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This chapter argues that education was a key arena for spreading the influence of psychology. This is not a novel view, but it is argued that too much emphasis has been placed on the role of psychology in mental testing and child guidance as a tool of regulation, and too little on its significance for a more progressive pedagogy. It is argued that the latter reached well beyond the pioneering activities of figures like Montessori, the Russells, and A. S. Neill, and highlights the excitement about psychology among teachers exposed to the new ideas through teacher training. The role of psychological advice in childcare is considered, downplaying the influence of behaviourism and highlighting the ambivalence of psychologists towards popularization.

By the late 1860s, county pauper lunatic asylums, many of which had been constructed immediately following the 1845 Asylums and Lunatics Acts, were experiencing severe overcrowding. Medical superintendents of lunatic asylums blamed overcrowding, in part, on the large number of ‘incurable’ patients conveyed from workhouses. In the sixty years of Victoria's reign in England, the climate of opinion had shifted dramatically, from an optimistic environment espousing the training of idiot children so that they could take up their positions as full members of society, to a pessimistic, restrictive ideology of controlling the movement, and later the fertility, of the ‘feeble-minded’ to prevent them sewing the seeds of future social failure. Yet, despite the transformation in the intellectual climate, many of the older social realities recognised after the establishment of the New Poor Law in 1834 persisted into the Edwardian era. The cooperation of superintendents of idiot asylums and Local School board committees facilitated the rise of mental testing, first in the metropolis and then in the provinces.

This chapter is concerned with how variations in socio-economic position affect physical disease. It begins by describing the pathways that theoretically link socio-economic position with physical disease, and by explaining the potential significance of psychobiological responses. The findings concerning psychobiological processes are organized round the primary methodologies that have been used to explore these pathways, namely animal studies, human laboratory mental stress testing, and naturalistic studies of biological function in everyday life. It is shown that there has been rapid development in this field over recent years, and that although there are still many uncertainties, we are moving into an era in which conclusions about the significance of psychobiological processes can be made with greater confidence.

This chapter examines the crucial role that the diagnostics and treatment of ‘imperfections’ in the child population played in the formation and growth of Russian child science. It emphasizes the plurality, indeterminacy, and intermixing of diagnostic regimes, which led to ambiguity and vagueness in the definition of infringements of the norm in child development. Analysis opens by considering the emergence of mental testing in Russia as a new means of measuring development and diagnosing deviations from the ‘normal’. It first looks at the fostering of mental testing as a purported ‘scientific’ substitute for school assessments and thus, potentially, a new way of framing educational norms. It then scrutinizes the use of mental testing on the boundaries between neuropsychiatric and psycho-educational diagnostics. The chapter then shifts from problems of diagnostics to those of therapeutics, by looking at the creation of special establishments for ‘defective’ children in the late tsarist period. While medical discourse dominated this domain, it ultimately generated hybrid forms of therapeutics, institutionalized as ‘curative pedagogy’, which stretched across medical, pedagogical, and correctional domains. The chapter concludes with an examination of pathologizations of children in the context of large-scale social upheavals, such as revolution and war. It examines two exemplary case studies in this context—the ‘epidemic’ of ‘child suicides’ in the wake of Russia’s 1905 revolution and the moral panic surrounding the effects of total war on the psychology of the Russian child during the First World War.

Neuropsychological assessment has a long history in the United States military and has played an essential role in ensuring the mental health and operational readiness of service members since World War I (Kennedy, Boake, & Moore, 2010). Over the years, mental health clinicians in the military have developed paper-and-pencil assessment instruments, which have evolved in terms of psychometric rigor and clinical utility, but not in terms of technological sophisti­cation. Since the advent of modern digital computing technology, considerable research has been devoted to the development of computer-automated neuropsychological assessment applications (Kane & Kay, 1992; Reeves, Winter, Bleiberg, & Kane, 2007), a trend that is likely to continue in the future. While many comparatively antiquated paper-and-pencil-based test instruments are still routinely used, it is arguably only a matter of time until they are supplanted by more technologically advanced alternatives. It is important to note, however, that questions have been raised about the ecological validity of many commonly used traditional neuropsychological tests, whether paper-and-pencil-based or computerized (Alderman, Burgess, Knight, & Henman, 2003; Burgess et al., 2006; Chaytor & Schmitter- Edgecombe, 2003; Chaytor, Schmitter-Edgecombe, & Burr, 2006; Parsons, 2016a; Sbordone, 2008). In the context of neuropsychological testing, ecological validity generally refers to the extent to which test performance corresponds to real-world performance in everyday life (Sbordone, 1996). In order to develop neuropsychological test instruments with greater ecological validity, investigators have increasingly turned to virtual reality (VR) technologies as a means to assess real-world performance via true-to-life simulated environments (Campbell et al., 2009; Negut, Matu, Sava, & Davis, 2016; Parsons, 2015a, 2015b, 2016a). Bilder (2011) described three historical and theoretical formulations of neuropsychology. First, clinical neuropsychologists focused on lesion localization and relied on interpretation without extensive normative data. Next, clinical neuropsychologists were affected by technological advances in neuroimaging and as a result focused on characterizing cognitive strengths and weaknesses rather than on differential diagnosis.

All doctors working in the ED will regularly meet patients with acute mental health problems. Five percent of total ED attendees are attrib–utable to mental disorder. With nationwide ED attendances averaging 400 000 per week during November to April 2013, the trend shows a growing pressure on emergency services. However, these figures repre–sent just the tip of the true burden of acute mental illness in our com–munities. Stigma, the healthcare funnel, and marginalization often mean that it is the sickest who finally present to the ED. It is also important to recognize the co-morbidity of mental illness and addictions in those seeking help for what initially appear to be physical complaints, as so often the mind and body are closely intertwined. Most common psychiatric presentations to the ED include DSH, alco–hol and substance misuse, delirium, acute psychosis, factitious disorders, medically unexplained symptoms (MUS), and acute stress reactions (such as to trauma). DSH is common but under-recognized. A quarter of people who die by suicide attended the ED in the preceding year. All patients in the ED presenting with self-harm should have a detailed psychosocial assessment. Alcohol is responsible for ?0% of all ED attendances. It is also an independent variable, raising the risk of DSH. Substance users are also frequent attendees, with high levels of medical morbidity and mortality. Patients with a dual diagnosis of substance use plus mental illness fre–quently present with multiple psychosocial problems. Acute psychosis may be caused by a functional disorder, such as schizophrenia, but organic conditions must also be considered. Where a patient is extremely disturbed in the ED, restraint and sedation may be necessary to enable safe and adequate assessment. Security presence may also be required to minimize the risk of violence, where this has been identified. Implications for working in the ED are that all doctors should famil–iarize themselves with the management of common acute psychiatric presentations. Know how to access local Trust rapid tranquillization guidelines. Read NICE guidelines for management of self-harm. Seize opportunities to screen for mental illness and social problems.

This chapter of practice exam questions aims to put you, albeit briefly, in the seat of an old age psychiatrist dealing with important aspects of psychiatric disease in older adults. Our population is ageing and this, in addition to wider public understanding and earlier diagnoses of dementia, is leading to an increasing burden of disease. Furthermore it is acknowledged that the incidence of affective and psychotic disorders unexpectedly peaks again as we reach old age and can be devastating if not recognized and managed effectively. The unique challenge of psychiatry of old age is the need for a sound grasp of general medicine and neurology to tackle unusual presentations of illness and possible multiple co-morbidities, in addition to a ground–ing in psychiatric theory. There remains a great need for lateral think–ing, particularly in liaison work on the medical and surgical wards where delirium is rife and can masquerade as everything psychiatric. Within the specialty, true collaboration exists as allied health professionals and psy–chiatrists work together at problem solving to improve patients’ quality of life beyond simply offering medication. An understanding of the pathology, epidemiology, diagnosis, and treat–ment of mental illness and dementia in older adults is an essential skill for any doctor at the coalface. Working with older adults is incredibly rewarding and never stops being educational to the clinician. These patients and their carers will continue to challenge and impress you throughout your career. As you manage to feel more confident with the facts, the practicalities and benefits of talking to and helping older adults become clearer. There is nothing that surpasses learning on the job, with many opportunities through attachments in psychiatry, GPs, ED, and geriatric wards. There are excellent resources available with regard to dementia, including NICE guidelines and the Alzheimer’s Society website. The aim of the following questions is to touch on a range of areas throughout the subject, taking us from first principles to practical applica–tion, through effective management, and support of older adults’ mental health and wellbeing.

This book has a combined focus on two neurodegenerative conditions: dementia with Lewy bodies and Parkinson’s disease with dementia. While patients with either disorder experience quite variable problems, these two disorders have striking similarities when viewed in the aggregate. Thus, the symptoms of these two conditions are much the same, and so are the treatment strategies. Before addressing treatment, it is crucial to define the relevant terms, broaden our understanding, and discuss how these diagnoses are made. We will start with some basics. These disorders typically start in middle age and later, where selected brain circuits deteriorate for unknown reasons. Common neurodegenerative conditions include Parkinson’s disease, Alzheimer’s disease, and amyotrophic lateral sclerosis (ALS; Lou Gehrig’s disease). Such conditions involve limited regions of the brain or spinal cord, slowly progressing and leading to disability. Each is clinically identified by the specific neurologic deficits unique to that condition. Why each affects certain brain regions, sparing others, is a crucial but unanswered question. Although much has been learned about degenerative syndromes, we do not know the causes of any of them. Dementia implies a loss of intellectual abilities sufficient to compromise activities of daily living. Most often the term dementia is used in the context of neurodegenerative disorders. Mild thinking and memory problems that do not substantially interfere with daily routines fall into the category of mild cognitive impairment (MCI; see below). Doctors diagnosing dementia rely on the history from the patient and family, plus cognitive tests. Short tests assessing memory, attention, and calculation, among other things, can be done in the doctor’s office. Such tests include the so-called Mini-Mental State Examination and the Short Test of Mental Status. More refined and informative tests, termed psychometric testing, are done under the auspices of psychologists; these typically require 2 to 4 hours. Clinicians addressing dementia must also look for treatable causes before concluding that the problem is a neurodegenerative dementia. This assessment typically includes a brain scan, blood tests, and a review of the patient’s medical history and medication list, which may indicate the need for additional testing.