Acute presentations index Acute alcohol withdrawal p560 Emergency detention p882, p888, p892, p896 Acute benzodiazepine withdrawal p600 Failed suicide attempt p784 Acute dystonic reactions p954 Fitness to be interviewed p698 Acute grief reaction p388 Fitness to plead p716 Acute manic episode p326 Fitness to remain in police custody p697 Acute opiate withdrawal p598 Hallucinogen intoxication p586 Acute psychotic episode p226 Lithium toxicity p339 Acute schizophrenic episode p192 Manipulative patients p994 Acute stress reaction p382 Medically unexplained symptoms p796 ADHD p626 Negotiating principles p984 Akathisia p946 Neuroleptic malignant syndrome p956 Amphetamine psychosis p585 Panic attack p362 Anorexia nervosa \200\224admission criteria p404 Paradoxical reactions to benzodiazepines p929 Antidepressant discontinuation syndrome p964 Patient demanding admission p996 Antipsychotic-induced parkinsonism p944 Patient demanding medication p996 Attempted hanging/ asphyxiation p987 Patient refusing urgent medical treatment p872, p1000 Attempted overdose p986 Patient threatening suicide by telephone p997 Capacity assessment p794 Patient wanting to leave the ward (against medical advice) p1000 Catatonia p992 Postnatal depression p470 Challenging behavior p766 Postpartum psychosis p470 Child protection issues p662; p998 Pre liver transplant p816 Clozapine \200\234red \200\235 result p213 Priapism p942 Culture-bound syndromes p914 Rapid tranquillisation p991 Deliberate self-harm p986 Risk of suicide p51 Delirium/acute confusional state p790 Risk of violence p692 Delirium tremens p558 Serotonin syndrome p960 Delusional disorder p224 Severe behavioral disturbance p988 Dementia p132 Suspected factitious illness p814, p997 Depression with psychotic symptoms p258 Tardive dyskinesia p950 Depression without psychotic symptoms p256 Threats of violence p996 28_Semple_Front.indd 1023 12/10/2012 7:07:04 PM Reference ranges Hematological values Hemoglobin 13 \200\22318 g/dL 11.5 \200\22316 g/dL Mean cell volume (MCV) 76 \200\22396 fL 150 \200\223400 \227109/L Platelets 4 \200\22311 \227109/L White cell count (WCC) 2.0 \200\2237.5 \227109/L Neutrophils 0.04 \200\2230.44 \227109/L Eosinophils 1.3 \200\2233.5 \227109/L Lymphocytes Biochemistry values Sodium 135 \200\223145 mmol/L Potassium 3.5 \200\2235.0 mmol/L Creatinine 70 \200\223150 mol/L Urea 2.5 \200\2236.7 mmol/L Calcium (total) 2.12 \200\2232.65 mmol/L Albumin 35 \200\22350 g/L Protein 60 \200\22380 g/L Alanine aminotransferase (ALT) 5 \200\22335 iu/L Alkaline phosphatase 30 \200\223150 u/L Bilirubin 3 \200\22317 g/L Gamma-glutamyl-transpeptidase ( GT) 11 \200\22351 iu/L 7 \200\22333 iu/L Thyroid stimulating hormone (TSH) 0.5 \200\2235.7 mu/L Thyroxine (T4) 70 \200\223140 nmol/L Thyroxine (free) 9 \200\22322 pmol/L Tri-iodothyronine (T3) 1.2 \200\2233.0 nmol/L Vitamin B12 0.13 \200\2230.68 nmol/L Folate 2.1 g/L Glucose (fasting) 3.5 \200\2235.0 mmol/L Prolactin <450 u/L <600 u/L Creatinine kinase (CK) 25 \200\223195 iu/L 25 \200\223170 iu/L Osmolality 278 \200\223305 mosmol/kg Urine Osmolality 350 \200\2231000 mosmol/kg 28_Semple_Front.indd 1024 12/10/2012 7:07:04 PM Sodium 100 \200\223250 mmol/24h Protein <150 mg/24h Hydroxymethylmandelic acid (HMMA, VMA) 16 \200\22348 mmol/24h Reference ranges for selected drugs Lithium 0.8 \200\2231.2 mmol/L (p000) 0.6 \200\2230.8 mmol/L (as an augmentative agent) Valproate 50 \200\223125 mg/L (p000) Carbamazepine 4 \200\22312 mg/L (p000) (>7 mg/L may be more ef \201 cacious in bipolar disorder) Clozapine 350 \200\223500 g/L (0.35 \200\2230.5 mg/L) (p000) Nortriptyline 50 \200\223150 g/L 28_Semple_Front.indd 1025 12/10/2012 7:07:04 PM This page intentionally left blank OXFORD MEDICAL PUBLICATIONS Oxford Handbook of Psychiatry 00_Semple_Prelims.indd i 12/10/2012 3:38:27 PM Published and upcoming Oxford Handbooks Oxford Handbook for the Foundation Oxford Handbook of General Program 3e Practice 3e Oxford Handbook of Acute Oxford Handbook of Genetics Oxford Handbook of Genitourinary Medicine 3e Oxford Handbook of Anesthesia 3e Oxford Handbook of Applied Dental Medicine, HIV and AIDS 2e Oxford Handbook of Geriatric Sciences Medicine Oxford Handbook of Cardiology 2e Oxford Handbook of Clinical and Laboratory Investigation 3 e Oxford Handbook of Clinical Oxford Handbook of Infectious Diseases and Microbiology Oxford Handbook of Key Clinical Evidence Dentistry 5e Oxford Handbook of Medical Oxford Handbook of Clinical Dermatology Diagnosis 2e Oxford Handbook of Medical Imaging Oxford Handbook of Medical Oxford Handbook of Clinical Examination and Practical Skills Sciences 2e Oxford Handbook of Clinical Oxford Handbook of Medical Statistics Oxford Handbook of Nephrology and Hematology 3e Oxford Handbook of Clinical Immunology and Allergy 3e Oxford Handbook of Clinical Medicine - 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It furthers the Univer sity \200\231s objective of excellence in research, scholarship, and education by publishin g worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries Oxford University Press, 2013 The moral rights of the authors have been asserted First edition published 2005 Second edition published 2009 Third edition published 2013 Imp ression: 1 All rights reserved. No part of this publication may be reproduced, stored in a retrieval s ystem, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license or under terms ag reed with the appropriate reprographics rights organization. Enquiries concerning reproduct ion outside the scope of the above should be sent to the Rights Department, Oxford Universi ty Press, at the address above You must not circulate this work in any other form, and you must impose this same condition on any acquirer British Library Cataloging in Publication Data Data available Library of Congress Cataloging in Publication Data Library of Congress Control Number: 2012 944040 ISBN 978 \200\2230 \200\22319 \200\223969388 \200\2237 Printed in China by C&C Offset Printing Co. Ltd Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and c linical procedures with the most up-to-date published product information and data sheets p rovided by the manufacturers and the most recent codes of conduct and safety regulations. T he authors and the publishers do not accept responsibility or legal liability for any error s in the text or for the misuse or misapplication of material in this work. Except where ot herwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding. 00_Semple_Prelims.indd iv 12/10/2012 3:38:27 PM v Dedication To Fiona (D.M.S.) 00_Semple_Prelims.indd v 12/10/2012 3:38:27 PM This page intentionally left blank vii Preface to the \201 rst edition Every medical student and doctor is familiar with that strange mixture of panic and perplex ity which occurs when, despite having spent what seems like endless hours studying, one is completely at a loss as to what to do when confronted with a real patient with real problem s. For doctors of our generation that sense of panic was eased somewhat by the reassur- ing presence in the white coat pocket of the original Oxford Handbook of Clinical Medicine. A quick glance at one of its pages before approaching the patient served to refresh factual k nowledge, guide initial assessment, and highlight \200\230not to be missed \200\231 areas, allowing one to enter the room with a sense of at least initial con \201 dence which woul d otherwise have been lacking. The initial months of psychiatric practice are a time of particular anxi- ety, when familia r medical knowledge seems of no use and the patients and their symptoms appear baf \202 in g and strange. Every new psychiatrist is familiar with the strange sense of relief when a \200\230medical \200\231 problem arises in one of their patients \200\224 \200\230 \201 na lly something I know about \200\231. At this time, for us, the absence of a similar volume to the Oxford Handbook of Clinical Medicine for Psychiatrists was keenly felt. This volume attempts to ful \201 l the same function for medical students and doctors beginning psychi atric training or practice. The white coat pocket will have gone, but we hope that it can p rovide that same portable reassurance. 2004 D.M.S. R.S.S. J.K.B. R.D. A.M.M. 00_Semple_Prelims.indd vii 12/10/2012 3:38:27 PM viii Preface to the second edition It is entirely unoriginal for authors to think of their books as their \200\230chil- dren \200\231. Nonetheless, during the process of creating the \201 rst edition of this handbo ok we found ourselves understanding why the comparison is often made: experiencing the tria ls of a prolonged gestation and a dif \201 cult deliv- ery, balanced by the pride of seein g one \200\231s offspring \200\230out in the world \200\231. And of course, the rapid forg etting of the pain leading to agreement to produce a second a few years later. We have updated the handbook to re \202 ect the substantial changes in mental health and i ncapacity legislation across the UK, updated clinical guidance, the continuing service chan ges across psychiatric practice and the more modest improvements in treatments and the evid ence base for psychiatric practice. The main audience for this handbook has been doctors in training. Unfortunately the most re cent change experienced by this group has been profoundly negative, namely the ill-starred reform of medical training in the UK. This attempt to establish a \200\230year zero \200 \231 in medical education is widely agreed to have been a disaster. A \200\230lost generat ion \200\231 of juniors has been left demoralized and bewildered \200\224some have left our shores for good. Despite this, we have been impressed and heartened by the cheerful optimism and stubborn de termination shown by the current generation of trainees and we have been tremendously pleas ed when told by some of them that they have found our handbook useful. To them and their su c- cessors we offer this updated version. 2008 D.M.S. R.S.S. 00_Semple_Prelims.indd viii 12/10/2012 3:38:27 PM ix Preface to the third edition One of the ironies of writing books is that the preface, that part to which the reader come s \201 rst, is the very part to which the writers come last of all. Once the rest of the book is \201 nished, composing the preface can allow the authors an opportunity for re \202 ection and an attempt at summing-up their initial aims and current hopes for the book as it leaves their hands for the \201 nal time. While writing this third preface we found it interesting to examine its two predecessors, t o see what they revealed about our thoughts at those times. Reading the \201 rst preface it \200\231s clear we were writing to ourselves, or at least to our slightly younger selves , re \202 ecting on the book we wished we \200\231d had during our psychiatric training. T he emotions conveyed are those of anxiety and hope. Moving on to the second, it is addresse d to our junior colleagues, and seems to us to convey a mixture of indignation and pride. I n this third edition we have continued to revise and update the book \200\231s contents in line with new developments in clinical practice. While these changes re \202 ect ongoing a nd incremental improvement, one cannot fail to be struck by how unsatisfactory the state of our knowledge is in many areas and how inadequate many of our current treatments are. On t his occasion we \201 nished the book with the hopes that it would continue to serve as a useful guide to current best practice and an aid in the manage- ment of individual patients , and that these current inadequacies would inspire, rather than discourage, the next gener ation of clinicians and researchers. Our feelings at the end of a decade of involvement wit h this handbook are therefore of realism mixed with optimism. 2012 D.M.S. R.S.S. 00_Semple_Prelims.indd ix 12/10/2012 3:38:28 PM x Acknowledgements First edition In preparing this Handbook, we have bene \201 ted from the help and advice o f a number of our more senior colleagues, and we would speci \201 cally like to thank Prof . E.C. Johnstone, Prof. K.P. Ebmeier, Prof. D.C.O. Cunningham-Owens, Prof. M. Sharpe, Dr S. Gaur, Dr S. Lawrie, Dr J. Crichton, Dr L. Thomson, Dr H. Kennedy, Dr F. Browne, Dr C. Faul kner, and Dr A. Pelosi for giving us the bene \201 t of their experience and knowledge. Al so our SpR colleagues: Dr G. Ijomah, Dr D. Steele, Dr J. Steele, Dr J. Smith, and Dr C. McI ntosh, who helped keep us on the right track. We \200\230piloted \200\231 early versions of various sections with the SHOs attending the Royal Edinburgh Hospital for teaching of the MPhil course in Psychiatry (now reborn as the MRCPsych course). In a sense they are all contribu- tors, through the discussions generate d, but particular thanks go to Dr J. Patrick, Dr A. Stan \201 eld, Dr A. Morris, Dr R. Sca lly, Dr J. Hall, Dr L. Brown, and Dr J. Stoddart. Other key reviewers have been the Edinburgh medical students who were enthusiastic in readi ng various drafts for us: Peh Sun Loo, Claire Tordoff, Nadia Amin, Stephen Boag, Candice Ch an, Nancy Colchester, Victoria Sutherland, Ben Waterson, Simon Barton, Anna Hayes, Sam Murr ay, Yaw Nyadu, Joanna Willis, Ahsan-Ul-Haq Akram, Elizabeth Elliot, and Kave Shams. Finally, we would also like to thank the staff of OUP for their patience, help, and support. Second edition In the preparation of the \201 rst edition of this handbook we were joined by three colleagues who contributed individual specialist chapters: Dr R. Darjee (Forensic psychiatry, Legal issues, and Personality disor- ders), Dr J. Burns (Old age psychiatry, C hild and adolescent psychiatry, and Organic illness) and Dr A. McIntosh (Evidence-based psy chiatry and Schizophrenia). They continue to contribute to this revised version. For this second edition we have been joined by four additional col- leagues who revised and updated specialist sections: Dr L. Brown (Child and adolescent psychiatry), Dr A. McKechan ie (Learning disability) and Dr J. Patrick and Dr N. Forbes (Psychotherapy). We are gratefu l to them for their advice and help. We are also pleased to acknowledge the assistance of Dr S. MacHale, Dr G. Masterton, Dr J. Hall, Dr N. Sharma, and Dr L. Calvert with indi- vidual topics and thank them for their adv ice and suggestions. Other helpful suggestions came from our reviewers and those individu- als who gave us feedback (both in person or via the feedback cards). Once again we thank the OUP staff for their encouragement and help. Third edition The contributors named above were joined for this third edition by Dr S. Jauh ar (Substance misuse), Dr S. Kennedy (Sexual disorders), 00_Semple_Prelims.indd x 12/10/2012 3:38:28 PM ACKNOWLEDGEMENTS xi Dr F. Queirazza (Therapeutic issues), Dr A. Quinn and Dr A. Morris (Forensic psychiatry), a nd Dr T. Ryan (Organic illness and Old age psy- chiatry). We are also pleased to acknowledg e the assistance of Prof. J. Hall and Prof. D. Steele who provided helpful suggestions and engaged in useful discussions. We remain indebted to the staff at OUP for their support of this book and its authors over the last decade. 00_Semple_Prelims.indd xi 12/10/2012 3:38:28 PM xii Contributors Sameer Jauhar Clinical Research Worker, Psychosis Studies, Institute of Psychiatry, London, UK David Semple Consultant Psychiatrist, Hairmyres Hospital, East Kilbride, UK Honorary Fellow Division of Psychiatry, University of Edinburgh, Edinburgh, UK Sarah Kennedy Locum Consultant Psychiatrist, St John \200\231s Hospital, Livingston, West L othian, UK Roger Smyth Consultant Psychiatrist, Department of Psychological Medicine, Royal In \201 r mary of Edinburgh. Honorary Clinical Senior Lecturer, University of Edinburgh, Edinburgh, U K Filippo Queirazza ST4 in General Adult Psychiatry, Hairmyres Hospital, Glasgow, UK Alex Quinn Consultant forensic psychiatrist, The Orchard Clinic, The Royal Edinburgh Hospit al, Edinburgh, UK Tracy Ryan Consultant Liaison Psychiatrist, Department of Psychological Medicine, Royal In \201 rmary of Edinburgh, Edinburgh, UK 00_Semple_Prelims.indd xii 12/10/2012 3:38:28 PM xiii Contents Symbols and abbreviations xiv 1 Thinking about psychiatry 2 Psychiatric assessment 3 Symptoms of psychiatric illness 4 Ev idence-based psychiatry 5 Organic illness 6 Schizophrenia and related psychoses 7 Depressiv e illness 8 Bipolar illness 9 Anxiety and stress-related disorders 10 Eating and impulse-co ntrol disorders 11 Sleep disorders 12 Reproductive psychiatry, sexual dysfunction, 1 33 83 107 129 173 231 301 351 397 413 and sexuality 461 489 511 535 609 669 725 775 819 865 907 923 981 1009 1023 13 Personality disorders 14 Old age psychiatry 15 Substance misuse 16 Child and adolescent psychiatry 17 Forensic psychiatry 18 Learning disability 19 Liaison psychiatry 20 Psychothe rapy 21 Legal issues 22 Transcultural psychiatry 23 Therapeutic issues 24 Dif \201 cult an d urgent situations 25 Useful resources 26 ICD-10/DSM-IV index Index 1043 00_Semple_Prelims.indd xiii 12/10/2012 3:38:28 PM xiv Symbols and abbreviations Abbreviations can be a useful form of shorthand in both verbal and written communication. T hey should be used with care however, as there is the potential for misinterpretation when people have different understandings of what is meant by the abbreviation (e.g. PD may mean personality disor- der or Parkinson \200\231s disease; SAD may mean seasonal affective dis order or schizoaffective disorder). 1 2 3 4 5 6 7 8 9 i d l p s A B G D S Warning Important Don \200\231t dawdle Male Female Therefore Approximately Approximately eq ual to Plus/minus Increased Decreased Leads to Primary Secondary Alpha Beta Gamma Delta Sig ma Registered trademark Bomb (controversial topic) 5-hydroxytryptamine (serotonin) 5-hydrox ytryptophan Six-item Cognitive Impairment Test Accident and Emergency Alcoholics Anonymous American Association of Intellectual and Developmental Disability American Academy of Sleep Disorders Airway/breathing/circulation (initial resuscitation checks); antecedents, behavi or, consequences; Autism Behavior Checklist X 5-HT 5-HTP 6CIT A & E AA AAIDD AASM ABC 00_Semple_Prelims.indd xiv 12/10/2012 3:38:28 PM SYMBOLS AND ABBREVIATIONS CONTENTS xv ABG ACC ACE \200\224R ACh AChE(Is) ACTH AD ADDISS Arterial blood gas Anterior cingulate cortex Addenbrooke \200\231s Cognitive Examination \200\224Revised Acetylcholine Acetylcholinesterase (inhibitors) Adrenocorticotrophic hormon e Alzheimer \200\231s disease Attention De \201 cit Disorder Information and Support Servi ce Alcohol dehydrogenase; antidiuretic hormone Attention de \201 cit hyperactivity disorde r Autism Diagnostic Interview \200\224Revised Activities of daily living Autism Diagnostic Observation Schedule ALS \200\223dementia \200\223Parkinson complex of Guam Anti-epileptic drug Atrial \201 brillation Alpha-fetoprotein Acquired immunode \201 ciency syndrome Abn ormal Involuntary Movement Scale American Journal of Psychiatry Also known as Alcoholic liv er disease Acetaldehyde dehydrogenase Approved mental health professional Approved medical practitioner Abbreviated Mental Test Anorexia nervosa Antinuclear factor Anterioposterior A merican Psychiatric Association Antisocial personality disorder Apolipoprotein E Addicted P hysicians \200\231 Program; amyloid precursor protein Acute respiratory distress syndrome A bsolute risk reduction Autism spectrum disorders Advanced sleep phase syndrome Approved soc ial worker Alcohol Use Disorders Identi \201 cation Test Blood alcohol concentration ADH ADHD ADI \200\224R ADLs ADOS ADPG AED AF AFP AIDS AIMS AJP aka ALD ALDH AMHP AMP AMT AN ANF AP APA APD ApoE APP ARDS ARR ASD ASPS ASW AUDIT BAC 00_Semple_Prelims.indd xv 12/10/2012 3:38:28 PM xvi SYMBOLS AND ABBREVIATIONS CONTENTS BAI bd BDI BDP-SCALE Borderline personality disorder scale BDNF BDZ BIMC BiPAP BJP BMI BMJ BNF BP BPD BPRS BPSD BSE C&A C(P)K Ca2+ CADASIL Beck Anxiety Index Bis die (twice daily) Beck Depression Inventory Brain derived neurotrophic factor Benzodiazepine Blessed Information Memory Concentration S cale Bi-level positive airways pressure British Journal of Psychiatry Body mass index Briti sh Medical Journal British National Formulary Blood pressure Borderline personality disorde r Brief Psychiatric Rating Scale Behavioral and psychological symptoms in dementia Bovine s pongiform encephalopathy Child and adolescent Creatine (phospho)kinase Calcium Cerebral aut osomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy Cut down? An noyed Guilty? Eye opener Child and Adolescent Mental Health Services Cyclic adenosine monop hosphate Childhood Autism Rating Scale Cognitive analytical therapy Cortico-basal degenerat ion Cerebral blood \202 ow Cognitive behavioral therapy Creatinine clearance Congestive c ardiac failure Cholecystokinin Conduct disorder Childhood disintegrative disorder Children s Depression Inventory Carbohydrate-de \201 cient transferrin Control event rate Chronic f atigue syndrome Creutzfeldt \200\223Jakob disease Creatinine kinase CAGE CAMHS cAMP CARS CAT CBD CBF CBT CC CCF CCK CD CDD CDI CDT CER CFS CJD CK 00_Semple_Prelims.indd xvi 12/10/2012 3:38:28 PM SYMBOLS AND ABBREVIATIONS CONTENTS xvii Cl \210\222 CMV CNS CO CO2 COAD COPD COPE CPA Chloride Cytomegalovirus Central nervous system Carbon monoxide Carbon dioxide Chronic obst ructive airways disease Chronic obstructive pulmonary disorder Calendar of premenstrual exp eriences Care program approach; Criminal Procedures Act; Care Program Approach Continuous p ositive airway pressure Clozapine Patient Monitoring Service Community psychiatric nurse Co mplex partial seizure Conditioned response Corticotropin-releasing factor; chronic renal fa ilure Corticotropin-releasing hormone C-reactive protein Conditioned stimulus Childhood sex ual abuse Cerebrospinal \202 uid Computed tomography Community Treatment Order; Compulsor y Treatment Order (Scotland) Cerebrovascular accident Cardiovascular system Chest X-ray Day (s) Dopamine Disordered action of the heart De \201 cits in attention, motor control, and perception d-amino acid oxidase activator Dementia of the Alzheimer type Deep brain stimula tion Dialectical behavioral therapy Developmental coordination disorder Disorders of extrem e stress not otherwise speci \201 ed Diagnostic interview for borderline personality Diagn ostic Interview for dsm Personality Disorders Diagnostic Interview Schedule Disrupted in Sc hizophrenia 1 CPAP CPMS CPN CPS CR CRF CRH CRP CS CSA CSF CT CTO CVA CVS CXR d DA DAH DAMP DAOA DAT DBS DBT DCD DESNOS DIB DIPD-IV DIS DISC 1 00_Semple_Prelims.indd xvii 12/10/2012 3:38:28 PM xviii SYMBOLS AND ABBREVIATIONS CONTENTS DKA DLB DLPFC DMP DMS DMST DMT DNA DNRI DOM DP DRSP DSH DSM-IV DSPS DTs DTTOS DZ E/P EBM EB MH EBV ECA ECG echo ECT EDC EDS EEG EER ELISA EMDR EMG EMW EOG EPA EPC EPSEs ERIC ERP ESR Diabetic Ketoacidosis Dementia with Lewy bodies Dorsolateral Prefrontal Cortex Designated m edical practitioner Denzapine Monitoring System Dexamethasone suppression test dimethyltryp tamine Deoxyribonucleic acid Dopamine-norepinephrine reuptake inhibitor 2,5-di-methoxy4-met hylamfetamine Depressive Daily record of severity of problems Deliberate self-harm Diagnost ic and Statistical Manual, 4th edition Delayed sleep phase syndrome Delirium tremens Drug t esting and treatment orders Dizygotic Extrapyramidal Evidence-based medicine Evidence-based mental health Epstein \200\223Barr virus Epidemiological Catchment Area Program (NIMH) Ele ctrocardiogram Echocardiogram Electro-convulsive therapy Emergency detention certi \201 ca te Excessive daytime sleepiness Electroencephalogram Experimental event rate Enzyme-linked immunosorbent assay Eye movement desensitization and reprocessing Electromyograph Early mor ning wakening Electro-oculogram Enduring power of attorney Epilepsy partialis continuans Ex tra-pyramidal side-effects Enuresis Resource and Information Center Exposure response preve ntion Erythrocyte sedimentation rate 00_Semple_Prelims.indd xviii 12/10/2012 3:38:28 PM SYMBOLS AND ABBREVIATIONS CONTENTS xix FAB FAS FBC FFT FGA FGF FIIS FISH fMRI FPG FSH FT FTD FTM g GABA GAD GAF GAG GARS GBL GCS G DS GENDEP GET GFR GGT GH GHB GHQ GI(T) GMC GnRH GP GSH GU GWA GWAS h HAD Frontal assessment battery Fetal alcohol syndrome Full blood count Family-focused therapy F irst generation antipsychotic Frenzied guilt and fear Factitious or induced illness syndrom e Fluorescence in situ hybridization Functional magnetic resonance imaging Fasting plasma g lucose Follicle-stimulating hormone Family therapy Fronto-temporal dementia Female to male Gram Gamma-aminobutyric acid Generalized anxiety disorder Global Assessment of Functioning Scale Glycosaminoglycans Gilliam Autism Rating Scale Gammabutyrolactone Glasgow Coma Scale Geriatric Depression Scale Genome-based Therapeutic Drugs for Depression Graded exercise th erapy Glomerular \201 ltration rate Gamma glutamyl transferase Growth hormone Gamma-hydro xybutyrate General Health Questionnaire Gastrointestinal tract General Medical Council Gona dotrophin-releasing hormone General practitioner Guided self-help Genitourinary Genome-wide association Genome-wide association Studies Hour HIV-associated dementia; Hamilton anxiety and depression rating scale 00_Semple_Prelims.indd xix 12/10/2012 3:38:28 PM xx SYMBOLS AND ABBREVIATIONS CONTENTS HADS HAM-A HAM-D HALO HAV Hb HBV Hct HCV HD HDL-C HDV HIV HLA HPA HR HRT HSV HVA HVS Hz IAD L IBS ICD ICD-10 ICER ICP ICU IDDM IED IHD IM IMHA INR Intcp IPCU IPDE IPT IQ IQCODE ITU Hospital Anxiety and Depression Scale Hamilton Anxiety Rating Scale Hamilton Rating Scale f or Depression Hampshire Assessment for Living with Others Hepatitis A virus Hemoglobin Hepa titis B virus Haematocrit Hepatitis C virus Huntington \200\231s disease (chorea) High-dens ity lipoprotein cholesterol Hepatitis D virus Human immunode \201 ciency virus Human leuco cyte antigen Hypothalamic \200\223pituitary \200\223adrenal (axis) Heart rate Hormone repla cement therapy Herpes simplex virus Homovanillic acid Hyperventilation syndrome Hertz (cycl es per second) Instrumental Activities of Daily Living Irritable bowel syndrome Impulse-con trol disorder International Classi \201 cation of Diseases, 10th revision Incremental cost -effectiveness ratio Intracranial pressure Intensive care unit Insulin-dependent diabetes m ellitus Intermittent explosive disorder Ischaemic heart disease Intramuscular Independent m ental health advocacy International normalized ratio (prothrombin ratio) Integrated Care Pa thways Intensive psychiatric care unit International Personality Disorder Examination Inter personal therapy Intelligence quotient Informant Questionnaire on Cognitive Decline Intensi ve care unit 00_Semple_Prelims.indd xx 12/10/2012 3:38:28 PM SYMBOLS AND ABBREVIATIONS CONTENTS xxi iu IV(I) IVDU JAMA K+ kg L LAC LD LFTs LH (RH) LOC LP LPA LR LRTI LSD LTM LTP MADRas mane M AOI MARS MCMI MCMs MCT MCV MD MDD MDMA MDQ ME MEG MERRF mg Mg2+ mGluR MHA MHAC MHC MHCNI International unit Intravenous (infusion) Intravenous drug user Journal of the American Med ical Association Potassium Kilogram Liter; left Looked-after child Learning disability Live r function tests Luteinizing hormone (releasing hormone) Loss of consciousness Lumbar punct ure Lasting powers of attorney Likelihood ratio Lower respiratory tract infection Lysergic acid diethylamide Long-term memory Long-term potentiation Montgomery-Asberg Depression Rati ng Scale In the morning Monoamine oxidase inhibitor Munich Antidepressant Response Signatur e Millon Clinical Multiaxial Inventory Major congenital malformations Magneto-convulsive th erapy Mean cell volume; mean corpuscular volume Mental disorder Major depressive disorder M ethylenedioxymethamfetamine (ecstasy) Mood Disorders Questionnaire Myalgic encephalomyeliti s Magnetoencephalogram Myoclonic epilepsy with ragged red \201 bres Milligram Magnesium R egional metabolism of glucose Mental Health Act Mental Health Act Commission Mental Health Commission (RoI) Mental Health Commission for Northern Ireland 00_Semple_Prelims.indd xxi 12/10/2012 3:38:28 PM xxii SYMBOLS AND ABBREVIATIONS CONTENTS MHO MHRT MHRTNI MHTS MI MID min(s) mL mmHg MMPI MMSE MND mPFC MR MRI MRS MS MSA MSE MSLT MT F Mth(s) MUS MWC MZ n N&V NA Na2+ NAD NARI NaSSA NCS NCS-R NDRI NE NEJM NFT ng NG(T) NICE Mental health of \201 cer Mental Health Review Tribunal Mental Health Review Tribunal for Northern Ireland Mental Health Tribunal for Scotland Myocardial infarction Multi-infarct de mentia Minute(s) Milliliter Millimeters of mercury Minnesota Multiphasic Personality Invent ory Mini Mental State Examination Motor neuron disease Medial prefrontal cortex Modi \201 ed release Magnetic resonance imaging Magnetic resonance spectroscopy Multiple sclerosis Mu ltiple system atrophy Mental state examination Multiple sleep latency test Male to female M onth(s) Medically unexplained symptoms Mental Welfare Commission (Scotland) Monozygotic Sam ple size, number of subjects Nausea and vomiting Narcotics Anonymous Sodium No abnormality detected Noradrenaline reuptake inhibitor Noradrenaline and speci \201 c serotonin antagon ist National Comorbidity Survey (1990 \200\22392) National Comorbidity Survey \200\223 Rep lication (2001 \200\22302) Noradrenergic and dopaminergic reuptake inhibitor Norepinephrine (noraderenaline) New England Journal of Medicine Neuro \201 brillary tangles Nanogram Nas ogastric (tube) National Institute for Health and Clinical Excellence 00_Semple_Prelims.indd xxii 12/10/2012 3:38:28 PM SYMBOLS AND ABBREVIATIONS CONTENTS xxiii NIDDM NIH NIMH NMD NMDA NMR NMRS NMS NNT NO NP NPH NPV NR NSAIDs nvCJD OASys OCD OCP od OD ODD OFC OGRS OGTT OPD OPG OR OSA OT PaCO2 PAG PAN PANDAS Non-insulin dependent diabetes mellitus National Institutes of Health National Institute of Mental Health (US) Neurosurgery for mental disorder N-methyl-D-aspartate Nuclear magnetic resonance Nuclear magnetic resonance spectroscopy Neuroleptic malignant syndrome Number nee ded to treat Nitric oxide Nocturnal panic attacks Normal pressure hydrocephalus Negative pr edictive values Nearest relative Non-steroidal anti-in \202 ammatory drugs New variant Cre utzfeldt \200\223Jakob disease Offender assessment system Obsessive \200\223compulsive diso rder Oral contraceptive pills Omni dei (once daily) Overdose Oppositional de \201 ant diso rder Orbitofrontal cortex Offender Group Reconviction Scale Oral glucose tolerance test Out patient department Of \201 ce of the Public Guardian Odds ratio Obstructive sleep apnoea O ccupational therapy Partial pressure of carbon dioxide in arterial blood Periaqueductal gra y matter Polyarteritis nodosa Pediatric autoimmune neurological disorder associated with st reptococcus Positive and Negative Symptom Scale Partial pressure of oxygen in arterial bloo d Personal assessment schedule Psychopathy checklist \200\224revised Psychopathy checklist \200\224screening version Pneumocystis carinii pneumonia; phencyclidine PANSS PaO2 PAS PCL-R PCL-SV PCP 00_Semple_Prelims.indd xxiii 12/10/2012 3:38:29 PM xxiv SYMBOLS AND ABBREVIATIONS PD PDD Personality disorder; panic disorder; Parkinson \200\231s disease Pervasive developmental d isorder; premenstrual dysphoric disorder Personality Disorder Questionnaire IV Pulmonary em bolism Picture exchange communication system Positron emission tomography Plasma homovanill ic acid Phenylketonuria Prolactin Periodic limb movement (in sleep) Premenstrual dysphoric disorder Past medical history Premenstrual syndrome Parent management training; premenstrua l tension Paroxysmal nocturnal dyspnoea; postnatal depression Per os (by mouth, orally) Pho sphate Positive predictive values Per rectum (by the rectum); pulse rate PDQ-IV PE PECS PET pHVA PKU PL PLMS PMDD PMH PMS PMT PND PO PO4 PPV PR PRIME-MD Primary Car e Evaluation of Mental Disorder PRISM Prospective record of the impact and severity of menstruation Prolactin (or PrL) Pro re nat a (as required) Prion protein Prostate-speci \201 c antigen Present state examination Prog ressive supranuclear palsy Post-traumatic amnesia Post-traumatic delirium Post-traumatic ep ilepsy Parathyroid hormone Post-traumatic stress disorder Prothrombin time Per vagina (by t he vagina) Prader \200\223Willi syndrome Fourth die sumendus (four times daily) Fourth in d ie (four times daily) Quality of Life Interview PRL PRN PrP PSA PSE PSNP PTA PTD PTE PTH PTSD PTT PV PWS qds qid QOLI 00_Semple_Prelims.indd xxiv 12/10/2012 3:38:29 PM SYMBOLS AND ABBREVIATIONS xxv R RA RAGF RAMAS RAS RBC rCBF RCP RCT RDC REM RET RIMA RMO ROR RPG RPS RR RRASOR RRR RSBD RS VP RTA RTI rTMS Rx s S SAD SANS SAP SAPS SARA SARI SBE SC SCARED Right Rheumatoid arthritis; retrograde amnesia Risk assessment guidance framework Risk asse ssment, management, and audit systems Reticular activating system Red blood cell Regional c erebral blood \202 ow Royal College of Psychiatrists Randomized controlled trial Research diagnostic criteria Rapid eye movement (sleep) Rational emotive therapy Reversible inhibit or of monoamine oxidase Responsible medical of \201 cer Risk of reconviction (score ) Rand om plasma glucose Reconviction prediction score Relative risk Rapid risk assessment of sex offender recidivism Relative risk reduction REM sleep behavior disorder Risk of sexual viol ence protocol Road traf \201 c accident Respiratory tract infection Repetitive transcrania l magnetic stimulation Recipe (treat with) Second (or sec) Section (of MHA) Seasonal affect ive disorder Scale for the Assessment of Negative Symptoms Standardized assessment of perso nality Scale for the Assessment of Positive Symptoms Spousal assault risk assessment Seroto nin antagonist and reuptake inhibitor Subacute bacterial endocarditis Subcutaneous Anxiety Screen for Child Anxiety-Related Emotional Disorders Structured Clinical Interview for DSM- IV personality disorder Supervised community treatment SCID-II SCT 00_Semple_Prelims.indd xxv 12/10/2012 3:38:29 PM xxvi SYMBOLS AND ABBREVIATIONS SD SDH SDQ SE SGA SIADH SIB SIDP-IV SL SLE SLL SM SNOAR SNRI SOAD SORAG SOREMP SP SPECT SPE T SR SRS SS SSP SSPE SSRI SST STAR*D stat STD STDO STI STM SWS SXR T t1/2 T3 T4 TA Standard deviation Subdural hematoma Strengths and differences questionaire Sleep ef \201 ciency Second generation antipsychotic Syndrome of inappropriate antidiuretic hormone secre tion Structured interview for borderlines Structured interview for DSM-IV personality disor der Sublingual Systemic lupus erythematosus Stereotactic limbic leucotomy Selective mutism Sleep and nocturnal obstructive apnoea redactor Serotonin and noradrenaline reuptake inhibi tor Second opinion appointed doctor Sexual offending risk appraisal guide Sleep onset REM p eriod Social phobia Single photon emission computed tomography Single photon emission tomog raphy Systematic review Sex reassignment surgery Serotonin syndrome Schedule for schizoid p ersonalities Subacute sclerosing panencephalitis Selective serotonin reuptake inhibitor Ste reotactic subcaudate tractotomy Sequenced Treatment Alternatives to Relieve Depression Stat im (immediately) Sexually transmitted disease Short-term detention order Sexually transmitt ed infection Short-term memory Slow wave sleep Skull X-ray Temperature Biological half-life Tri-iodothyronine Thyroxine Total abstinence 00_Semple_Prelims.indd xxvi 12/10/2012 3:38:29 PM SYMBOLS AND ABBREVIATIONS xxvii TB TCA TD tds TeCA TENS TFTs TG TGA THC TIA tid TLE ToRCH Tuberculosis Tricyclic antidepressant Tardive dyskinesia Ter die sumendus (three times dail y) Tetracyclic antidepressant Transcutaneous electrical nerve stimulation Thyroid function tests Triglycerides Transient global amnesia Tetrahydrocannabinol Transient ischaemic attac k Ter in die (three times daily) Temporal lobe epilepsy Toxoplasmosis, rubella, cytomegalov irus, herpes simplex virus Temperature, pulse, respirations (general observations) Thyroid- releasing hormone Treatment-resistant schizophrenia (Gilles de la) Tourette \200\231s syndr ome Tuberous sclerosis Thyroid-stimulating hormone Total sleep time Units Urea and electrol ytes Urine glucose Uvulopalatopharyngoplasty Unconditioned response Upper respiratory tract Upper respiratory tract infection Unconditioned stimulus Ultrasound (scan) Urinary tract i nfection Variant Creutzfeldt \200\223Jakob disease Venereal Disease Research Laboratory (te st for syphilis) Visual evoked potential Von Hippel \200\223Lindau Vanillyl mandelic acid V entromedial prefrontal cortex Vagus nerve stimulation White blood cell TPR TRH TRS TS TSC TSH TST U U&Es UG UPPP UR URT URTI US US(S) UTI vCJD VDRL VEP VHL VMA vm PFC VNS WBC 00_Semple_Prelims.indd xxvii 12/10/2012 3:38:29 PM SYMBOLS AND ABBREVIATIONS xxviii WCC WD WFMH WHO WISPI wk(s) WM WPA XR Y \200\223BOCS YMRS yr(s) ZTAS