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    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.

    Clinical Manual of Cultural Psychiatry

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    The interaction of culture and mental illness is the focus of the Clinical Manual of Cultural Psychiatry, which is designed to help mental health clinicians become culturally competent and skilled in the treatment of patients from diverse backgrounds. The product of nearly two decades of seminar experience, the book teaches clinicians when it is appropriate to ask «Is what I am seeing in this patient typical behavior in his or her culture?» The ability to see someone else's worldview is essential for working with ethnic minority and culturally diverse patients, and the author, who designed the course that was this handbook's precursor, has expanded the second edition to take into account shifting demographics and the changing culture of mental health treatment.The content of the new edition has been completely updated, expanded to include new material, and enhanced by innovative features that will prove helpful for mental health clinicians as they encounter diverse patient populations. The new chapter on women reflects the fact that mental health disparities extend beyond ethnic minorities. Women have significantly higher rates of posttraumatic stress disorder and affective disorders, for example, yet research on women has been limited largely to the relationship between reproductive functioning and mental health. Two new chapters address the alarming number of unmet mental health needs that lesbian, gay, bisexual, and transgender patients suffer from. These chapters emphasize the need for mental health providers and policy makers to remedy these disparities. A new chapter has been added to help clinicians determine the role religious and spiritual beliefs play in psychological functioning, because religious and spiritual beliefs have been found to have both positive and negative effects on mental health. The newly introduced DSM-5® Cultural Formulation Interview (CFI) is addressed in the book's introduction and is included in its entirety, along with an informant module, 12 supplementary modules, and guidelines for their use in a psychiatric assessment. In addition, the reader has access to videotaped examples using simulated patients to illustrate practical application of the DSM-5® Outline for Cultural Formulation and CFI. Extensive information on ethnopsychopharmacology, reviewing clinical reports of ethnic variation with several different classes of psychotropic medications and examining the relationship of pharmacogenetics, ethnicity, and environmental factors to pharmacologic treatment of minorities. The book updates coverage of African American, Asian American, Latino/Hispanic, and Native American/Alaskan Native cultures as they relate to mental health issues while retaining the nuanced approach that was so effective in the first edition. Course-tested and DSM-5® compatible throughout, the Clinical Manual of Cultural Psychiatry is a must-read for clinicians in our diverse era.

    Bipolar Depression

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    Although depression is the most common presentation of bipolar disorder, correct diagnosis generally requires a history of mania and thus presents a formidable challenge. This book provides clinicians with the necessary guidance to distinguish this illness and pursue an appropriate therapeutic course. It brings together a team of clinical investigators who offer cutting-edge research on the topic and address the most critical concerns regarding its treatment.Bipolar Depression first introduces a hierarchical model for diagnosis to allow the clinician to distinguish between bipolar and unipolar depression, addressing problems of misdiagnosis and overdiagnosis as well as differentiating attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder. Early chapters review the neurobiology and genetics of this highly heritable condition, presenting studies of neurotransmitter function and brain imaging studies and documenting the susceptibility of specific chromosomes as loci for bipolar disorder. Other chapters address the particular issues of bipolar depression in children, for whom a diagnosis is especially problematic, and suicide, focusing on the need for assessment during both acute and maintenance treatment with interventions appropriate to a patient's symptoms and history. Bipolar Depression offers critiques of specific treatment approaches: Lithium and antiepileptic drugs: featuring a review of the most recent research on the use of lithium, in which higher doses are shown to be effective, plus coverage of lamotrigine, valproic acid, carbamazepine, oxcarbazepine, and topiramate. Antidepressants: offering new perspectives on a complex field, including a discussion of the randomized clinical trial literature and observational studies on their use, and citing cautions regarding side effects. Antipsychotics: evaluating the difference between first- and second-generation medications and discussing their role in controlling acute depressions. Novel approaches to treatment: including the use of atypical neuroleptics, electroconvulsive therapy, transcranial magnetic stimulation, vagus nerve stimulation, ketogenic diet, omega-3 fatty acids, myo-inositol, and dopamine agonists. Psychological interventions: focusing on the inclusion of cognitive-behavioral therapy or interpersonal social rhythm therapy for nonmelancholic depressions in patients who had previously received psychoeducation. Despite the past decade's advances in practice and research, there remains much room for progress in understanding and treating bipolar depression. This book blazes a trail toward that goal, opening new doors in recognizing differences between bipolar and unipolar forms of depression while offering both researchers and clinicians key insights into this troubling illness.