Kaplan + Sadock's Synopsis of Psychiatry, 11e

KAPLAN & SADOCK’S Synopsis of Psychiatry Behavioral Sciences/Clinical Psychiatry

Eleventh

Edition

C ontributing E ditors

Caroly S. Pataki, M.D. Clinical Professor of Psychiatry & Biobehavioral Sciences David Geffen School of Medicine at UCLA Norman Sussman, M.D. Professor of Psychiatry, NewYork University School of Medicine; Director, Treatment Resistant Depression Program and Co-director, Continuing Education in Psychiatry, Department of Psychiatry; Attending Psychiatrist, Tisch Hospital, NewYork, NewYork

KAPLAN & SADOCK’S Synopsis of Psychiatry Behavioral Sciences/Clinical Psychiatry

Eleventh

Edition

Benjamin James Sadock, M.D. Menas S. Gregory Professor of Psychiatry, Department of Psychiatry, NewYork University School of Medicine; Attending Psychiatrist, Tisch Hospital; Attending Psychiatrist, Bellevue Hospital Center; NewYork, NewYork Virginia Alcott Sadock, M.D. Professor of Psychiatry, Department of Psychiatry, NewYork University School of Medicine; Attending Psychiatrist, Tisch Hospital; Attending Psychiatrist, Bellevue Hospital Center, NewYork, NewYork Pedro Ruiz, M.D. Professor of Psychiatry, Executive Vice-Chair and Director of Clinical Programs, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida

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11th edition

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Previous Editions First Edition 1972 Second Edition 1976 Third Edition 1981 Fourth Edition 1985 Fifth Edition 1988 Sixth Edition 1991 Seventh Edition 1994 Eighth Edition 1998 Ninth Edition 2003 Tenth Edition 2007

Library of Congress Cataloging-in-Publication Data Sadock, Benjamin J., author. Kaplan & Sadock’s synopsis of psychiatry : behavioral sciences/clinical psychiatry.—Eleventh edition / Benjamin James Sadock, Virginia Alcott Sadock, Pedro Ruiz. p. ; cm. Kaplan and Sadock’s synopsis of psychiatry Synopsis of psychiatry Preceded by Kaplan & Sadock’s synopsis of psychiatry / Benjamin James Sadock, Virginia Alcott Sadock. 10th ed. 2007. Includes bibliographical references and index. Summary: “The goal of this book is to foster professional competence and ensure the highest quality care to those with mental illness. An eclectic, multidisciplinary approach has been its hallmark; thus, biological, psychological, and sociological factors are equitably presented as they affect the person in health and disease”–Provided by publisher. ISBN 978-1-60913-971-1 (alk. paper) I. Sadock, Virginia A., author. II. Ruiz, Pedro, 1936- author. III. Title. IV. Title: Kaplan and Sadock’s synopsis of psychiatry. V. Title: Synopsis of psychiatry. [DNLM: 1. Mental Disorders. WM 140] RC454 616.89—dc23 2014021574 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 contradictions, 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.

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Cover Illustration: Artist Surrounded by Masks (detail), 1899 by James Ensor (1860–1949). © 2014 Artists Rights Society (ARS), NewYork/SABAM, Brussels.

To Our Grandchildren

Preface

debt to the more than 2,000 contributors to the current and pre- vious editions of the Comprehensive Textbook of Psychiatry , all of whom have allowed us to synopsize their work. At the same time, we must accept responsibility for the modifications and changes in the new work. COMPREHENSIVE TEACHING SYSTEM This textbook forms one part of a comprehensive system devel- oped by us to facilitate the teaching of psychiatry and the behav- ioral sciences. At the head of the system is the Comprehensive Textbook of Psychiatry , which is global in depth and scope; it is designed for and used by psychiatrists, behavioral scientists, and all workers in the mental health field. Synopsis of Psychiatry is a relatively brief, highly modified, and current version useful for medical students, psychiatric residents, practicing psychiatrists, and mental health professionals. Two special editions derived from Synopsis , Concise Textbook of Clinical Psychiatry and Concise Textbook of Child and Adolescent Psychiatry , contain descriptions of all psychiatric disorders, including their diagno- sis and treatment in adults and children, respectively. They will be useful for clinical clerks and psychiatric residents who need a succinct overview of the management of clinical problems. Another part of the system, Study Guide and Self-Examination Review of Psychiatry , consists of multiple-choice questions and answers; it is designed for students of psychiatry and for clinical psychiatrists who require a review of the behavioral sciences and general psychiatry in preparation for a variety of examinations. The questions are modeled after and consistent with the format used by the American Board of Psychiatry and Neurology (ABPN), the National Board of Medical Examiners (NBME), and the United States Medical Licensing Examination (USMLE). Other parts of the system are the various editions of the pocket handbooks: Pocket Handbook of Clinical Psychiatry, Pocket Handbook of Psychiatric Drug Treatment, Pocket Hand- book of Emergency Psychiatric Medicine, and Pocket Handbook of Primary Care Psychiatry . Those books cover the diagnosis and treatment of psychiatric disorders, psychopharmacology, psychiatric emergencies, and primary care psychiatry, respec- tively, and are designed and written to be carried by clinical clerks and practicing physicians, whatever their specialty, to provide a quick reference. Finally, Comprehensive Glossary of Psychiatry and Psychology provides simply written defini- tions for psychiatrists and other physicians, psychologists, stu- dents, other mental health professionals, and the general public. Together, these books create a multiple approach to the teach- ing, study, and learning of psychiatry.

This is the eleventh edition of Kaplan & Sadock’s Synopsis of Psychiatry, which was first published more than 40 years ago. During that time, it has gained the reputation of being an independent, consistent, accurate, objective, and reliable compendium of new events in the field of psychiatry. Since its beginning, the goal of this book has been to foster professional competence and ensure the highest quality care to those with mental illness. An eclectic, multidisciplinary approach has been its hallmark; thus, biological, psychological, and sociological factors are equitably presented as they affect the person in health and disease. Synopsis serves the needs of diverse professional groups: psychiatrists and nonpsychiatric physicians, medical students, psychologists, social workers, psychiatric nurses, and other men- tal health professionals, such as occupational and art therapists, among others. Synopsis is also used by nonprofessionals as an authoritative guide to help them collaborate in the care of a family member or friend with mental illness. As authors and editors, we have been extremely gratified by the wide acceptance and use of Synopsis , both in the United States and around the world. We are especially pleased that Pedro Ruiz, M.D., who joined us as third editor for the last (Tenth) edition of the Comprehen- sive Textbook of Psychiatry, is continuing his association with us as co-author of Synopsis. Dr. Ruiz is not only a close friend but is a distinguished academic psychiatrist, renowned as both an educator and clinician. He is past president of the American Psychiatric Association and serves as the current president of the World Psychiatric Association. Dr. Ruiz is Professor of Psy- chiatry and Executive Vice-Chair and Director of Clinical Pro- grams at the University of Miami Miller School of Medicine. HISTORY This textbook evolved from our experience editing the Com- prehensive Textbook of Psychiatry . That book is nearly 4,000 double-column pages long, with more than 450 contributions by outstanding psychiatrists and behavioral scientists. It serves the needs of those who require an exhaustive, detailed, and encyclo- pedic survey of the entire field. In an effort to be as comprehen- sive as possible, the textbook spans two volumes to cover the material, clearly rendering it unwieldy for some groups, espe- cially medical students, who need a brief and more condensed statement of the field of psychiatry. To accomplish this, sections of the Comprehensive Textbook of Psychiatry were deleted or condensed, new subjects were introduced, and all sections were brought up to date, especially certain key areas, such as psycho- pharmacology. We wish to acknowledge our great and obvious

vi

vii

Preface

CLASSIFICATION OF DISORDERS DSM-5

As in all Kaplan & Sadock books, color plates of proprietary forms of commonly used psychiatric drugs including their dos- age forms are pictured. All new drugs developed since the last edition was published are included. In addition, new illustra- tions and color plates have been added to many sections. CASE HISTORIES Case histories are an integral part of Synopsis. They are used extensively throughout the text to add clarity and bring life to the clinical disorders described. Cases come from various sources including the contributors to the current and previous editions of the Comprehensive Textbook of Psychiatry and our hospital colleagues, all of whom we thank for their contribu- tions. Some also come from the authors’ clinical experience at Bellevue Hospital in New York. Cases appear in tinted type to help the reader find them easily. NEW AND UPDATED SECTIONS The introduction of DSM-5 in 2013 reframed psychiatric nosol- ogy, and the reader will find every section of Synopsis revised and updated to reflect those changes. The chapter on Classification in Psychiatry provides a concise overview and definition of every psychiatric disorder listed in DSM-5. In the rest of the book, each of these disorders is discussed in great detail in separate chapters and sections. In addition, almost every major mental disorder is accompanied by its corresponding DSM-5 diagnostic table. The table of contents was reorganized starting with the chapter called Neural Sciences, in which three new sections were added: Neural Development and Neurogenesis reflects the important role of the developing nervous system in the causa- tion of mental illness; Applied Electrophysiology describes the effects of electrical impulses in the brain and its relation to clini- cal psychiatry; and Immune System and Central Nervous System Interactions describes the complex effects of the immune sys- tem on the brain in health and disease. A new section entitled Normality and Mental Health pro- vides the reader with a framework within which to understand the boundaries of mental illness. Similarly, another new section, Positive Psychology, describes emerging theories and therapeu- tic approaches that contribute to mental health. A chapter called Contributions of the Sociocultural Sciences contains three new sections entitled Sociology and Ethology, Transcultural Psychiatry, and Culture-Bound Syndromes that, taken together, reflect the tremendous impact that culture has on both the manifestations and prevalence of mental disorders around the world. The chapter End-of-Life Issues covers death, dying, bereave- ment, and palliative care to reflect the important role psychia- trists have in the clinical specialty of palliative medicine. This chapter also covers pain control, which is a relatively new but important area in which psychiatrists play a significant role. In the chapter entitled Gender Dysphoria —a new diagnostic category included in DSM-5—special attention is given to issues that affect gay, lesbian, bisexual, and transgender per- sons. The chapter Psychiatry and Reproductive Medicine was revised extensively to keep pace with advances in women’s health issues. The chapter Ethics in Psychiatry was updated to include an extensive discussion of physician-assisted suicide.

A fifth edition of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders was published in 2013 called DSM-5. It contains the official nomen- clature used by psychiatrists and other mental health profes- sionals in the United States; the psychiatric disorders discussed in the textbook are consistent with and follow that nosology. Every section dealing with clinical disorders has been updated thoroughly and completely to include the revisions contained in DSM-5. The reader also will find DSM-5 tables for most major mental disorders reprinted in this textbook as it has been in each of our editions. The DSM is the “law of the land” and, as mentioned previ- ously, is the nomenclature used throughout this textbook; how- ever, some clinicians and researchers have reservations about various aspects of the DSM, which readers will find mentioned in Synopsis. As future editions of the DSM appear, this textbook, as always, will allow room for dissent before and especially after every new version appears. It will continue to provide a forum for discussion, evaluation, criticism, and disagreement, while duly acknowledging the official nomenclature. ICD-10 Readers also should be aware of a parallel classification system developed by the World Health Organization (WHO) called the International Statistical Classification of Diseases and Related Health Problems (ICD-10). There are textual differences between DSM and ICD, but according to treaties between the United States and the WHO, the diagnostic code numbers must be identical to ensure uniform reporting of national and interna- tional psychiatric statistics. ICD diagnoses and numerical codes are accepted by Medicare, Medicaid, and private insurance companies for reimbursement purposes in the United States. COVER ART AND ILLUSTRATIONS Synopsis was one of the first modern psychiatric textbooks to use art and photographs to illustrate psychiatric subjects in order to enrich the learning experience, and we have continued that tradition through each edition. The cover art is a detail of a painting entitled Artist Sur- rounded by Masks by the Belgian-born artist James Ensor (1860– 1949), who was fascinated by masks, which for him represented the hypocrisy of humankind. Masks have played a role through- out human history. They both hide and reveal; they hide what we do not wish to show to others or to ourselves or what we wish to keep secret, and they reveal what we wish others to see. In the rehabilitation of psychiatric patients, making masks has been used by art therapists to help patients explore their feelings and to experience their creativity. The psychiatrist Hervey Cleckley coined the term “mask of sanity” to refer to the psychopath who manipulates others but who is, beneath the façade of normality, profoundly disturbed. Carl Jung wrote of the persona (derived from the Latin word for mask) as the image we wish to present to the world behind which lay other images of the self. We hope that the cover art enriches the learning experience for our readers.

viii

Preface

drome were added as new diagnostic entities. These and other changes are reflected in the expanded coverage of disorders that usually begin in childhood and adolescence. The section dealing with the impact of terrorism has been updated to reflect new information about posttraumatic stress disorders in chil- dren, including the latest data on the psychological effects on children exposed to natural and man-made disasters. The sec- tion Anxiety Disorders was reorganized and updated thoroughly, and Obsessive-Compulsive Disorder is now a separate chapter. The section that deals with the use of pharmacological agents in children was updated extensively to reflect the many changes in the use of medications to treat disorders of childhood that have occurred since the last edition this book was published. GLOSSARY Unique to this edition is a new and updated comprehensive glos- sary of psychiatric signs and symptoms. Psychiatry is a descrip- tive science and the knowledge and accurate usage of the many terms available to the clinician is crucial to successful diagnosis and treatment. We hope readers find this new addition to the textbook of use. REFERENCES Each section in Synopsis ends with a number of citations that include reviews of the literature and up-to-date references in addition to relevant chapters in our larger textbook, Comprehen- sive Textbook of Psychiatry . References are limited in number; in part this was to conserve space, but more importantly, we are mindful that modern-day readers consult Internet databases such as PubMed and Google Scholar to stay abreast of the most current literature, and we encourage that trend. ACKNOWLEDGMENTS We deeply appreciate the work of our distinguished contributing editors, who gave generously of their time and expertise. Caroly Pataki, M.D., was responsible for updating and revising the sec- tion on childhood and adolescent disorders. She has served with distinction as Contributing Editor of child psychiatry in the Com- prehensive Textbook for many editions, and we thank her for her tremendous help in this area. Norman Sussman, M.D., updated the section on psychopharmacology, enabling us to provide the reader with the current material in this ever-changing and rap- idly expanding area. He also served as Contributing Editor for the Comprehensive Textbook in the area of psychopharmacology. We thank Dorice Viera, Associate Curator of the Frederick L. Ehrman Medical Library at the New York University School of Medicine, for her valuable assistance in the preparation of this and previous editions in which she participated. We especially wish to express our deep thanks to our two project editors in NewYork: Nitza Jones-Sepulveda was with us for over a decade and worked on this and on many other Kaplan & Sadock books before moving into the private sector, and her vast knowledge of every aspect of book publishing was indis- pensable. She will be greatly missed. We also wish to thank Hayley Weinberg, who played a major role in the production of this book. She worked with enthusiasm, intelligence, and alacrity. We also wish to acknowledge and thank Gloria Robles in Miami,

This topic is also given special attention in the section enti- tled Euthanasia and Physician-Assisted Suicide. In the last edition, the section on Posttraumatic Stress Disorder covered the tragic events of September 11, 2001, involving the World Trade Center in New York and the Pentagon in Washington. Regrettably, other disasters such as Hurricane Sandy and the Newtown killings have occurred since then. The psychological effects of those events are covered, as are the effects of the wars in Iraq and Afghanistan on the mental health of the veterans of those wars. Related to that is new coverage of the effects of terrorism and torture, two areas rarely covered in textbooks of psychiatry, but of extreme importance to psychiatrists who treat its victims. Two new chapters, Public Psychiatry and World Aspects of Psychiatry, have been added to this edition, both of which reflect the national and global scope of psychiatry and the need for cli- nicians to understand disorders that appear around the world. A new section called Brain Stimulation Methods describes such new advances as transmagnetic and deep brain stimula- tion developed to restore health to those patients who have not responded to conventional therapies and who are among the most severely mentally ill. The chapter on psychotherapy has been expanded to include newer treatments such as Mentalization and Mindfulnes s, both of which are covered in a newly written section. And, as in pre- vious editions, the chapter Pharmacological Treatment covers every drug used by psychiatrists to treat mental illness. It has been completely updated to include all new drugs introduced since the last edition of this book was published. Finally, every chapter in the behavioral sciences section has been revised and updated to reflect the latest advances in the field. PSYCHOPHARMACOLOGY The authors are committed to classifying drugs used to treat mental disorders according to their pharmacological activ- ity and mechanism of action rather than using such categories as antidepressants, antipsychotics, anxiolytics, and mood sta- bilizers, which are overly broad and do not reflect, scientifi- cally, the clinical use of psychotropic medication. For example, many antidepressant drugs are used to treat anxiety disorders; some anxiolytics are used to treat depression and bipolar dis- orders; and drugs from all categories are used to treat other clinical problems, such as eating disorders, panic disorders, and impulse-control disorders. Many drugs are also used to treat a variety of mental disorders that do not fit into any broad clas- sification. Information about all pharmacological agents used in psychiatry, including pharmacodynamics, pharmacokinetics, dosages, adverse effects, and drug–drug interactions, was thor- oughly updated to reflect recent research. CHILDHOOD DISORDERS The chapters covering childhood disorders were extensively revised to include important new material. DSM-5 introduced new childhood diagnostic categories and eliminated others. For example, diagnoses such as Pervasive Developmental Disorder, Rett’s Disorder, and Asperger’s Disorder are now subsumed under the rubric of Autism Spectrum Disorder, and Disruptive Mood Dysregulation Disorder and Attenuated Psychosis Syn-

ix

Preface

Lippincott Williams & Wilkins has been our publisher for nearly half a century and as always, their staff was most efficient. Jamie Elfrank, Acquisitions Editor at LWW was extremely helpful in many aspects of our work and we value not only her assistance but her friendship as well. We also wish to thank Andrea Vosburgh, Production Editor at LWW who helped immeasurably in the many details involved in putting this book together. She went far beyond her role as production editor serv- ing as part-time copy editor, picture editor, permissions editor and many other roles too numerous to mention. Her optimism and dedication to the project were extraordinarily helpful. Chris Miller at Aptara also deserves our thanks for her work on this and other Kaplan & Sadock titles. We especially wish to acknowledge Charley Mitchell, past Executive Editor at LWW, who encouraged and guided us for over 20 years before moving on to a career in academia. We value his friendship now as much as we did throughout the years he was at LWW. Finally, we want to express our deep thanks to Charles Mar- mar, M.D., Professor and Chairman of Psychiatry at New York University School of Medicine, who gave us his full support throughout the project. He has guided the department into the 21 st century with dedication, skill, and enthusiasm. Under his leadership, NYU has become one of the leading centers of psy- chiatry and neuroscience both in this country and around the world.

who was of invaluable assistance to all of the authors, especially Dr. Ruiz. Among the many others to thank are Seeba Anam, M.D., René Robinson, M.D., Nora Oberfield, M.D., Marissa Kaminsky, M.D., Caroline Press, M.D., Michael Stanger, M.D., Rajan Bahl, M.D., and Jay K. Kantor, Ph.D., all of whom con- tributed to various editions of Synopsis . Laura Erikson-Schroth, M.D., deserves special thanks for her help in the section on Gen- der Dysphoria . We especially want to thank Samoon Ahmad, M.D., who helped us tremendously as Consulting Editor in the area of psychopharmacology. We also wish to acknowledge the contributions of James Sadock, M.D., and Victoria Sadock Gregg, M.D., for their help in their areas of expertise: emergency adult and emergency pediatric medicine, respectively. We thank Alan and Marilyn Zublatt for their generous sup- port of this and other Kaplan & Sadock textbooks. Over the years they have been unselfish benefactors to many educational, clinical, and research projects at the NYU Medical Center. We are deeply grateful for their help. We want to take this opportunity to acknowledge those who have translated this and other Kaplan & Sadock books into for- eign languages, including Chinese, Croatian, French, German, Greek, Indonesian, Italian, Japanese, Polish, Portuguese, Roma- nian, Russian, Spanish, and Turkish, in addition to a special Asian and international student edition.

Contents

1 Neural Sciences

4.3 Other Psychodynamic Schools

174 188

1

4.4 Positive Psychology

1.1 Introduction

1 4

1.2 Functional Neuroanatomy 1.3 Neural Development and Neurogenesis 1.4 Neurophysiology and Neurochemistry 1.5 Psychoneuroendocrinology 1.6 Immune System and Central Nervous System Interactions

5 Examination and Diagnosis of the Psychiatric Patient

18

192

5.1 Psychiatric Interview, History, and Mental Status Examination 5.2 The Psychiatric Report and Medical Record 5.3 Psychiatric Rating Scales 5.4 Clinical Neuropsychology and Intellectual Assessment of Adults 5.5 Personality Assessment: Adults and Children 5.6 Neuropsychological and Cognitive Assessment of Children

35 63

192

211 217

67 71 84 88

1.7 Neurogenetics

1.8 Applied Electrophysiology

236

1.9 Chronobiology

246

2 Contributions of the Psychosocial Sciences

257

93 2.1 Jean Piaget and Cognitive Development 93 2.2 Attachment Theory 97 2.3 Learning Theory 101 2.4 Biology of Memory 110 2.5 Normality and Mental Health 123

5.7 Medical Assessment and

Laboratory Testing in Psychiatry

266 275

5.8 Neuroimaging

5.9 Physical Examination of the Psychiatric Patient

283

6 Classification in Psychiatry

290

3 Contributions of the Sociocultural Sciences

131

7 Schizophrenia Spectrum and Other Psychotic Disorders

3.1 Sociobiology and Ethology 3.2 Transcultural Psychiatry 3.3 Culture-Bound Syndromes

131 139 145

300

7.1 Schizophrenia

300 323 327

7.2 Schizoaffective Disorder 7.3 Schizophreniform Disorder 7.4 Delusional Disorder and Shared Psychotic Disorder 7.5 Brief Psychotic Disorder, Other Psychotic Disorders, and Catatonia

4 Theories of Personality and Psychopathology

151

330

4.1 Sigmund Freud: Founder of Classic Psychoanalysis

151 167

4.2 Erik H. Erikson

339

x

xi

Contents

8 Mood Disorders 347 8.1 Major Depression and Bipolar Disorder 347 8.2 Dysthymia and Cyclothymia 380

14 Chronic Fatigue Syndrome and Fibromyalgia

504

15 Feeding and Eating Disorders

509

9 Anxiety Disorders

387

15.1 Anorexia Nervosa 15.2 Bulimia Nervosa

509 516

9.1 Overview

387 392 398

9.2 Panic Disorder 9.3 Agoraphobia 9.4 Specific Phobia

15.3 Binge Eating Disorder and Other Eating Disorders 15.4 Obesity and the Metabolic Syndrome

519

400 9.5 Social Anxiety Disorder (Social Phobia) 405 9.6 Generalized Anxiety Disorder 407 9.7 Other Anxiety Disorders 413

522

16 Normal Sleep and Sleep-Wake Disorders

533

10 Obsessive‑Compulsive and Related Disorders

16.1 Normal Sleep

533 536

418

16.2 Sleep-Wake Disorders

10.1 Obsessive‑Compulsive Disorder 10.2 Body Dysmorphic Disorder

418 427 429

17 Human Sexuality and Sexual Dysfunctions

10.3 Hoarding Disorder 10.4 Hair-Pulling Disorder (Trichotillomania)

564

17.1 Normal Sexuality 17.2 Sexual Dysfunctions 17.3 Paraphilic Disorders

431 10.5 Excoriation (Skin-Picking) Disorder 434

564 575 593

11 Trauma- and Stressor-Related Disorders

437 11.1 Posttraumatic Stress Disorder and Acute Stress Disorder 437 11.2 Adjustment Disorders 446

18 Gender Dysphoria

600

19 Disruptive, Impulse-Control, and Conduct Disorders

608

12 Dissociative Disorders

451

20 Substance Use and Addictive Disorders

13 Psychosomatic Medicine

616

465

20.1 20.2 20.3 20.4 20.5 20.6 20.7 20.8

13.1 Introduction and Overview 13.2 Somatic Symptom Disorder 13.3 Illness Anxiety Disorder 13.4 Functional Neurological Symptom Disorder (Conversion Disorder) 13.5 Psychological Factors Affecting Other Medical Conditions

Introduction and Overview Alcohol-Related Disorders Caffeine-Related Disorders Cannabis-Related Disorders Hallucinogen-Related Disorders Inhalant-Related Disorders Opioid-Related Disorders Sedative-, Hypnotic-, or Anxiolytic-Related Disorders Stimulant-Related Disorders

616 624 639 644 648 656 659

465 468 471

473

477 489 496 499

13.6 Factitious Disorder

13.7 Pain Disorder

666 671

13.8 Consultation-Liaison Psychiatry

20.9

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Contents

20.10 Tobacco-Related Disorders 680 20.11 Anabolic-Androgenic Steroid Abuse 685 20.12 Other Substance Use and Addictive Disorders 689 20.13 Gambling Disorder 690

28.2 28.3

Brief Psychodynamic Psychotherapy 853 Group Psychotherapy, Combined Individual and Group Psychotherapy, and Psychodrama 857 Family Therapy and Couples Therapy 863

28.4 28.5 28.6 28.7 28.8 28.9

Dialectical Behavior Therapy

868 869 873 877 883 887 891 894

Biofeedback

21 Neurocognitive Disorders

694

Cognitive Therapy Behavior Therapy

21.1 Introduction and Overview

694 697

21.2 Delirium

Hypnosis

21.3 Dementia (Major Neurocognitive Disorder) 21.4 Major or Minor Neurocognitive Disorder Due to Another Medical Condition (Amnestic Disorders) 21.5 Neurocognitive and Other Disorders

28.10 Interpersonal Therapy 28.11 Narrative Psychotherapy 28.12 Psychiatric Rehabilitation 28.13 Combined Psychotherapy and Pharmacology

704

718

897 901

28.14 Genetic Counseling

Due to a General Medical Condition 723

28.15 Mentalization-Based Therapy and Mindfulness

21.6 Mild Cognitive Impairment

737

907

22 Personality Disorders

742

29 Psychopharmacological Treatment 910 29.1

General Principles of Psychopharmacology

23 Emergency Psychiatric Medicine 763 23.1 Suicide 763 23.2 Psychiatric Emergencies in Adults 774 23.3 Psychiatric Emergencies in Children 785

910

29.2

Medication-Induced Movement Disorders -Adrenergic Receptor Agonists, a 1 -Adrenergic Receptor Antagonists: Clonidine, Guanfacine, Prazosin, and Yohimbine

923

29.3 a 2

929

24 Complementary and Alternative Medicine in Psychiatry

29.4 b -Adrenergic Receptor Antagonists

791

933 936 938 942

29.5 29.6 29.7 29.8

Anticholinergic Agents

Anticonvulsants Antihistamines

25 Other Conditions that May be a Focus of Clinical Attention

812

Barbiturates and Similarly Acting Drugs Benzodiazepines and Drugs Acting on GABA Receptors

944

29.9

26 Physical and Sexual Abuse of Adults 824

948 954 956

29.10 Bupropion 29.11 Buspirone

27 Psychiatry and Reproductive Medicine

29.12 Calcium Channel Blockers 957 29.13 Carbamazepine and Oxcarbazepine 959 29.14 Cholinesterase Inhibitors and Memantine 963 29.15 Disulfiram and Acamprosate 966 29.16 Dopamine Receptor Agonists and Precursors 969

831

28 Psychotherapies

845

28.1

Psychoanalysis and Psychoanalytic Psychotherapy

845

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Contents

29.17 Dopamine Receptor Antagonists (First-Generation Antipsychotics)

31.4d Social (Pragmatic) Communication Disorder

972 981 983 991 993 994 997

1149

29.18 Lamotrigine

31.4e Unspecified

29.19 Lithium

Communication Disorder 1151

29.20 Melatonin Agonists: Ramelteon and Melatonin

31.5 31.6 31.7 31.8

Autism Spectrum Disorder Attention Deficit/Hyperactivity Disorder Specific Learning Disorder

1152

29.21 Mirtazapine

1169 1181 1190

29.22 Monoamine Oxidase Inhibitors 29.23 Nefazodone and Trazodone 29.24 Opioid Receptor Agonists 29.25 Opioid Receptor Antagonists: Naltrexone, Nalmefene, and Naloxone 29.26 Phosphodiesterase-5 Inhibitors 29.27 Selective Serotonin–Norepinephrine Reuptake Inhibitors 29.28 Selective Serotonin Reuptake Inhibitors 29.29 Serotonin–Dopamine Antagonists and Similarly Acting Drugs (Second-Generation or Atypical Antipsychotics) 1023 29.30 Stimulant Drugs and Atomoxetine 1033 29.31 Thyroid Hormones 1039 29.32 Tricyclics and Tetracyclics 1040 29.33 Valproate 1045 29.34 Nutritional Supplements and Medical Foods 1049 29.35 Weight Loss Drugs 1060 1000 1004 1008 1010 1013

Motor Disorders

31.8a Developmental

Coordination Disorder

1190

31.8b Stereotypic Movement Disorder 31.8c Tourette’s Disorder 31.8d Persistent (Chronic) Motor or Vocal Tic Disorder Feeding and Eating Disorders of Infancy or Early Childhood 31.9b Rumination Disorder 31.9c Avoidant/Restrictive Food Intake Disorder 31.9a Pica

1194 1197

1205

31.9

1205 1206 1207 1209 1211 1212 1214

31.10 Elimination Disorders

31.10a Encopresis 31.10b Enuresis

31.11 Trauma- and Stressor-Related Disorders in Children

1216

31.11a Reactive Attachment

Disorder and Disinhibited Social Engagement Disorder

30 Brain Stimulation Methods 30.1 Electroconvulsive Therapy

1065

1217

31.11b Posttraumatic Stress Disorder of Infancy, Childhood, and Adolescence

1065 1072

30.2 Other Brain Stimulation Methods 30.3 Neurosurgical Treatments and Deep Brain Stimulation

1221

1077

31.12 Mood Disorders and Suicide in Children and Adolescents

1226

31.12a Depressive Disorders and Suicide in Children and Adolescents 31.12b Early-Onset Bipolar Disorder

31 Child Psychiatry

1082

31.1

Introduction: Infant, Child, and Adolescent Development Assessment, Examination, and Psychological Testing Communication Disorders 31.4a Language Disorder 31.4b Speech Sound Disorder 31.4c Child-Onset Fluency Disorder (Stuttering) Intellectual Disability

1226

1082

31.2

1236

1107 1118 1137 1137 1144

31.12c Disruptive Mood

31.3 31.4

Dysregulation Disorder 1242

31.12d Oppositional Defiant Disorder 31.12e Conduct Disorder

1244 1247

31.13 Anxiety Disorders of Infancy, Childhood, and Adolescence

1147

1253

xiv

Contents

32 Adulthood

31.13a Separation Anxiety

1325

Disorder, Generalized Anxiety Disorder, and Social Anxiety Disorder (Social Phobia)

33 Geriatric Psychiatry

1334

1253 1261

31.13b Selective Mutism

31.14 Obsessive-Compulsive Disorder in Childhood and Adolescence 31.15 Early-Onset Schizophrenia 31.16 Adolescent Substance Abuse 1273 31.17 Child Psychiatry: Other Conditions 1279 31.17a Attenuated Psychosis Syndrome 1279 31.17b Academic Problem 1280 31.17c Identity Problem 1282 31.18 Psychiatric Treatment of Children and Adolescents 1283 31.18a Individual Psychotherapy 1283 31.18b Group Psychotherapy 1288 31.18c Residential, Day, and Hospital Treatment 1291 31.18d Pharmacotherapy 1295 31.18e Psychiatric Treatment of Adolescents 1301 1263 1268

34 End-of-Life Issues

1352

34.1 Death, Dying, and Bereavement

1352 1359

34.2 Palliative Care

34.3 Euthanasia and Physician-Assisted Suicide

1370

35 Public Psychiatry

1374

36 Forensic Psychiatry and Ethics in Psychiatry

1381

36.1 Forensic Psychiatry 36.2 Ethics in Psychiatry

1381 1392

37 World Aspects of Psychiatry

1400

31.19 Child Psychiatry: Special Areas of Interest

1305

Glossary Signs and Symptoms in Psychiatry 1407 Index 1419

31.19a Forensic Issues in Child Psychiatry 1305 31.19b Adoption and Foster Care 1310 31.19c Child Maltreatment and Neglect 1314 31.19d Impact of Terrorism on Children 1320

About The Authors�

Benjamin J. Sadock, M.D. Benjamin James Sadock, M.D., is the Menas S. Gregory Profes- sor 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 NewYork Medi- cal College, and completed his internship at Albany Hospital. He completed his residency at Bellevue Psychiatric Hospital and then entered military service as Captain USAir force, where he served as Acting Chief of Neuropsychiatry at Sheppard Air Force Base in Texas. He has held faculty and teaching appoint- ments at Southwestern Medical School and Parkland Hospital in Dallas and at New York Medical College, St. Luke’s Hospi- tal, the New York State Psychiatric Institute, and Metropolitan Hospital in NewYork City. Dr. Sadock joined the faculty of the NYU School of Medicine in 1980 and served in various posi- tions: 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, Psychiat- ric 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 Hos- pital and is a Consulting Psychiatrist at Lenox Hill Hospital. Dr. Sadock is a Diplomate of the American Board of Psychia- try and Neurology and served as an Associate Examiner for the Board for more than a decade. He is a Distinguished Life Fellow of theAmerican PsychiatricAssociation, a Fellow of theAmerican College of Physicians, a Fellow of the New York Academy of Medicine, and a member of Alpha Omega Alpha Honor Soci- ety. 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 Con- tinuing 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 NewYork Medical College and was appointed Fac- ulty Scholar at NYU School of Medicine in 2000. He is the author or editor of more than 100 publications (including 49 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, skiing, traveling, and is an enthusiastic fly fisherman. Virginia A. Sadock, M.D. Virginia Alcott Sadock, M.D., joined the faculty of the NewYork 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 Medi- cal 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 devel- opmental 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 Psychia- try 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 Dis- trict 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 NYUAlumni Association of Sex Therapists. She has partici- pated in the National Medical Television Network series Women in Medicine and the Emmy Award–winning PBS television doc- umentary 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

xv

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About The Authors�

Houston, in Houston, Texas. He is a Distinguished Life Fellow of the American Psychiatric Association, a Fellow of the Ameri- can College of Psychiatrists, the American Association for Social Psychiatry, the Benjamin Rush Society and the Ameri- can 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 Psy- chiatric Administrators. He was President of the American Col- lege of Psychiatrists (2000–2001), the American Association for Social Psychiatry (2000–2002), the American Board of Psy- chiatry and Neurology (2002–2003), the American Psychiatric Association (2006–2007), and is currently President Elect of the World Psychiatric Association. He has served in more than 40 Editorial Boards, among them: TheAmerican Journal of Psy- chiatry, Psychiatric Services, The American Journal on Addic- tions, and World Psychiatry. He has received over 60 awards and honors, among them: The Administrative Psychiatry Award, Simon Bolivar Award, Tarjan Award, Nancy C.A. Roeske Cer- tificate of Excellence, and the Irma J. Bland Award from the American Psychiatric Association; also, the Bowis Award from the American College of Psychiatrists. He is the author or editor of more than 600 publications; he has delivered worldwide more than 200 grand rounds and invited lectures; he has also made more than 400 worldwide scientific presentations. He and his wife Angela have two children, Pedro Pablo and Angela Maria, and four grandchildren, Francisco Antonio, Pedro Pablo, Jr., Omar Joseph, III, and Pablo Antonio. Dr. Ruiz enjoys reading literary novels, theater, films, traveling, and fishing.

New York Medical College, and trained in psychiatry at Met- ropolitan 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 pharmaco- therapy. She and her husband have two children, James and Victoria, both emergency physicians, and two grandchildren, 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 Professor and Interim Chair of the Depart- ment of Psychiatry and Behavioral Sciences at the University of Texas Medical School at Houston. He graduated from medi- cal school at the University of Paris in France. He conducted his residency training in psychiatry at the University of Miami Medical School in Florida. He has held faculty appointments at a professorial level at Albert Einstein College of Medicine in NewYork City, and at Baylor College of Medicine and the Uni- versity of Texas Medical School at Houston. He has served in various positions: 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, all at Albert Einstein College of Medicine in New York City; Chief, Psychiatry 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 and Vice Chair of the Depart- ment of Psychiatry at the University of Texas Medical School at

1 Neural Sciences

patients in an optimal manner. If the brain is the organ of focus for mental illnesses, then it may be time to be more ambitious in building the classification of patients with mental illnesses directly from our understanding of biology, rather than only from the assessment of a patient’s symptoms. The Human Brain The following neural sciences sections each address a field of brain biology. Each of these fields could be relevant to the pathophysiology and treatment of mental illnesses. Although the complexity of the human brain is daunting compared with other organs of the body, progress can only be made if one approaches this complexity consistently, methodically, and bravely. The neuronal and glial cells of the human brain are orga- nized in a characteristic manner, which has been increasingly clarified through modern neuroanatomical techniques. In addi- tion, our knowledge of normal human brain development has become more robust in the last decade. The human brain clearly evolved from the brain of lower animal species, allowing infer- ences to be made about the human brain from animal studies. Neurons communicate with one another through chemical and electrical neurotransmission. The major neurotransmitters are the monoamines, amino acids, and neuropeptides. Other chemi- cal messengers include neurotrophic factors and an array of other molecules, such as nitric oxide. Electrical neurotransmis- sion occurs through a wide range of ion channels. Chemical and electrical signals received by a neuron subsequently initiate various molecular pathways within other neurons that regulate the biology and function of individual neurons, including the expression of individual genes and the production of proteins. In addition to the central nervous system (CNS), the human body contains two other systems that have complex, internal communicative networks: the endocrine system and the immune system. The recognition that these three systems communicate with each other has given birth to the fields of psychoneuro- endocrinology and psychoneuroimmunology. Another property shared by the CNS, the endocrine system, and the immune system is the regular changes they undergo with the passage of time (e.g., daily, monthly), which is the basis of the field of chronobiology. Psychiatry and The Human Brain In the first half of the 20 th century, the advances in psycho- dynamic psychiatry, as well as in social and epidemiological psychiatry, led to a separation of psychiatric research from the

▲▲ 1.1 Introduction The human brain is responsible for our cognitive processes, emo- tions, and behaviors—that is, everything we think, feel, and do. Although the early development and adult function of the brain are shaped by multiple factors (e.g., epigenetic, environmental, and psychosocial experiences), the brain is the final integrator of these influences. Despite the many advances in neural sci- ences over the last several decades, including the “decade of the brain” in the 1990s, and the wide acceptance of the brain as the biological substrate for normal and abnormal mental functions, there has not been a true transformational advance in the treat- ment of mental disorders for more than half a century. The most obvious reason for the absence of more progress is the profound complexity of the human brain. A perhaps less obvious reason is the current practice of psychiatric diagnosis, which, for most clinicians, is based on syndrome-based classification systems. The purpose of this chapter is to introduce the neural sciences sections, which describe the anatomy and function of the human brain, and then to discuss how an evolution of thinking toward a brain-based or biologically based diagnostic system for mental illness might facilitate our efforts to advance brain research, to develop better treatments , and to improve patient care. In other fields of medicine, diagnosis is based on physical signs and symptoms, a medical history, and results of labora- tory and radiological tests. In psychiatry, a diagnosis is based primarily on the clinician’s impression of the patient’s interpre- tation of his or her thoughts and feelings. The patient’s symp- toms are then cross-referenced to a diagnostic or classification manual (e.g., Diagnostic and Statistical Manual of Mental Dis- orders [DSM-5], International Statistical Classification of Dis- eases and Related Health Problems [ICD]) containing hundreds of potential syndromes, and one or more diagnoses are applied to the particular patient. These standard classification systems represent significant improvements in reliability over previous diagnostic systems, but there is little reason to believe that these diagnostic categories are valid, in the sense that they represent discrete, biologically distinct entities. Although a patient with no symptoms or complaints can be diagnosed as having diabe- tes, cancer, or hypertension on the basis of blood tests, X-rays, or vital signs, a patient with no symptoms cannot be diagnosed with schizophrenia, for example, because there are no currently recognized objective, independent assessments. The goals of clinicians and researchers are to reduce human suffering by increasing our understanding of diseases, develop- ing new treatments to prevent or cure diseases, and caring for

1