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This chapter focuses on the question of diagnosis of psychiatric disorders and examines the relationship between neuroscience and psychiatry from this perspective. Despite the penetrating gaze of neuroscience, which has opened up the brain to vision in so many ways, psychiatric classification remains superficial. This neuromolecular vision seems incapable of grounding the clinical work of psychiatry in the way that has become routine in other areas of medicine. Despite the conviction of most practitioners that they deal with conditions that have a corporeal seat in the brain of the afflicted individual, psychiatry has failed to establish the bridge that, from the nineteenth century on, underpinned the epistemology of modern clinical medicine—the capacity to link the troubles of the troubled and troubling individuals who are its subjects with the vital anomalies that underpin them.

This chapter examines different forms of neurosurgery, psychosurgery, and neurostimulation for neurological and psychiatric disorders. It discusses the weighing of benefits and risks in determining whether neurosurgery or psychosurgery can be justified. The issue of consent from patients figures more importantly in brain surgery than in any other area of neuroethics because of the invasiveness of the procedure and the risk of significant neurological impairment following surgery. It is also because the competence necessary for consent may be impaired by dysfunction of the organ that is both the intended area of intervention and the basis for competence and consent. Different forms of neurostimulation are considered, from electrodes implanted inside the brain, as well as from devices outside the brain. Finally, the possible use of neurostimulation for managing pain is considered.

This chapter serves as a guide for developing a course in psychiatric epidemiology; that is, epidemiological methods applied to the study of psychiatric disorders rather than the epidemiology of specific psychiatric disorders. Methodological issues particularly relevant for these pathologies are emphasized, leaving the delineation of the substantive content of different mental disorders to the instructor's interests and expertise. This course does not need to assume prior training in psychiatry or psychopathology, and can be oriented to students at different educational levels. It is expected that students enrolled in this type of course have an interest in public health, medicine or psychology.

Clinical neuropsychology plays a crucial role in the assessment of cognitive impairment in clinical practice and in research in psychiatry. Recent advances in knowledge have allowed for more fine-grained cognitive analysis of specific impairments. This in turn can lead to a greater understanding of the neural basis of abnormal behaviour. The development of neuropsychological measures allows for the valid and reliable assessment of treatment efficacy. This is particularly important as ‘negative features’ (including cognitive impairment) have become increasingly recognized as key targets for pharmacological treatment in psychiatry. This chapter reviews the clinical presentation and common neuropsychological features of some of the major psychiatric disorders. These include anorexia nervosa, Asperger's syndrome, autism, bulimia nervosa, Capgras syndrome, conversion disorder (hysteria), Cotard syndrome, and De Clerambault's syndrome.

This chapter traces the development of the epidemiology of mental disorders. Topics discussed include early epidemiology from 1901–60, improving diagnosis and counting the prevalence of a broad spectrum of disorders, identifying the target population, the scope of psychiatric epidemiological studies, multiple diagnoses and comorbidity, and the current status of epidemiological studies of mental disorders.

The role and potential relevance of estrogen and other sex steroids to psychiatric disorders is the focus of current scientific attention. Estrogen has been described as a 5-HT, NA and ACh agonist; it also modulates DA2 receptors. This chapter reviews the implications to the reproductive life cycle of women. Specifically, it discusses the impact of hormonal fluctuations during menarche, premenstrually, during pregnancy and postpartum, and perimenopausally.

Individuals with epilepsy are at increased risk of a number of psychiatric disorders including anxiety, depression, and psychosis. However, when considering the performance of people with epilepsy on neuropsychological tests, little attention has generally been paid to the role that comorbid psychological/psychiatric disturbance may play in influencing scores and test profiles. This chapter considers how patients with comorbid psychosis or depression might perform on standard tests batteries, and how mood might account for discrepancies between patients' self-reported cognitive difficulties and observed test scores. It addresses recent developments in understanding the cerebral substrates of psychosis and depression in people with epilepsy. It also considers the role of effort in test-taking performance, both in patients with epilepsy and also patients with psychogenic nonepileptic seizures, and the extent to which the profiles of these two patient groups might differ in this respect. Some comments are made on potential clinical observations/interventions that might sensibly be considered with respect to psychological factors in patients with epilepsy undergoing neuropsychological assessment. Finally, the chapter considers clinically similar memory phenomena presenting in psychiatry and epilepsy settings and their key differences.

This chapter examines the data regarding the prevalence of psychiatric disorders and suicide risk among gay and bisexual men in the United States. It begins by examining the methodological underpinnings of research on gay and bisexual men's health and mental health. It then provides an in-depth review of the evidence for health disparities affecting gay and bisexual men for a range of psychiatric disorders including depression and other affective disorders, anxiety disorders, and suicide symptoms. The chapter discusses the role of social context as one explanation for the increased prevalence of mental health disorders among gay and bisexual men, including the effects of homophobia and discrimination. It ends with recommendations for future research.

Dopamine (DA) has received substantial attention due to its involvement in a wide array of neurological and psychiatric disorders, ranging from Parkinson's disease to affective disorders and schizophrenia. As a result, this system has been studied extensively at many levels of analysis. This is an exciting time for research into psychiatric disorders and the DA system, as evidenced by the convergence of basic neuroscience and clinical research studies on common pathophysiological targets. Dopamine itself has been described as involved in reward and addiction, in attention and compulsions, and in cognition and affect. However, recent studies suggest that the DA system may act to coordinate integration of information via selective potentiation of circuits or pathways. This suggests that DA is acting as a “glue” that holds together plastic relationships among diverse brain structures. This chapter focuses on the system physiology of the DA system in intact animals, how the DA system is regulated, and how dysregulation of this system may contribute to the pathophysiology of major psychiatric disorders.

This chapter examines the growing importance of diagnosis and treatment of depression and other psychiatric disorders in patients with terminal cancer. Depression is a common complication among patients receiving end of life care that continues to be under-recognized and remains a source of considerable suffering. The amelioration of depression is essential in order to provide effective and comprehensive palliative care, as it will minimize prolonged suffering, maximize the potential for a meaningful existence, and help provide a higher quality of life for patients near the end of life.

This chapter initially presents the case of Andrew, a man with pre-existing post-traumatic stress disorder (PTSD) that was exacerbated by the bullying he received while serving in the army. Modern biological psychiatrists assume that psychiatric disorders can be classified into a discrete number of diseases analogous to those encountered in physical medicine. Andrew's anxiety about his diagnosis is a reminder that this assumption may have important consequences for both clinicians and patients. For the clinician, classifying the patient's experiences under a diagnosis seems like an important first step in order to make sense of the patient's difficulties. For the patient, being diagnosed will often evoke some kind of emotional response. The chapter shows the importance of having a widely used system of psychiatric classification that provides a realistic and meaningful framework for understanding the problems of patients. This question of diagnostic validity lies at the center of modern psychiatric theory.

This chapter is intended to serve as a guide for developing a course in psychiatric epidemiology; that is, epidemiological methods applied to the study of psychiatric disorders rather than the epidemiology of specific psychiatric disorders. Methodological issues that are particularly challenging for this branch of epidemiology are emphasized, including the definition and identification of cases, psychometric issues for measures of psychopathology, the choice of study design and sampling frame, and theoretical models of environmental and genetic origins of psychiatric disorders. References to epidemiological studies of specific pathologies are included that are particularly illustrative of important methodological points. The issues raised in this chapter are not unique to psychiatry but rather reflect the current state of knowledge about the etiology of psychiatric disorders and the concomitant problems of diagnosis and disease classification.

Although critiques of current epidemiologic methods frequently invoke concepts derived from a complexity framework, applications of these approaches to epidemiologic problems are scarce. Broader application awaits both conceptual and methodological development. This chapter describes the broad outlines of this approach to explore and envision its potential for psychiatric epidemiologic research. It also draws attention to some nascent examples on the horizon.

College students with psychiatric disorders are among the fastest growing population of students on campus. Psychiatric disorders are a high-incidence disorder. Depression and anxiety are becoming so common on university campuses that most student counselling centers can no longer manage the high demand for professional help. There is still a great deal of stigma involved with mental illness which only results in students denying or hiding their disorders rather than learning to advocate for themselves. Professors who are accepting of all students and are aware of statements that can be hurtful to someone with mental illness will be most successful with this population. Working together with others as a team within the university provides a safety net for fragile students in crisis.

Scientific commonsense would suggest that very young children cannot have psychiatric disorders such as bipolar disorder or major depression since they do not have the level of development to express the complex characteristics of these disorders. This chapter provides a detailed survey of current evidence supporting this common sense claim. The chapter first gives a general perspective on DSM that will be applied in looking at childhood psychiatric diagnoses and should be of some interest in its own right. I argue that there are some DSM based categorizations--those of major depressive disorder and bipolar disorder--that have substantial empirical support. I look at these two classifications as the best case for pediatric psychiatric disorders. I argue that this best case fails given our current state of knowledge, raising doubts in general about psychiatric diagnoses in small children. This conclusion has practical importance, since small children are increasingly being given powerful psychoactive drugs.

Pregnancy is characterized by profound metabolic and physiological alterations involving virtually every organ system. Among apparently healthy women, the metabolic challenges, or “stress test” of pregnancy may contribute to adverse perinatal and neonatal outcomes, and may also unmask susceptibility for maternal chronic disorders. Available clinical and epidemiologic data are supportive of the hypothesis that common medical complications of pregnancy including gestational diabetes mellitus, and hypertensive disorders of pregnancy may represent, at least for some women, their underlying risk for developing related chronic medical conditions as they age. This chapter first provides a brief overview of maternal metabolic, physiological, and anatomical changes during pregnancy. These are followed by a review of selected maternal pre-gestational chronic medical conditions and those arising during pregnancy. The chapter closes with a discussion of the influence of other factors, including intimate partner violence, on maternal physical and mental well-being.

The experience of nervous breakdown achieved a significance in Victorian culture that went far beyond the substantial interest bestowed by the medical profession on so perplexing and elusive an illness. Nervous breakdown, a popular name for incapacitating depression, is not a specific disease that can be traced to a single cause. It is an abstract concept, encompassing many symptoms that vary from one patient to another, with invariably devastating effect. The characteristic sense of overwhelming hopelessness, emptiness, impotence, and uselessness, the incapacity to focus attention or reach decisions, the obsessive thoughts and fears, the diminished self-esteem, the extreme lethargy, and the inability to take interest or pleasure in any aspect of life make existence scarcely tolerable. This book attempts to ascertain what nervous breakdown meant to the Victorians, both to patients who experienced the baffling disorder and to medical practitioners who tried to treat it.