarios and thereby internalize important concepts more quickly* Constructive "take-home" points at the end of each chapter that summarize key information and caution against common clinical errors.* References and suggested readings to help readers pursue a deeper understanding of concepts and repair any gaps in knowledge. Emergency psychiatry is one of the most stressful and challenging areas of practice for the psychiatric clinician. The guidelines and strategies outlined in Clinical Manual of Emergency Psychiatry, Second Edition, will help psychiatric trainees and educators alike to make sense of the complex clinical situations they encounter and guide them to advance their skills as clinicians and educators.

Over the last three decades, the visibility -- and public acceptance -- of self-identified lesbian women and gay men and bisexual and transgender individuals has increased dramatically, making it more important than ever to understand the dynamics of their relationships.

This timely work, part of Volume 21 in the Review of Psychiatry series, offers compelling facts and insights in a concise yet comprehensive format, bringing together the latest research and clinical practice in this rapidly evolving field. - Chapter 1 details normal adolescent development and the extra challenges imposed by the development of a sexual identity that is different from that of most of their peers, including the lack of lesbian, gay, bisexual, and transgender role models.

- Chapter 2 presents a rare discussion about theoretical models (managing a concealable stigma, minority stress and resilience, and coping with multiple minority statuses) and empirical data on aging as a stigmatized sexual minority, including the similarities and differences of aging between the sexual minority communities and the heterosexual community and special issues in working with aging ethnic minority gay men, lesbians, and bisexual persons.

- Chapter 3 breaks new ground by detailing the expanding role of the psychiatrist or other mental health professional as forensic expert and therapist -- requiring not only an in-depth understanding of lesbian and gay mental health issues, but also the often-daunting task of encouraging and teaching judges and juries to better understand these issues as they relate to discriminatory laws in child custody/visitation, workplace harassment/other discrimination, domestic violence, and immigration/asylum.

- Chapter 4 covers both the three types of etiological theories on homosexuality presented in the scientific literature and an historical overview of clinical attitudes toward homosexuality, from early modern theories (Karl Ulrichs, Krafft-Ebing, and Freud) to the present day, reporting on some adverse side effects of sexual conversion treatment that have been either overlooked or ignored in the reparative therapy literature and raising important clinical and ethical concerns.

- Chapter 5 examines the public and professional evolution of thinking toward U.S. African race and toward sexual orientation with regard to the reevaluation of the psychiatric diagnosis and treatment of gender identity disorder. Among other topics, the author presents a fascinating discussion of differences between sexual orientation and gender (e.g., anatomical, social, hormonal, psychological, legal, or political), and distinctions between transgenderism and homosexuality, including an illuminating case example.

Thought-provoking and informative, this compact volume will be welcomed by residents, clinicians, and students alike as they continue to look for ways to better differentiate health from pathology and successfully treat these remarkably diverse individuals.

This book offers a resource to aid in implementing psychosocial screening, assessment, and consequently integrating prevention, care and treatment (i.e. pharmacological, psychosocial rehabilitation and psychotherapeutic) in medicine. It is becoming increasingly recognized that one method of combating spiraling health care costs in developed nations is to integrate psychiatric care into medicine including primary care settings. This volume reviews the main issues relative to the paradigm of a person-centered and recovery-oriented approach that should imbue all medical areas and specialties. It proposes integration methods in screening and assessment, clinimetric approach, dignity conserving care, cross-cultural and ethical aspects, treatment and training as a basic and mandatory need of a whole psychosomatic approach bridging the several specialties in medicine. As such, the book addresses a topic that all physicians, including primary care and psychiatric professionals in a wide variety of mental health settings are currently discussing, planning and preoccupied with, namely the task of integrating mental health into all the medical fields, including primary care, cardiology, psychiatry, oncology and so on.

This book provides a reference and contextual basis for depression, burnout and suicide among oncology and other medical professionals. Oncology as a medical subspecialty is at a unique apex of this crisis. While the same pressures in medicine certainly apply to oncologists, oncology is particularly stressful as a changing field with diverse patient and societal expectations for outcomes. In addition to experiencing the stress of caring for patients that could succumb to their cancer diagnoses, these professionals are regularly confronted with an onslaught of new medical information and a landscape that is changing at a breakneck pace. These are just a few factors involved in the increasing rates of burnout among oncologists as well as other medcial professionals. By addressing a gap in identifying mental health problems among health care professionals, this book sheds light on mental health problems and suicide among physicians. Importantly, this book is a call to action of the professional and administrative organizations to work on improving mental health of physicians. Anxiety and depression affect not only the individual doctor but also patient care. Given the increasing attention to these issues along with limited yet applicable data regarding how to address these issues, the text aims to bring the latest data face to face with consensus opinion and can be used to ultimately enhance oncologic and psychiatric practices. Written by experts in the field, Depression, Burnout and Suicide in Physicians: Insights from Oncology and Other Medical Professions aims to significantly increase awareness and contribute to understanding the necessity of preventive measures on individual, family, and care givers levels.