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CONTRIBUTING EDITORS Hagop S. Akiskal, M.D. Professor, Department of Psychiatry, Director, International Mood Center, University of California San Diego School of Medicine, La Jolla, California; Chief, Mood Disorders, VA San Diego Healthcare System, San Diego, California. Dilip V. Jeste, M.D. Senior Associate Dean for Healthy Aging and Senior Care, Estelle and Edgar Levi Chair in Aging, Distinguished Professor of Psychiatry and Neurosciences, Director, Sam and Rose Stein Institute for Research on Aging, University of California San Diego School of Medicine, La Jolla, California. John H. Krystal, M.D. Robert L. McNeil, Jr., Professor of Translational Research; Chair of Psychiatry, Yale University School of Medicine; Chief of Psychiatry Services, Yale-New Haven Hospital; Director, Clinical Neuroscience Division, VA National Center for PTSD; Director, NIAAA Center for the Translational Neuroscience of Alcoholism, New Haven, Connecticut. Roberto Lewis-Fernández, M.D. Professor of Psychiatry, Columbia University College of Physicians and Surgeons; Director, New York State Center of Excellence for Cultural Competence, Director, Hispanic Treatment Program, New York State Psychiatric Institute, New York, New York. Kathleen Ries Merikangas, Ph.D. Senior investigator, Chief, Genetic Epidemiology, Research Branch, Division of Intramural Research Programs at the National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland. Charles B. Nemeroff, M.D., Ph.D. Professor and Chair, Department of Psychiatry and Behavioral Science, University of Miami Leonard M. Miller School of Medicine, Miami, Florida. Karin Neufeld, M.D., M.P.H. Associate Professor, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine; Clinical Director of Psychiatry, Johns Hopkins Bayview Medical Center, Baltimore, Maryland. Caroly Sue Pataki, M.D. Clinical Professor of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California. Robert G. Robinson, M.D. Professor, Department of Psychiatry, University of Iowa, Iowa City, Iowa. Eric Cameron Strain, M.D. Professor, Director, Johns Hopkins Center for Substance Abuse Treatment and Research, Medical Director, Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, Maryland. Robert A. Sweet, M.D. Professor of Psychiatry and Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Carol A. Tamminga, M.D. Professor and Chairman, Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, Texas. K & S ’ APLAN ADOCK S COMPREHENSIVE TEXTBOOK OF PSYCHIATRY V O L U M E I / I I T E N T H E D I T I O N EDITORS Benjamin J. Sadock, M.D. Menas S. Gregory Professor of Psychiatry, Department of Psychiatry, New York University School of Medicine; Attending Psychiatrist, Tisch Hospital; Attending Psychiatrist, Bellevue Hospital Center; New York, New York Virginia A. Sadock, M.D. Professor of Psychiatry, Department of Psychiatry, New York University School of Medicine; Attending Psychiatrist, Tisch Hospital; Attending Psychiatrist, Bellevue Hospital Center, New York, New York Pedro Ruiz, M.D. Clinical Professor, Menninger Department of Psychiatry and Behavioral Sciences Baylor College of Medicine Houston, Texas Acquisitions Editor: Chris Teja Product Development Editor: Andrea Vosburgh, Franny Murphy Editorial Assistant: Brian Convery Marketing Manager: Rachel Mante Leung Production Project Manager: Bridgett Dougherty Design Coordinator: Holly McLaughlin Manufacturing Coordinator: Beth Welsh Prepress Vendor: Aptara, Inc. 10th edition Copyright © 2017 Wolters Kluwer. “Kaplan Sadock Psychiatry” with the pyramid logo is a trademark of Lippincott Williams & Wilkins. Copyright © 2009 by Lippincott Williams & Wilkins. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at [email protected], or via our website at lww.com (products and services). 9 8 7 6 5 4 3 2 1 Printed in China 978-1-4511-0047-1 1-4511-0047-7 Library of Congress Cataloging-in-Publication Data available upon request This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work. This work is no substitute for individual patient assessment based upon healthcare professionals’ examination of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data and other factors unique to the patient. The publisher does not provide medical advice or guidance and this work is merely a reference tool. Healthcare professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments. Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made and healthcare professionals should consult a variety of sources. When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects and identify any changes in dosage schedule or contraindications, particularly if the medication to be administered is new, infrequently used or has a narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work. LWW.com Dedicated to all persons who work with and care for the mentally ill About the Editors BENJAMIN J. SADOCK, M.D. Benjamin James Sadock, M.D., is the Menas S. Gregory Professor of Psychiatry in the Department of Psychiatry at the New York University (NYU) School of Medicine. He is a graduate of Union College, received his M.D. degree from New York Medical College, and completed his internship at Albany Hospital. He completed his residency at Bellevue Psychiatric Hospital and then entered military service as Captain US Air force, where he served as Acting Chief of Neuropsychiatry at Sheppard Air Force Base in Texas. He has held faculty and teaching appointments at Southwestern Medical School and Parkland Hospital in Dallas and at New York Medical College, St. Luke’s Hospital, the New York State Psychiatric Institute, and Metropolitan Hospital in New York City. Dr. Sadock joined the faculty of the NYU School of Medicine in 1980 and served in various positions: Director of Medical Student Education in Psychiatry, Co- Director of the Residency Training Program in Psychiatry, and Director of Graduate Medical Education. Currently, Dr. Sadock is Co-Director of Student Mental Health Services, Psychiatric Consultant to the Admissions Committee, and Co-Director of Continuing Education in Psychiatry at the NYU School of Medicine. He is on the staff of Bellevue Hospital and Tisch Hospital. Dr. Sadock is a Diplomate of the American Board of Psychiatry and Neurology and served as an Associate Examiner for the Board for more than a decade. He is a Distinguished Life Fellow of the American Psychiatric Association, a Fellow of the American College of Physicians, a Fellow of the New York Academy of Medicine, and a member of Alpha Omega Alpha Honor Society. He is active in numerous psychiatric organizations and was president and founder of the NYU-Bellevue Psychiatric Society. Dr. Sadock was a member of the National Committee in Continuing Education in Psychiatry of the American Psychiatric Association, served on the Ad Hoc Committee on Sex Therapy Clinics of the American Medical Association, was a Delegate to the Conference on Recertification of the American Board of Medical Specialists, and was a representative of the American Psychiatric Association Task Force on the National Board of Medical Examiners and the American Board of Psychiatry and Neurology. In 1985, he received the Academic Achievement Award from New York Medical College and was appointed Faculty Scholar at NYU School of Medicine in 2000. He is the author or editor of more than 100 publications (including 50 books), a reviewer for psychiatric journals, and lectures on a broad range of topics in general psychiatry. Dr. Sadock maintains a private practice for diagnostic consultations and psychiatric treatment. He has been married to Virginia Alcott Sadock, M.D., Professor of Psychiatry at NYU School of Medicine, since completing his residency. Dr. Sadock enjoys opera, golf, traveling, and is an enthusiastic fly fisherman. VIRGINIA A. SADOCK, M.D. Virginia Alcott Sadock, M.D., joined the faculty of the New York University (NYU) School of Medicine in 1980, where she is currently Professor of Psychiatry and Attending Psychiatrist at the Tisch Hospital and Bellevue Hospital. She is Director of the Program in Human Sexuality at the NYU Langone Medical Center, one of the largest treatment and training programs of its kind in the United States. She is the author of more than 50 articles and chapters on sexual behavior and was the developmental editor of The Sexual Experience, one of the first major textbooks on human sexuality, published by Williams & Wilkins. She serves as a referee and book reviewer for several medical journals, including the American Journal of Psychiatry and the Journal of the American Medical Association. She has long been interested in the role of women in medicine and psychiatry and was a founder of the Committee on Women in Psychiatry of the New York County District Branch of the American Psychiatric Association. She is active in academic matters, served as an Assistant and Associate Examiner for the American Board of Psychiatry and Neurology for more than 20 years, and was also a member of the Test Committee in Psychiatry for both the American Board of Psychiatry and the Psychiatric Knowledge and Self- Assessment Program (PKSAP) of the American Psychiatric Association. She has chaired the Committee on Public Relations of the New York County District Branch of the American Psychiatric Association, has been a regional council member of the American Association of Sex Education Counselors and Therapists, a founding member of The Society of Sex Therapy and Research, and is President of the NYU Alumni Association of Sex Therapists. She has participated in the National Medical Television Network series Women in Medicine and the Emmy Award–winning PBS television documentary Women and Depression and currently hosts the radio program Sexual Health and Well-being (Sirius-XM) at NYU Langone Medical Center. She lectures extensively both in this country and abroad on sexual dysfunction, relational problems, and depression and anxiety disorders. She is a Distinguished Fellow of the American Psychiatric Association, a Fellow of the New York Academy of Medicine, and a Diplomate of the American Board of Psychiatry and Neurology. Dr. Sadock is a graduate of Bennington College, received her M.D. degree from New York Medical College, and trained in psychiatry at Metropolitan Hospital. She lives in Manhattan with her husband, Dr. Benjamin Sadock, where she maintains an active practice that includes individual psychotherapy, couples and marital therapy, sex therapy, psychiatric consultation, and pharmacotherapy. She and her husband have two children, James and Victoria, both emergency physicians, and three grandchildren, Oliver, Emily and Celia. In her leisure time, Dr. Sadock enjoys theater, film, golf, reading fiction, and travel. PEDRO RUIZ, M.D. Pedro Ruiz, M.D., is currently Clinical Professor at the Menninger Department of Psychiatry & Behavioral Sciences of Baylor College of Medicine in Houston, Texas and also Professor Emeritus in the Department of Psychiatry & Behavioral Sciences of Albert Einstein College of Medicine of Yeshiva University in New York City, New York. He graduated from medical school at the University of Paris in France. He conducted his residency training in psychiatry at the University of Miami Leonard M. Miller School of Medicine in Florida. He has held faculty appointments at a professorial level at Albert Einstein College of Medicine in New York City, Baylor College of Medicine in Houston, the University of Texas Medical School at Houston, and the University of Miami Leonard M. Miller School of Medicine in Miami. He has served in various academic positions during his career; among them: Director of the Lincoln Hospital Community Mental Health Center, Director of the Bronx Psychiatric Center, Assistant Dean and Vice Chair of the Department of Psychiatry at the Albert Einstein College of Medicine in New York City; Chief of Psychiatric Service at Ben Taub General Hospital and Vice Chair of the Department of Psychiatry at Baylor College of Medicine in Houston, Texas; Medical Director of the University of Texas Mental Sciences Institute, Vice Chair and Interim Chair of the Department of Psychiatry at the University of Texas Medical School at Houston, Texas; and Executive Vice Chair of the Department of Psychiatry and Behavioral Sciences of the University of Miami Leonard M. Miller School of Medicine in Miami, Florida. Dr. Ruiz is also a Distinguished Life Fellow of the American Psychiatric Association, a Fellow of the American College of Psychiatrists, the American Association for Social Psychiatry, the Benjamin Rush Society and the American Group Psychotherapy Association, and an Honorary Fellow of the World Psychiatric Association. He is also a member of the American Academy of Addiction Psychiatry, the Group for the Advancement of Psychiatry, the American Association of Community Psychiatrists and the American Association of Psychiatric Administrators. Dr. Ruiz has also been President of the American College of Psychiatrists (2000–2001), the American Association for Social Psychiatry (2000–2002), the American Board of Psychiatry and Neurology (2002–2003), the American Psychiatric Association (2006–2007), the World Psychiatric Association (2011–2014), and the World Association on Dual Disorders (2015–2018). Dr. Ruiz has also served in more than 45 Editorial Boards, among them: The American Journal of Psychiatry, Psychiatric Services, The