Handbook of Outpatient Treatment of Adults: Nonpsychotic Mental Disorders PDF
Preview Handbook of Outpatient Treatment of Adults: Nonpsychotic Mental Disorders
Handbook of Outpatient Treatment of Adults Nonpsychotic Mental Disorders Handbook of Outpatient Treatment of Adults Nonpsychotic Mental Disorders Edited by Michael E. Thase, M.D. Western Psychiatric Institute and Clinic Pittsburgh, Pennsylvania Barry A. Edelstein, Ph.D. West Virginia University Morgantown, West Virginia and Michel Hersen, Ph.D. Western Psychiatric Institute and Clinic Pittsburgh, Pennsylvania Springer Science+Business Media, LLC Llbrary of Congre• • Cotaloglng-ln-Publ1catlon DaU Handbook of Dutpat1ent treatllent of adults: nonpsychetle menta1 d1sarders I edlted by Mtchael E. Thase. Barry A. Edelsteln. and M1chel Harsen. p. CII. Includas blbllographlcal rafaranC8$. ISBN 978-1-4899-0896-4 ISBN 978-1-4899-0894-0 (eBook) DOI 10.1007/978-1-4899-0894-0 1. Psychlatrlc hosp1tals--Outpat1ent serv1ces. 2. Psychotherapy. I- Tha.e. Mlchael E. II. Edelsteln. Barry A. • 1945- III. Har.an. Mlche1. [DNLM, 1. Mental Dlsorders--tharapy--handbooks. 2. Mental Health ServlcBs--Un1ted StatBs--handbooks. 3. Outpat1ent C11nics. Hosplta I--Unltad States--handbooks. ~ 34 H235931 RC439.4.H3S 1990 S1S.89· 14--dc20 DNLWDLC for LI brary of Congres. 89-23242 CIP © 1990 Springer Science+Business Media New York Originally published by Plenum Press, New York in 1990 Softcover reprint of the hardcover 1 st edition 1990 AII rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher Contributors GENE G. ABEL, Behavioral Medicine Institute, Atlanta, Georgia 30327-4104; and Emory University School of Medicine, Atlanta, Georgia 30302 JACQUE;s BARBER, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania 19104 THOMAS P. BERESFORD, Michigan Alcohol Program, University of Michigan Medical Center, Ann Arbor, Michigan 48109 GARY R. BIRCHLER, University of California School of Medicine, and Psychology Ser vice, V.A. Medical Center, San Diego, California 92161 JosEPH E. BIRON, Psychology Department, University of Montana, Missoula, Montana 59812 FREDERIC C. BLOW, Michigan Alcohol Program, University of Michigan Medical Center, Ann Arbor, Michigan 48109 PHILIP H. BORNSTEIN, Psychology Department, University of Montana, Missoula, Mon tana 59812 BONNIE M. BREKKE, Psychology Department, University of Montana, Missoula, Mon tana 59812 BENJAMIN BuRSTEN, 103 Gamet Lane, Oak Ridge, Tennessee 37830. JOSEPH R. CAUTELA, Behavior Therapy Institute, Sudbury, Massachusetts 01776 JACK R. CORNELIUS, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania 15213 v VI PAUL CRITS-CHRISTOPH, Department of Psychiatry, University of Pennsylvania, Phila delphia, Pennsylvania 19104 CONTRIBUTORS EDWARD DENGROVE, 541 North Edgemere Drive, West Allenhurst, New Jersey 07711 JEFFREY R. FITZGERALD, Western Carolina Center, Morganton, North Carolina 28655 E. B. FoA, Medical College of Pennsylvania, Philadelphia, Pennsylvania 19129 CAROLYN FoRD, Psychology Department, University of Montana, Missoula, Montana 59812 CHARLES V. FORD, Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205 MINNA R. FYER, Department of Psychiatry, Cornell University Medical College, New York, New York 10021 ALAN J. GELENBERG, Department of Psychiatry, University of Arizona College of Medi cine, Health Sciences Center, Tucson, Arizona 85724 MADELINE GERSHWIN, University of California School of Medicine, San Diego, Califor nia 92161 JOSEPH R. HAAS, Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina 27412-5001 C. V. HALDIPUR, Richard H. Hutchings Psychiatric Center, Syracuse, New York 13210 ANNE K. HALL, Florida Hospital, Orlando, Florida 32803 KATHRYN S. K. HALL, Department of Psychiatry, UMDNJ-Robert Wood Johnson Medical School, Piscataway, New Jersey 08854 RICHARD C. W. HALL, Psychiatric Programs, Florida Hospital, Orlando, Florida 32803 STEVEN C. HAYES, Department of Psychology, University of Nevada, Reno, Nevada 89557-0062 DALE J. HINDMARSH, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, Pennsylvania 15213 L. K. GEORGE Hsu, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, Pennsylvania 15213 LAUREN P. JONES, University of California at Berkeley, Berkeley, California 94720 ALBERT J. KEARNEY, Maynard Public Schools, Maynard, Massachusetts 01754 MARTIN B. KELLER, Massachusetts General Hospital, Boston, Massachusetts 02114 vii CONTRIBUTORS MICHAEL KIDORF, Department of Psychology, Florida State University, Tallahassee, Florida 32306 ALAN R. LANG, Department of Psychology, Florida State University, Tallahassee, Flor ida 32306 SANDRA R. LEIBLUM, Department of Psychiatry, UMDNJ-Robert Wood Johnson Medi cal School, Piscataway, New Jersey 08854 RoBERT C. LONG, Benjamin Rush Center, Syracuse, New York 13202 LESTER LuBORSKY, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania 19104 RoBERT S. MARIN, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, Pennsylvania 15213 P. R. McCARTHY, Biobehavioral Research Institute, Chester Springs, Pennsylvania 19425. JuAN E. MEZZICH, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, Pennsylvania 15213 JEROME A. Morro, University of California. School of Medicine, San Francisco, Califor nia 94143 BENOIT H. MuLSANT, Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, Pennsylvania 15213 PAMELA E. PARKER, Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205 B. AsH OK RAJ, Department of Psychiatry and Behavioral Medicine, University of South Florida College of Medicine, Tampa, Florida 33613 DENNIS H. REID, Western Carolina Center, Morganton, North Carolina 28655 JOANNE-L. RouLEAU, Behavioral Medicine Institute, Atlanta, Georgia 30327-4104; and Emory University School of Medicine, Atlanta, Georgia 30302 FRANCES M. SESSA, Massachusetts General Hospital, Boston, Massachusetts 02114 SHAWN C. SHEA, Monadmock Family Services, Keene, New Hampshire 03431 DAVID V. SHEEHAN, Department of Psychiatry and Behavioral Medicine, University of South Florida College of Medicine, Tampa, Florida 33613 viii ANNE D. SIMONS, Department of Psychology, University of Oregon, Eugene, Oregon 97403 CONTRIBUTORS PAUL H. SoLOFF, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, Pennsylvania 15213 DAVID B. STUDE, Psychology Department, University of Montana, Missoula, Montana 59812 MICHAEL E. THASE, Department of Psychiatry, University of Pittsburgh School of Medi cine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania 15213 JoE E. THORNTON, Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, Pennsylvania 15213 BICK WANCK, Saratoga Therapy and Training, Saratoga Springs, New York 12866; and Albany Medical College, Albany, New York 12302 Preface During the past several decades, the field of mental health care has expanded greatly. This expansion has been based on greater recognition of the prevalence and treatability of mental disorders, as well as the availability of a variety of forms of effective treatment. Indeed, throughout this period, our field has witnessed the introduction and the wide spread application of specific pharmacological treatments, as well as the development, refinement, and more broadly based availability of behavioral, psychodynamic, and marital and family interventions. The community mental health center system has come into being, and increasing numbers of mental health practitioners from the fields of psychiatry, psychology, social work, nursing, and related professional disciplines have entered clinical practice. In concert with these developments, powerful sociopolitical and socioeconomic forces-including the deinstitutionalization movement of the late 1960s and early 1970s and the cost-containment responses of the 1980s, necessitated by the spiraling cost of health care-have shaped the greatest area of growth in the direction of outpatient services. This is particularly true of the initial assessment and treatment of nonpsychotic mental disorders, which now can often be managed in ambulatory-care settings. Thus, we decided that a handbook focusing on the outpatient treatment of mental disorders would be both timely and useful. When we first began outlining the contents of this book, the third edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disor ders (DSM-III) was in its fourth year of use. Because this classification system had already received acceptance as the official nomenclature for mental disorders in the United States, we decided that our handbook should follow the diagnostic format used by the system. Nevertheless, a number of the conditions covered in this diagnostic system (e.g., a majority of the personality disorder diagnoses) had not received sufficient em pirical study to warrant their own chapters in a handbook. In addition, the outpatient management of a variety of special populations could not be comprehensively covered by restricting the content of this handbook to specific diagnostic groupings. Slowly, a struc ture for this handbook emerged, centering on four major sections. The first, "Genera~ Issues," covers topics related to diagnosis and overviews of pharmacotherapy and two major models of psychotherapy: psychodynamic and behavioral therapy. The second section presents coverage of the major specific mental disorders. The publication of a ix X revised edition of the DSM-Ill midway through this project has been addressed within these specific chapters, as appropriate. The third section provides reviews of the outpa PREFACE tient management of a number of special populations, including adolescents, the elderly, the mentally retarded, Vietnam veterans, and individuals who are comorbid for both a mental disorder and a substance abuse disorder. We have also included in this section a chapter relating the role of marital dysfunction to the overall treatment of specific mental disorders. Finally, in Part IV, special topics related to outpatient clinical practice are addressed: ethical and legal issues, the management of suicidal patients, general office practice issues, and the conducting of research within an outpatient practice. As editors, we have grappled with the essential issue of what topics should and should not be covered within the limits of this handbook. We have chosen not to address the specific disorders of alcoholism and drug abuse; rather, we have focused on the impact of alcohol and substance abuse on the assessment and treatment of persons suffering from primary psychiatric disorders. Similarly, we have chosen not to emphasize the role of partial hospital programming because such programming is preferentially used for indi viduals with psychotic disorders. Each of us has carried our fair share of the editorial chores. We would like to acknowledge the contributions of the numerous experts whose chapters in their specialty areas appear in this book. Next, we wish to thank our secretaries who typed and retyped many parts of the manuscript. We also thank the editorial staff of Plenum Press for its heroic efforts to translate this long manuscript into its final form. Finally, we appreciate the efforts of our editor, Eliot Werner, whose substantial patience was thoroughly tested in seeing this project through to completion. Michael E. Thase Michel Hersen Barry Edelstein
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