Medically unexplained somatic symptoms are problematic in psychiatry, primary care settings, and other clinical areas. The burden they impose on health-care systems constitutes a significant public health problem. At the international symposium "Rethinking Somatoform Disorders," this problem was addressed by specialists working in somatoform disorders, psychiatric nosology, epidemiology, and biological and cross-cultural psychiatry. The meeting was the third of the Keio University International Symposia for Life Sciences and Medicine, in collaboration with the World Health Organization and the World Psychiatric Association.

"Adapt or perish, now as ever, is Nature's inexorable imperative. " -H. G. Wells, Mind at the End of Its Tether (1946) Doctors are trained to treat people suffering from various diseases. This is the main form of their activity and usually the reason for which they selected medicine as their profession. The notion that they should become managers and engage in activi ties such as programming, calculating cost, assessing cost-benefit ratios, and thinking about pricing in accordance with the social utility of their intervention, is both foreign and abhorrent to them. They are sometimes willing to say how much they need in order to have a well-functioning service: usually they prefer to state what specific apparatus and other things they require without specifying the price of their demand. They can be persuaded to add a price tag to what they think is necessary for their work: but that was about as far as they would go, until recently. The growing emphasis on human rights over the past few decades, the greater emphasis on quality of life and the public's heightened expectations about their health led, in many industrialized countries, to a greater demand for health services. This, com bined with improved possibilities of diagnosis and treatment (at higher cost ), led to a significant increase in financial demands which made governments and health-care systems uneasy and ready to accept any solution that would stop the spiral of seem ingly endless cost augmentation."

Paradigms Lost challenges key paradigms currently held about the prevention or reduction of stigma attached to mental illness using evidence and the experience the authors gathered during the many years of their work in this field. Each chapter examines one currently held paradigm and presents reasons why it should be replaced with a new perspective. The book argues for enlightened opportunism (using every opportunity to fight stigma), rather than more time consuming planning, and emphasizes that the best way to approach anti-stigma work is to select targets jointly with those who are most concerned. The most radical change of paradigms concerns the evaluation of outcome for anti-stigma activities. Previously, changes in stigmatizing attitudes were used as the best indicator of success. Paradigms Lost and its authors argue that it is now necessary to measure changes in behaviors (both from the perspective of those stigmatized and those who stigmatize) to obtain a more valid measure of a program's success. Other myths to be challenged: providing knowledge about mental illness will reduce stigma; community care will de-stigmatize mental illness and psychiatry; people with a mental illness are less discriminated against in developing countries.
Paradigms Lost concludes by describing key elements in successful anti stigma work including the recommended duration of anti-stigma programmes, the involvement of those with mental illness in designing programmes, and the definition of programmes in accordance with local circumstances. A summary of weaknesses of currently held paradigms and corresponding lists of best practice principles to guide future anti-stigma action and research bring this insightful volume to an apt conclusion.

There is now clear evidence of causal links between specific forms of behaviour and the improvement or deterioration of health states. Unless human behaviour can be influenced, there can be no progress in promoting health, preventing disease and alleviating suffering. This book is an important contribution to the understanding of the relationship between health and behaviour. Topics have been selected for expert review on the basis of their intrinsic importance and also their relative neglect in the published literature. They cover all stages of the life cycle and a range of social and cultural settings. Health workers and behavioural scientists, particularly those working in the fields of mental health, human development and community medicine, will find this a stimulating and informative work of direct relevance to their practice.

The diagnosis and assessment of personality disorders has lagged considerably behind that of most other mental disorders. However, the IPDE is an instrument which is compatible, through two modules, with both ICD-10 and DSM-IV criteria. In the form of a semi-structured clinical interview, it provides a means of measuring major categories of personality disorders which have been previously ignored. It is also unique in that it seeks to secure reliable and uniform diagnosis which is both internationally and cross-culturally acceptable. Written by leading international authorities, this volume forms an invaluable reference manual to the IPDE instrument and its development. Its first section includes an overview of the worldwide field trials of the interview and aspects of epidemiology which affect the current status of diagnosis and assessment research. The second section detailing the full interview schedule and scoring system for the instrument will further facilitate its use by both clinician and researcher.

Public Health Aspects of Diagnosis and Classification of Mental and Behavioral Disorders: Refining the Research Agenda for DSM-5 and ICD-11 provides a comprehensive summary of the current state of mental health classification in the United States and internationally, fostering a better understanding of primary research and clinical needs and facilitating the efforts of service planners, researchers and trainees to address current use of psychiatric diagnosis in the public health sector. The volume reflects the proceedings of a research planning conference convened by the APA and World Health Organization (WHO) that focused on public health aspects of the diagnosis and classification of mental disorders.

Highly relevant to the ongoing development of DSM-5 and ICD-11, the book includes the background papers prepared and presented by the Conference Expert Groups. The resulting collection: - Discusses the current state of mental illness prevention efforts and the role of public health in supporting them -- critical topics, given that development of effective strategies to reduce mental illness around the world depends on the accuracy with which risk and protective factors can be identified, defined, and understood.- Features international perspectives on public health implications of psychiatric diagnosis, classification, and service, providing viewpoints that are broad and more globally relevant. - Views mental health education, and awareness on a macro level, including its impact on social and economic policy, forensics and the legal system, and education. This approach facilitates the continued development of a research base in community health and promotes the establishment of programs for monitoring, treating, and preventing mental illness.- Addresses many fascinating and clinically relevant issues, such as those raised by the concept and the definition of mental disorders and how these impact psychiatric services and practice by individual providers.

This collection should prove useful to the advisory groups, task forces, and working groups for the revision of these two classifications, as well as for researchers in the area of diagnosis and classification, and more generally in public health.

Ethics in Psychiatry: (1) presents a comprehensive review of ethical issues arising in psychiatric care and research; (2) relates ethical issues to changes and challenges of society; (3) examines the application of general ethics to specific psychiatric problems and relates these to moral implications of psychiatry practice; (4) deals with recently arising ethical problems; (5) contains contributions of leading European ethicists, philosophers, lawyers, historians and psychiatrists; (6) provides a basis for the exploration of culture-bound influences on morals, manners and customs in the light of ethical principles of global validity.

With the international consensus towards community care of the mentally ill, there came a growing need for meaningful evaluation of services. Redressing the lack of guidance this book describes how to do mental health service research. It comprehensively reviews developments in research design, method and measurement at the level of both whole service systems and individual programmes within mental health services. Each of the issues is adeptly illustrated with practical descriptions of comprehensive evaluation projects. The important advances already achieved in knowledge about effective services are highlighted along with descriptions of future work that will further develop our understanding of meeting patient requirements. This volume will appeal to all who are involved in mental health service research as well as those who make use of their results.

Ethics in Psychiatry: (1) presents a comprehensive review of ethical issues arising in psychiatric care and research; (2) relates ethical issues to changes and challenges of society; (3) examines the application of general ethics to specific psychiatric problems and relates these to moral implications of psychiatry practice; (4) deals with recently arising ethical problems; (5) contains contributions of leading European ethicists, philosophers, lawyers, historians and psychiatrists; (6) provides a basis for the exploration of culture-bound influences on morals, manners and customs in the light of ethical principles of global validity.

"Adapt or perish, now as ever, is Nature's inexorable imperative. " -H. G. Wells, Mind at the End of Its Tether (1946) Doctors are trained to treat people suffering from various diseases. This is the main form of their activity and usually the reason for which they selected medicine as their profession. The notion that they should become managers and engage in activi ties such as programming, calculating cost, assessing cost-benefit ratios, and thinking about pricing in accordance with the social utility of their intervention, is both foreign and abhorrent to them. They are sometimes willing to say how much they need in order to have a well-functioning service: usually they prefer to state what specific apparatus and other things they require without specifying the price of their demand. They can be persuaded to add a price tag to what they think is necessary for their work: but that was about as far as they would go, until recently. The growing emphasis on human rights over the past few decades, the greater emphasis on quality of life and the public's heightened expectations about their health led, in many industrialized countries, to a greater demand for health services. This, com bined with improved possibilities of diagnosis and treatment (at higher cost!), led to a significant increase in financial demands which made governments and health-care systems uneasy and ready to accept any solution that would stop the spiral of seem ingly endless cost augmentation.

The diagnosis and assessment of personality disorders has lagged considerably behind that of most other mental disorders. However, the IPDE is an instrument which is compatible, through two modules, with both ICD-10 and DSM-IV criteria. In the form of a semi-structured clinical interview, it provides a means of measuring major categories of personality disorders which have been previously ignored. It is also unique in that it seeks to secure reliable and uniform diagnosis which is both internationally and cross-culturally acceptable. Written by leading international authorities, this volume forms an invaluable reference manual to the IPDE instrument and its development. Its first section includes an overview of the worldwide field trials of the interview and aspects of epidemiology which affect the current status of diagnosis and assessment research. The second section detailing the full interview schedule and scoring system for the instrument will further facilitate its use by both clinician and researcher.

There is clear evidence of causal links between specific forms of behaviour and the improvement or deterioration of health states. Unless human behaviour can be influenced, there can be no progress in promoting health, preventing disease and alleviating suffering. This book is an important contribution to the understanding of the relationship between health and behaviour. Topics have been selected for expert review on the basis of their intrinsic importance and also their relative neglect in the published literature. They cover all stages of the life cycle and a range of social and cultural settings. Health workers and behavioural scientists, particularly those working in the fields of mental health, human development and community medicine, will find this a stimulating and informative work of direct relevance to their practice.

Ethics, Culture, and Psychiatry: International Perspectives is a textbook that explores the best ways to promote the use of the Declaration of Madrid, which outlines ethical standards for psychiatric practice throughout the world. The book is written with two questions in mind, both easy to pose and difficult to answer: - Is it possible to formulate a set of principles that will be valid for all psychiatrists, regardless of the cultures to which they belong or in which they live and practice, or are there as many sets of ethical principles as there are cultures?- If there is such a set of principles, what should we do to ensure that psychiatry as a discipline makes a significant contribution to societal good without helping the evil?

To facilitate the exploration of this territory, 15 experts from a variety of cultures examine the most pressing ethical issues prevalent within the current practice of psychiatry. Many of the dilemmas probed in this book are routinely encountered by clinicians who work in increasingly multicultural societies. The text covers issues that are broadly relevant to clinical practice and research, including: - An overview of ethics and societies around the world- Discussions of ethical practices and dilemmas specific to various cultural regions- Transcultural debate on overarching issues, such as incompetent patients, informed consent, and mental health law reform- The complete copy of The Declaration of Madrid printed in the appendix

Readers will find that this is a textbook that stimulates and supports, rather than closes, the debate on ethical aspects of professional psychiatric behavior. Ethics, Culture, and Psychiatry: International Perspectives is much more than just a book on ethics -- it is a major contribution to understanding the impact of culture and history on the ethical practice of medicine around the world, and a continuous search for a consensus on how to live together and make contributions to the well-being of people with mental illness, their families, and the family of humans on our planet.

In the late 1960s, the World Health Organization initiated a series of international studies of the incidence, characteristics, course, and consequences of schizophrenia. Those studies - the largest ever in the history of psychiatry - provided important data about the disorder in groups of patients living in different countries and cultures, and first focused attention on the differences in short-term prognosis for schizophrenia between the third world and industrialized countries. In the 1990s, the International Study of Schizophrenia (ISoS) set out to relocate those subjects and to determine their clinical and social status some 15 to 25 years later.
Recovery from Schizophrenia is a comprehensive account of what ISoS found, reporting follow-up results for over 1000 subjects examined in the earlier WHO studies (and in several local studies as well). The body of this volume consists of detailed descriptions of the long-term course and outcome of schizophrenia, together with portraits of the field research sites in 14 countries. Introductory and synoptic chapters lay out the origin and design of the WHO studies culminating in ISoS, and synthesize the study's main findings. ISoS shows that, with appropriate treatment, schizophrenia has a favorable outcome for a substantial portion of those afflicted. The surprising finding of the short-term follow-up studies - that outcome was better in the developing than in the developed countries - is confirmed here for long-term course. Yet while prognosis continues to favor subjects in developing countries, the varied outcomes for those in developed nations still offers ample reason for hope.
This book is the first of its kind. The massivemultinational investigations upon which it is based are unique in psychiatry and cross-cultural epidemiology. Recovery from Schizophrenia will be a valuable resource for researchers, epidemiologists, policymakers, and mental health professionals worldwide, providing evidence that supports investment in the care of persons with schizophrenia.

In 2012, Paradigms Lost critically examined the key paradigms used in programs aiming to prevent or reduce the stigma attached to mental illness. Today, many programs addressing stigma have been successfully developed or improved using the notions and recommendations presented in that volume. Paradigms Lost, Paradigms Found builds on the lessons of the first edition and adds new approaches to reducing the stigma related to mental illness. It brings together the latest theory and experience in the field to provide effective recommendations for addressing stigma in its various forms. This second edition also presents targeted programs used by different social groups and explores future directions in stigma prevention, including evolving techniques for the digital age. Integrating experience with modern technology, Paradigms Lost, Paradigms Found provides evidence and inspiration for mental health advocates seeking to prevent or reduce stigma of mental illness and protect the rights of people with mental and substance use disorders.

It is well established that people suffering from schizophrenia have a higher prevalence of serious physical illness and a higher mortality than the general population. This book provides the first comprehensive and systematic review of current research evidence on the prevalence of physical diseases in people with schizophrenia, a disorder afflicting approximately 1% of the global population, and a group with mortality rates twice as high as the general population. The epidemiological data described in this book will provide the basis for improved awareness of these problems and better treatment for patients. This is the first in a series of books addressing an issue emerging as a priority in the mental health field: the timely and proper recognition of physical health problems in people with mental disorders. They should be read by policy makers, service managers, mental health professionals and general practitioners.

As Director of the Division of Mental Health at the World Health Organization, and President of the World Psychiatric Association, Norman Sartorius has surveyed the state of psychiatry worldwide and campaigned for greater equity and honesty in the clinical and research agenda. The essays collected here represent his latest thinking, and include some of his speeches and previously published articles. They range from trenchant critiques of mental health service delivery and prevention to more light-hearted, anecdotal pieces on language use and increasing productivity. All address core concerns for mental health programs today: the definition of needs; the role of psychiatry worldwide; and the challenges that urbanization presents for mental health.

With the emerging international consensus toward community care of the mentally ill, there comes a growing need for meaningful evaluation of services. Redressing the current lack of guidance this book describes how to do mental health service research. Contributors comprehensively review the most recent developments in research design, method and measurement at the level of both whole service systems and individual programs within mental health services. Practical descriptions of comprehensive evaluation projects illustrate each issue and many chapters examine important earlier advances in effective service knowledge as well as future work that will further develop our understanding of meeting patient requirements.

The updated edition of this classic book provides the busy clinician, psychiatric resident and medical student with the most up-to-date information on etiology, diagnosis and treatment of psychiatric disorders. The reader is provided with contemporary information and literature supported by a close survey of the field. Several new chapters dealing with new concepts in biology and treatment of mental disorders have been added to complete this expanded edition.

Medically unexplained somatic symptoms are problematic in psychiatry, primary care settings, and other clinical areas. The burden they impose on health-care systems constitutes a significant public health problem. At the international symposium "Rethinking Somatoform Disorders," this problem was addressed by specialists working in somatoform disorders, psychiatric nosology, epidemiology, and biological and cross-cultural psychiatry. The meeting was the third of the Keio University International Symposia for Life Sciences and Medicine, in collaboration with the World Health Organization and the World Psychiatric Association.

Substance abuse disorders are among the most prevalent psychiatric disorders and are frequently comorbid with other psychiatric and health conditions and accompanied by social problems; however, they remain under-recognized and under-treated. Many physicians and mental health practitioners receive little-to-no training in the identification and treatment of these disorders. Approaches to their prevention include some of the major success stories in modern public health as well as some of the deepest controversies in public life. This new title in the WPA series "Evidence and Experience in Psychiatry" informs psychiatrists and a wide range of professional groups from health and social services about these disorders and their treatment and control.

'Highly Commended' in the Psychiatry section of the 2012 BMA Book Awards

A Companion to the Classification of Mental Disorders provides essential reading as a background and supplement to both the recently produced DSM-5 and the forthcoming ICD-11. It focuses on the processes of classification and diagnosis, and the uses for these classifications. The book emphasises the dangers of regarding any current psychiatric classification as true or complete, in view of the present partial state of knowledge about the causes and mechanisms of most mental and behavioural disorders. This book is unique in containing a number of chapters that give a brief history of the cooperative efforts and projects necessary for the production of internationally agreed psychiatric classifications. The discussion begins in 1965 with the US/UK Diagnostic study, the preparations for ICD-8 with its first international glossary, and the International Pilot Study of Schizophrenia, designed and coordinated by the World Health Organization. While recognizing the importance of the innovations of the DSM series of classifications of the American Psychiatric Association, the book also takes a truly international perspective. The expert authors are well placed to do this, having been personally involved in many of the collaborative studies and developments discussed. A Companion to the Classification of Mental Disorders is an illustration of how much international collaborative work has been necessary over several decades to produce the currently agreed classifications. There is still a long way to go, but a start has been made.

Die 4. Auflage der Psychiatrie der Gegenwart ist voellig neu konzipiert; sie umfasst jetzt 6 Bande. Beibehalten hat man den editorischen Leitgedanken, der auch die Vorauflagen pragte: Nicht enzyklopadische Vollstandigkeit, sondern der aktuelle Erfahrungsstand der Psychiatrie wird - paradigmatisch - vermittelt. Das Werk bringt zu jedem Thema eine UEbersicht des wissenschaftlich gesicherten Wissens, dessen Anwendung in der Praxis sowie Brennpunkte, Entwicklungstrends, Zukunftsperspektiven des Fachs. Wesentliche Akzentsetzungen der 4. Auflage sind die internationale Vielfalt der Beitrage, die Gewichtung von "Migration, Postraumatischer Belastungsstoerung - allgemein: Spezifischen Lebenssituationen", die Integration neuer Erkenntnisse etwa in der Molekularbiologie, im Bereich bildgebender Verfahren oder in der Neuropsychologie. Neu und leserfreundlich ist das zweifarbige, mit Mariginalienspalte versehene Innenlayout.

Assessment and Staging of Care for Dementia: The IDEAL schedule and its user manual is a unique resource containing a global clinical staging schedule for dementia alongside essential, practical information on how to use it. The International Schedule for the Integrated Assessment and Staging of Care for Dementia (IDEAL) schedule assesses a patient's capacity to function in seven domains. These domains are 'activities of daily living', 'physical health', 'cognitive functioning', 'behavioural and psychological symptoms', 'social support', 'informal care', and 'formal professional care'. Each domain has a set of anchor points to assist with rating the different dimensions appropriately along with critical information on how to calculate the total sum score on the IDEAL schedule. In addition to the IDEAL schedule itself, this resource includes a glossary of key terms and guidance on recommended priorities for interventions for different symptoms and severity patterns. Global examples of how to apply the schedule based on different levels of resources and experience are also presented along with relatable case studies mapped directly to the schedule. Created by the International Dementia Alliance, this innovative tool and user manual is suitable for health care professionals with experience in the diagnosis and treatment of people with dementia around the world, as well as any of those involved in dementia care.

This book presents a thorough and critical review of current knowledge about the age of onset of mental disorders. The opening chapters offer information about the impact of the age of onset on the clinical picture, course, and outcome of physical illnesses, and about the neurobiological implications and correlates of different ages of onset. The impact and correlates of the ages of onset of all the most important mental disorders are then discussed in detail by internationally renowned scientists. The background to the book is the recognition that a better understanding of age of onset makes it possible to estimate the lifetime risk of disorders, helps to elucidate pathogenesis, and facilitates efficient, targeted clinical management. The book will be of value for clinicians, mental health professionals, mental health researchers, epidemiologists, and different stakeholders in the mental health field.