Category Archives: Psychological Medicine

Alcohol Abuse and Dependence

There are a number of different types of alcohol abuse, and a wide range of physical, social and psychological problems are associated with excessive drinking. Until recently, much attention was devoted to the syndrome of alcohol dependence. In fact, doctors should be concerned with the health problems caused by alcohol abuse whether or not such abuse is related to actual physiological dependence on alcohol. The

Hysterical Neurosis and Personality

Hysterical neurosis or hysteria is a condition in which there are symptoms and signs of disease with three characteristics: 1 They occur in the absence of physical pathology. 2 They are produced unconsciously. 3 They are not caused by overactivity of the sympathetic nervous system. The lifetime prevalence has been estimated at 3-6 per 1000 in women, with a lower incidence in men. Most cases begin before the age of

Obsessional Neuroses and Personality

Obsessional neuroses are characterized by obsessional thinking and compulsive behaviour (see p. 959) together with varying degrees of anxiety, depression and depersonalization. They account for some 2% of referrals to psychiatrists and have a prevalence in the general population of about 1 in 1000. Insomnia Anxiety Tremulousness Muscle twitchings Perceptual distortions Frank convulsions Withdrawal syndrome with ben

Neuroses and Personality Disorders

These disorders constitute the largest portion of psychiatric disorders, accounting for 50% of admissions to psychiatric hospitals, 75% of patients seen in psychiatric outpatient clinics, and over 90% of the psychiatric disorders seen and managed by general practitioners. There is an overlap between neuroses and personality disorders, although in general they can be distinguished. The neuroses are defined below

Suicide and Attempted Suicide (Deliberate Selfharm)

Between 11 and 17% of people who have suffered a severe depressive disorder at any time will eventually commit  suicide. About 1% of deaths in England and Wales each year are due to suicide, yielding a rate of 8 per 100000. Living alone Immigrant status Recent bereavement, separation or divorce Recent loss of a job or retirement Living in a socially disorganized area Male sex Older age Family history of affective

Manic-Depressive Disorder

The central feature of this disorder is an abnormality of mood, either depression or elation or both. Mood is best considered in terms of a continuum ranging from severe depression at one extreme to severe mania at the other, with normal, stable mood at the centre. Manic-depressive disorders are divided into bipolar manic-depression, in which patients suffer attacks of both depression and mania, and unipolar disor


The term schizophrenia was coined by the Swiss psychiatrist Eugen Bleuler in 1908 as a ‘rending (disconnection) or splitting of the psychic functions’. The normal integration of emotional and cognitive functions is ruptured in schizophrenia. The annual prevalence of the condition ranges between 2 and 4 per 1000. The lifetime risk of contracting schizophrenia is 1%, but for firstdegree relatives of suf

Organic Psychiatric Disorders

Organic brain diseases result from structural pathology, as in senile dementia, or from disturbed eNS function, as in fever-induced delirium. A classification of organic brain syndromes, derived from the American classification, DSM III, is shown in Table 19.5. Delirium Dementia Amnestic syndrome Organic delusional syndrome Organic affective syndrome Intoxication and withdrawal syndromes Classification of organic


Psychological and physical symptoms commonly occur together; surveys have shown that they tend to cluster in some people, while others remain relatively free from illnesses. The commonest presentation of psychiatric illhealth in physically ill patients is as affective disorders or acute organic brain syndromes. The relationship between psychological and physical symptoms may be understood in one of three ways: 1

Abnormal Beliefs and Interpretations of Events

The main form of abnormal belief is the delusion (Information box 19.1). Delusions can be: PRIMARY or autochthonous, i.e. they appear suddenly and with full conviction but without any preceding or related mental events. For example, a patient on being offered a cup of tea suddenly believes that this indicates that the Russians have landed at Dover. SECONDARY, i.e. derived from some preceding morbid experience, suc