The Medical Basis of Psychiatry The Medical Basis of Psychiatry Third Edition Edited by S. Hossein Fatemi, MD, PhD Professor of Psychiatry and Adjunct Professor of Pharmacology and Neuroscience University of Minnesota Medical School, Minneapolis, MN, USA Paula J. Clayton, MD Medical Director, American Foundation for Suicide Prevention, New York, NY, USA Foreword by Norman Sartorius, MD, PhD, FRCPsych Professor of Psychiatry, University of Geneva, Geneva, Switzerland Editors S. Hossein Fatemi, MD, PhD Paula J. Clayton, MD Department of Psychiatry American Foundation for Suicide Prevention University of Minnesota 120 Wall Street School of Medicine, MMC 392, New York, NY 10005, USA 420 Delaware Street, SE [email protected] Minneapolis, MN 55455, USA [email protected] ISBN: 978-1-58829-917-8 e-ISBN: 978-1-59745-252-6 Library of Congress Control Number: 2007943489 c 2008 Humana Press, a part of Springer Science+Business Media, LLC All rights reserved. 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The publisher makes no warranty, express or implied, with respect to the material contained herein. Cover illustration: see Fig. 38.2 and discussion on p. 708. Printed on acid-free paper 987654321 springer.com To George Winokur. SHF and PJC To my father, S. Mehdi Fatemi, and to my family, S. Ali Fatemi, MD, Naheed Fatemi, Parvin Fatemi, S. Mohammad Fatemi, Neelufaar Fatemi, Maryam Jalali-Mousavi, and last but not least, my mother, Fatemeh Parsa Moghaddam, whose love and support have enabled me to complete this work. SHF To my children, who have tolerated my passion for work and psychiatry: Clarissa Beth Weirick, Matthew Charles Clayton and Andrew Curtis Clayton, to George and his lovely family and to all those at Washington University Department of Psychiatry who taught me and inspired me. PJC Foreword This book has brought together the contributions of more than mood. Another dilemma is the biological versus nonbiolog- 70 outstanding experts in their fields, and this alone should be ical approach to psychiatric problems: here again, the chap- enough to recommend it to psychiatrists and others engaged ters on various methods of investigation, i.e., in the labo- in mental health research and education, as well as to those ratory, in the application of neuroimaging techniques, and focusing on the organization and provision of mental health in epidemiological studies, clearly show the advantages of care. But there are other features in this assembly of excellent each of these approaches without diminishing the value of the chapters that speak for this volume and make it quite unique. others. The dilemma of biological versus nonbiological treat- Thus, the editors of The Medical Basis of Psychiatry,Third ments is also resolved in a similar manner, showing even more Edition, have demonstrated that several important issues often clearly that the editors took a balanced, ecumenical, and prac- presented as major dilemmas before psychiatrists are in fact tical approach to the key aspects of today’s psychiatry. minor problems, and, therefore, discussion about them should It gives me great pleasure, therefore, to thank the editors not be allowed to block progress. The first is deciding between of and contributors to The Medical Basis of Psychiatry, Third a classification of mental disorders in groups of categories Edition, for their efforts, which have resulted in such a versus a crosswise examination of the domain of psychiatry comprehensive review of current evidence and issues of rele- by means of dimensions of functioning. Both are possible and vance to psychiatry, and to express the hope that this work will necessary, and the series of chapters dealing with groups of find the wide distribution that its quality and coverage richly categories of mental disorders that opens this book is richly deserves. complemented by the chapters that deal with dimensions Norman Sartorius, MD, PhD of functioning, such as thought disorder and disturbances of Geneva, Switzerland vii Preface Nearly 14 years have elapsed since the second edition of The major goal of previous editions of The Medical Basis of this book was published. George Winokur pioneered the early Psychiatry was to update the busy clinician, psychiatric resi- editions of this book and contributed significantly to the dent, and medical student with the most current information scientific value of this book by recruiting first-class psychi- on the etiology, diagnosis, and treatment of psychiatric disor- atrists and neuroscientists to contribute. However, George ders. This goal has been our focus for the third edition. All Winokur’s major contribution to the advancement of psychi- attempts have been made to provide the reader with the most atry remains his development of the Washington University up-to-date information and literature supported by a close criteria, along with Samuel Guze, Eli Robins, John Feighner, survey of the field. We are grateful to all the chapter authors, Robert Woodruff Jr., and Rodrigo Munoz. These criteria revo- who have strived to provide the reader with the biological lutionized and promulgated the first scientific classification of foundations of psychiatry. The Third Edition adds chapters psychiatric nosology. Psychiatry has emerged as a burgeoning dealing with new concepts in biology and treatment of mental scientific field with major advances in etiology and treat- disorders. We are optimistic that The Medical Basis of Psychi- ment of several disorders. Just as there was excitement in the atry, Third Edition, upholds the standards of this classic text- anatomic advances that took place a hundred years ago when book, and that its focus on the biologic and medical aspects of Emil Kraepelin and his collaborators took on the enormous psychiatry will continue to be of significant help to all inter- task of classifying psychiatric disorders based on rational ested in the scientific practice of psychiatry. scientific thinking, new advances in genetics, biochemistry, neuroanatomy, and pharmacotherapy of mental disorders have S. Hossein Fatemi, MD, PhD brought us even closer to a better understanding of complex Minneapolis, MN, USA disorders such as schizophrenia, bipolar disorder, depression, Paula J. Clayton, MD and even autism. New York, NY, USA ix Acknowledgments Many have helped to make the publication of this book We are also grateful to the publishers and authors who possible, including Dr. John Vuchetich. We are especially have generously given approval for reproduction of tables indebted to Mr. Timothy D. Folsom, who faithfully reviewed and figures, as well as to Mr. Richard Lansing, Mr. John all chapters for accuracy and worked as a liaison between Morgan, Ms. Sharmila Krishnamurthy, of Integra, and the the editors and the authors of the chapters and Ms. Teri Jane Humana Press for an excellent job in publishing this Reutiman, for help with various aspects of editing this book. book. We are grateful to Ms. Laurie Iversen for clerical assistance. We are also grateful to Dr. Alessandro Guidotti and Dr. Shitij SHF Kapur for their contributions to Chapter 40. PJC xi Contents Foreword.................................................................................................... vii Preface..................................................................................................... ix Acknowledgments ........................................................................................... xi Contributors.................................................................................................xvii ColorPlates................................................................................................. xxi Part I Syndromes—Adult 1 TheMentalStatusExamination............................................................................. 3 Hagop S. Akiskal 2 Syndromes of Brain Dysfunction Presenting with Cognitive Impairment or Behavioral Disturbance: Delirium, Dementia, and Mental Disorders Caused by a General Medical Condition . ................. 17 Keith E. Isenberg and Keith Garcia 3 The Amnestic Syndrome ................................................................................... 39 Hillel Grossman 4 BipolarIllness............................................................................................. 47 Paula J. Clayton 5 MajorDepressiveDisorder.................................................................................. 73 David L. Dunner 6 Schizophrenia . ............................................................................................ 85 S. Hossein Fatemi 7 Schizoaffective and Schizophreniform Disorders ..............................................................109