New Oxford Textbook of Psychiatry

2161 Pages·2012·26.95 MB·English

by  Michael G. Gelder

New Oxford Textbook of
Psychiatry
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VOLUME 1
New Oxford Textbook of
Psychiatry
SECOND EDITION
Edited by
Michael G. Gelder
Emeritus Professor of Psychiatry,
Warneford Hospital, University of Oxford,
Oxford, UK
Nancy C. Andreasen
Director, Mental Health Clinical Research Centre,
University of Iowa Hospital and Clinic,
Iowa City, USA
Juan J. López-Ibor Jr.
Professor of Psychiatry,
Complutense University, Madrid, Spain
and
John R. Geddes
Professor of Epidemiological Psychiatry
University of Oxford, Warneford Hospital,
Oxford, UK
1
1
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Preface to the second edition
This new edition, like the fi rst, aims to present a comprehensive account of established knowledge into which new information
account of clinical psychiatry with reference to its scientifi c basis can be fi tted and against which recent fi ndings can be evaluated.
and to the ill person’s perspective. As in the fi rst edition, the authors As well as seeking to provide an authoritative account of essential
are drawn from many countries, including the UK, the USA, knowledge, each chapter in the new edition includes a brief list
12 countries in continental Europe, and Australasia. The favourable of sources of further information, including where appropriate,
reception of the fi rst edition has led us to invite many of the regularly updated web sites.
original authors to revise their chapters for this second edition but An essential component of good practice is the need to be aware
50 chapters are the work of new authors, many concerned with of patients’ perspectives, to respect their wishes, and to work with
subjects that appeared in the fi rst edition, while others are com- them, and often their families, as partners. The book opens with
pletely new. The forensic psychiatry section has the most new chap- an important chapter on the experience of being a patient, and
ters, followed by the section on psychology as a scientifi c basis of there are chapters on stigma, ethics, and the developing topic of
psychiatry. values-based practice.
The overall plan of the book resembles that of the fi rst edition We are grateful to the following who advised us about parts
(see preface to the 1st edition, reprinted on pages vii and viii). One of the book; Professor John Bancroft (Psychosexual Disorders),
important feature is that information about treatment appears in Professor Tom Burns (Social and Community Psychiatry), Professor
more than one place. The commonly used physical and psycho- William Fraser (Intellectual Disability), Professor Keith Hawton
logical treatments are described in Section 6. Their use in the treat- (Suicide and Deliberate Self Harm), Professor Susan Iversen
ment of any particular disorder is considered in the chapter con- (Psychology), Professor Robin Jacoby (Old Age Psychiatry),
cerned with that disorder and the account is in two parts. The fi rst Professor Paul Mullen (Forensic Psychiatry), Sir Michael Rutter
part is a review of evidence about the effects of each of the treat- (Child and Adolescent Psychiatry), and Professor Gregory Stores
ments when used for that disorder. The second part, called (Sleep Disorders).
Management, combines evidence from clinical trials with accumu-
The editors
lated clinical experience to produce practical advice about the day
to day care of people with the disorder.
Although much information can now be obtained from internet
searches, textbooks are still needed to provide the comprehensive
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Preface to the fi rst edition
Three themes can be discerned in contemporary psychiatry: the beginning to uncover the neurobiological mechanisms involved in
growing unity of the subject, the pace of scientifi c advance, and the psychiatric disorder. Striking progress has been achieved in the
growth of practice in the community. We have sought to refl ect understanding of Alzheimer’s disease, for example, and there are
these themes in the New Oxford Textbook of Psychiatry and to pres- indications that similar progress will follow in uncovering the
ent the state of psychiatry at the start of the new millennium. The causes of mood disorder, schizophrenia, and autism. Knowledge
book is written for psychiatrists engaged in continuous education of genetics and the neurosciences is so extensive and the pace of
and recertification; the previous, shorter, Oxford Textbook of change is so rapid that it is diffi cult to present a complete account
Psychiatry remains available for psychiatrists in training. The book within the limited space available in a textbook of clinical psychiatry.
is intended to be suitable also as a work of reference for psychia- We have selected aspects of these sciences that seem, to us and
trists of all levels of experience, and for other professionals whose the authors, to have contributed signifi cantly to psychiatry or to be
work involves them in the problems of psychiatry. likely to do so before long.
Psychological and social sciences and epidemiology are essential
The growing unity of psychiatry methods of investigation in psychiatry. Although the pace of
advance in these sciences may not be as great as in the neurosciences,
The growing unity in psychiatry is evident in several ways. Biological
the findings generally have a more direct relation to clinical
and psychosocial approaches have been largely reconciled with a gen-
phenomena. Moreover, the mechanisms by which psychological
eral recognition that genetic and environmental factors interact, and
and social factors interact with genetic, biochemical, and structural
that psychological processes are based in and can infl uence neurobio-
ones will continue to be important however great the progress in
logical mechanisms. At the same time, the common ground between
these other sciences. Among the advances in the psychological and
the different psychodynamic theories has been recognized, and is
social sciences that are relevant to clinical phenomena, we have
widely accepted as more valuable than the differences between them.
included accounts of memory, psychological development, research
The practice of psychiatry is increasingly similar in different
on life events, and the effects of culture. Epidemiological studies
countries, with the remaining variations related more to differences
continue to be crucial for defi ning psychiatric disorders, following
between national systems of health care and the resources available
their course, and identifying their causes.
to clinicians, than to differences in the aims of the psychiatrists
working in these countries. This unity of approach is refl ected in Psychiatry in the community
this book whose authors practise in many different countries and
yet present a common approach. In this respect this textbook dif- In most countries, psychiatry is now practised in the community
fers importantly from others which present the views of authors rather than in institutions, and where this change has yet be
drawn predominantly from a single country or region. completed, it is generally recognized that it should take place. The
Greater agreement about diagnosis and nosology has led to a change has done much more than transfer the locus of care; it has
better understanding of how different treatment approaches are converted patients from passive recipients of care to active partici-
effective in different disorders. The relative specifi city of psycho- pants with individual needs and preferences. Psychiatrists are now
pharmacological treatments is being matched increasingly by the involved in the planning, provision, and evaluation of services for
specifi city of some of the recently developed psychological treat- whole communities, which may include members of ethnic minor-
ments, so that psychological treatment should no longer be applied ities, homeless people, and refugees. Responsibility for a commu-
without reference to diagnosis, as was sometimes done in the past. nity has underlined the importance of the prevention as well as the
treatment of mental disorder and of the role of agencies other than
The pace of scientifi c advance health services in both. Care in the community has also drawn
attention to the many people with psychiatric disorder who are
Advances in genetics and in the neurosciences have already treated in primary care, and has led to new ways of working between
increased knowledge of the basic mechanisms of the brain and are psychiatrists and physicians. At the same time, psychiatrists have
viii preface
worked more in general hospitals, helping patients with both In the latter, the account is generally in two parts: a review of
medical and psychiatric problems. Others have provided care for evidence about the effi cacy of the treatment, followed by advice
offenders. on man agement in which available evidence is supplemented,
where necessary, with clinical experience. Treatment methods
The organization of the book designed specially for children and adolescents, for people
with mental retardation (learning disability), and for patients
In most ways, the organization of this book is along conventional
within the forensic services are considered in Parts 9, 10, and 11
lines. However, some matters require explanation.
respectively.
Part 1 contains a variety of diverse topics brought together
Social psychiatry and service provision are described in Part 7.
under the general heading of the subject matter and approach to
Public policy issues, as well as the planning, delivery, and evalua-
psychiatry. Phenomenology, assessment, classifi cation, and ethical
tion of services, are discussed here. Psychiatry in primary care is an
problems are included, together with the role of the psychiatrist
important topic in this part of the book. There are chapters on
as educator and as manager. Public health aspects of psychiatry
the special problems of members of ethnic minorities, homeless
are considered together with public attitudes to psychiatry and to
people, and refugees, and the effects of culture on the provision
psychiatric patients. Part 1 ends with a chapter on the links between
and uptake of services.
science and practice. It begins with a topic that is central to good
Child and adolescent psychiatry, old age psychiatry, and mental
practice—the understanding of the experience of becoming
retardation are described in Parts 8, 9, and 10. These accounts are
a psychiatric patient.
less detailed than might be found in textbooks intended for
Part 2 is concerned with the scientifi c foundations of psychiatry
specialists working exclusively in the relevant subspecialty. Rather,
grouped under the headings neurosciences, genetics, psychological
they are written for readers experienced in another branch of psy-
sciences, social sciences, and epidemiology. The chapters contain
chiatry who wish to improve their knowledge of the special subject.
general information about these sciences; fi ndings specifi c to a
We are aware of the controversy surrounding our choice of the title
particular disorder are described in the chapter on that disorder.
of Part 10. We have selected the term ‘mental retardation’ because it
Brain imaging techniques are discussed here because they link basic
is used in both ICD-10 and DSM-IV. In some countries this term
sciences with clinical research. As explained above, the chapters are
has been replaced by another that is thought to be less stigmatizing
selective and, in some, readers who wish to study the subjects in
and more acceptable to patients and families. For example, in the
greater detail will fi nd suggestions for further reading.
United Kingdom the preferred term is ‘learning disability’. While
Part 3 is concerned with dynamic approaches to psychiatry. The
we sympathize with the aims of those who adopt this and other
principal schools of thought are presented as alternative ways of
alternative terms, the book is intended for an international reader-
understanding the infl uence of life experience on personality and
ship and it seems best to use the term chosen by the World Health
on responses to stressful events and to illness. Some reference is
Organization as most generally understood. Thus the term mental
made to dynamic psychotherapy in these accounts, but the main
retardation is used unless there is a special reason to use another.
account of these treatments is in Part 6. This arrangement sepa-
In Part 11, Forensic Psychiatry, it has been especially diffi cult to
rates the chapters on the practice of dynamic psychotherapy from
present a general account of the subject that is not tied to practice
those on psychodynamic theory, but we consider that this disad-
in a single country. This is because systems of law differ between
vantage is outweighed by the benefi t of considering together the
countries and the practice of forensic psychiatry has to conform
commonly used forms of psychotherapy.
with the local legal system. Although many of the examples in this
Part 4 is long, with chapters on the clinical syndromes of adult
part of the book may at fi rst seem restricted in their relevance
psychiatry, with the exception of somatoform disorders which
because they are described in the context of English law, we hope
appear in Part 5, Psychiatry and Medicine. This latter contains
that readers will be able to transfer the principles described in these
more than a traditional account of psychosomatic medicine. It also
chapters to the legal tradition in which they work.
includes a review of psychiatric disorders that may cause medical
Finally, readers should note that the history of psychiatry is pre-
symptoms unexplained by physical pathology, the medical, surgi-
sented in more than one part of the book. The history of psychiatry
cal, gynaecological, and obstetric conditions most often associated
as a medical specialty is described in Part 1. The history of ideas
with psychiatric disorder, health psychology, and the treatment of
about the various psychiatric disorders appears, where relevant,
psychiatric disorder in medically ill patients.
in the chapters on these disorders, where they can be considered
Information about treatment appears in more than one part
in relation to present-day concepts. The history of ideas about
of the book. Part 6 contains descriptions of the physical and
aetiology is considered in Part 2, which covers the scientifi c basis of
psychological treatments in common use in psychiatry. Dynamic
psychiatric aetiology, while the historical development of dynamic
psychotherapy and psychoanalysis are described alongside
psychiatry is described in Part 3.
counselling and cognitive behavioural techniques. This part of the
Michael Gelder
book contains general descriptions of the treatments; their use for
Juan López-Ibor
a particular disorder is considered in the chapter on that disorder.
Nancy Andreasen
Acknowledgements from the
fi rst edition
We are grateful to the many colleagues who have advised us about substance use disorders); Professor Guy Goodwin (mood disorders);
certain parts of the book. Professor John Bancroft (sexuality, gender identity, and their
The following helped us to plan specialized parts of the book: disorders); Professor Gregory Stores (sleep–wake disorders);
Dr Jeremy Holmes (Section 3, Psychodynamic Contributions to Professor Keith Hawton (suicide and attempted suicide). In Section 6,
Psychiatry); Professor Richard Mayou (Section 5, Psychiatry and Professor Philip Cowen advised about somatic treatments,
Medicine); Professor Robin Jacoby (Section 8, Psychiatry of Old Dr Jeremy Holmes about psychodynamic treatments, and Professor
Age); Sir Michael Rutter (Section 9, Child and Adolescent Psychiatry); David Clark about cognitive behavioural therapy. Dr Max
Professor William Fraser (Section 10, Intellectual Disablity); Professor Marshall provided helpful advice about forensic issues for
Robert Bluglass (Section 11, Forensic Psychiatry). Section 7. We also thank the many other colleagues whose helpful
The following helped us to plan certain sections within Section 4, suggestions about specifi c problems aided the planning of the
General Psychiatry: Professor Alwyn Lishman (delirium, dementia, book.
amnestic syndrome, and other cognitive disorders); Professor Finally, we record our special gratitude to the authors and to the
Griffi th Edwards (alcohol use disorders); Dr Philip Robson (other staff of Oxford University Press.