Theory and Practice of Psychiatry

Theory and Practice of Psychiatry

Theory and Practice of Psychiatry

Theory and Practice of Psychiatry


Exploring various approaches to psychiatric disorders, including neurobiology, dimensional personality assessment, behavioural science, and psychodynamic and cognitive theories, this book lucidly illustrates each approach's strengths and weaknesses and suggests how clinicians can interweave them in working with patients. Using clinical vignettes and recent research findings to illustrate the connections between phenomenology, pathophysiology, and treatment, it covers all of the major psychiatric disorders and includes tables listing their DSM-IV-TR diagnostic criteria.


This is a wonderful time in history to be practicing psychiatry. Neuroscientists are unearthing staggering amounts of information about the functioning of the brain at the anatomic, cellular, and subcellular level. An explosion of new pharmaceutical agents offers the prospect of safer and more effective treatments for mental illnesses that just a few decades ago were considered either purely “psychological” in origin, or untreatable, or both. The public is becoming more comfortable with the notion that mental illness is not synonymous with “moral weakness.” Research in naturalistic settings (i.e., in typical clinical environments) is demonstrating to the insurance industry and to state and federal governments that psychiatric treatment not only can be efficacious; it can be cost-effective.

Further, we are learning more about which treatments are most effective for which psychiatric disorders. Ideally, the treatment that a clinician prescribes to a given patient should be dictated by that patient's particular needs, not by which residency program the treating clinician happened to attend or by the clinician's theoretical “orientation.” This ideal increasingly is becoming a reality.

However, many things have remained the same. Stigma related to mental illness remains ubiquitous. Further, while the availability of a plethora of new pharmaceutical agents has encouraged even general physicians to familiarize themselves with recent advances in neuroreceptor subtyping (after all, why prescribe a 5HT serotonin receptor partial agonist when you now can prescribe a 5HT serotonin receptor antagonist?), it also has resulted in physicians being increasingly subjected to a bewildering array of confusing and often contradictory data. In addition, all of the new drugs in the world aren't especially useful if physicians fail to recognize that a mental disorder is present, or make the wrong diagnosis, or don't appropriately monitor for specific target symptoms through careful, serial mental status examinations. Many physicians report that they feel ill-equipped in these areas.

Finally, patients continue to present to physicians because their thoughts, their emotions, their behaviors, and their lives are in a state of turmoil, not because they are worried that their brain chemistry is in a state of turmoil. The fact that some psychiatrists have come to see themselves as “psychopharmacologists” and are only meeting with patients for brief “medication checks” hardly represents a major advance in the history of psychiatry. Addressing patients' chemistry is not enough in many cases. The ma-

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