Psichiatria

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 classificationAsuch as the disruption to clinical practice by a radical shift in diagnosing personality disorderAthese 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.

Seeking to integrate the large volume of clinical research on relational processes and mental health disorders with other scientific advances in psychiatry, Relational Processes and DSM-V builds on exciting advances in clinical research on troubled relationships. These advances included marked improvements in the assessment and epidemiology of troubled relationships as well the use of genetics, neuroscience, and immunology to explore the importance of close relationships in clinical practice. Advances in family-based intervention, and prevention are also highlighted to help practitioners and researchers find common ground and begin an empirically based discussion about the best way to revise the DSM. Given the overwhelming research showing that relationships play a role in regulating neurobiology and genetic expression and are critical for understanding schizophrenia, conduct disorder, and depression among other disorders, relational processes must be a part of any empirically based plan for revising psychiatric nosology in DSM-V. The chapters in this book counter the perspective that we can safely discard the biopsychosocial model that has guided psychiatry in the past. The contributors examine the relevance of close relationships in such issues as the basic psychopathology of mental disorders, factors influencing maintenance and relapse, sources of burden for family members, and guiding family-based interventions. By tying relational processes to basic research on psychopathology, they demonstrate the value of integrating basic behavioral and brain research with a sophisticated understanding of the self-organizing and self-sustaining characteristics of relationships. Coverage includes: -research linking relational processes to neuroscience, neurobiology, health outcomes, intervention research, prevention research, and genetics -consideration of specific circumstances, such as promoting healthy parenting following divorce and relational processes in depressed Latino adolescents -optimal approaches to the assessment of relational processes with clinical significance, such as child abuse, partner abuse, and expressed emotion. -a simple introduction to the methodology of taxometrics, offering insight into whether key relational processes are distinct categories or continuously distributed variables -an overview of the links between relational processes and psychiatric outcomes, providing a theoretical foundation for the discussion of links to psychopathology Together, these contributions seek to develop a shared commitment among clinicians, researchers, and psychopathologists to take seriously the issue of relational processes as they relate to diagnoses within DSM-and to encourage mental health care workers at all levels to harness the generative and healing properties of intimate relationships and make them a focus of clinical practice. It is a book that will prove useful to all who are interested in integrating greater sensitivity to relational processes in their work.

American Psychiatric Association (APA) Practice Guidelines provide recommendations to help psychiatrists make treatment decisions that are supported by the best available evidence, including from current research and expert consensus. The guidelines are developed by expert work groups, who review available evidence using an explicit methodology. Iterative drafts undergo wide review by other experts, allied organizations, and the APA membership. Every guideline is also reviewed and approved for publication by the APA Assembly and Board of Trustees. This process balances the conclusions of scientific research with the practical experience of professionals working in the field. In addition to providing recommendations that may improve patient care, the guidelines may be used for education by medical students and residents, psychiatrists seeking recertification, other mental health professionals, and the general public. Researchers may use the guidelines to identify important clinical questions for which more research could be expected to improve treatment decision making. The thirteen Practice Guidelines are -Psychiatric Evaluation of Adults, Second Edition -Delirium -Alzheimer's Disease and Other Dementias of Late Life -HIV/AIDS -Substance Use Disorders, Second Edition -Schizophrenia, Second Edition -Major Depressive Disorder, Second Edition -Bipolar Disorder, Second Edition -Panic Disorder -Acute Stress Disorder and Posttraumatic Stress Disorder -Eating Disorders, Third Edition -Borderline Personality Disorder -Suicidal Behaviors These guidelines help you -Understand clinical features and symptoms -Make a confident differential diagnosis -Evaluate interventions commonly used to treat specific disorders -Select the appropriate site of service -Educate the patient and family -Assess the efficacy and risks of available medications -Develop an individualized treatment plan Interactive continuing medical education programs for many of the individual practice guidelines are available on the APA's web site (www.psych.org/cme). Each program offers AMA PRA Category 1 CreditsA that are accepted by the APA and the American Medical Association. The American Board of Psychiatry and Neurology (ABPN) has reviewed the APA Practice Guidelines CME Program and has approved it as part of a comprehensive lifelong learning program, which is mandated by the American Board of Medical Specialties as a necessary component of maintenance of certification.

Cognitive-behavior therapy (CBT) leads the field of psychotherapy in the evidence-based study and treatment of many psychological disorders. However, CBT has been less prominently applied to the study and prevention of suicidal behaviors. This volume is a compilation of theory, research, and intervention practices focused on cognition and suicide. It brings together for the first time many of the world's leading authorities, who seek to answer such questions as, "How is the thinking of suicidal individuals different from nonsuicidal individuals?" "What cognitive vulnerabilities place an individual at risk for developing suicidal ideation and behavior when stressed?" And, "how does what we know of the thinking of suicidal people translate into cognitive-behavioral treatment strategies?" Each contributor discusses a particular theoretical and/or research framework, often with specific guidelines for clinical intervention tailored to specific cognitive vulnerabilities exhibited by suicidal patients. All of the major CBT theoretical systems are represented, including Aaron Beck's Cognitive Therapy, Albert Ellis's Rational-Emotive Behavior Therapy, and Marsha Linehan's Dialectical Behavior Therapy. Specific empirically-derived cognitive features are also addressed, such as deficient problem-solving skills, perfectionism, negative body image, and overgeneral autobiographical memory. Implications for understanding and intervening with suicidal individuals are profound - suicidal thought processes are viewed here as causal (as opposed to merely correlated) factors in suicidality. Such thoughts, perhaps for the first time, begin to be viewed, not only as part of the problem, but as part of a potential solution.

Andrew Lakoff argues that a new 'pharmaceutical' way of thinking about and acting upon mental disorder is coming to reshape not only the field of psychiatry, but also our very notions of self. Drawing from a comprehensive ethnography of psychiatric practice in Argentina (a country which boasts the most psychoanalysts per capita in the world) Lakoff looks at new ways of understanding and intervening in human behaviour. He charts the globalization of pharmacology, particularily the global impact of US psychiatry and US models of illness, and further illustrates the clashes, conflicts, alliances and reformulations that take place when psychoanalytic and psychopharmacological models of illness and cure meet. Highlighting the social and political implications that these new forms of expertise about human behaviour and human thought bring, Lakoff presents an arresting case-study that will appeal to scholars and students alike.