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Authors: Sadock, Benjamin James; Sadock, Virginia Alcott

Title: Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th Edition

Copyright ©2007 Lippincott Williams & Wilkins

> Front of Book > Authors

Authors

Benjamin James Sadock M.D.

Menas S. Gregory Professor of Psychiatry and Vice Chairman

Department of Psychiatry, New York University School of Medicine; Attending Psychiatrist, Tisch Hospital; Attending Psychiatrist, Bellevue Hospital Center; Consulting Psychiatrist, Lenox Hill Hospital, New York, New York

Virginia Alcott Sadock M.D.

Professor of Psychiatry

Department of Psychiatry, New York University School of Medicine; Attending Psychiatrist, Tisch Hospital; Attending Psychiatrist, Bellevue Hospital Center, New York, New York

Contributing Editors

Jack A. Grebb M.D.

Professor of Psychiatry

Department of Psychiatry, New York University School of Medicine, New York, New York; Vice President, Clinical Design and Evaluations, Neuroscience, Bristol-Myers Squibb, Walingford, Connecticut

Caroly S. Pataki M.D.

Clinical Professor of Psychiatry and the Biobehavioral Sciences

Keck School of Medicine at the University of Southern California; Director, Child and Adolescent Psychiatry Residency Training Program, University of Southern California, Los Angeles, California

Norman Sussman M.D.

Professor of Psychiatry

New York University School of Medicine; Co-director, Continuing Education in Psychiatry, Department of Psychiatry; Associate Dean for Postgraduate Programs, NYU Postgraduate Medical School; Attending Psychiatrist, Tisch Hospital, New York, New York

Secondary Editors

Charles W. Mitchell

Acquisitions Editor

Katey Millet

Developmental Editor

Joyce A. Murphy

Managing Editor

Bridgett Dougherty

Production Editor

Benjamin Rivera

Manufacturing Manager

Stephen Druding

Designer Coordinator

Aptara, Inc.

Compositor

Quebecor World-Taunton

Printer

Authors: Sadock, Benjamin James; Sadock, Virginia Alcott

Title: Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th Edition

Copyright ©2007 Lippincott Williams & Wilkins

> Front of Book > Dedication

Dedication

To Celia and Emily

Authors: Sadock, Benjamin James; Sadock, Virginia Alcott

Title: Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th Edition

Copyright ©2007 Lippincott Williams & Wilkins

> Front of Book > Preface

Preface

This is the tenth edition of Kaplan & Sadock's Synopsis of Psychiatry to appear since its founding over 35 years ago and the second edition to be published in the 21st century. 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. Each edition is thoroughly updated and the textbook has the reputation of being an independent, consistent, accurate, objective, and reliable compendium of new events in the field of psychiatry.

Synopsis serves the needs of diverse professional groups: psychiatrists and nonpsychiatric physicians, medical students, psychologists, social workers, psychiatric nurses, and other mental 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 Synopsis' wide acceptance and use, both in the United States and around the world.

History

This textbook evolved from our experience editing the Comprehensive Textbook of Psychiatry. That book is nearly 4,000 double-column pages long, with more than 400 contributions by outstanding psychiatrists and behavioral scientists. It serves the needs of those who require an exhaustive, detailed, and encyclopedic survey of the entire field. In an effort to be as comprehensive as possible, the textbook spans two volumes to cover the material, clearly rendering it unwieldy for some groups, especially 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 psychopharmacology. We wish to acknowledge our great and obvious debt to more than 2,000 contributors to the current and previous 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

The textbook forms one part of a comprehensive system developed by us to facilitate the teaching of psychiatry and the behavioral 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. A special edition of Synopsis, Concise Textbook of Clinical Psychiatry contains descriptions of all psychiatric disorders, including their diagnosis and treatment. It 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 pocket handbooks: Pocket Handbook of Clinical Psychiatry, Pocket Handbook of Psychiatric Drug Treatment, Pocket Handbook 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, respectively, and are designed and written to be carried in the pocket by clinical clerks and practicing physicians, whatever their specialty, to provide a quick reference. Finally, Comprehensive Glossary of Psychiatry and Psychology provides simply written definitions for psychiatrists and other physicians, psychologists, students, other mental health professionals, and the general public. Together, these books create a multiple approach to the teaching, study, and learning of psychiatry.

Classification of Disorders

DSM-IV-TR

A revision of the fourth edition of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), called DSM-IV-TR (TR stands for text revision), was published in 2000. It contains the official nomenclature used by psychiatrists and other mental health professionals 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-IV-TR.

ICD-10

Synopsis was the first U.S. textbook to include the definitions and diagnostic criteria of mental disorders used in the tenth revision of the World Health Organization's 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 World Health Organization, the diagnostic code numbers must be identical to ensure uniform reporting of national and international psychiatric statistics. Currently, both DSM and ICD diagnoses and numerical codes are accepted by Medicare, Medicaid, and private insurance companies for reimbursement purposes in the United States. Readers can find the DSM-IV-TR classification with the equivalent ICD-10 classification listed in Chapter 9. Color cues differentiate DSM and ICD diagnostic tables as a further aid to the reader.

Cover Art and Illustrations

Synopsis was one of the first modern psychiatric textbooks to use art and photographs to illustrate psychiatric subjects to enrich the learning experience.

The cover art is entitled Melancholy by the Norwegian artist, Edvard Munch (1863–1943). In this painting, the limp female figure with her hidden face is stooped over and unable to raise her eyes to view the beautiful landscape of the fjords which normally lighten the mood of those who gaze on them. To Munch, the inability to obtain pleasure coupled with withdrawal and introversion were the hallmarks of melancholic depression.

Color plates of all psychiatric drugs and their dosage forms, including all new drugs developed since the last edition was published, are also included, as in all Kaplan & Sadock books. New illustrations and color plates have been added to many sections.

Case Histories

Case histories, which make clinical disorders more vital for the student, are an integral part of Synopsis. All cases in this edition are new, derived from various sources: ICD-10 Casebook, DSM-IV-TR Casebook, DSM-IV-TR Case Studies, contributors to the Comprehensive Textbook of Psychiatry, and the authors' clinical experience at New York's Bellevue Hospital Center. We especially wish to thank the American Psychiatric Press and the World Health Organization for permission to use many of their cases. Cases appear in tinted type to help the reader find them easily.

New and Updated Sections

Chapter 1, The Patient-Doctor Relationship, has been rewritten to reflect new concepts in the complex relationship between the doctor and his or her patient. A discussion of the “narrative”—the story the patient tells—and its effect on that interaction is also included. Chapter 2 has been expanded to include a comprehensive survey of normality. Aging is covered in a new section that considers the process not as a disease but as an evolving part of the life cycle and includes a thorough survey of normal aging.

Chapter 3, The Brain and Behavior, has been reorganized, revised, updated, and extensively rewritten. The section, Functional Neuroanatomy, emphasizes the influence of function rather than structure on behavior. The sections, Psychoneuroendocrinology, and Psychneuroimmunology and Chronobiology, have been expanded to reflect the rapid advances in these fields. A newly written section, Neurogenetics, details the important and complex role of genetics in both normal and abnormal behavior.

The chapter End-of-Life Care and Palliative Medicine has been updated and reflects the important role that psychiatrists play in the clinical specialty of palliative care and pain control. Too little time—especially in medical school—is provided in training students to care for the dying patient with sensitivity and compassion. The chapter, Psychiatry and Reproductive Medicine, was extensively revised both to keep pace with advances in women's health issues and to clarify the confusion surrounding antepartum and postpartum events, contraception, abortion, and the role of hormone replacement therapy in women's mental health.

The chapter Ethics in Psychiatry was completely revised and updated and includes an extensive discussion of the role of euthanasia and physician-assisted suicide and their impact on the practice of medicine.

The section Mental Disorders Due to a General Medical Condition contains an updated discussion of prion disorders and “mad cow disease.” In the last edition, the section Posttraumatic Stress Disorder and Acute Stress Disorder covered the tragic events of September 11, 2001, involving the World Trade Center in New York and the Pentagon in Washington. With the passage of time, we are now able to provide reliable data on the psychological sequelae of those events. Other disasters, however, have occurred since then, such as hurricane Katrina and the Pakistan earthquake in 2005. The psychological effects of those events are also covered. Two chapters, Anthropology and Cross-Cultural Psychiatry, and Cross-Cultural Syndromes, reflect the global scope of psychiatry and the need for clinicians to understand disorders that appear around the world. A new section called Brain Stimulation Methods describes many new advances in stimulating the brain in an effort to restore health to those patients who have not responded to conventional therapies and who are among the most severely mentally ill.

The sections on psychotherapy have been expanded with new, separate, and up-to-date discussions on genetic counseling, cognitive therapy, interpersonal therapy, hypnosis, and dialectical behavior therapy.

This edition continues the tradition of speaking out on sociopolitical issues that affect the delivery of health care. Practitioners have a special obligation to know about such issues that inform the physical and psychological well-being of their patients. Thus, discussions are included on the homeless mentally ill, deinstitutionalization, working conditions and number of hours medical house staff are on duty, the role of managed care in medicine and psychiatry, and the regulation of medicine by government agencies, among other areas of controversy.

Finally, every section on clinical psychiatry has been updated to include the latest information about diagnosing and treating mental disorders. The references are also completely up-to-date.

Psychopharmacology

The authors are committed to classifying drugs used to treat mental disorders according to their pharmacological activity and mechanism of action rather than using such broad categories as antidepressants, antipsychotics, anxiolytics, and mood stabilizers, which are overly broad and do not reflect, scientifically, 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 disorders; 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 classification. Information about all pharmacological agents used in psychiatry, including pharmacodynamics, pharmacokinetics, dosages, adverse effects, and drug–drug interactions, was thoroughly updated and includes all drugs approved since publication of the previous edition.

Childhood Disorders

The chapters, Adolescent Substance Abuse and Forensic Issues in Child Psychiatry, were revised and expanded to reflect the epidemic of illicit drug use among youth and the problems of violence and delinquency. Data about posttraumatic stress disorders in children have been added, including the latest data on the psychological effects on children exposed to terrorist activities and natural disasters. The section Anxiety Disorders was reorganized and updated thoroughly. Every clinical disorder section was updated and revised, especially those that deal with the use of pharmacological agents in children.

Acknowledgments

We deeply appreciate the work of our distinguished group of contributing editors, who gave generously of their time and expertise. Caroly Pataki, M.D., was responsible for updating and revising the section on childhood and adolescent disorders. 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 rapidly expanding field. We thank Jack Grebb, M.D., who guided us in the neural sciences and who was co-author of the seventh edition of Synopsis. He has an encyclopedic knowledge of the field from which we benefited immensely. 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 was so very helpful.

Nitza Jones played a key and invaluable role as Project Editor, as she has for many of our other books. Her vast knowledge of every aspect of book publishing was indispensable and she contributed heavily to editing the text. She was ably assisted by Regina Furner who also performed an invaluable service as Picture Editor. Both worked with enthusiasm, alacrity, and intelligence. Among the many others to thank are René Robinson, M.D., Caroline Press, M.D., Michael Stanger, M.D., Rajan Bahl, M.D., Samoon Ahmad, M.D., and Jay K. Kantor, Ph.D., all of whom contributed to the text. Seeba Anam, M.D., deserves special mention for her help in the section on Reproductive Psychiatry.

We also wish to acknowledge the contributions of James Sadock, M.D., and Victoria Gregg, M.D., for their help in their areas of expertise: emergency adult and emergency pediatric medicine, respectively.

We want to take this opportunity to acknowledge those who have translated this and other Kaplan & Sadock books into foreign languages, including Chinese, Croation, French, German, Greek, Indonesian, Italian, Japanese, Polish, Portuguese, Romanian, Russian, Spanish, and Turkish, in addition to a special Asian and international student edition.

The staff at Lippincott Williams & Wilkins was most efficient. We wish to thank Katey Millet for her prodigious efforts. We have been fortunate to have worked with her for many years on many projects and her help and support have been invaluable. Bridgett Dougherty at LW&W and Judi Rohrbaugh and Chris Miller at Aptara also deserve our thanks. Joyce Murphy, Managing Editor, and Charley Mitchell, Executive Editor, have been loyal friends over the years and their help and enthusiasm for our projects have been most welcome.

We especially want to acknowledge and thank Alan and Marilyn Zublatt for their generous support 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 thank them not only for ourselves but on behalf of all those at NYU—students, clinicians, and researchers—who have benefited from their extraordinary humanitarian vision.

Finally, we want to express our deep thanks to Robert Cancro, M.D., who retired after 28 years serving as Chairman of Psychiatry at New York University School of Medicine and who gave us his full support. He was succeeded as Chair in 2006 by Dolores Malaspina, M.D., to whom we extend a warm welcome as she leads the Department of Psychiatry at NYU into the 21st century.

B. J. S.

V. A. S.

New York University School of Medicine, New York, New York