The fields of psychiatry and child psychiatry are encumbered by numerous and complex relational, medicolegal, and ethical dilemmas. This practical and clinically relevant book attempts to bring clarity to complex clinical presentations through the integration of psychodynamic, family systems, medicolegal, and ethical perspectives. It recognizes that the intimate and often difficult work with such complex cases requires consultation with multidimensional experts to address psychodynamic, family, ethical, and therapeutic issues. In the process, the author aims to foster the comfort and skill in dealing with these cases that is essential to the personal and professional growth of the psychiatrist. It is further anticipated that the book will assist in developing best practice standards for assessment and intervention in cases of this nature.

Bringing together treatment and referral advice from existing guidelines, this text aims to improve access to services and recognition of common mental health disorders in adults and provide advice on the principles that need to be adopted to develop appropriate referral and local care pathways.

Why do some psychiatric patients fail to get better, even when in the care of competent clinicians? Treatment-refractory conditions are all too common in everyday clinical practice. Treatment resistance occurs across the full spectrum of psychiatric disorders, incurring enormous emotional, economic, and social costs. In the United States, treatment of depression alone costs more than $40 billion annually, and as many as 40% of patients with depression have a treatment-refractory form of the illness. This groundbreaking clinical guide starts where standard textbooks end, focusing on clinical strategies to be used after all basic treatment options, such as medication and psychotherapy, have failed. In this book expert contributors address the sequential clinical steps in treating difficult-to-treat psychiatric patients by offering a blend of evidence-based clinical recommendations, detailed case vignettes, treatment algorithms, and -- when necessary to go beyond the reach of evidence -- the clinical wisdom of leaders in the field. The chapters in this user-friendly, practical guide are organized by major disorder. Each chapter offers concrete recommendations on what to do when the usual first steps in therapy are ineffective, including evidence for biopsychosocial treatments alone versus in combination, generic versus specific therapies, and literature reviews and the latest expert wisdom. A sampling includes The management of the complex and often refractory bipolar disorder, which involves replacing or combining lithium treatment with anticonvulsants or atypical antipsychotic agents with adjuncts such as benzodiazepines, thyroid hormone, and electroconvulsive therapy, but also -- above all -- with careful attention to the therapeutic alliance. The importance of combined therapeutic modalities for patients with schizophrenia -- especially given managed care's cost-cutting strategies, which deprive many schizophrenic patients of effective treatment modalities such as family therapy or early use of an atypical antipsychotic. Combination treatments for anxiety, with medications adjusted over time as symptoms wax and wane, and early and appropriate interventions to mitigate internal and external environmental stressors. The emphasis on common sense, optimism, a sense of humor, and an iron constitution as the most important tools for clinicians wishing to work with the most severely ill patients with borderline personality disorder. The importance of individual differences in biological vulnerability, emotionality and expressiveness, cognitive schemas and beliefs, prior traumatic experience, resilience, and coping strategies for successful treatment of posttraumatic stress disorder. Packed with up-to-date information of immediate relevance, this volume will prove invaluable in both classroom and clinical practice, for everyone from beginning interns and residents to experienced psychiatric and medical practitioners and social workers.

Ask for a definition of primary care, and you are likely to hear as many answers as there are health care professionals in your survey. Primary Care fills this gap with a detailed definition already adopted by professional organizations and praised at recent conferences. This volume makes recommendations for improving primary care, building its organization, financing, infrastructure, and knowledge baseâ€"as well as developing a way of thinking and acting for primary care clinicians. Are there enough primary care doctors? Are they merely gatekeepers? Is the traditional relationship between patient and doctor outmoded? The committee draws conclusions about these and other controversies in a comprehensive and up-to-date discussion that covers: The scope of primary care. Its philosophical underpinnings. Its value to the patient and the community. Its impact on cost, access, and quality. This volume discusses the needs of special populations, the role of the capitation method of payment, and more. Recommendations are offered for achieving a more multidisciplinary education for primary care clinicians. Research priorities are identified. Primary Care provides a forward-thinking view of primary care as it should be practiced in the new integrated health care delivery systemsâ€"important to health care clinicians and those who train and employ them, policymakers at all levels, health care managers, payers, and interested individuals.

Part 1 - About the difficult consultations with adolescents project; Aim and methods of the project; Case A 'Anne' - The adolescent who will not speak; Organising the material; Part 2 - The Case presentations; Case 1 - Hidden agendas; Case 2 - Aggression; Case 3 - Depression; Case 4 - Getting it right; Case 5 - Confidentiality; Case.

Grounded in author Allen Frances's extensive clinical experience, this comprehensive yet concise guide helps the busy clinician find the right psychiatric diagnosis and avoid the many pitfalls that lead to errors. Covering every disorder routinely encountered in clinical practice, Frances provides the ICD-9-CM and ICD-10-CM (where feasible) codes required for billing, a useful screening question, a colorful descriptive prototype, lucid diagnostic tips, and a discussion of other disorders that must be ruled out. The book closes with an index of the most common presenting symptoms, listing possible diagnoses that must be considered for each. Frances was instrumental in the development of past editions of the DSM and provides helpful cautions on questionable aspects of DSM-5. The revised edition features ICD-10-CM codes where feasible throughout the chapters, plus a Crosswalk to ICD-10-CM Codes in the Appendix. The Appendix, links to further coding resources, and periodic updates can also be accessed online (www.guilford.com/frances_updates).

This unique, ground-breaking new reference makes clinical psychiatry easily accessible to physicians and related professionals who treat patients with mental problems. Co-authored by primary care physicians and psychiatrists, the book presents clinical wisdom, insights, and "trade secrets" not usually shared. Readers will find comprehensive, realistic coverage of conditions actually seen by family physicians, regardless of how these problems are addressed in training or reimbursed by insurance plans. Primary Care Psychiatry also assists readers in making referrals in situations where patients are resistant, or when referral resources are unavailable. Each section begins with a list of differentials to help readers work toward a diagnosis, and then details the best standard and alternative treatment options available. A consistent outline format, highlighted critical content, and user-friendly charts and tables enable readers to quickly access and summarize the information they need. Explicit and detailed physician-patient dialogues (scripts) demonstrate how to put clinical principles into immediate use. Appendices contain extensive, annotated lists of practical patient education materials, self-help books, and more. One appendix also summarizes the immediate effects and relevant side effects of psychiatric drugs. All chapters have been peer-reviewed and edited by primary care physicians, psychiatrists, and physicians-in-training, to ensure accuracy and clinical value.