Prenatal Alcohol Exposure: A Clinician's Guide PDF
Preview Prenatal Alcohol Exposure: A Clinician's Guide
PRENATAL ALCOHOL EXPOSURE A Clinician’s Guide Mansfield Mela, MBBS, M.Sc.Psych. Mela_Final.indd 1 11/20/2020 1:41:40 PM PRENATAL ALCOHOL EXPOSURE A Clinician’s Guide PRENATAL ALCOHOL EXPOSURE A Clinician’s Guide by Mansfield Mela, MBBS, M.Sc.Psych. Director, Centre for Forensic Behavioral Science and Justice Studies Professor, Department of Psychiatry, University of Saskatchewan Diagnostic Research Lead, Canada FASD Research Network Forensic Psychiatrist, Regional Psychiatric Centre Saskatoon, Canada Note: The author has worked to ensure that all information in this book is accurate at the time of publication and consistent with general psychiatric and medical standards, and that information concerning drug dosages, schedules, and routes of administration is accurate at the time of publication and consistent with standards set by the U.S. Food and Drug Administration and the general medical community. As medical research and practice continue to advance, however, therapeutic standards may change. Moreover, specific situations may require a specific therapeutic response not included in this book. For these reasons and because human and mechanical errors sometimes occur, we recommend that readers follow the advice of physicians directly involved in their care or the care of a member of their family. Books published by American Psychiatric Association Publishing represent the findings, conclusions, and views of the individual authors and do not necessarily represent the policies and opinions of American Psychiatric Association Publishing or the American Psychiatric Association. If you wish to buy 50 or more copies of the same title, please go to www.appi.org/ specialdiscounts for more information. Copyright © 2021 American Psychiatric Association Publishing ALL RIGHTS RESERVED First Edition Manufactured in the United States of America on acid-free paper 25 24 23 22 21 5 4 3 2 1 American Psychiatric Association Publishing 800 Maine Avenue SW, Suite 900 Washington, DC 20024-2812 www.appi.org Library of Congress Cataloging-in-Publication Data Names: Mela, Mansfield, author. | American Psychiatric Association Publishing, publisher. Title: Prenatal alcohol exposure : a clinician's guide / by Mansfield Mela. Description: First edition. | Washington, DC : American Psychiatric Association Publishing, [2021] | Includes bibliographical references and index. Identifiers: LCCN 2020048844 (print) | LCCN 2020048845 (ebook) | ISBN 9781615372393 (paperback ; alk. paper) | ISBN 9781615373697 (ebook) Subjects: MESH: Fetal Alcohol Spectrum Disorders—psychology | Prenatal Exposure Delayed Effects | Mental Disorders—diagnosis | Mental Disorders—therapy Classification: LCC RG629.F45 (print) | LCC RG629.F45 (ebook) | NLM WQ 211 | DDC 618.3/26861—dc23 LC record available at https://lccn.loc.gov/2020048844 LC ebook record available at https://lccn.loc.gov/2020048845 British Library Cataloguing in Publication Data A CIP record is available from the British Library. Contents Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xix PART I History and Epidemiology 1 History of Fetal Alcohol Spectrum Disorder and Mental Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2 Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 3 Prenatal Exposure to Multiple Psychoactive Substances . . . . . . . . . . . . . . . . . . . . . . . 29 PART II Etiology 4 Understanding Etiological Mechanisms . . . . . . . . 59 5 Neurocognitive Mechanisms . . . . . . . . . . . . . . . . . . . 79 PART III Presentation 6 Clinical Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . .93 7 Mental Disorder Manifestation of Fetal Alcohol Spectrum Disorder . . . . . . . . . . . . . . . . . . . .127 8 Profile of Associated Mental Disorders . . . . . . . . .139 PART IV Assessment and Diagnosis 9 Neuroimaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .157 10 Psychological Testing . . . . . . . . . . . . . . . . . . . . . . . . .169 11 Laboratory Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . .187 12 Diagnostic Nosology . . . . . . . . . . . . . . . . . . . . . . . . . .201 PARTV Treatment 13 Pharmacological Intervention . . . . . . . . . . . . . . . . .227 14 Psychological Treatment . . . . . . . . . . . . . . . . . . . . . .245 15 Critical Success Factors . . . . . . . . . . . . . . . . . . . . . . . .271 PARTVI Special Populations 16 Special issues in Children and Adolescents (the Young) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .291 17 Special Issues in the Elderly . . . . . . . . . . . . . . . . . . .313 18 Special Issues in Forensic Mental Health . . . . . . .325 19 The Emergency Room . . . . . . . . . . . . . . . . . . . . . . . .353 PARTVII Systems of Care 20 Clinical Relevance of Fetal Alcohol Spectrum Disorder in the Mental Health System . . . . . . . . .369 21 Future of the Interface of Prenatal Alcohol Exposure and Mental Disorder . . . . . . . . . . . . . . . .403 Appendix: Abbreviations . . . . . . . . . . . . . . . . . . . . . .421 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .423 Preface This book provides clinically relevant information for mental health ex- perts, but it goes beyond that to provide sufficient content to improve cli- nicians’ level of comfort with information to which they have not hitherto been exposed. Clinicians in this context include professionals in the medi- cal, mental, educational, vocational, legal and correctional, child welfare, and others in the health and social services sectors who encounter individ- uals with a hidden disability. The scope and course content of curricula needed to equip professionals are usually informed by the requisite skills and experience for optimum clinical care. Professionals require essential training to appropriately support patients who navigate the mental health system because of the consequences of prenatal alcohol exposure (PAE). Because curricula have only recently begun to incorporate this material, a text providing basic as well as advanced information is necessary. This book is significant because its content is useful for professional training across many mental health disciplines. It covers information missing from curric- ula about the long-term effects of PAE (fetal alcohol spectrum disorder [“FASD 101”]) and includes clinical information on the mental disorders relevant to FASD. Given the burgeoning research and knowledge in this area, the text also updates, synthesizes, and consolidates current informa- tion into one source. Even seasoned mental health professionals well versed in the research data can use this information to become better educated and informed on the intersecting mental health consequences of PAE. Because a large number of individuals with neurobehavioral disorder associated with PAE/FASD also manifest overlapping features of mental disorders or have additional mental disorder diagnoses, advocating for a separate system that addresses their specific needs has lasting implications and benefits. Acknowledging the realities of life, educating and training mental health professionals to adapt their practices to recognize these needs ix
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