Approach to the Psychiatric Patient
Case-Based Essays
Edited by John W. Barnhill, M.D.
Approach to the Psychiatric Patient is a case-based exploration of psychiatry. It is both a general introduction to multiple aspects of the field and a series of sophisticated discussions that clarify controversies, dilemmas, and ambiguities. By covering the psychiatric waterfront while featuring many subspecialties, the book intends to fill a gap that exists between standard psychiatric reviews, specialty texts, and pocket guides. Further, by making use of over 100 essayists, Approach to the Psychiatric Patient captures much of the complexity and richness that make modern psychiatry a fascinating challenge. The ten cases span a broad diagnostic spectrum, from geriatric depression (case 2) and schizophrenia (case 4) to substance abuse (case 6) and disappointment over an exam failure (case 10). The situations range from inpatient hospitalizations (case 1) and emergency room evaluations (case 3) to outpatient assessments (case 7) and long-term psychotherapies (case 8). Perhaps most importantly, the 100 essays have been written by a broad range of specialists who have all been asked to comment specifically on one aspect of their particular case. These essays are brief (about 1500 words) and are intended to serve as “curbside consults” in which the expert dispenses a sharp perspective on the particular situation. The book highlights a broad span of human experience. For example, in the first case, a middle-aged man has been admitted to a psychiatric unit after having tried to kill himself. Experts comment on depression, suicidality, psychodynamics, the interview, the neurobiology of stress, inpatient psychiatry, brain stimulation, pharmacology, supportive psychotherapy, and couples therapy, and they also describe relevant aspects of the African American experience and the historical development of the field of psychiatry. In the final case, a medical student presents for a psychiatric assessment after having failed a gross anatomy test. This case prompts discussions of her evaluation (e.g., essays on the medical school experience, somatoform disorders, the neurobiology of obsessions, narcissism, and the first-generation Asian American), and on her treatment (e.g. essays on complementary medicine, mindfulness meditation, self psychology, therapeutic zeal, empathy, self-defeating behavior, and evidence-based psychotherapy). An expert then provides an overview for each of the 10 chapters. After the overview, each chapter concludes with a set of thought-provoking assertions that are intended to provoke the reader into further consideration of the patient and situation. In order to create the book’s richly complex mosaic, the editor has attracted some of the country’s most eminent psychiatrists and psychologists. There are several ways to attract such a multidisciplinary group and to then encourage their best efforts. In this case, the editor chose to recruit faculty members from one set of interconnected institutions: Weill Cornell Medical College, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, Memorial Sloan-Kettering Cancer Center, and Rockefeller University. This limitation inevitably led to the exclusion of some distinguished authors, but it did lead to the vigorous participation of some experts who might not have otherwise agreed to contribute. Practical and thoughtful, Approach to the Psychiatric Patient serves as an expert on the shoulder to clinicians who approach psychiatric patients as well as to anyone who is curious about the state of the art of modern psychiatry.
Contents
Foreword. Preface. Introduction. How to Use This Book. Double Depression and James Avery. Depression. Suicide. The psychodynamic formulation. The interview of the depressed patient. The African American patient. Neurobiology of stress. What is psychiatry? Inpatient psychiatry. Psychopharmacology of depression. Pharmacogenomics. Brain stimulation and neuromodulation. Supportive psychotherapy. Couples therapy. Overview of double depression. Summary points. Geriatric Depression and Peter Burke. Capacity. The psychiatric attitude. Depression and medical illness. Neurotrophins. Testing at the bedside. Interpersonal psychotherapy. Service delivery. Overview of geriatric depression. Summary points. Mood Instability and Amy Cahill. Mood instability. Borderline personality organization. Axis I and Axis II. Eating disorders. Dialectical behavior therapy. Risk management. Pharmacology of mood instability. Overview of mood instability. Summary points. Schizophrenia and Anthony Da Piazza. Schizophrenia. Violence and schizophrenia. Schizophrenia and brain circuitry: a neuroimaging perspective. Psychodynamics of psychosis. Outsider art. Pharmacology of schizophrenia. Cognitive-behavioral therapy. Comprehensive healthcare. Recovery. Homelessness and social history. Overview of schizophrenia. Summary points. Terminal Illness and Dorothy Ewing. Part A. Delirum. Part B. Pain and substance abuse. The psychodynamic consultation. Working with the family. The difficult patient. Genetic counseling. Spirituality. Meaning-centered therapy. The doctor–patient relationship. Overview of hospital psychodynamics. Summary points. Agitation and Stephen Franken. Part A. Managing multiple patients in the emergency department. Evaluating an emergency patient. Stimulant abuse. Part B. Consultation-liaison psychiatry. Informed consent. HIV/AIDS. Internalized homophobia. Sexuality and sexual dysfunction. Jekyll and Hyde. Psychotherapy selection. Overview of connection. Summary points. Adolescent Bereavement and Amelia Gutierrez. An ethical dilemma. Adolescent bereavement. Suicide. Interview of the adolescent. Psychological impact of dislocation. The Dominican patient. Virginia Woolf: on being ill. Neurobiology of attachment. Pharmacology of adolescent depression. Interpersonal psychotherapy. Psychodynamics of depression. Overview of adolescent depression. Summary points. Anxiety and Sophia Hastings. Part A. Anxiety disorders. Alcohol abuse. Neurobiology of alcohol. Pharmacology of anxiety. Cognitive-behavioral therapy. Panic-focused psychodynamic psychotherapy. Part B. After effects of sexual abuse. Overview of countertransference. Summary points. Hypomania and Jennifer Ingram. Attention deficit. Bipolar disorder. Bipolar spectrum disorder. Premenstrual dysphoria. Sleep. Autism’s effect on the family. Creativity and mental illness. Being lesbian. Love. Psychodynamic psychotherapy. Overview of hypomania. Summary points. Exam Failure and Grace Jin. Part A. Interview of the medical student. Somatoform disorders and obsessionality. Neurobiology of obsessions. Narcissistic injury and narcissistic defenses. A first-generation Asian American. Complementary medicine and integrative pharmacology. Mindfulness meditation. Part B. Therapeutic zeal. Empathy. Self psychology. The Kohut/Kernberg controversy. Evidence-based psychotherapy. The self-defeating patient. Overview of an evaluation. Summary points. Bibliography. Index.
Contributors
George S. Alexopoulos, M.D.
Margaret Altemus, M.D.
Donna T. Anthony, M.D., Ph.D.
Paul S. Appelbaum, M.D.
Elizabeth L. Auchincloss, M.D.
Jack D. Barchas, M.D.
John W. Barnhill, M.D.
Hilary J. Beattie, Ph.D.
Marina Benaur, M.D.
Andrew Bennett, M.D.
William Breitbart, M.D.
Beth S. Brodsky, Ph.D.
Richard P. Brown, M.D.
Martha Bruce, Ph.D.
Fredric N. Busch, M.D.
Deborah L. Cabaniss, M.D.
Ian Canino, M.D.
John F. Clarkin, Ph.D.
Arnold M. Cooper, M.D.
Francine Cournos, M.D.
Janis L. Cutler, M.D.
Katherine Dalsimer, Ph.D.
Carolyn J. Douglas, M.D.
Jane Epstein, M.D.
Aaron Esman, M.D.
Susan Evans, Ph.D.
Brian A. Fallon, M.D.
Stephen J. Ferrando, M.D.
Marianne N. Findler, Ph.D.
Joseph J. Fins, M.D.
Peter J. Freed, M.D.
Zachary Freyberg, M.D., Ph.D.
Richard A. Friedman, M.D.
Richard C. Friedman, M.D.
William Frosch, M.D.
Mindy Thompson Fullilove, M.D.
Cathryn A. Galanter, M.D.
David W. Galarneau, M.D.
Patricia L. Gerbarg, M.D.
Andrew J. Gerber, M.D., Ph.D.
Roberto Gil, M.D.
Charles Glatt, M.D., Ph.D.
Robert A. Glick, M.D.
Scott J. Goldsmith, M.D.
Michael F. Grunebaum, M.D.
Katherine A. Halmi, M.D.
Jeffrey K. Halpern, M.D.
David J. Hellerstein, M.D.
Daniel Herrera, M.D., Ph.D.
Margaret E. Hertzig, M.D.
Kim Hopper, Ph.D.
Colleen Jacobson, Ph.D.
David Kahn, M.D.
Gurmeet S. Kanwal, M.D.
Kevin V. Kelly, M.D.
Otto F. Kernberg, M.D.
Robert Kertzner, M.D.
Kenneth L. Kirsh, Ph.D.
David W. Kissane, M.D.
Sibel Klimstra, M.D.
James H. Kocsis, M.D.
Nathan Kravis, M.D.
Yulia Landa, Psy.D.
Francis Lee, M.D., Ph.D.
Phillip Lee, M.D.
Eve Leeman, M.D.
Steven P. Levine, M.D.
Petros Levounis, M.D., M.A.
Jeffrey A. Lieberman, M.D.
Sarah H. Lisanby, M.D.
George J. Makari, M.D.
J. John Mann, M.D.
Eric R. Marcus, M.D.
John C. Markowitz, M.D.
Peter M. Marzuk, M.D.
Mary Jane Massie, M.D.
Marlin R.A. Mattson, M.D.
P. Anne McBride, M.D.
Bruce S. McEwen, Ph.D.
Robert Michels, M.D.
Sharon Alspector Mozian, M.D.
Laura Mufson, Ph.D.
Philip R. Muskin, M.D.
Alfredo Nudman, M.D.
Sharone Ornstein, M.D.
Laszlo A. Papp, M.D.
Sandra Park, M.D.
Steven D. Passik, Ph.D.
Ethel S. Person, M.D.
Cynthia R. Pfeffer, M.D.
Bruce Phariss, M.D.
H. Jonathan Polan, M.D.
Shannon R. Poppito, Ph.D.
Dionne R. Powell, M.D.
James L. Rebeta, Ph.D.
Diane Rudolph, M.D.
Adam Savitz, M.D., Ph.D.
David W. Schab, M.D.
Roy Schafer, Ph.D.
Daniel S. Schechter, M.D.
Franklin Schneier, M.D.
Peter A. Shapiro, M.D.
Theodore Shapiro, M.D.
David Silbersweig, M.D.
Helen Blair Simpson, M.D., Ph.D.
Smit S. Sinha, M.D.
Alexandra L. Sporn, M.D.
Barbara H. Stanley, Ph.D.
Jennifer Cooper Stelwagon, M.D.
Charles P. Stowell, M.D.
Ayame Takahashi, M.D.
Michael Terman, Ph.D.
Susan C. Vaughan, M.D.
Milton Viederman, M.D.
Daniel Weisholtz, M.D.
Erica Willheim, Ph.D.
Frank Yeomans, M.D., Ph.D.
Robert C. Young, M.D.
Reviews
"Recognizing that our patients are our best teachers, Dr. Barnhill invited many of psychiatry’s most gifted clinicians and educators to distill what can be learned from pivotal facets of patients’ clinical presentations. The net result is a unique, illuminating, and captivating jewel of a book which is destined to be treasured by a trove of serious learners—from medical students and first year psychiatry residents to seasoned practitioners."—Stuart C. Yudofsky, M.D., D.C. and Irene Ellwood Professor and Chair, The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
"This is a fascinating textbook that attempts to approach the clinical and educational challenges of treating psychiatric patients from a truly multidisciplinary perspective using a case-based format. Other publications have used case-based presentations as a stimulus for thoughtful discussion, but none, to my knowledge, have approached this as Dr. Barnhill does."—Carol A. Bernstein, M.D., The American Journal of Psychiatry, August 2009
"This book is filled with wisdom and insight. Each short essay is written from a well-defined angle. The essays address one of ten composite cases that were well thought out and capture real-world problems. Each case is then addressed by about ten clinical points of view, and each section ends with a helpful list of the summary points. Approach to the Psychiatric Patient provides an educational resource that is valuable not only to trainees but also to seasoned clinicians in any of our disciplines."—John Santopietro, M.D., Psychiatric Services , October 2009
About the Authors
John W. Barnhill, M.D., is Associate Professor of Clinical Psychiatry and Public Health at Weill Cornell Medical College; Chief of the Consultation-Liaison Service at New York-Presbyterian Hospital/Weill Cornell Medical Center; and a faculty member at the Columbia University Center for Psychoanalytic Training & Research in New York City.
Ordering Information
2009 · 565 pages · ISBN 9781585623006 · Paperback · $67.00 · Item #62300 Buy this title NOW!
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