Roger Smyth’s research while affiliated with University of Edinburgh and other places

This fourth edition of what has become an indispensable pocket guide to general psychiatry and the subspecialties continues to provide portable reassurance to health professionals at all levels of experience when dealing with psychiatric issues. As well as a comprehensive overview of the common presentations in psychiatry, this handbook includes practical guidance on the principles of management for individual conditions. Subspecialties, including old age psychiatry, substance misuse, child and adolescent psychiatry, forensic psychiatry, intellectual disability, liaison psychiatry, and psychotherapy are covered in separate chapters, as are overarching considerations such as legal issues, cultural context, and therapeutics. As in previous editions, the handbook is indexed alphabetically, by ICD-10/DSM-5 codes, and by acute presentations for quick access to topics. The text is peppered with clinical observations, guidance, and commentary, reflecting the authors’ own experiences of working in psychiatry. This new edition has been thoroughly revised and updated to include the latest clinical guidelines, new licensed drug indications, changes to the legislature impacting on psychiatric practice across the United Kingdom and Ireland, the new DSM-5 classification system, and the anticipated ICD-11 changes to diagnostic coding.

This chapter covers therapeutic issues in psychiatry, from medication adherence, off-label prescribing and associated legal considerations, negative side effects such as weight gain and sexual dysfunction in different forms of psychiatric medicines, potential interactions or contraindications for prescribing, and specific side effects. Special prescribing cases, such as psychiatric medicine in pregnancy and breastfeeding patients or those with heart, liver, or kidney disease, are explained.

This chapter covers the psychotherapies, a collection of treatments for mental disorders which employ language and communication as a means of producing change. It covers assessment and selection of an appropriate method for the individual patient, a history of Freud and other pioneers of psychotherapy to provide a background context, before examining different types of therapy. Briefly explaining the theory of psychotherapy, the phases of psychosexual development, and the object relations theory, it goes into detail on behavioural therapies such as cognitive behavioural therapy, interpersonal psychotherapy, dialectical behaviour therapy, and solution therapy. Counselling methods are described to aid the reader in developing their skills.

This chapter covers depression. After a historical perspective, it describes the symptoms, caseness, and clinical presentations to aid in diagnosis. Epidemiology and aetiology of the disease are both covered, and specific investigations for diagnosis are outlined. The course and prognosis are discussed, and management principles are covered. Both inpatient and outpatient treatment are covered. Treatment methods for depression both with and without psychotic features are defined, and treatment-resistant depression management is also discussed. Antidepressants, including schedules for swapping or stopping drugs, are covered, including tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and selective serotonin reuptake inhibitors (SSRIs), as well as assorted other pharmaceutical interventions. Electroconvulsive therapy (ECT) is covered in detail.

This chapter covers neuropsychiatry in the medical sense (behavioural neurology and neuropsychiatry). Starting with the psychiatric presentations of organic illness and neurological examinations and investigations in psychiatry, it covers movement disorders, neurodevelopmental disorders, epilepsy, Parkinson’s disease and other related syndromes, and the psychiatric effects of central nervous system infections and human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). Outlining both the aetiology and treatment for dementia and Alzheimer’s disease, other specific neurodegenerative conditions are also featured.

Covering the role of the psychiatrist in forensic situations, from participation in the criminal justice system and legal definitions of crime (including homicide, violence, and sexual offences) to the relationship between mental disorders and offending, this chapter addresses secure hospitals and units, police and court liaison, and the role of the prison psychiatry. Legal provisions and how to give evidence in court are described, and an overview of pathways through the criminal health and justice system for mentally disordered offenders is provided. Fitness to plead and criminal responsibility are both explained.

This chapter concerns liaison psychiatry and the assessment and management of psychiatric and psychological illnesses in the general medical population. It covers the 12 most common referral types, assessment of depressive and anxiety symptoms, psychotic symptoms and confusion, depression in physical illness, delirium, and management after self-harm. Focusing on capacity and consent, as well as differential diagnoses and potential management principles for medically unexplained symptoms, it covers the basis of working as a psychiatrist in a hospital.

This chapter introduces ways of thinking about psychiatry, from investigating the question ‘what is disease’ to techniques for diagnosis and treatment and overarching themes of the role of the psychiatrist. With a brief history and a discussion of potential future directions of the discipline, this chapter provides an overview and rationale for the subsequent content.

Covering sleep research, normal sleep, and then sleep–wake disorders, this chapter splits abnormal sleep into insomnia, hypersomnia, circadian rhythm disorders, and parasomnias. Individual cases, such as sleep-related epilepsy, panic attacks, and sleep-related violence, are all defined. The effects of psychiatric medication on sleep (either sedative or alerting) are defined, as well as the effects of recreational drugs. The intersection of other psychiatric disorders on the sleep schedule are described, and potential differential diagnoses listed.

This chapter defines substance abuse. Splitting up alcohol and other drugs, although recognizing that alcohol is a drug in its own right, it covers dependence, screening, assessment, planning treatment, management of withdrawal, and plans for maintaining abstinence. Also covering tobacco, illegal drugs, and novel psychotropic substances, substitute prescribing, and legal issues, this chapter has a table of street slang associated with drug misuse to aid the reader.