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    Age and Gender Considerations in Psychiatric Diagnosis

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    Written to help identify major gaps in our knowledge of how gender and age affect psychiatric diagnoses and to stimulate much-needed research to fill these gaps, Age and Gender Considerations in Psychiatric Diagnosis serves as both a valuable short-term source for the DSM-V Task Force and its disorder-specific workgroups, and a long-term guide for future studies that will contribute to revised psychiatric classifications in these three areas.Here, 47 experts present findings in three areas of psychiatric research that historically have been neglected but rightfully have received increasing attention in recent years and thus are worthy of investigation into their clinical features, etiology, and course:1. Significant gender differences in prevalence, symptom profiles, and risk factors for mental disorders, including neurodevelopmental, neurophysiological, and environmental factors for men and women that cut across diagnostic categories-for example, the critical importance of gender in how psychiatric illness develops and presents; DSM's approach to gender to date; and relevant research findings and gaps in the epidemiology, etiology, and pathophysiology of disorders and the gender-related expression of psychopathology, including the controversial and complex question of whether DSM should have different diagnostic criteria for men and women.2. Mental disorders in infancy and early childhood, including diagnosis and measurement of psychopathology; PTSD and social and cognitive factors related to the experience of stress; reactive attachment disorder (unique in part because of its specificity to early childhood); mood and anxiety disorders and difficulties in diagnosis; sleep disorders, including two new disorders, Night-Waking Dysomnia and Sleep-Onset Dysomnia; feeding disorders, including the need to address overeating and overfeeding (especially given the alleged U.S. epidemic of obesity); early childhood manifestations of behavior disorders; and early symptoms and diagnosis of autism.3. Mental disorders in the elderly, such as dementia and depression, once considered normal consequences of aging but now understood to represent mental disorders, including the need to identify specific brain structure abnormalities, biomarkers, and the many contributing biological, psychosocial, and environmental factors of mental illness in late life and to understand their roles in the elderly to better diagnose and monitor disease progression.Written for clinicians and researchers alike, this thought-provoking compendium contributes critical information that helps enhance our understanding of the causes of mental disorders, develop effective preventive and treatment interventions, and inform future editions of DSM and ICD.

    Entering Private Practice

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    Packed with practical advice from experts, and based on the editor's many years of organizing career seminars for psychiatric residents, Entering Private Practice: A Handbook for Psychiatrists offers a comprehensive curricular approach – highlighted throughout by user-friendly forms, samples, and checklists – to setting out on a career in private practice.Entering Private Practice: A Handbook for Psychiatrists details the advantages and disadvantages of private practice and emphasizes that practitioners must love their work and balance it with a successful personal life. Following a systematic, no-nonsense approach to private practice, these distinguished contributors discuss the nuts and bolts of how to, Find and set up a private practice, including the use of technology and the web to minimize administrative overhead and enhance clinical services – A self-administered form to get started; advice on finance, Internet searches, networking, and interviewing; pros and cons of solo practice, small and large psychiatric groups, and multidisciplinary and multispecialty groups; and step-by step instructions on everything from choosing a location and handling finances and billing to hiring staff and selecting décor Market a practice – Top 10 tips for both internal marketing (advice for communicating with patients and sample patient and physician surveys), and external marketing (effective outlets, including directory listings, brochures and sample content, direct mail, and the media; includes sample press release and media pitch) Navigate the ins and outs of insurance billing and relationships – Basic principles and procedures to help practitioners do good work for reasonable pay and help patients get what they most need despite limited resources (including Medicare forms and checklists for understanding insurance benefits and notifying patients about the costs of ancillary services) Relate to primary care physicians – Integration of care (referral, consultation, and collaboration) to achieve better patient outcomes, including basic principles and skills for effective communication Steer clear of legal pitfalls – The top 10 legal and risk management areas of concern for psychiatrists, including practice rules, confidentiality, record-keeping, compliance, managed care, and malpractice insurance, among others Avoid or deal with common ethical problems – Confidentiality, informed consent, boundaries, dealing with industry, continuing education responsibilities, general health care ethics, collaboration, and money issues illustrated by case vignettes Joining the ranks of essential guides, Entering Private Practice: A Handbook for Psychiatrists is a must-read for any psychiatrist planning a career in or a career change to private practice.

    Dimensional Models of Personality Disorders

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    DSM-IV and ICD-10 both diagnose personality disorders categorically, yet studies indicate that many patients meet criteria for an excessive number of diagnoses, raising the question of whether personality disorders are discrete conditions or rather distinctions along dimensions of general personality functioning. This collection of papers renews long-standing proposals for a dimensional model of personality disorder, describing alternative models, addressing questions about their clinical application and utility, and suggesting that future research seek to integrate such models within a common hierarchical structure.With contributions by preeminent researchers in the field, Dimensional Models of Personality Disorders is drawn from a conference series convened by APA, WHO, and NIH in order to plan for the fifth edition of the DSM. The Nomenclature Work Group concluded that consideration should be given to basing part or all of DSM-V on dimensions rather than categories, and recommended that a dimensional model for personality disorders should serve as a basis for exploring dimensional approaches in other areas. Accordingly, the volume opens with a presentation of 18 proposals for dimensional models and proceeds with provocative contributions on a number of related issues ranging from hard science to clinical practice. Among the topics addressed are Behavioral and molecular genetic research supporting an etiologically informed dimensional classification of personality disorders The as-yet tenuous associations between dimensional trait measures of personality as contained in the models of Cloninger, Depue, and Siever-Davis, and specific neurobiological measures, as examined in neurotransmitter research Potential links between childhood and adolescent temperament and personality dimensions and adult personality psychopathology Studies examining the covariation of personality dimensions across cultures The continuity of Axis I and Axis II disorders and a proposed hierarchical structure of mental disorders that integrates the psychopathology of Axis I disorders with specific personality traits The dual challenges of coverage and cutoffs that must be addressed if dimensional models are to be considered viable alternatives to the existing categorical diagnostic system Although the editors acknowledge that concerns are certain to be raised regarding conversion to a dimensional classification – such as the disruption to clinical practice by a radical shift in diagnosing personality disorder – these papers make a strong case for opening the field to alternative ways of enhancing clinical utility and improving the validity of basic classification concepts. Together, they offer stimulating insight into how we approach personality disorders, with the hope of encouraging a new model of diagnosis for DSM-V.

    Depression and Personality

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    Depression and Personality: Conceptual and Clinical Challenges offers an intriguing new look at where we are in understanding the relationship between personality dimensions, disorders, and mood disorder. It is both a cogent update of conceptual models and a clearly written, practical guide to the challenges faced every day by clinicians as they treat patients with depression and bipolar disorder.Laying the groundwork for subsequent chapters, the editors emphasize the value of not only robust pharmacotherapy augmented by psychosocial interventions (with a focus on the assets rather than the liabilities of a patient's temperament), but also of a detailed review of where we are today. An introductory overview provides valuable historical perspective on the evolution of personality from «humors» to body constitution and temperament. In 10 informative chapters, 22 contributors discuss The neurobiological dimensions of personality, focusing on affect-related traits as they review the evidence for serotonin and norepinephrine disturbance based on challenge paradigms, and the range of models to understand the interrelationship between personality and depression. The justification for depressive personality in both categorical terms, i.e., adding to the diagnostic armamentarium of DSM-V, and dimensional terms, focusing on the Five Factor Model to provide a link between several facets of neuroticism and depressive personality disorder. The impact of personality on various aspects of treatment, filling in a gap in the pharmacotherapy literature by asserting that personality pathology can affect the patient's capacity to seek, be engaged in, or be compliant with treatment. Key assessment and treatment issues, recommending a multimodal phased treatment approach that involves targeted pharmacotherapy and integrated individual psychotherapy. The role of personality disorder in the assessment and treatment of chronic depression, with a concise, practical overview of medication and psychotherapy issues regarding the role of Axis II disorders, and the complex relationship between bipolar disorder and personality factors. The complexity involved in adolescent depression with personality disorder, providing a conceptual framework for understanding what factors of personality contribute to vulnerability for depression in adolescents, and depression in later life, including particularly relevant issues such as the role of physical illness and organic factors on the clinical presentation of personality and affective disorder Invaluable reading for clinicians and researchers alike, Depression and Personality: Conceptual and Clinical Challenges offers fascinating perspectives on the historical antecedents, neurobiological dimensions, and conceptual models regarding the relationship between personality and depression.

    Community Child and Adolescent Psychiatry

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    Child psychiatrists and psychologists, clinical nurses, social workers, and other mental health practitioners working in the public sector – where limited funds, poverty, social environments, and bureaucracy add to the daily challenges – can now turn to Community Child and Adolescent Psychiatry for approaches and insights to make their work easier and more productive.Twenty chapters are divided into four main sections, where 31 seasoned clinicians and administrators detail the most useful tasks, strategies, and tactics for child and family-focused community mental health professionals: Multiple facets of public sector agency work with or consultation to community agencies from the major mental health disciplines employed in community settings, differentiating roles and responsibilities and detailing consultation phases, including pitfalls Basic community practice principles and issues commonly faced by public sector professionals, including particular types of agencies and differences between rural and urban practice Contemporary concerns about the impact of a managed care or cost-cutting environment on service delivery, including reimbursement, differentiating consultation from direct service, and the location of a system of care Descriptions of the setting or activity of each community agency, including the qualifications that allow the professional or trainee to enter and work in that system Practicalities of clinical practice or consultation or both in community settings in the current service environment Questions – from differing perspectives – that mental health care practitioners must consider before consulting to or assuming a staff or administrative position in a community agency, different types of demands – and discussion of/for each role Managed care has forever altered the service system landscape of mental health care in both the private and public sectors. Community Child and Adolescent Psychiatry provides insight into the public system of care and the requisite tools to manage the rapidly changing clinical, political, and administrative landscape. As a resource guide to the profession, Community Child and Adolescent Psychiatry emphasizes the practical necessities of child psychiatrists and other professionals working with mentally ill youngsters and their families in the practice of community psychiatry and public mental health. Trainees, practitioners, and administrators alike will welcome this indispensable road-map to a higher level of practice in community settings.

    Clinical Guide to the Treatment of the Mentally Ill Homeless Person

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    A case-based, clinical guide applicable to a variety of settings, this book offers evidence-based expert advice on the difficult challenges inherent in working with underserved homeless populations. The American Association of Community Psychiatrists' Clinical Guide to the Treatment of the Mentally Ill Homeless Person is a concise, practical work that gives busy clinicians the information they need; it not only is more up-to-date than existing publications, but also offers case- and site-based content that provides more hands-on, practical advice. Written by clinicians, for clinicians, it offers approaches to therapy and rehabilitation from the vantage point of the treatment environment, from street to housing and everything in between.The book reflects approaches to the clinical care of homeless people refined over two decades, building not only on the work of academic research but more importantly on the firsthand experience of clinicians. Its organization by treatment setting or specific subpopulation allows readers quick access to the chapters most relevant to their work. The first five chapters follow a sequence of naturalistic settings – such as shelters and the work of Assertive Community Treatment Teams – that demonstrate a model of engagement, intensive care, and ongoing rehabilitation. Subsequent chapters define specific scenarios that depict patients at various points on the engagement-rehabilitation continuum. Each chapter contains a clinical case example; guides to differential diagnosis, treatment planning, and accessing entitlements; and a flow chart for rehabilitation, including opportunities for student/resident or community involvement. The book emphasizes: A real-world orientation that provides a nuts-and-bolts approach to such cases as families, homeless children, veterans – even individuals in rural settings. Cases that enable readers to follow the progress of individuals as they progress through the network of care. The importance of Assertive Community Treatment and «housing first» models of rehabilitation. Data supporting the importance of Critical Time Intervention, particularly with regard to homeless families. Examples of clinical interviewing techniques for engagement and treatment of challenging individuals who are being seen in community settings. These illustrated techniques can be incorporated into educational curricula. This is an indispensable resource for any mental health professional working with homeless populations and is also useful for medical students' clinical rotation in community psychiatric settings. Its examples of clinically engaging the homeless person are equally instructive for teaching interviewing skills to any professionals – whether in law enforcement, social work, substance abuse treatment, or the clergy – who encounter these forgotten members of society.

    Advances in Treatment of Bipolar Disorder

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    Despite works published as recently as 2002, the continuing rapid evolution of new medications and adjunctive psychosocial interventions for bipolar disorder has made the concise Advances in Treatment of Bipolar Disorder essential for today's clinicians who want to stay abreast of the latest developments in treating this complex and challenging mental illness.Meticulously referenced with numerous tables and illustrations, Advances in Treatment of Bipolar Disorder offers a very timely and exciting perspective on new ways to treat bipolar disorder. After an overview, six succinct chapters written by experts review recent developments – emphasizing interventions supported by controlled studies – in the following areas: Advances in treatment of patients with acute mania: discussing newer antipsychotics, which as a class are effective as primary treatments for acute mania, and have emerging potential roles in maintenance treatment, and acute bipolar depression; and anticonvulsants, some of which are effective for as primary treatments for acute mania or maintenance, and others of which although not primary treatments for bipolar disorders may provide benefits as adjuncts for comorbid conditions. New developments in the treatment of acute bipolar depression: describing therapeutic options beyond mood stabilizers and highlighting that adjunctive use of antidepressants requires additional adequately powered controlled studies to support this common approach. Techniques in the maintenance treatment of patients with bipolar disorder: including both medications and adjunctive psychosocial therapies, which together can help clinicians manage medication adverse effects and maintain the therapeutic alliance, treatment adherence, and involvement of significant others to enhance outcomes. Innovations in the treatment of rapid-cycling bipolar disorder: although no treatment has received FDA approval for the management of this challenging presentation, results of controlled trials are beginning to provide clinically relevant insights in to the treatment of patients with rapid cycling, offering hope for more effective future therapies. The treatment of children and adolescents with bipolar disorder: no treatment has FDA approval for the treatment of pediatric patients with bipolar disorder and controlled data are limited, yet recent research is beginning to yield important new information about the diagnosis and management of children and adolescents with this illness or its putative prodromes. Phenomenology and management of bipolar disorder in women: introducing important new information to enhance clinicians' understanding of the importance of accounting for gender differences and reproductive health in the treatment of women with bipolar disorder. Advances in Treatment of Bipolar Disorder helps clinicians to better understand the utility of both older medications and important new treatment options as it highlights the need for additional research to ensure further progress in overcoming the challenges of caring for patients with bipolar disorder.

    Clinical Manual of Impulse-Control Disorders

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    Visibility of impulse-control disorders (ICDs) has never been greater than it is today, both in the field of psychiatry and in popular culture. Changes in both society and technology have contributed to the importance of conceptualizing, assessing, and treating impulse-control disorders (ICDs). The ground-breaking Clinical Manual of Impulse-Control Disorders focuses on all of the different ICDs as a group.Here, 25 recognized experts provide cutting-edge, concise, and practical information about ICDs, beginning with the phenomenology, assessment, and classification of impulsivity as a core symptom domain that cuts across and drives the expression of these complex disorders. Subsequent chapters discuss Intermittent explosive disorder, an often overlooked ICD characterized by impulsive aggression. Childhood conduct disorder and the antisocial spectrum. Self-injurious behavior and its relationship to impulsive aggression and childhood trauma. Sexual compulsions and their serious public health implications. Binge eating, a highly familial disorder associated with serious medical complications and psychopathology. Trichotillomania, which may be related to obsessive-compulsive disorder, skin picking, and nail biting. Kleptomania, a heterogeneous disorder that shares features with ICDs as well as with mood, anxiety, and addictive disorders. Compulsive shopping, more common in women, with treatments ranging from self-help and financial counseling to trials with selective serotonin reuptake inhibitors. Pyromania and how it differs from arson. Pathological gambling, a maladaptive behavioral addiction that is increasing in step with legalized and Internet gambling. Internet addiction, ranging from excessive seeking of medical information to dangerous sexual behaviors. The remarkable Clinical Manual of Impulse-Control Disorders sheds light on the complex world of ICDs. As such, it will be welcomed not only by clinicians and researchers but also by individuals and family members coping with these disorders.

    The American Psychiatric Publishing Textbook of Personality Disorders

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    This new edition of The American Psychiatric Publishing Textbook of Personality Disorders has been thoroughly reorganized and updated to reflect new findings, expanded treatment options and considerations, and future directions, such as translational research, enhancing the text's utility while maintaining its reputation as the foremost reference and clinical guide on the subject. In four exhaustive and enlightening sections, the book covers basic concepts of personality disorders, etiology, clinical assessment, diagnosis, and treatment, and it addresses special issues that may arise with specific populations or settings. In addition, the text offers many features and benefits: Several chapters describe the intense efforts to identify the scientifically strongest – and clinically relevant – approaches to conceptualizing and enumerating personality traits and pathology. The book does not sidestep ongoing controversies over classification but addresses them head-on by including chapters by experts with competing perspectives. The hybrid dimensional/categorical alternative model of classification for personality disorders included in the DSM-5 is included in an appendix and thoroughly referenced throughout the volume and discussed in detail in several chapters. Coverage of current research is up-to-date and extensive. Longitudinal naturalistic studies, which have shown surprising patterns of improvement in patients with selected personality disorders, as well as new and more rigorous treatment studies, have yielded critical findings in recent years, all of which are thoroughly addressed. Dozens of vivid and detailed case examples are included to illustrate diagnostic and treatment concepts. The editors have selected a roster of contributors second to none, and the text has been scrupulously edited for consistency of language, tone, and coverage. As clinical populations become better defined, new and more rigorous treatment studies are being conducted with increasingly promising results. The American Psychiatric Publishing Textbook of Personality Disorders offers clinicians, residents, and trainees in all disciplines a front row seat for the latest findings and clinical innovations in this burgeoning field.

    Textbook of Men's Mental Health

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    The first of its kind, this book reflects progress in a too-little explored corner of psychiatry to show that gender plays an integral role in mental health issues for men. Textbook of Men's Mental Health provides clinicians with the information they need for understanding how certain disorders manifest differently in men – and for recognizing how treatment responses in men differ from those in women. Multidisciplinary coverage in this groundbreaking guide draws from fields such as public health and substance abuse to create a well-rounded approach to addressing men's specific mental health problems.With contributions by today's experts in men's mental health, this work gathers the latest research about men's psychiatric issues, from the difficulties in diagnosing male depression to strategies for engaging men in marital therapy. First addressing developmental issues specific to childhood, adolescence, and old age, the text then presents treatment options for an array of problems, from anxiety to sexual disorders to posttraumatic stress disorder. This volume then addresses psychosocial issues as they apply uniquely to men, such as fathering, marriage, aggression, and overcoming the stigma of mental health treatment – as well as a chapter on how men's ethnicity influences the effectiveness of therapy. Among the topics discussed are how men behave in intimate relationships with women – and the mental health considerations unique to gay men psychiatric disorders more prevalent in men than women, such as substance abuse, antisocial personality, and conduct disorder up-to-date facts on male sexual functioning, covering erectile dysfunction, premature ejaculation, and male orgasmic disorder why disorders less common in men – anxiety, depression, PTSD – require different treatment than for women coverage of compulsive disorders seen in men both more frequently, such as pathological gambling and compulsive sexual behavior – and less frequently, such as kleptomania and compulsive buying insight into how body image, a problem usually associated with women, has become a serious health issue for men, as evidenced by eating disorders, muscle dysmorphia, and steroid abuse No previous text has addressed such a wide range of issues concerning men's mental health, presented here in evidence-based coverage featuring case vignettes, key points, practice guidelines, and an extensive reference list in each chapter. Clinicians who wish to make more prudent decisions regarding the care of men with mental health issues will find this text indispensable to their practice – and to the well-being of their male patients.