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Schizophrenia Overview - Clinical Presentation

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M2 Psychiatry- Lecture Notes: Anxiety Disorders

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Includes bibliographical references and index. ISBN pbk. Lynall, Mary-Ellen, author.


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Saunders, Kate, author. Harrison, P. Paul J. Preceded by work : IV. Title: Psychiatry. Mental Disorders—Handbooks. WM 34] RC Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. Cover image: iStockphoto. Contents Foreword by Professor John Geddes, vi Preface, vii Acknowledgements, viii Quick guides, 1 History-taking checklist, 1 Mental State Examination checklist, 2 Structure of a psychiatric case presentation, 3 1 Getting started, 5 2 The basic psychiatric assessment, 9 3 Diagnosis-specific assessments, 19 4 Risk: harm, self-harm and suicide, 40 5 Completing and communicating the assessment, 47 6 What causes mental health problems?

Foreword When Paul Harrison, Mike Sharpe and I were offered the chance to take over the eighth edition of Lecture Notes in Psychiatry in , we spent a great deal of time together thinking through the structure of a book that would portray psychiatry as the evidence-based, patient-oriented branch of medicine that we knew it could be. We wanted to apply the principles of clinical epidemiology — not just in our recommen- dations around use of treatments but also to challenge traditional approaches to history and examination taking in psychiatry.

The Oxford University Department of Psychiatry is proud of its heritage of producing and updating its suite of textbooks, a process initiated by Michael Gelder when he was the first Head of Department. To an extent, all textbooks are out of date as soon as they are published but even with the developments in information technology, a concise, portable, pa- per textbook containing an up-to date synthesis of current knowledge occupies its own niche and still has a major role in training.

Frequent revisions and updating are, however, critical to keep them accurate and useful. This is hard work of course and after three editions, Paul, Mike and I felt that we could not face revising the book again!

Lecture Notes Psychiatry

It is marvellous to see that Gautam, Mary-Ellen and Kate have done so with such aplomb, keeping what remains useful from earlier editions but updating it with great skill. John Geddes 7. Preface The skills, attitudes and knowledge inherent in learn- ing psychiatry are relevant to all doctors — and to all other health professionals.

We have written this book with medical students and psychiatric trainees in mind, but anticipate it being a useful resource for any health professional interested in the subject. We describe a practical approach towards psy- chiatry.


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Chapter 1 outlines the principles behind the practice of modern psychiatry and introduces the psychiatric assessment. Our guide to assessment comprises a basic psychiatric assessment Chapter 2 , followed by diagnosis-specific assessments Chapter 3 and a guide to risk assessment Chapter 4. Chapter 5 describes how to draw everything together and com- municate the information to others.

The middle chapters cover the principles of aetiol- ogy Chapter 6 , treatment Chapter 7 and psychiat- ric services Chapter 8. The main psychiatric disor- ders of adults are covered in Chapters 9—15, followed by childhood disorders Chapter 16 and learning disability Chapter Chapter 18 discusses psychia- try in non-psychiatric medical settings — the place where most psychiatry actually happens.

Chapter 19 Mental health and the law is a new addition to the book and one you are likely to find useful in which- ever setting you work. Given our illustrious predecessors, we were hum- bled to be asked to write the 11th edition of Lecture Notes. Indeed we aimed to build upon the last edition of the book written so eloquently by Paul Harrison, John Geddes and Michael Sharpe. To facilitate learning, we have added learning ob- jectives at the start of each chapter and highlighted key points towards the end.

Multiple-choice ques- tions have been added, along with detailed explana- tions of the answers, to allow the reader to consoli- date key points. Links to key papers and guidelines have been added for readers keen to know more about a particular disorder. We hope we have done justice to the work started by Paul, John and Michael in keeping this Lecture Se- ries book both informative and enjoyable. We thank Jonathan Price, who was instrumental in drawing our team together and in setting the direc- tion in the early days of our writing. We are grateful to colleagues who have generously shared their exper- tise with us.

Acknowledgements We would like to thank the following people for their contribution to this book. Dr Jonathan Price University of Oxford for bring- ing the author team together, and for helping set the direction in the early days of our work on this edition of the book. Psychiatry Lecture Notes, Eleventh Edition.

In-patient treatment? Periods of abstinence? Similarly, conditions such as dementia may move be- tween psychiatry and neurology.

ISBN 13: 9780632088805

The conditions in which psychiatrists have devel- oped expertise have tended to be those that either manifest with disordered psychological function- ing emotion, perception, thinking and memory or those that have no clearly established biological ba- sis. However, scientific developments are showing us that these so-called psychological disorders are associated with abnormalities of the brain, just as so-called medical disorders are profoundly affected by psychological factors.

Consequently, the delinea- tion between psychiatry and the rest of medicine can increasingly be seen as only a matter of convenience and convention. Traditional assumptions, however, continue to in- fluence both service organization with psychiatric services usually being planned and often situated separate from other medical services and terminol- ogy see below.

Where is psychiatry going? Most psychiatric problems are seen and treated in primary care, with many oth- ers handled in the general hospital. Only a minor- ity are managed by specialist psychiatric services. So psychiatry should be learned and practised in these other settings too.

go to link Diag- nostic,prognosticandtherapeuticdecisionsshould, of course, be based on the best available evidence. It may come as a surprise to discover that current psy- chiatric interventions are as evidence-based and sometimes more so as in other specialties. Psychiatry can seem disconcertingly different from other specialties, especially if your first experience is on a psychiatric in-patient unit. How do I approach a patient? What am I trying to achieve? Is he or she dangerous? How does psychiatry relate to the rest of medicine?

This chapter is meant to help orientate anyone facing this situation. What is psychiatry? Psychiatry is, in fact, funda- mentally similar to the rest of medicine: the treat- ments used are primarily evidence-based, with suc- cess rates comparable with those in other specialties. Psychiatric patients are not a breed apart — psychiatric diagnoses are common in medical patients, and most patients with psychiatric disorders are treated in pri- mary care.

And psychiatrists are no stranger than other doctors, probably. Psychiatric disorders may be defined as illnesses that are conventionally treated with treatments used by psychiatrists, just as surgical conditions are those thought best treated by surgery.