Although humor is used in this book to highlight diagnostic findings, it is not our intent to laugh at people with psychiatric problems. On the contrary, we hope that reading this book will enable you to help and understand patients better.
Where appropriate, we have integrated the DSM III (Diagnostic and Statistical Manual of Mental Disorders, Third Edition, American Psychiatric Association) into the text. For lists of diagnostic criteria and a complete review of the psychiatric nomenclature, the reader is referred to this reference manual.
In the four years since this book was last revised a number of important events have occurred in psychiatry. Some of these include: the introduction of the DSM— III—R (Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, American Psychiatric Association, 1987); the release of several new psychotropic medications such as fluoxetine, clomipramine, and clozapine; research findings on the efficacy of certain types of psychotherapy ; and a heightened focus on the psychological trauma and disability resulting from abuse, particularly sexual abuse.
We have attempted to engage the reader in a ‘conversation’ throughout this book. The ‘psychiatrist’ we address may be a medical student, psychiatric resident, or graduate student in psychology, social work or other field. The context we imply is usually a medical one but we believe the information contained here is applicable and pertinent in a wide range of mental health settings.
“… Contrary to popular opinion, psychiatrists deal with topics other than sex. What could be more important than sex? The psychiatrist deals with many varieties of mental dysfunction. One can appreciate this simply by reviewing some of the common terms in psychiatry:
Affect: Psychiatrists are always interested in how a patient feels at a particular time. Sadness, anger, happiness, and irritation are all examples of affects. The type of affect, its appropriateness to the situation, its stability, and its intensity are important diagnostically (see Mood).
Akathisia: A state of motor restlessness, commonly seen as a side effect of antipsychotic drugs. The patient seems unable to sit still and usually is very troubled by this symptom.
Attention: The ability to concentrate on a task.
Autistic: This term refers to modes of behavior in which the patient disregards his environment in a pervasive way appearing to respond to internal stimuli only.
Blocking: Thought processes stop for emotional reasons. This commonly occurs in grand rounds presentations.
Capitation: Placing a monetary value for purposes of insurance reimbursement on a disease, usually expressed as a fraction. Numerator = value of disease (usually expressed in cents); denominator = piece of body under consideration (e.g. limbic system); subdenominator = time period of insurance (usually expressed in decades or centuries).
Carve Out: An end run around capitation.
Catatonia: This is a state of stupor with alteration in motor functioning. It may occur in psychosis and mood disorders but is also seen in certain neurological conditions. House staff may become catatonic after being on call for 48 hours straight.
Circumstantiality: Too much digression precedes communication of central idea.
Clanging: Thoughts occur in sequence because of the way words sound, not because of content….”