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A Short Textbook of PSYCHIATRY Every effort has been made to ensure that drug dosage schedules in this book are accurate and conform to the standards accepted at the time of publication. However, as recommendations for treatment vary in the light of continuing research and clinical experience, the reader is advised to verify drug dosage schedules contained in the product information sheets included in the package of each drug as well as Summary of Product Characteristics (SPC), before any drug is administered. It is the responsibility of the treating physician, relying on experience and knowledge about the patient, to determine the dose(s) and the best treatment for the patient. Neither the publisher nor the author assumes responsibility for any possible untoward consequences. A Short Textbook of PSYCHIATRY Seventh Edition Niraj Ahuja MBBS MD MRCPsych Consultant Psychiatrist Newcastle Upon Tyne, UK Formerly Associate Professor (Psychiatry) GB Pant Hospital and Associated Maulana Azad Medical College (MAMC) and Lok Nayak Hospital, New Delhi, India Formerly also at Department of Psychiatry Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry Lady Hardinge Medical College (LHMC) and Smt. SK Hospital, New Delhi All India Institute of Medical Sciences (AIIMS), New Delhi, India Contributing Editor Savita Ahuja MBBS DGO DFSRH DRCOG ® JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD New Delhi • St Louis (USA) • Panama City (Panama) • London (UK) • Ahmedabad • Bengaluru Chennai • Hyderabad • Kochi • Kolkata • Lucknow • Mumbai • Nagpur Published by Jitendar P Vij Jaypee Brothers Medical Publishers (P) Ltd Corporate Offi ce 4838/24 Ansari Road, Daryaganj, New Delhi - 110002, India, Phone: +91-11-43574357, Fax: +91-11-43574314 Registered Offi ce B-3 EMCA House, 23/23B Ansari Road, Daryaganj, New Delhi - 110 002, India Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021 +91-11-23245672, Rel: +91-11-32558559, Fax: +91-11-23276490, +91-11-23245683 e-mail: [email protected], Website: www.jaypeebrothers.com Of fi ces in India • Ahmedabad, Phone: Rel: +91-79-32988717, e-mail: [email protected] • Bengaluru, Phone: Rel: +91-80-32714073, e-mail: [email protected] • Chennai, Phone: Rel: +91-44-32972089, e-mail: [email protected] • Hyderabad, Phone: Rel:+91-40-32940929, e-mail: [email protected] • Kochi, Phone: +91-484-2395740, e-mail: [email protected] • Kolkata, Phone: +91-33-22276415, e-mail: [email protected] • Lucknow, Phone: +91-522-3040554, e-mail: [email protected] • Mumbai, Phone: Rel: +91-22-32926896, e-mail: [email protected] • Nagpur, Phone: Rel: +91-712-3245220, e-mail: [email protected] Overseas Offi ces • North America Offi ce, USA, Ph: 001-636-6279734, e-mail: [email protected], [email protected] • Central America Offi ce, Panama City, Panama, Ph: 001-507-317-0160, e-mail: [email protected], Website: www.jphmedical.com • Europe Offi ce, UK, Ph: +44 (0) 2031708910, e-mail: [email protected] A Short Textbook of Psychiatry © 2011, Niraj Ahuja All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher. This book has been published in good faith that the material provided by author is original. Every effort is made to ensure accuracy of material, but the publisher, printer and author will not be held responsible for any inadvertent error (s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only. First Edition: 1990 Second Edition: 1992 Third Edition: 1995 Fourth Edition: 1999 Fifth Edition: 2002 Sixth Edition: 2006 Reprint: 2009 Seventh Edition: 2011 ISBN: 978-93-80704-66-1 Typeset at JPBMP typesetting unit Printed at For Manisha and Neha Preface to the Seventh Edition It is rather humbling to consider that it has been two decades that the Short Textbook of Psychiatry has enjoyed a wide distribution among the undergraduate medical students, interns, junior residents, postgraduate psychiatry students, nursing students, psychology and psychiatric social work students, occupational therapy and physi- otherapy students, general medical practitioners, other physicians and health professionals in India and some other countries. I am really indebted to the many astute readers who have provided a very constructive and useful feedback, along with encouraging comments regarding the existing format and the contents of the book. The seventh edition of the Short Textbook of Psychiatry has been once again extensively revised and updated. Signifi cant changes have been made in almost all the chapters, especially in chapters on diagnosis and classifi cation, psychoactive substance use disorders, psychopharmacology, schizophrenia, mood disorders and other biological methods of treatment. Coloured-shaded boxes have been added at various places in the text to highlight the important points in tables and fi gures. The chapter on psychiatric history and examination contains a summary of laboratory tests in psychiatry, in additions to other signifi cant changes. The appendices have been revised and contain a glossary of common psychiatric terms. The Short Textbook of Psychiatry sincerely hopes to retain its original aim of providing a brief yet compre- hensive account of the psychiatric disorders and their allied aspects in a ‘user-friendly’ and ‘easy-to-follow’ manner. I am grateful to Shri Jitendar P Vij, Chairman and Managing Director, Jaypee Brothers Medical Publishers (P) Ltd for his exquisite control over the production and distribution of the Short Textbook of Psychiatry over the last 20 years. I hope you enjoy reading the book and I warmly welcome critical comments and constructive suggestions. Please send your comments by email to [email protected]. July 2010 Niraj Ahuja Preface to the First Edition Psychiatry, as a branch of Medicine, has been cold-shouldered by physicians for a long time. There are vari- ous reasons for such an attitude. But, the most important exposition is an unfamiliarity with the psychiatric disorders and their treatment. This is easy to understand in the light of the fact that an easily comprehensible, non-intimidating and concise text on psychiatry was not earlier available. Recently too, the various postgraduate entrance examinations have laid an increasing emphasis on psychiatry and its related branches. Keeping this in mind, the Medical Examination Review—Psychiatry (Multiple Choice Questions with Explanatory Answers) was written, the new edition of which appears this year. Its tremendous success during the last four years and encouraging suggestions from the readers have been a source of stimulation for drafting this text. The Short Textbook of Psychiatry aims to provide a brief yet comprehensive account of psychiatric disor- ders and their allied aspects. While striving to make the book simple and easy-to-follow, an attempt has been made to keep the book aligned to the most recent developments in classifi cation, terminology and treatment methods. The Short Textbook of Psychiatry is addressed to medical students, interested physicians and other health professionals. A postgraduate student in psychiatry will fi nd the text elementary and basic, although a fi rst year postgraduate will fi nd it useful for a broad introduction to the subject. I will like to put on record my deep appreciation for Shri Jitendar P Vij, Managing Director; Mr. Pawaninder Vij, Production Manager and their effi cient staff at the Jaypee Brothers Medical Publishers (P) Ltd, New Delhi for bringing out this volume in a short time. I welcome critical comments and constructive suggestions from the readers. January 1990 Niraj Ahuja Contents 1. Diagnosis and Classifi cation in Psychiatry ......................................................................................1 2. Psychiatric History and Examination ...............................................................................................5 3. Organic (Including Symptomatic) Mental Disorders ................................................................... 19 4. Psychoactive Substance Use Disorders ........................................................................................33 5. Schizophrenia ................................................................................................................................. 54 6. Mood Disorders .............................................................................................................................. 69 7. Other Psychotic Disorders ............................................................................................................. 83 8. Neurotic, Stress-related and Somatoform Disorders ................................................................... 89 9. Disorders of Adult Personality and Behaviour ...........................................................................113 10. Sexual Disorders ........................................................................................................................... 121 11. Sleep Disorders ............................................................................................................................. 133 12. Behavioural Syndromes Associated with Psychological Disturbances and Physiological Factors ...........................................................................................................
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