Troublesome Disguises E-Book

Dinesh Bhugra

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 579

Veröffentlichungsjahr: 2014

Beschreibung

Troublesome Disguises examines psychiatric conditions which are not necessarily uncommon, rare or exotic but are challenging for the clinician who may struggle to reach a diagnosis and to set up management strategies.

However, with familiarity, these conditions can and should be recognised. This new edition is an exercise in consciousness-raising as well as a warning to beware of diagnostic systems which, despite their many virtues, may become too influential and may perpetuate errors which are to the detriment of patients.

For the clinician struggling to understand and treat patients who fail to fit the usual diagnostic categories, Troublesome Disguises provides wise instruction in the virtue of entertaining doubts, as well as practical advice for the assessment and management of atypical cases.

Leseprobe

CONTENTS

Cover

Title page

Copyright page

Contributors

Preface

Part I: Challenging psychiatric conditions

Chapter 1: Shared pathologies

Definition

History

Clinical phenomena

Epistemology

Conclusion

References

Chapter 2: Paraphrenia

Introduction

Kraepelin’s paraphrenia

Paraphrenia revisited

Discussion

References

Chapter 3: Brief reactive psychoses

Introduction

Classification

Epidemiology

Treatment

Conclusion

References

Chapter 4: Cycloid psychoses

Historical aspects

Incidence

Symptoms and course of the group of disorders

Classification in ICD-10, DSM-IV, and DSM-V

Etiology and neurobiology

Therapy

Conclusion

References

Chapter 5: Borderline personality disorder

Phenomenology

Neurobiology

DSM-5 alternative model

Conclusion

References

Chapter 6: Recurrent self-harm

What is self-harm?

Prevalence and correlates of self-harm in the general population

Why do people engage in recurrent self-harm?

Clinicians’ attitudes toward self-harm

Economic costs

Treatments

Psychological interventions

Treatment in people with borderline personality disorder

Conclusion

References

Chapter 7: Finding the truth in the lies

Introduction

Current conceptualization of malingering

Alternative models of malingering

Symptom presentation and record review: Feigning of psychiatric symptoms

Objective personality measures

Conclusion

References

Chapter 8: Recurrent brief depression

Introduction

Development of the concept of recurrent brief depression

Recurrent brief depression in clinical studies

Underlying causes

Could RBD be treatable with psychotropic drugs?

Could RBD be treatable with psychological interventions?

Conclusion

Acknowledgments

References

Chapter 9: Conversion disorders

Introduction

Historical aspects

Epidemiology: Where are the conversion disorders of yesteryear?

Terminology: There’s a lot in a name!

Difficulties in diagnosing conversion disorders

Difficulty in understanding conversion disorders

Diagnosing conversion disorders

Nosological issues

Challenges in management and outcome

Conclusion

References

Chapter 10: ADHD controversies

Introduction

Genetic influences

Classification issues and ADHD: DSM-IV versus DSM5

Gender differences in ADHD

Comorbidity and ADHD

ADHD and bipolar disorder

Learning problems and ADHD

Inattentive ADHD

Conclusion

References

Chapter 11: Post-traumatic stress disorder

Introduction

History of PTSD

DSM and PTSD

Impact of DSM-5

Heterogeneity of PTSD

Role of impairment

The issue of caseness

Compensation and PTSD

Biological dysfunction or social construction?

References

Chapter 12: Bipolar disorder

Introduction

Manic-depressive illness

Bipolar disorder

Conclusion

Acknowledgments

References

Part II: Rare psychotic disorders

Chapter 13: Misidentification delusions

Introduction

Variety of misidentification delusions

Occurrence of misidentification delusions

Theoretical explanations

Conclusion

References

Chapter 14: Delirium

Introduction

Phenomenology

Etiology

Approach to diagnosis

Differential diagnosis

Conclusion

Case study

References

Chapter 15: Paraphilias and culture

Introduction

Definitions

Paraphilic disorder

Culture and the individual

Prevalence of paraphilias

Culture and the pedophilic disorder

Fetishistic disorder

Procreation or pleasure

Cultural behaviour or paraphilia?

Sexual masochism disorder

The biology of sexual behaviours

Conclusion

References

Chapter 16: Pseudodementia

Dementia

Pseudodementia

Neuropsychology, brain imaging, and other investigations

Conclusion

Acknowledgments

References

Chapter 17: Culture-bound syndromes

Introduction

Society and illness

Culture-bound syndromes in the diagnostic manuals (DSM and ICD)

Characteristics of culture-bound syndromes [10]

Specific culture-bound syndromes

The future of culture-bound syndromes

Conclusion

Acknowledgments

References

Chapter 18: Delusional infestations

Introduction

Historical context

Case presentation

Clinical features

Management problems and potential solutions

Conclusions

References

Chapter 19: Baffling clinical encounters

A puzzling encounter

The two solitudes

Bridging the two solitudes

Final remarks

References

Index

End User License Agreement

List of Tables

Chapter 03

Table 3.1 History of the concept of brief reactive psychosis and classification of brief reactive psychoses.

Chapter 05

Table 5.1 DSM-IV diagnosis of borderline personality disorder (at least 5 must be present).

Chapter 08

Table 8.1 Diagnostic criteria for “major” depressive disorders.

Table 8.2 Recurrent brief depression: the Zurich study criteria (from Angst and Dobler-Mikola [16]).

Table 8.3 Recurrent brief depression in ICD-10 and DSM-5.

Table 8.4 Proposed criteria for efficacy studies in recurrent brief depression (from Montgomery et al. [27]).

Chapter 09

Table 9.1 Clinical subtypes of conversion disorders.

Chapter 13

Table 13.1 Common misidentification delusions.

Table 13.2 Hypothesised deficits responsible for delusions.

Chapter 14

Table 14.1 Etiology of delirium: I WATCH DEATH.

Table 14.2 Risk factors for delirium.

Chapter 15

Table 15.1 Specific paraphilic disorders.

Table 15.2 Types of deviance and cultural-biological influences.

Table 15.3 Interaction between individuals and cultures.

Chapter 17

Table 17.1 Various culture-bound syndromes.

Table 17.2 Nosological interplay between psychiatric disorders and culture-bound syndromes [14].

Table 17.3 Findings of studies conducted in clinical settings (originally published in

Textbook of Cultural Psychiatry,

Bhugra D, Bhui K (eds.) [14]).

Chapter 18

Table 18.1 Minimal criteria for DI.

Table 18.2 Main differential diagnosis of DI.

Table 18.3 Some suggestions for approaching a patient with DI.

Chapter 19

Table 19.1 Psychiatric diagnoses (more than one diagnosis per patient),

N

=50.

Table 19.2 Pain somatic symptoms detected during the medical interview (more than one diagnosis per patient),

N

=50.

List of Illustrations

Chapter 03

Figure 3.1 Proposal for the revision of the classification of acute and transient psychotic disorders in ICD-11 [18]. The proposal mainly suggests subdividing the ICD-10 group of “acute and transient psychotic disorders” into a group of polymorphic brief psychotic disorders with symptoms of schizophrenia (ICD-11 B05), with primary delusional symptoms (ICD-11 B04) and in those without symptoms of schizophrenia (ICD-11 B02).

Figure 3.2 Temporal relationship between traumatic life events and psychotic disorders. Arrows indicate the occurrence of a catastrophic stressor. In the upper panel, psychotic symptoms occur immediately and with a rapid progression to a full psychotic clinical picture within a very short time (at most several days). Symptoms subside over weeks or months and full recovery is attained. Relapses (usually without a second stressor) may occur (indicated by the dotted line). In the lower panel, a traumatic event has no immediate temporal relationship with the psychotic symptoms, but may raise the susceptibility to subsequent stressors, which may not even reach the intensity of the first stressor (second stressor indicated by the dotted arrow).

Chapter 05

Figure 5.1 Sequential theoretical model of BPD pathogenesis.

Figure 5.2 Theoretical model of BPD symptom expression.

Chapter 17

Figure 17.1 Nosological timeline.

Figure 17.2 Number of publications on Brain Fag citations.

Chapter 18

Figure 18.1 Multiple excoriations and ulcers widely distributed in patient’s back.

Figure 18.2 Appearance of cutaneous lesions after healing.

Guide

Cover

Table of Contents

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Troublesome disguises

Managing challenging disorders in psychiatry

EDITED BY

Dinesh Bhugra

Professor of Mental Health and Cultural Diversity

Institute of Psychiatry, King’s College London

London, UK

Gin S. Malhi

Professor and Chair

Department of Psychiatry

Sydney Medical School

University of Sydney

Sydney, Australia

SECOND EDITION

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Library of Congress Cataloging-in-Publication Data

Troublesome disguises : managing challenging disorders in psychiatry / edited by Dinesh Bhugra, Gin S. Malhi. – Second edition.  p. ; cm. Includes bibliographical references and index.

 ISBN 978-1-119-99314-8 (cloth)I. Bhugra, Dinesh, editor. II. Malhi, Gin S., editor.[DNLM: 1. Mental Disorders–diagnosis. WM 141] RC469 616.89′075–dc23

    2014029376

A catalogue record for this book is available from the British Library.

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: Giuseppe Arcimboldo [Public domain], via Wikimedia Commons

Contributors

Richard AtkinsonConsultant Old Age Psychiatrist, Lancashire Care NHS Foundation Trust, Preston, UK

Oyedeji AyonrindeConsultant Psychiatrist, South London and Maudsley NHS Foundation Trust,London, UK

David S. BaldwinProfessor of Psychiatry and Head of Mental Health Group,Clinical and Experimental Sciences Academic Unit, Faculty of Medicine,University of Southampton, UK

Michael BerkIMPACT Strategic Research Centre, Deakin University, Department of Psychiatry,Orygen Research Centre, and The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Australia

German E. BerriosEmeritus Chair of the Epistemology of Psychiatry, Emeritus Consultant Neuropsychiatrist, Department of Psychiatry, University of Cambridge,Cambridge, UK

Dinesh BhugraProfessor of Mental Health and Cultural Diversity, Institute of Psychiatry,King’s College London, London, UK

Rohan BorschmannClinical Psychologist, Institute of Psychiatry, King’s College London, London, UK

Lise BouchardDirector of Research, Runajambi Institute for the Study of Quichua Culture and Health, Otavalo, Ecuador

Richard A. BryantSchool of Psychology, University of New South Wales, Sydney, Australia

Alistair BurnsProfessor of Old Age Psychiatry, Vice Dean for the Faculty of Medical and Human Sciences, National Clinical Director for Dementia in England,University of Manchester, Manchester, UK

Santosh K. ChaturvediDepartment of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India

Max ColtheartARC Centre of Excellence in Cognition and Its Disorders, and Department of Cognitive Science, Macquarie University, Sydney, Australia

Michael H. ConnorsDementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, Australia

Peter FalkaiDepartment of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany

Wolfgang GaebelDepartment of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, LVR-Clinics Düsseldorf, Düsseldorf, Germany

Alkomiet HasanDepartment of Psychiatry and Psychotherapy, Ludwig-Maximilians-University,Munich, Germany

Sean P. HeffernanSchweizer Fellow in Affective Disorders, Johns Hopkins Hospital, Baltimore, Maryland, U.S.

Mario IncayawarDirector, Runajambi Institute for the Study of Quichua Culture and Health,Otavalo, Ecuador

David JolleyHonorary Reader in Psychiatry of Old Age, Personal Social Services Research Unit,University of Manchester, UK

Robyn LangdonARC Centre of Excellence in Cognition and Its Disorders, and Department of Cognitive Science, Macquarie University, Sydney, Australia

Florence LevySchool of Psychiatry, University of New South Wales and Prince of Wales Hospital, Sydney, Australia

Constantine LyketsosElizabeth Plank Althouse Professor and Chair of Psychiatry, Johns Hopkins Bayview Professor of Psychiatry and Behavioral Sciences, Baltimore, Maryland, U.S.

Berend MalchowDepartment of Psychiatry and Psychotherapy, Ludwig-Maximilians-University,Munich, Germany

Sioui Maldonado-BouchardResearch Associate, Runajambi Institute for the Study of Quichua Culture and Health, Otavalo, Ecuador

Gin S. MalhiProfessor and Chair, Department of Psychiatry, Sydney Medical School,University of Sydney, Sydney, Australia

Ivana S. MarkováReader/Honorary Consultant in Psychiatry, Centre for Health and Population Sciences, Hull York Medical School, University of Hull, Hull, UK

Paul MoranReader/Honorary Consultant Psychiatrist, Institute of Psychiatry, King’s CollegeLondon, London, UK

Karin NeufeldClinical Director of Psychiatry, Johns Hopkins Bayview Associate Professor of Psychiatry and Behavioral Science, Baltimore, Maryland, U.S.

Esther OhAssistant Professor, Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Associate Director, the Johns Hopkins Memory and Alzheimer’s Treatment Center, Baltimore, Maryland, U.S.

John M. OldhamSenior Vice President and Chief of Staff, The Menninger Clinic,Barbara and Corbin Robertson Jr. Endowed Chair for Personality Disorders,Professor and Executive Vice Chair, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, U.S.

Soumya ParameshwaranDepartment of Psychiatry, Kasturba Medical College, Mangalore, India

Andrea SchmittDepartment of Psychiatry and Psychotherapy, Ludwig-Maximilians-University,Munich, Germany

Julia M. SinclairSenior Lecturer in Psychiatry, Clinical and Experimental Sciences Academic Unit,Faculty of Medicine, University of Southampton, UK

Holly TabernikDepartment of Psychiatry and Health Behavior, Georgia Regents University, Augusta, Georgia, U.S.

Julio ToralesProfessor of Psychiatry and Medical Psychology and Head of the Psychodermatology Unit, Department of Psychiatry, School of Medical Sciences,National University of Asunción, Paraguay

Michael J. VitaccoDepartment of Psychiatry and Health Behavior, Georgia Regents University, Augusta, Georgia, U.S.

Jüergen ZielasekDepartment of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, LVR-Clinics Düsseldorf, Düsseldorf, Germany

Preface

As a profession, psychiatry is often seen as a specialty where the classification of symptoms into syndromes is both arbitrary and varied. This perception belies the fact that clinical diagnosis is difficult per se, and especially so when considering perturbations of the mind. With an increased demand for services for people with mental health problems, and ever increasing numbers of diagnoses and subtypes, it is inevitable that clinicians may find the process challenging and may sometimes struggle to assign diagnoses with precision. Consequently, many psychiatric illnesses remain underdiagnosed, whereas others are overdiagnosed or misdiagnosed altogether. As with all rare diagnoses in medicine, unusual psychiatric illnesses remain rare, which makes them not only exotic but much more difficult to recognise. But these are not solely taxonomic or epidemiological considerations. They exact a considerable clinical cost: following misdiagnosis or missed diagnosis, patients, their families, and their caregivers continue to suffer, and the burden of disease continues to mount. Clinical experience has shown quite clearly that the longer a diagnosis is missed and remains inadequately treated, the greater the likelihood that the condition will become refractory and cause ongoing distress to those affected. The diagnosis of disease is the responsibility of physicians, whereas patients want treatment for their ailments and illnesses and lessening of their suffering. Hence there is an inherent tension within the therapeutic encounter and alliance, a theme revisited in many of the chapters in this book.

The first edition of this volume, with Professor Alistair Munro as co-editor, appeared in 1997. In the intervening period, psychiatry as a profession as well as psychiatric diagnoses have evolved considerably, highlighted most notably perhaps by the recent publication of DSM-5 and the impending arrival of ICD-11. This second edition is testament to the success of the first edition but at the same time has been completely rewritten so as to detail further some of the older conditions and provide important updates; in addition, it includes many new conditions that appear for the first time. The rates of these psychiatric diagnoses range from commonplace to rare, but all are essential knowledge for practising clinicians, who need to be aware of both frequent and extraordinary conditions that pose diagnostic conundrums and can be difficult to define. We hope that this combination of theoretical and practical considerations of various psychiatric conditions will prove useful to clinicians and researchers alike, and hence many of the clinical conditions described herein are not unusual, but are simply conditions that are often overlooked or difficult to delineate.

We envisage that readers will benefit by using the contributions to enhance their clinical awareness of these potentially troublesome diagnoses and exercise caution in blindly following any classificatory system and its unsophisticated application across populations, contexts, and cultures. In practice, the errors both of commission and omission need to be revisited on a regular basis and we hope that this volume will facilitate critical consideration of diagnosis and thereby diminish the likelihood of misdiagnosis and missed diagnoses.

We are indebted to the many contributors who have selflessly shared their expertise, experience, knowledge, and skills. In addition to thanking them, we would also like to express our gratitude to Dr Joan Marsh, formerly at Wiley-Blackwell, and her team. Finally, our thanks would not be complete without acknowledging the sterling efforts of Andrea Livingstone, who guided this project with sage diplomacy and delightful spirit.

Dinesh Bhugra and Gin S. Malhi

Part IChallenging psychiatric conditions

Chapter 1Shared pathologies

German E. Berrios1 and Ivana S. Marková2

1Emeritus Chair of the Epistemology of Psychiatry, Emeritus Consultant Neuropsychiatrist, Department of Psychiatry, University of Cambridge, Cambridge, UK

2Reader/Honorary Consultant in Psychiatry, Centre for Health and Population Sciences, Hull York Medical School, University of Hull, Hull, UK

Definition

Until recently “Shared Pathologies” was the official DSM-IV-T [1] name for clinical phenomena having in common the fact that persons, through their socio-emotional relationships, may share mental symptoms or disorders similar in form and/or content. Such temporal concurrence has led clinicians to calling such complaints shared, communicated, transferred, or passed on. Although the A + B combination (folie à deux) is the commonest form of the disorder, this can also occur in families (folie à famille) or even larger social groups (schools or other institutions). This, together with the fact that the terms shared and communicated are (covertly) explanatory, has impeded the formulation of an adequate operational definition.