Kaplan G., Sadok B. Clinical psychiatry. Download
TRANSLATION FROM ENGLISH ADDED

PARTICIPANTS OF THE RUSSIAN EDITION
Editor-in-Chief - Tatyana Borisovna Dmitrieva, Corresponding Member. RAMS, professor
Editors and authors of additions
Aleksandrovsky Yuriy Anatolievich, Dr. med. Sciences, Professor - Managing Editor
Avedisova Alla Sergeevna, Ph.D. honey. Sciences (Ch. 15, 24) Bardenshtein Leonid Mikhailovich, Doctor of Medicine. Sci., Professor (Ch. 9, 10) Vandysh-Bubko Vasiliy Vasilievich, Dr. med. Sciences (Ch. 3, 4) Guryeva Valeria Alexandrovna, Doctor of Medicine. sciences, professor (ch. 20)
Enikeev Iskander Derdovich, Ph.D. honey. in Medicine, Fellow of the American Psychiatric Association, M.D., Ph.D. (translation editor)
Igonin Andrey Leonidovich, Dr. sciences, professor (ch. 5)
Kekelidze Zurab Ilyich, Dr. med. sciences (ch. 19, 22, 25)
Klimenko Tatyana Valentinovna, doctor of medical sciences sciences (ch. 6)
Kogan Boris Mikhailovich, Dr. sciences (ch. 27)
Kolosov Vladimir Petrovich, Ph.D. honey. sciences (ch. 23)
Kondratiev Fedor Viktorovich, Dr. sciences, professor (ch. 7, 8)
Romasenko Lyubov Vladimirovna, Dr. Sciences (Ch. 11, 12, 14, 17)
Tkachenko Andrey Anatolievich, Dr. sciences (ch. 13)
Shishkov Sergey Nikolaevich, Ph.D. legal sciences (ch. 26)
Shostakovich Boris Vladimirovich, Dr. Sciences, Professor (Ch. 16, 18)

GEOTAR MEDICINE Moscow 1998
UDC 616. 89 (075 8) BBK56 14Ya73 P86
ISBN 5-88816-010-5
PocketHandbookofClinicalPsychiatry//HaroldIKaplan, BenjaminJSadock//Baltimore, Williams & Wilkins - ISBN 0-683-04583-0

Recommended by the Ministry of Health of the Russian Federation as a teaching aid for students of medical universities, interns, residents, medical cadets of institutions of additional professional education.

Translation of the 2nd edition of the "Concise Guide to Clinical Psychiatry" by the world-famous authors G Kaplan and B Sadok (1996, Williams & Wilkins publishing house) The publication has been supplemented and adapted by leading Russian psychiatrists in accordance with the characteristics and traditions of Russian psychiatry. The book covers modern scientific and practical information on key aspects of etiology, symptoms, diagnosis and treatment of all forms of mental pathology. The text is presented concisely, accessible, accompanied by a large number of tables that facilitate the perception of the material.

The book is intended for psychiatrists, general practitioners and medical students

The rights to this publication belong to the publishing house GEOTAR MEDICINE Reproduction and distribution in any form of part or the whole publication cannot be carried out without the written permission of the publisher

FOREWORD
Acquaintance with the basics of clinical disciplines taught in medical schools around the world is of great importance for expanding the horizons of medical students and young doctors.
Despite the fact that modern medicine is basically international, in many countries it retains its own traditions and schools, and the level of development of medical science largely depends on the material and technical capabilities of healthcare.
This determines the regional and national peculiarities of understanding and solving medical, diagnostic, preventive, and rehabilitation problems, which sometimes creates difficulties for specialists from different countries in finding a common language for professional communication.

All this is clearly manifested in the example of modern psychiatry. Today, various classification and diagnostic schemes are used in medical institutions in the United States (DSM-IV-R), European countries (ICD-10), and in Russia, where ICD-9 is still used.
At the same time, there are a large number of comments accepted in each country and options for approaches for making a psychiatric diagnosis.
One of the main ways to overcome these differences is to get acquainted with fundamental scientific publications, primarily with guidelines for students and doctors published in foreign countries.

Unfortunately, modern foreign manuals on psychiatry have hardly been translated in Russia until recently. Known from annotated translations, they did not give a complete picture of the author's positions and did not always represent the essence of their approaches to understanding the foundations of psychopathology.

The publication in Russia of the American manual on psychiatry by G. Kaplan and B. Sadok, repeatedly reprinted in many countries of the world, undertaken by the young publishing house GEOTAR MEDICINE, is a significant event in Russian psychiatry for a number of reasons.

Firstly, this book allows you to "according to the original source" to get acquainted with the principles and main methodological approaches in making a diagnosis and conducting a "standardized" treatment of the mentally ill, adopted in the United States and many English-speaking countries.

Secondly, the book is written taking into account the current trend of convergence of psychiatry with other areas of clinical medicine and is aimed not only at a qualified psychiatrist, but also at a general practitioner. In this regard, it can become an important tool in our country for specialists in various clinical disciplines, as well as for district and family doctors.

Thirdly, the book is notable for its methodological clarity and complete coverage of all the major clinical problems of modern psychiatry. Its 27 main chapters and good reference support allow you to navigate almost all issues of diagnosis, therapy and rehabilitation of the mentally ill.

The published guide is not limited to the translation of the author's text. A large team of highly qualified specialists worked on its adaptation for the Russian reader and the addition (in agreement with the authors), who by right could become co-authors of individual chapters of the manual. All additions and comments to the translation are in italics in the text.

"Clinical Psychiatry" is published in Russia shortly after the Russian-American meeting of specialists in the field of psychiatry (Moscow, September 1997), who discussed issues of interaction within the Healthcare Committee of the Russian-American Commission on Economic and Technological Cooperation ("Gore-Chernomyrdin Commission" ).

At this meeting, specific areas of cooperation in the field of scientific research and practical psychiatry were outlined. Among them, translations of scientific and educational literature are of great importance. The publication of the book by G. Kaplan and B. Sadok is a real fulfillment of the cooperation plan, contributing to the expansion of contacts between domestic psychiatrists and American colleagues.

I would like to express my confidence that this book will have a large number of interested, thinking readers and it will contribute to the mutual enrichment of Russian and American psychiatry.

Chief Editor
Minister of Health of Russia
Corresponding Member of the Russian Academy of Medical Sciences, Professor T.E. Dmitrieva ​

Content
1. Diagnosis and classification in psychiatry .............................................. .............................. 13
I. Introduction ............................................... ................................................. ................... 13
II. Classification of mental disorders .............................................................. ................... fourteen
2. Psychiatric examination: medical history, mental state, clinical signs and symptoms .................................................................. .............................................. 23
I. Introduction ............................................... ................................................. ................. 23
II. Methodology of the clinical interview .......................................................... ................... 23
III. Psychiatric medical history ............................................................... ........................... 25
IV. Mental condition................................................ .............................................. 26
V. Somatic and neurological examination .............................................................. ........ thirty
VI. Recording Findings from the Medical History and Evaluation of Mental Status ....................... 30
VII. Definitions (definitions) of signs and symptoms found during the examination of the mental state .............................................................. ......................... 34
3. Delirium, dementia, amnestic and other cognitive disorders and mental disorders due to somatic and neurological diseases ............................................................... ................................................. ................................. 43
I. Introduction ............................................... ................................................. ................. 43
II. Clinical examination .............................................................. ............................................... 44
III. Delirium .................................................. ................................................. ................. 44
IV. Dementia ................................................. ................................................. ............... 47
V. Dementia in Alzheimer's disease (TWO).................................................. ................... 51
VI. Vascular dementia .............................................................. ............................................... 54
VII. Pick's disease................................................... ................................................. .......... 57
VIII. Creutzfeldt-Jakob disease .............................................................. ................................. 57
IX. Huntington's disease (progressive hereditary chorea, Huntington's chorea) ................................................. ................. 57
X. Parkinson's disease (shaking palsy).................................................................. .............. 58
XI. Other dementias................................................... ................................................. ..59
XII. Amnestic disorders .................................................................. ................................... 59
XIII. Transient global amnesia .............................................................. ........................... 61
XIV. Mental disorders due to somatic or neurological diseases.................................................................................. ................................................. ...... 61
XV. Other pathological conditions ............................................................... ................................... 62
4. Neuropsychiatric aspects of HIV infection .............................................................. ................. 67
I. Introduction ............................................... ................................................. ................... 67
II. Clinical manifestations of CNS damage .............................................................. ................... 69
III. Psychopathological syndromes .............................................................. ................................. 70
IV. Treatment................................................. ................................................. ................. 71
5. Substance Use Disorders ..............................................................75
I. Introduction ............................................... ................................................. ................. 75
II. Opioids .................................................. ................................................. ................... 84
III. Sedatives, hypnotics and anxiolytics .............................................................. 87
IV. Stimulants (phenamine and substances similar in their effect to phenamine) .................................................................. ................................................. ................... 89
V. Cocaine ............................................... ................................................. ................... 90
VI. Cannabis.................................................. ................................................. ............... 91
VII. Hallucinogens .................................................................. ................................................. ..... 92
VIII. PCP ................................................. ................................................. ....................... 93
IX. Inhalants ............................................... ................................................. .................94
X. Caffeine ............................................................... ................................................. ...................... 95
XI. Nicotine................................................. ................................................. ................... 95
6. Alcohol use disorders .............................................................. .......... 97
I. Introduction ........................................: ..... ................................................. ................. 97
II. Alcohol dependence and alcohol abuse ............................................................. 98
III. Alcohol intoxication (alcohol intoxication).................................................................. .104
IV. Psychotic disorder with hallucinations caused by alcohol .............................. 106
V. Alcoholic withdrawal syndrome.................................................................... .................................... 106
VI. Alcohol withdrawal syndrome with delirium (delirium tremens).................................................................. 106
VII. Persistent amnestic disorder caused by alcohol .............................................. 108
VIII. Persistent alcohol-induced dementia .............................................................. ................. 109
7. Schizophrenia ............................................... ................................................. ................... 111
I. Definition ............................................................... ................................................. .......... 111
II. Historical information ................................................................ ................................................. 111
III. Diagnosis and symptoms ............................................................... ................................................. 111
IV. Types of schizophrenia .............................................................. ................................................. .114
V. Epidemiology ............................................................... ................................................. ...... 116
VI. Etiology................................................. ................................................. .............. 117
VII. Laboratory and psychological research............................................................... ...... 119
VIII. Pathophysiological features .............................................................. ......................... 120
IX. Psychodynamic factors .................................................................. ................................. 120
X. Differential diagnosis .................................................................. ................................... 121
XI. Course and prognosis ............................................... ................................................. .. 122
XII. Treatment................................................. ................................................. ................ 123
8. Delusional and other psychotic disorders .............................................. .............. 129
I. Brad ............................................... ................................................. ......................... 129
II. Schizophreniform disorder .............................................................. ......................... 133
III. Schizoaffective disorder .............................................................. ............................. 134
IV. Brief psychotic disorder .............................................................. ........ 135
V. Induced psychotic disorder .............................................................. ............ 136
VI. Postpartum psychosis .................................................................. ............................................. 137
VII. Psychotic disorder, unspecified ....................................................................... .............. 138
9. Mood disorders............................................................... ............................................... 141
I. Introduction ............................................... ................................................. ................ 141
II. Diagnosis, signs and symptoms ............................................... ................................. 141
III. Epidemiology................................................. ................................................. .... 148
IV. Etiology................................................. ................................................. ............. 149
V. Laboratory and psychological research............................................................... ........ 150
VI. Psychodynamics ................................................................ ................................................. ..... 151
VII. Differential diagnosis .................................................................. ................................. 151
VIII. Course and prognosis ............................................... ................................................. 154
IX. Treatment................................................. ................................................. ................ 155
10. Anxiety disorders............................................................... ............................................. 161
I. Definition ............................................................... ................................................. .......... 161
II. Diagnosis and symptoms ............................................................... ................................................. 161
III. Epidemiology................................................. ................................................. .... 163
IV. Etiology................................................. ................................................. ............ 170
V. Psychological research............................................................... ................................. 171
VI. Laboratory research................................................ ................................. 171
VII. Pathophysiological features .............................................................. ......................... 171
VIII. Psychodynamics ................................................................ ................................................. .... 172
IX. Differential diagnosis .................................................................. ................................. 173
X. Course and forecast .................................................. ................................................. ...... 175
XI. Treatment................................................. ................................................. ................. 176
11. Somatotrophic Disorders, Mimic Disorders and Simulation .................................179
I. Somatoform disorders............................................................... .................................... 179
II. Factitious Disorders .................................................................. ...................................... 191
III. Simulation................................................. ................................................. .............. 193
12. Dissociative disorders............................................................... ................................... 195
I. Introduction ............................................... ................................................. ................. 195
II. Dissociative amnesia .................................................................. ......................................... 196
III. Dissociative fugue .............................................................. ................................................. 199
IV. Dissociative Identity Disorder.................................................................... ......... 201
V. Depersonalization disorder............................................................... ....................... 203
IV. Dissociative disorder, unspecified ............................................................... ............ 204
13. Sexual dysfunctions, gender identity disorders and paraphilias... 205
I. Sexual dysfunctions............................................................... .............................. 205
II. Gender Identification Disorders .............................................................. ...................... 214
III. Paraphilia ............................................................ ................................................. ............. 220
14. Disorders associated with gray hair .............................................. ................................... 223
I. Introduction ............................................... ................................................. ................. 223
II. Anorexia nervosa .............................................................. ................................................. .. 223
III. Bulimia Nervosa .............................................................. ................................................. .... 227
15. Sleep disorders.................................................... ................................................. ........ 231
I. Introduction ............................................... ................................................. ................. 231
II. Primary sleep disorders .............................................................. ................................... 233
III. Sleep Disorders Associated with Psychiatric Disorders...............................................241
IV. Other sleep disorders .............................................................. ................................................. 241
16. Violation of control over impulses and disorders of adjustment .......................................... 243
I. Violation of control over impulses .............................................. ...................... 243
II. Adjustment Disorders .................................................................. ................................................... 248
17. Psychosomatic disorders and disorders associated with the action of psychogenic factors .............................................................. ................................................. ........... 251
I. Psychosomatic disorders ............................................................... ............................... 251
II. Psychiatry by type of consultation-interaction .............................................. ..... 261
III. Special conditions for the treatment of therapeutic patients .............................................. ....263
IV. Pain................................................. ................................................. ......................... 265
V. Analgesia ............................................................... ................................................. ................. 266
VI. Alternative (non-traditional) medicine .................................................................. .................266
18. Personality disorders............................................................... ................................................. 269
I. Introduction ............................................... ................................................. ................. 269
II. Personality disorders with manifestations of eccentricity and eccentricity .................................271
III. Disorders with manifestations of theatricality, emotionality and lability ... 275
IV. Personality Disorders with Manifestations of Anxiety and Fear ..........................................282
V. Other personality disorders .............................................................. ...................................... 286
19. Suicides, excitement and other medical emergencies .................................................................. .... 289
I. Introduction ............................................... ................................................. ................. 289
II. Self-defense-precautions to be taken by the doctor.....289
III. Preventing Harm to Yourself and Others.................................................................. 290
IV. Other Conditions Requiring Urgent Psychiatric Care .................................................293
20. Disorders of infancy, childhood and adolescence ............................................. 309
I. Principles of diagnostic assessment of the condition of children and adolescents .............................. 309
II. Child development................................................ ................................................. .... 313
III. Mental retardation................................................ ................................................. 321
IV. General developmental disorders .............................................................. ...............................327
V. Disorders of learning, motor skills and communication...............................................331
VI. Attention Deficit Disorders and Destructive Behavior............................334
VII. Behavioral disorders in infancy and early childhood due to gray hair...... 339
VIII. Tic Disorders .............................................................. ......................................... 340
IX. Disorders of excretory functions .............................................................. .................... 342
X. Other disorders of infancy, childhood and adolescence .............................. 344
XI. Other disorders occurring in childhood and adolescence ...................... 346
XII. Other Disorders Occurring in Childhood .............................................................. 347
21. Geriatric psychiatry............................................................... ................................... 349
I. Introduction ............................................... ................................................. ................. 349
II. Epidemiology................................................. ................................................. ...... 349
III. Medical aspects .................................................................. ............................................... 349
IV. Clinical Syndromes .................................................................. ............................................. 350
V. Psychotherapy of the elderly .............................................. ................................... 364
22. Bereavement and death .............................................. ................................................. 367
I. Grief, grief and bereavement .............................................. ......................................... 367
II. Death and dying .............................................................. ................................................. ... 370
23. Psychotherapy .............................................................. ................................................. .............. 373
I. Introduction ............................................... ................................................. ................. 373
II. Psychoanalysis and psychoanalytic psychotherapy .............................................................. ... 373
III. Behavioral Therapy .................................................................. ................................... 375
IV. Cognitive Therapy .................................................................. ............................................... 376
V. Family therapy............................................................... ................................................. ... 377
VI. Interpersonal Therapy .................................................................. .................................... 377
VII. Group therapy .................................................................. ................................................. 377
VIII. Couples Therapy or Marriage Therapy .............................................. ...............................379
24. Psychopharmacology and other types of biological therapy .............................................................. 383
I. Basic principles of psychopharmacology .............................................. ................. 383
II. Anxiolytics and hypnotics .............................................................. .................................... 387
III. Antipsychotic drugs .................................................................. ................................. 395
IV. Antidepressants .................................................................. ................................................. .411
V. Anti-manic drugs............................................................... ................................. 425
VI. Other drugs ................................................................ ................................................. .428
VII. EST.................................................. ................................................. ....................... 431
VIII. Psychosurgery ................................................................ ................................................. ..... 434
25. Movement disorders caused by the influence of drugs ... 435
I. Introduction ............................................... ................................................. ................ 435
II. Parkinsonism caused by neuroleptics .............................................................. ............. 435
III. Acute dystonia caused by neuroleptics .............................................................. ........... 437
IV. Acute akathisia caused by neuroleptics .............................................................. ............ 437
V. Tardive dyskinesia caused by antipsychotics .............................................................. ........ 438
VI. Malignant neuroleptic syndrome ............................................................. ......... 440
VII. Postural tremor associated with drug exposure .......... 441
VIII. Hyperthermic syndromes .................................................................. ................................. 441
26. Legal aspects of psychiatry .............................................. ................................. 443
I. Introduction ............................................... ................................................. ................. 443
II. Legal aspects of psychiatric practice .............................................................. ..... 444
III. Legal Aspects of Child and Adolescent Psychiatry.................................................... 449
IV. Legal Aspects of Psychiatry and Civil Law....................................................... 450
V. Legal Aspects of Psychiatry and Criminal Law .......................................................... .. 451
VI. Conclusion................................................. ................................................. ............ 452
27. Laboratory research in psychiatry .............................................. .................... 453
I. Introduction ............................................... ................................................. ................. 453
II. Screening tests for somatic diseases .............................................................. ... 454
III. Drugs used to treat psychiatric disorders..............................................454
IV. Laboratory research................................................ .................................... 457
V. Other laboratory tests .................................................................. ...................... 466
28. Handbook............................................... ................................................. ................. 477
I. Abbreviations ............................................................... ................................................. .......... 477
II. Glossary of terms................................................... ................................................. ... 478
III. DSM-IV Classification............................................................... ............................................. 488
IV. Author's guide ................................................................ ............................................... 505

There will be a judge for everything against the Jews.
For liveliness. For mind. For stoop.
For the fact that a Jewish woman shot at the leader.
Because she missed.

So later the poet wrote.
Who is Fanny Kaplan?

This woman in Soviet times became a symbol of "absolute evil." The stronger the authority of Lenin's personality grew in the country, the more demonic the figure of the one who raised her hand against the leader of the world proletariat looked.

Conversely, for those who did not like the Soviet regime, the person of a little woman who tried to destroy the communist tyrant aroused deep respect.

And in folklore Fanny Kaplan completed the top three "Lenin's women" along with Nadezhda Krupskaya and Inessa Armand. There was even a legend that those very shots were not a political assassination at all, but the revenge of a rejected woman.

Love and revolution

So who is Fanny Kaplan really and why did she shoot Lenin?

She was born in Ukraine, in the Volyn province, on February 10, 1890. Her father was Chaim Roitblat who worked as a teacher in a Jewish elementary school. The future terrorist was then called Feiga Khaimovna Roytblat.

A deeply religious Jewish family, in which, in addition to Feiga, there were seven more children, was not prosperous. And that's putting it mildly. The prospects for a poor Jewish girl in Tsarist Russia, where anti-Semitism at that time was practically elevated to the rank of state policy, were not very many.

Therefore, there is nothing surprising in the fact that as a teenager, Feiga became involved in the activities of revolutionary circles. Most of all, she was drawn to the anarchists. It was in their ranks that the 15-year-old girl met the first Russian revolution.

She changed her real name to the pseudonym Fanny Kaplan, acquired the party nickname "Dora" and plunged headlong into the revolutionary struggle. The ardor of the girl was complemented by a feeling of falling in love - her comrade-in-arms became her chosen one Victor Garsky, he is Yakov Shmidman.

Together they were preparing a major terrorist attack - an attempt on the life of the Kyiv Governor-General Sukhomlinov. If Garsky had a certain experience behind him, then for Fanny this action should have been a debut. However, everything ended in complete failure.

December 22, 1906 in the Kyiv hotel "Kupecheskaya" there was a powerful explosion. The gendarmes who arrived at the scene found a wounded woman at the explosion site, who was Fanny Kaplan. It was not difficult for experienced professionals to determine that an improvised device exploded.

How exactly this happened and who was to blame is unknown. However, Garsky, leaving his comrade-in-arms and beloved, fled. Fanny, on the other hand, fell into the hands of the gendarmes with a shell shock, wounds to her arms and legs, and a pistol was also found in her room.

ten years of hell

By that time, the tsarist authorities did not stand on ceremony in the means of suppressing revolutionary uprisings. 16-year-old Fanny Kaplan was awaiting trial, which sentenced her to death. However, given her age, her death was replaced with indefinite hard labor.

I must say that during interrogations, Fanny showed her character, not telling anything about her lover who betrayed her, or about other associates.

And then there was Transbaikalia, Maltsev hard labor prison, and then the most terrible in Russia Akatui hard labor. This is how a girl who did not have time to see anything in life, who did not show herself in anything in the revolution, ended up in a real earthly hell.

The consequences of the injury and overwork led to the fact that Fanny in January 1909 was completely blind. She tried to commit suicide, but she failed. The prison administration, making sure that the girl did not feign loss of vision, gave her some indulgences in her work. Three years later, vision was partially restored.

Surprisingly, in hard labor Fanny continued to think about politics. She was seriously influenced by other prisoners, primarily a socialist-revolutionary Maria Spiridonova. It was she who, in 1918, shortly before the assassination attempt on Lenin, would raise a revolt of the Left Socialist-Revolutionaries against the Bolsheviks in Moscow, which would fail.

Fanny Kaplan no longer considers herself an anarchist, but a Socialist-Revolutionary. However, for those sentenced to indefinite hard labor, is there a difference?

Freedom to her, like other political prisoners, brought the February Revolution. Having entered hard labor at the age of 16, she was released at the age of 27. However, those who saw her after her release considered her a deep old woman - overwork in the mines and the consequences of the injury affected.

From Ulyanovsk to Ulyanovsk

There is no home, no family - Fanny's relatives moved to America back in 1911. The closest to her were those with whom she went through hard labor.

The provisional government took care of the prisoner of tsarism - she received a ticket to Evpatoria, where a sanatorium was opened for former political prisoners.

There, in the summer of 1917, Fanny, who had recovered and cheered up, met Ulyanov. But not with Vladimir, but with his brother Dmitry. They still argue about the relationship between Fanny and the leader’s brother, but one thing is known for sure - thanks to Ulyanov Jr., Kaplan received a referral to Dr. Girshman’s Kharkov eye clinic.

The operation in Kharkov helped - Kaplan began to see better. In the Crimea, she gets a job as the head of courses for the training of workers of volost zemstvos.

This was hardly what Fanny dreamed of. But she was sure that her fate would change. Here the Constituent Assembly convenes, in which the Socialist-Revolutionaries will have the majority, and then ...

But in October 1917, the Bolshevik revolution broke out, which violated all the plans of both the Socialist-Revolutionaries in general and Fanny in particular.

In February 1918, when it became clear that there would definitely be no Constituent Assembly, Kaplan decided to act. If at the dawn of her revolutionary career she did not kill the governor-general, then why not make up for this omission by killing Lenin.

For the Socialist-Revolutionary Party, individual terror was the usual method of struggle, so that Fanny had more than enough like-minded people among his party comrades. And the situation was extremely acute - the Treaty of Brest-Litovsk with Germany forced many to turn away from the Bolsheviks, and the defeat of the Left SRs in July 1918 gave rise to many who wanted to settle not only political, but also personal scores with Lenin and other prominent Bolsheviks.

For a woman without a family and children who went through a hard labor hell, putting her life at stake again was a common thing. Moreover, the chances of success were very high.

One step away from success

At that time, there was no modern idea of ​​\u200b\u200bthe protection of top officials. Half a century before the assassination attempt on Lenin Alexander II almost grabbed a bullet from a terrorist Dmitry Karakozov. The king was saved not by security, but by the intervention of a bystander. The guards did not save the Austrian Archduke Ferdinand whose death triggered the outbreak of the First World War.

Yes, and Lenin himself, who miraculously survived in August 1918, almost died six months later. His car was stopped by ordinary robbers, they threw the leader of the proletariat along with the driver into the street and drove away.

Under these conditions, even a well-known politician could be killed by any determined person, let alone something, and Fanny Kaplan's determination was not to be taken. It was not a hindrance and poor eyesight - it was necessary to shoot from a short distance.

The circumstances of what happened on August 30, 1918 are still being debated. Versions are put forward, one more fantastic than the other - staging, Sverdlov's conspiracy, "second shooter", etc., etc.

Fanny Kaplan herself also let in fog, pleading guilty during the arrest, but did not tell anything about those who helped her. No wonder - she was also silent 12 years before, after the explosion in Kyiv.

She explained her actions simply and logically: Lenin was a traitor to the revolution, and his life pushed back the onset of socialism for decades. With her shots, Fanny tried to remove this obstacle.

That evening, Lenin, like other Bolshevik leaders, spoke at the Friday rallies at the factories. In the morning in Petrograd as a terrorist Leonid Kannegiser the head of the Petrograd Cheka was killed Moses Uritsky. Despite this, Lenin did not change his plans. A brilliant orator, Lenin spoke at a rally at the Michelson factory and, surrounded by workers, moved to the exit. He was about to get into the car when a woman approached him with a question. While Lenin was talking to her, Kaplan approached him from behind and fired three shots. Two bullets hit the neck and arm of the Bolshevik leader, the third hit a woman who was talking to him.

Legend of Kaplan

The seriously wounded Lenin was sent to the Kremlin, Kaplan was detained a few minutes later. According to witnesses, Fanny said: "I have done my duty and I will die with valor." During interrogations, she insisted that she acted alone.

There was no long investigation, which makes some researchers assure that Fanny knew too much, and they hastened to get rid of her.

But, perhaps, everything is simpler - the Bolsheviks, furious with the murder of Uritsky and the attempt on Lenin's life, officially announced the beginning of the "Red Terror", which was supposed to hit their ideological and class enemies. In this situation, they were not going to burden themselves with judicial investigative ceremonies. September 3, 1918 Chairman of the All-Russian Central Executive Committee Yakov Sverdlov gave a verbal order: to shoot Kaplan. Commandant of the Kremlin Pavel Malkov led Fanny Kaplan to the yard of the auto-combat detachment named after the All-Russian Central Executive Committee, where he personally shot her to the sound of running cars.

Fanny's body was pushed into a tar barrel, doused with gasoline and burned near the walls of the Kremlin.

Not spoiled by fame during her lifetime, Fanny Kaplan became famous after her death. For the Soviet people, she became "terrorist number one." Her story is overgrown with legends - someone allegedly saw her alive years after the execution, either on Solovki, or in Kazakhstan, or somewhere in the Caucasus. Today, rock bands are named after her, and she is the subject of countless anecdotes, historical books, and films.

Does she deserve it? Probably not. But the Greek Herostratus also at one time sentenced to oblivion, but everything turned out exactly the opposite. The story has its own, special sense of humor.

A series of educational literature for

medical students, interns, residents,

medical cadets of institutions of additional

vocational education

Series Editorial Board:

Akchurin Renat Suleimanovich, corresponding member. RAMS, Head of the Department of Cardiovascular Surgery, RKNPK of the Ministry of Health of the Russian Federation

Volodin Nikolai Nikolaevich, Dr. Sci., Professor, Head of the Department of Educational Institutions of the Ministry of Health of the Russian Federation

Denisov Igor Nikolaevich, corresponding member. RAMS, Vice-Rector for Academic Affairs, MMA named after V.I. THEM. Sechenov

Dmitrieva Tatyana Borisovna, corresponding member. RAMS, Professor, Minister of Health of the Russian Federation

Knyazhev Vladimir Alexandrovich, Dr. Sciences, Professor, Deputy Minister of Science and Technology of the Russian Federation

Kulakov Vladimir Ivanovich, acad. RAMS, Director of the Scientific Center for Obstetrics, Gynecology and Perinatology RAMS

Lopukhin Yury Mikhailovich, acad. RAMS, Director of the Research Institute of Physical and Chemical Medicine of the Ministry of Health of the Russian Federation

Martynov Anatoly Ivanovich, acad. RAMS, Vice-President of RAMS

Moshetova Larisa Konstantinovna, Dr. Sciences, Professor, RMAPO Rector

Paltsev Mikhail Alexandrovich, acad. RAS, acad. RAMS, rector of MMA named after THEM. Sechenov

Pokrovsky Valentin Ivanovich, acad. RAMS, President of RAMS

Saveliev Victor Sergeevich, acad. RAS, acad. RAMS, Head of the Department of Faculty Surgery, RSMU

Trufakin Valery Alekseevich, acad. RAMS, Vice-President of RAMS, Chairman of the Presidium of the SB RAMS

Khaitov Rakhim Musaevich, acad. RANS, corresponding member. RAMS, Director of the Scientific Center of Immunology of the Ministry of Health of the Russian Federation

Chuchalin Alexander Grigorievich, acad. RAMS, Director of the Research Institute of Pulmonology of the Ministry of Health of the Russian Federation

Yaitsky Nikolay Antonovich, Dr. Sciences, Professor, Rector of St. Petersburg State Medical University

Yarygin Vladimir Nikitich, acad. RAMS, Rector of the Russian State Medical University named after V.I. N.I. Pirogov

CLINICAL PSYCHIATRY

Translation from English supplemented

Chief Editor

T.B. Dmitrieva

corresponding member RAMS, professor

GEOTAR MEDICINE Moscow 1998

UDC 616. 89 (075 8) BBK56 14Ya73 P86

as a teaching aid for medical students,

interns, residents, medical cadets of institutions

additional professional education

Clinical Psychiatry translation from English add //Ch ed TB Dmitrieva - M GEOTAR MEDICINE, 1998 - ISBN 5-88816-010-5 Pocket Handbook of Clinical Psychiatry//Harold I Kaplan, Benjamin J Sadock//Baltimore, Williams & Wilkins - ISBN 0-683-04583-0

Translation of the 2nd edition of the "Concise Guide to Clinical Psychiatry" by the world-famous authors G Kaplan and B Sadok (1996, Williams & Wilkins publishing house) The publication has been supplemented and adapted by leading Russian psychiatrists in accordance with the characteristics and traditions of Russian psychiatry. The book covers modern scientific and practical information on key aspects of the etiology, symptoms, diagnosis and treatment of all forms of mental pathology. The text is concise, accessible, accompanied by a large number of tables that facilitate the perception of the material.

The book is intended for psychiatrists, general practitioners and medical students

Printed in the Russian Federation

The rights to this publication belong to the publishing house GEOTAR MEDICINE Reproduction and distribution in any form of part or the whole publication cannot be carried out without the written permission of the publisher

Isbn 5 88816 010 5

© Williams & Wilkins, 1996 ©GEOTAR MEDICINE, 1998

PARTICIPANTS OF THE RUSSIAN EDITION

Editor-in-Chief - Tatyana Borisovna Dmitrieva, Corresponding Member. RAMS, professor

Aleksandrovsky Yuriy Anatolievich, Dr. med. Sciences, Professor - Managing Editor

Avedisova Alla Sergeevna, Ph.D. honey. Sciences (Ch. 15, 24) Bardenshtein Leonid Mikhailovich, Doctor of Medicine. Sci., Professor (Ch. 9, 10) Vandysh-Bubko Vasiliy Vasilievich, Dr. med. Sciences (Ch. 3, 4) Guryeva Valeria Alexandrovna, Doctor of Medicine. sciences, professor (ch. 20)

Enikeev Iskander Derdovich, Ph.D. honey. in Medicine, Fellow of the American Psychiatric Association, M.D., Ph.D. (translation editor)

Igonin Andrey Leonidovich, Dr. sciences, professor (ch. 5)

Kekelidze Zurab Ilyich, Dr. med. sciences (ch. 19, 22, 25)

Klimenko Tatyana Valentinovna, doctor of medical sciences sciences (ch. 6)

Kogan Boris Mikhailovich, Dr. sciences (ch. 27)

Kolosov Vladimir Petrovich, Ph.D. honey. sciences (ch. 23)

Kondratiev Fedor Viktorovich, Dr. sciences, professor (ch. 7, 8)

Romasenko Lyubov Vladimirovna, Dr. Sciences (Ch. 11, 12, 14, 17)

Tkachenko Andrey Anatolievich, Dr. sciences (ch. 13)

Shishkov Sergey Nikolaevich, Ph.D. legal sciences (ch. 26)

Shostakovich Boris Vladimirovich, Dr. Sciences, Professor (Ch. 16, 18)

FOREWORD

Acquaintance with the basics of clinical disciplines taught in medical schools around the world is of great importance for expanding the horizons of medical students and young doctors. Despite the fact that modern medicine is basically international, in many countries it retains its own traditions and schools, and the level of development of medical science largely depends on the material and technical capabilities of healthcare. This determines the regional and national peculiarities of understanding and solving medical, diagnostic, preventive, and rehabilitation problems, which sometimes creates difficulties for specialists from different countries in finding a common language for professional communication. All this is clearly manifested in the example of modern psychiatry. Today, various classification and diagnostic schemes are used in medical institutions in the United States (DSM-IV-R), European countries (ICD-10), and in Russia, where ICD-9 is still used. At the same time, there are a large number of comments accepted in each country and options for approaches for making a psychiatric diagnosis. One of the main ways to overcome these differences is to get acquainted with fundamental scientific publications, primarily with guidelines for students and doctors published in foreign countries. Unfortunately, modern foreign manuals on psychiatry have hardly been translated in Russia until recently. Known from annotated translations, they did not give a complete picture of the author's positions and did not always represent the essence of their approaches to understanding the foundations of psychopathology.

The publication in Russia of the American manual on psychiatry by G. Kaplan and B. Sadok, repeatedly reprinted in many countries of the world, undertaken by the young publishing house GEOTAR MEDICINE, is a significant event in Russian psychiatry for a number of reasons.

Firstly, this book allows you to "according to the original source" to get acquainted with the principles and main methodological approaches in making a diagnosis and conducting a "standardized" treatment of the mentally ill, adopted in the United States and many English-speaking countries.

Secondly, the book is written taking into account the current trend of convergence of psychiatry with other areas of clinical medicine and is aimed not only at a qualified psychiatrist, but also at a general practitioner. In this regard, it can become an important tool in our country for specialists in various clinical disciplines, as well as for district and family doctors.

Thirdly, the book is notable for its methodological clarity and complete coverage of all the major clinical problems of modern psychiatry. Its 27 main chapters and good reference support allow you to navigate almost all issues of diagnosis, therapy and rehabilitation of the mentally ill.

The published guide is not limited to the translation of the author's text. A large team of highly qualified specialists worked on its adaptation for the Russian reader and the addition (in agreement with the authors), who by right could become co-authors of individual chapters of the manual. All additions and comments to the translation are in italics in the text.

"Clinical Psychiatry" is published in Russia shortly after the Russian-American meeting of specialists in the field of psychiatry (Moscow, September 1997), who discussed issues of interaction within the Healthcare Committee of the Russian-American Commission on Economic and Technological Cooperation ("Gore-Chernomyrdin Commission" ).

At this meeting, specific areas of cooperation in the field of scientific research and practical psychiatry were outlined. Among them, translations of scientific and educational literature are of great importance. The publication of the book by G. Kaplan and B. Sadok is a real fulfillment of the cooperation plan, contributing to the expansion of contacts between domestic psychiatrists and American colleagues.

I would like to express my confidence that this book will have a large number of interested, thinking readers and it will contribute to the mutual enrichment of Russian and American psychiatry.

Chief Editor

Minister of Health of Russia

Corresponding Member of the Russian Academy of Medical Sciences, Professor "T.E. Dmitrieva

1. Diagnosis and classification in psychiatry .............................................. .............................. 13

I. Introduction ............................................... ................................................. ................... 13

II. Classification of mental disorders .............................................................. ................... fourteen

2. Psychiatric examination: medical history, mental state, clinical signs and symptoms .................................................................. .............................................. 23

I. Introduction ............................................... ................................................. ................. 23

II. Methodology of the clinical interview .......................................................... ................... 23

III. Psychiatric medical history ............................................................... ........................... 25

IV. Mental condition................................................ .............................................. 26

V. Somatic and neurological examination .............................................................. ........ thirty

VI. Recording Findings from the Medical History and Evaluation of Mental Status ....................... 30

VII. Definitions (definitions) of signs and symptoms found

in the examination of the mental state .................................................... ................ 34

3. Delirium, dementia, amnestic and other cognitive disorders

and mental disorders caused by somatic and neurological

diseases ................................................................ ................................................. ............... 43

I. Introduction ............................................... ................................................. ................. 43

II. Clinical examination .............................................................. ............................................... 44

III. Delirium .................................................. ................................................. ................. 44

IV. Dementia ................................................. ................................................. ............... 47

V. Dementia in Alzheimer's disease (TWO).................................................. ................... 51

VI. Vascular dementia .............................................................. ............................................... 54

VII. Pick's disease................................................... ................................................. .......... 57

VIII. Creutzfeldt-Jakob disease .............................................................. ................................. 57

IX. Huntington's disease (progressive hereditary chorea, Huntington's chorea) ................................................. ................. 57

X. Parkinson's disease (shaking palsy).................................................................. .............. 58

XI. Other dementias................................................... ................................................. ..59

XII. Amnestic disorders .................................................................. ................................... 59

XIII. Transient global amnesia .............................................................. ........................... 61

XIV. Mental disorders due to somatic or neurological diseases.................................................................................. ................................................. ...... 61

XV. Other pathological conditions ............................................................... ................................... 62

4. Neuropsychiatric aspects of HIV infection .............................................................. ................. 67

I. Introduction ............................................... ................................................. ................... 67

II. Clinical manifestations of CNS damage .............................................................. ................... 69

III. Psychopathological syndromes .............................................................. ................................. 70

IV. Treatment................................................. ................................................. ................. 71

5. Substance Use Disorders ..............................................................75

I. Introduction ............................................... ................................................. ................. 75

II. Opioids .................................................. ................................................. ................... 84

III. Sedatives, hypnotics and anxiolytics .............................................................. 87

IV. Stimulants (phenamine and substances similar in their effect to phenamine) .................................................................. ................................................. ................... 89

V. Cocaine ............................................... ................................................. ................... 90

VI. Cannabis.................................................. ................................................. ............... 91

VII. Hallucinogens .................................................................. ................................................. ..... 92

VIII. PCP ................................................. ................................................. ....................... 93

IX. Inhalants ............................................... ................................................. .................94

X. Caffeine ............................................................... ................................................. ...................... 95

XI. Nicotine................................................. ................................................. ................... 95

6. Alcohol use disorders .............................................................. .......... 97

I. Introduction ........................................: ..... ................................................. ................. 97

II. Alcohol dependence and alcohol abuse ............................................................. 98

III. Alcohol intoxication (alcohol intoxication).................................................................. .104

IV. Psychotic disorder with hallucinations caused by alcohol .............................. 106

V. Alcoholic withdrawal syndrome.................................................................... .................................... 106

VI. Alcohol withdrawal syndrome with delirium (delirium tremens).................................................................. 106

VII. Persistent amnestic disorder caused by alcohol .............................................. 108

VIII. Persistent alcohol-induced dementia .............................................................. ................. 109

7. Schizophrenia ............................................... ................................................. ................... 111

I. Definition ............................................................... ................................................. .......... 111

II. Historical information ................................................................ ................................................. 111

III. Diagnosis and symptoms ............................................................... ................................................. 111

IV. Types of schizophrenia .............................................................. ................................................. .114

V. Epidemiology ............................................................... ................................................. ...... 116

VI. Etiology................................................. ................................................. .............. 117

VII. Laboratory and psychological research............................................................... ...... 119

VIII. Pathophysiological features .............................................................. ......................... 120

IX. Psychodynamic factors .................................................................. ................................. 120

X. Differential diagnosis .................................................................. ................................... 121

XI. Course and prognosis ............................................... ................................................. .. 122

XII. Treatment................................................. ................................................. ................ 123

8. Delusional and other psychotic disorders .............................................. .............. 129

I. Brad ............................................... ................................................. ......................... 129

II. Schizophreniform disorder .............................................................. ......................... 133

III. Schizoaffective disorder .............................................................. ............................. 134

IV. Brief psychotic disorder .............................................................. ........ 135

V. Induced psychotic disorder .............................................................. ............ 136

VI. Postpartum psychosis .................................................................. ............................................. 137

VII. Psychotic disorder, unspecified ....................................................................... .............. 138

9. Mood disorders............................................................... ............................................... 141

I. Introduction ............................................... ................................................. ................ 141

II. Diagnosis, signs and symptoms ............................................... ................................. 141

III. Epidemiology................................................. ................................................. .... 148

IV. Etiology................................................. ................................................. ............. 149

V. Laboratory and psychological research............................................................... ........ 150

VI. Psychodynamics ................................................................ ................................................. ..... 151

VII. Differential diagnosis .................................................................. ................................. 151

VIII. Course and prognosis ............................................... ................................................. 154

IX. Treatment................................................. ................................................. ................ 155

10. Anxiety disorders............................................................... ............................................. 161

I. Definition ............................................................... ................................................. .......... 161

II. Diagnosis and symptoms ............................................................... ................................................. 161

III. Epidemiology................................................. ................................................. .... 163

IV. Etiology................................................. ................................................. ............ 170

V. Psychological research............................................................... ................................. 171

VI. Laboratory research................................................ ................................. 171

VII. Pathophysiological features .............................................................. ......................... 171

VIII. Psychodynamics ................................................................ ................................................. .... 172

IX. Differential diagnosis .................................................................. ................................. 173

X. Course and forecast .................................................. ................................................. ...... 175

XI. Treatment................................................. ................................................. ................. 176

I. Somatotrophic Disorders, Mimic Disorders and Simulation ..................................179

I. Somatoform disorders............................................................... .................................... 179

II. Factitious Disorders .................................................................. ...................................... 191

III. Simulation................................................. ................................................. .............. 193

12. Dissociative disorders............................................................... ................................... 195

Introduction ................................................ ................................................. ................ 195

II. Dissociative amnesia .................................................................. ......................................... 196

III. Dissociative fugue .............................................................. ................................................. 199

IV. Dissociative Identity Disorder.................................................................... ......... 201

V. Depersonalization disorder............................................................... ....................... 203

IV. Dissociative disorder, unspecified ............................................................... ............ 204

13. Sexual dysfunctions, gender identity disorders and paraphilias... 205

I. Sexual dysfunctions............................................................... .............................. 205

II. Gender Identification Disorders .............................................................. ...................... 214

III. Paraphilia ............................................................ ................................................. ............. 220

14. Disorders associated with gray hair .............................................. ................................... 223

I. Introduction ............................................... ................................................. ................. 223

II. Anorexia nervosa .............................................................. ................................................. .. 223

III. Bulimia Nervosa .............................................................. ................................................. .... 227

15. Sleep disorders.................................................... ................................................. ........ 231

I. Introduction ............................................... ................................................. ................. 231

II. Primary sleep disorders .............................................................. ................................... 233

III. Sleep Disorders Associated with Psychiatric Disorders...............................................241

IV. Other sleep disorders .............................................................. ................................................. 241

16. Violation of control over impulses and disorders of adjustment .......................................... 243

I. Violation of control over impulses .............................................. ...................... 243

II. Adjustment Disorders .................................................................. ................................................... 248

17. Psychosomatic and action disorders

psychogenic factors .............................................................. ................................................. .251

I. Psychosomatic disorders ............................................................... ............................... 251

II. Psychiatry by type of consultation-interaction .............................................. ..... 261

III. Special conditions for the treatment of therapeutic patients .............................................. ....263

IV. Pain................................................. ................................................. ......................... 265

V. Analgesia ............................................................... ................................................. ................. 266

VI. Alternative (non-traditional) medicine .................................................................. .................266

18. Personality disorders............................................................... ................................................. 269

I. Introduction ............................................... ................................................. ................. 269

II. Personality disorders with manifestations of eccentricity and eccentricity .................................271

III. Disorders with manifestations of theatricality, emotionality and lability ... 275

IV. Personality Disorders with Manifestations of Anxiety and Fear ..........................................282

V. Other personality disorders .............................................................. ...................................... 286

19. Suicides, excitement and other medical emergencies .................................................................. .... 289

I. Introduction ............................................... ................................................. ................. 289

II. Self-defense-precautions to be taken by the doctor.....289

III. Preventing Harm to Yourself and Others.................................................................. 290

IV. Other Conditions Requiring Urgent Psychiatric Care .................................................293

20. Disorders of infancy, childhood and adolescence ............................................. 309

I. Principles of diagnostic assessment of the condition of children and adolescents .............................. 309

II. Child development................................................ ................................................. .... 313

III. Mental retardation................................................ ................................................. 321

IV. General developmental disorders .............................................................. ...............................327

V. Disorders of learning, motor skills and communication...............................................331

VI. Attention Deficit Disorders and Destructive Behavior............................334

VII. Behavioral disorders in infancy and early childhood due to gray hair...... 339

VIII. Tic Disorders .............................................................. ......................................... 340

IX. Disorders of excretory functions .............................................................. .................... 342

X. Other disorders of infancy, childhood and adolescence .............................. 344

XI. Other disorders occurring in childhood and adolescence ...................... 346

XII. Other Disorders Occurring in Childhood .............................................................. 347

21. Geriatric psychiatry............................................................... ................................... 349

I. Introduction ............................................... ................................................. ................. 349

II. Epidemiology................................................. ................................................. ...... 349

III. Medical aspects .................................................................. ............................................... 349

IV. Clinical Syndromes .................................................................. ............................................. 350

V. Psychotherapy of the elderly .............................................. ................................... 364

22. Bereavement and death .............................................. ................................................. 367

I. Grief, grief and bereavement .............................................. ......................................... 367

II. Death and dying .............................................................. ................................................. ... 370

23. Psychotherapy .............................................................. ................................................. .............. 373

I. Introduction ............................................... ................................................. ................. 373

II. Psychoanalysis and psychoanalytic psychotherapy .............................................................. ... 373

III. Behavioral Therapy .................................................................. ................................... 375

IV. Cognitive Therapy .................................................................. ............................................... 376

V. Family therapy............................................................... ................................................. ... 377

VI. Interpersonal Therapy .................................................................. .................................... 377

VII. Group therapy .................................................................. ................................................. 377

VIII. Couples Therapy or Marriage Therapy .............................................. ...............................379

24. Psychopharmacology and other types of biological therapy .............................................................. 383

I. Basic principles of psychopharmacology .............................................. ................. 383

II. Anxiolytics and hypnotics .............................................................. .................................... 387

III. Antipsychotic drugs .................................................................. ................................. 395

IV. Antidepressants .................................................................. ................................................. .411

V. Anti-manic drugs............................................................... ................................. 425

VI. Other drugs ................................................................ ................................................. .428

VII. EST.................................................. ................................................. ....................... 431

VIII. Psychosurgery ................................................................ ................................................. ..... 434

25. Movement disorders caused by the influence of drugs ... 435

I. Introduction ............................................... ................................................. ................ 435

II. Parkinsonism caused by neuroleptics .............................................................. ............. 435

III. Acute dystonia caused by neuroleptics .............................................................. ........... 437

IV. Acute akathisia caused by neuroleptics .............................................................. ............ 437

V. Tardive dyskinesia caused by antipsychotics .............................................................. ........ 438

VI. Malignant neuroleptic syndrome ............................................................. ......... 440

VII. Postural tremor associated with drug exposure .......... 441

VIII. Hyperthermic syndromes .................................................................. ................................. 441

26. Legal aspects of psychiatry .............................................. ................................. 443

I. Introduction ............................................... ................................................. ................. 443

II. Legal aspects of psychiatric practice .............................................................. ..... 444

III. Legal Aspects of Child and Adolescent Psychiatry.................................................... 449

IV. Legal Aspects of Psychiatry and Civil Law....................................................... 450

V. Legal Aspects of Psychiatry and Criminal Law .......................................................... .. 451

VI. Conclusion................................................. ................................................. ............ 452

27. Laboratory research in psychiatry .............................................. .................... 453

I. Introduction ............................................... ................................................. ................. 453

II. Screening tests for somatic diseases .............................................................. ... 454

III. Drugs used to treat psychiatric disorders..............................................454

IV. Laboratory research................................................ .................................... 457

V. Other laboratory tests .................................................................. ...................... 466

28. Handbook............................................... ................................................. ................. 477

I. Abbreviations ............................................................... ................................................. .......... 477

II. Glossary of terms................................................... ................................................. ... 478

III. DSM-IV Classification............................................................... ............................................. 488

Diagnosis and classification

in psychiatry

I. INTRODUCTION

Modern classification diagnostic systems DSM-IV and the International Classification of Diseases of the 10th revision (ICD-10) currently adopted in Russia are intended for statistical analysis based on a fairly universal reproducibility of diagnostic assessments by different doctors. This predetermines, at the first stage of analysis, mainly the assessment of individual psychopathological phenomena. DSM-IV and ICD-10 largely discipline the doctor's clinical thinking, but do not replace conceptual approaches in the assessment of psychopathological manifestations and mental illness in general.

Experience shows that scientific and practical issues of diagnostic assessments in psychiatry are solved most fruitfully with the mutual complementation of symptomatic and nosological assessments of disorders.

Despite the fundamental commonality and proximity of methodological approaches, DSM-IV and ICD-10 are not identical classification systems. At the same time, they provide a similar description of individual syndromic groups, forms and variants of mental disorders, and many of the main categories of disorders in ICD-10 are included in the corresponding categories of DSM-IV.

A mental disorder is a disease state with psychopathological or behavioral manifestations associated with a malfunction of the body as a result of exposure to biological, social, psychological, genetic, physical or chemical factors. It is determined by the degree of deviation from the concept of mental health taken as the basis. Each disease is characterized by certain symptoms.

The types of mental disorders in this manual are classified according to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) of the American Psychiatric Association. It contains descriptions of more than 200 diseases. The official DSM-IV classification and code numbers (which are used on medical reports and insurance policies) are listed at the beginning and end of this guide. The goal of the DSM-IV system is reliability (different observers should get the same results) and validity. The DSM-IV uses a descriptive method, and the characteristic symptoms of a given disorder must be identified to establish a diagnosis. Taking into account special criteria increases the reliability of the diagnosis made by the clinician.

Mental disorders in general (in addition to the DSM-IV classification) are divided into psychotic, neurotic, functional and organic. Psychotic - loss of a sense of reality, accompanied by delusions and hallucinations, for example, in schizophrenia.

14 Chapter I IIA

14 Chapter I IIA

Neurotic - loss of a sense of reality is not observed; disorders are due mostly to intrapsychic conflicts or life events that cause anxiety, manifested by symptoms such as obsessions, phobias, compulsiveness. Functional - structural disorders and etiological factors that could be called the cause of the disease are not known.

Organic - diseases that are caused by structural (morphological) changes in the brain; they are usually accompanied by cognitive (intellectual) impairment, delirium, or dementia (eg, Pick's disease). The term "organic" is not used in the DSM-IV because it implies that some mental disorders do not have a biological component, but it is widely used in clinical practice.

II. CLASSIFICATION OF MENTAL DISORDERS

The DSM-IV defines 17 main categories of mental disorders, represented by

A. Disorders of infancy, childhood and adolescence.

1. Mental retardation. Violation of intellectual functions; begins during development; accompanied by developmental delay (immaturity), difficulty learning and social adaptation. According to the intelligence quotient (IQ), they are divided into mild (from 50-55 to 70), moderate (from 35-40 to 50-55), severe (from 20-25 to 35-40) and deep (below 20-25) .

2. Learning disorders. Difficulties in acquiring specific skills in counting, writing, reading due to developmental delays.

3. Disorders of motor skills. Disturbances in the development of motor coordination (developmental coordination disorder). In children with this disorder, movements are often clumsy and uncoordinated.

4. Disorders of communication. A developmental disorder that makes it difficult to form sentences expected at this age (expressive speech disorder), difficulty using and understanding words (receptive-expressive speech disorder), difficulty pronouncing speech sounds (speech articulation disorder), impaired fluency, tempo, and rhythm of speech (stuttering) ).

5. General developmental disorders. They are characterized by autistic, atypical behavior, significant immaturity, inadequate development and the inability to separate their personality from their mother's. They are divided into autistic disorder (stereotypical behavior, refusal of verbal communication), Rett syndrome (loss of speech and motor skills simultaneously with slow head growth), disintegrative disorder of childhood (loss of acquired speech and motor skills up to 10 years), Lsperger's syndrome (stereotypical behavior with some ability to communicate) and general developmental disorder, unspecified.

6. Disorders with attention deficit and destructive behavior. Characterized by attention deficit hyperactivity disorder, cocky, aggressive, confrontational behavior, delinquency, hostility, feelings of rejection, negativism, or impulsiveness. Patients are usually

Diagnosis and classification in psychiatry 15

do not obey their parents and do not recognize their authority. They are divided into attention deficit hyperactivity disorder (insufficient concentration of attention, lack of perseverance in activities that require concentration, jumping from one to another, impulsivity, disorganized excessive activity), conduct disorder (propensity to delinquency), disorder in the form of defiant opposition (negativism, deliberately defiant behavior, disobedience, conflict).

7. Eating disorders in infancy and early childhood. Characterized by disturbed, bizarre eating habits that usually start in childhood or adolescence and continue into adulthood. Of these, picacism (eating inedible substances) and a disorder in the form of repeated regurgitation (regurgitation) are distinguished.

8. Disorders in the form of a tick. Characterized by a sudden, involuntary, repetitive, stereotyped movement or uttered sound. They are subdivided into de da Typemma syndrome (vocal tic and coprolalia), a chronic motor or auditory tic disorder, and a transient tic disorder.

9. Disorders of excretory functions (excretion). Fecal incontinence (encopresis) or urinary incontinence (enuresis) due to physiological or mental disorders.

10. Other disorders of infancy, childhood or adolescence. Selective mutism (the child is unable to talk in certain situations), reactive attachment disorder in infancy or early childhood (significant impairment of the ability to establish relationships that arose in the first 5 years of life), stereotyped movement disorder (thumb sucking, nail biting, skin picking) , separation anxiety disorder (fear of being away from home with marked prolonged anxiety).

Delirium, dementia, amnestic and other cognitive disorders. Disorders characterized by a change in the structure and activity of the brain, as a result of which there is an inability to learn, orientation, correct judgment and mental activity, memory disorder.

1. Delirium. It is characterized by short-term clouding of consciousness and cognitive disorders. There are several causes: somatic neurological disease, such as infection, exposure to a psychoactive substance, such as cocaine, opiates, phencyclidine, polyetiological factors, such as head trauma and kidney disease, and unspecified delirium.

2. Dementia. It is characterized by a sharp impairment of memory, the ability to make correct judgments, orientation and other cognitive functions. Dementia of the Alzheimer's type usually begins in people over 65 years of age and is manifested by a progressive decrease in intelligence, delirium, depression; vascular dementia is caused by vascular thrombosis and hemorrhage; dementia due to other somatic or neurological diseases, such as human immunodeficiency virus (HIV), head trauma; a number of other varieties, such as dementia in Pick's disease, dementia in Creutzfeldsch-Jakob disease (caused by a slowly developing transmissible

16 Chapter 1 IIB

virus); dementia caused by a toxin or drug (psychoactive substance), such as gasoline vapors, atropine; dementia with multiple etiologies or unspecified causes. 3. Amnestic disorder. It is characterized by memory impairment and forgetfulness. Caused by somatic or neurological diseases (hypoxia), toxin, medicinal or narcotic substances, such as marijuana, diazepam.

B. Mental disorders caused by somatic and neurological diseases. Symptoms of mental disorders that occur as a direct result of physical or neurological diseases. Includes disorders caused by syphilis, encephalitis, brain abscess, cardiovascular disease, trauma, epilepsy, intracranial tumor, endocrine disorders, pellagra, beriberi, infections (eg, typhoid, malaria), and CNS degenerative diseases (eg, multiple sclerosis). May present with catatonic disorders, such as stroke, or personality changes, such as brain tumors, as well as delirium, dementia, amnestic and psychotic disorders, mood disorders, anxiety, sexual dysfunction, and sleep disorders. D. Substance use disorders.

1. Disorders associated with addiction to psychoactive substances. Substance dependence or abuse (formerly known as drug addiction). These substances include alcohol, nicotine (tobacco), caffeine, etc. Patients may abuse opium or alkaloids, synthetic morphine-like analgesics such as PCP, barbiturates, other sleeping pills, tranquilizers, cocaine, cannabis, or Indian hemp (hashish , marijuana), psychostimulants (such as phenamine, hallucinogens) and inhalants.

2. Disorders caused by exposure to psychoactive substances. Psychoactive drugs and other substances can cause intoxication and withdrawal syndromes, delirium, persistent dementia, persistent amnestic disorder, psychotic disorder, mood disorder, anxiety disorder, sexual dysfunction, and sleep disturbance.

3. Disorders associated with alcohol use. A type of substance use disorder. These disorders include alcohol intoxication (alcohol intoxication), intoxication delirium (usually develops after drinking for several days), alcohol withdrawal syndrome, alcohol withdrawal syndrome with delirium (includes alcoholic delirium), alcoholic psychoses (includes alcoholic hallucinosis, which differs from delirium in a clear consciousness), persistent amnestic disorder caused by alcohol [Korsakoff's syndrome, often preceded by Wernicke's encephalopathy, neurological disorders - ataxia, ophthalmoplegia, confusion; their combination (Wernicke-Korsakoff syndrome)], and persistent alcohol-induced dementia (distinguished from Wernicke-Korsakoff syndrome by multiple cognitive impairments). Alcohol-related mood disorder, anxiety disorder, and sleep disorder may also be observed.

Diagnosis and classification in psychiatry 17

D. Schizophrenia and other psychotic disorders. Diseases that are manifested by disorders of thinking and perception are often accompanied by delusions and hallucinations.

1. Schizophrenia. It is characterized by changes in the emotional sphere (ambivalence, alienation, loss of contact with other people, inadequate response, loss of empathy for people), in behavior (autistic, aggressive, ridiculous, "strange") and in thinking (distortion of reality, sometimes accompanied by delusions and hallucinations ). Schizophrenia is divided into several types: 1. Disorganized (hebephrenic) schizophrenia: incoherent thinking, antics, emotional impoverishment and inadequacy of emotional reactions, foolishness, mannerisms, frequent somatic complaints, periodic incoherent delusions and hallucinations; 2. Catatonic schizophrenia - a form of the disease with excessive excitation (characterized by excessive and sometimes violent motor activity) or general lethargy, a state of stupor, mutism, negativism, waxy flexibility and in some cases the so-called vegetative state; 3. Paranoid schizophrenia - schizophrenia characterized by delusions of persecution or grandeur, sometimes hallucinations or excessive religiosity; the patient is often hostile and aggressive; 4. Undifferentiated schizophrenia - behavioral disorders with persistent delusions and hallucinations; 5. Residual schizophrenia - signs of schizophrenia after a psychotic schizophrenic episode in patients who are not in a psychotic state. (Post-schizophrenic depressive disorder may occur during the residual phase.)

2. Delusional (paranoid) disorder. Psychotic disorder with stable delusions, eg erotomanic, grandeur, jealousy, persecution, somatic, type unspecified. Paranoia is a rare condition characterized by the gradual creation of an elaborate system of delusions with ideas of grandeur; is chronic; the rest of the personality remains unaffected.

3. Short-term psychotic disorder. Psychotic disorder lasting less than 1 month caused by an external stressor.

4. Schizophreniform disorder. A schizophrenia-like disorder with delusions, hallucinations, and inappropriate behavior that lasts less than 6 months.

5. Schizoaffective disorder. It is characterized by a combination of schizophrenic symptoms and pronounced mania (bipolar type) or depression (depressive type).

6. Induced psychotic disorder. The same delusion occurs in two people, one of whom is of low intelligence or dependent on the other [also known as induced paranoid disorder, which can occur in a group of people, folie a deux (delirium together)].

7. Psychotic disorders due to somatic or other illness. Hallucinations and delusional disorders caused by any disease, such as epilepsy, beriberi, meningitis.

8. Psychotic disorder caused by a psychoactive substance. Symptoms of psychosis caused by the use of psychotropic or other substances, such as hallucinogens, cocaine.

18 Chapter 1 NOT

9. Psychotic disorder, unspecified (atypical psychosis). Psychotic symptoms associated with: 1) a certain culture (whom - a fear of penis reduction found in South and East Asia); 2) a certain time or event (postpartum psychosis - 48-72 hours after birth); 3) a unique group of symptoms (Capgras syndrome - patients think that they have a double). E. Mood disorders (in the old terminology, affective disorders). Characterized by depression that dominates the mental life of the patient and is the cause of dysfunction. Mood disorders can be caused by physical or neurological disease, psychoactive drugs (cocaine) or drugs (such as anticancer drugs, reserpine).

1. Bipolar disorders. They are characterized by great emotional lability, remission and recurrence. Bipolar I disorder - a manic or mixed state usually with a major depressive episode; bipolar II disorder - a major depressive episode and a hypomanic episode (less severe than mania) without a manic or mixed episode; cyclothymic disorders are a less severe form of bipolar disorder.

2. Depressive disorders. Major depressive disorder - extremely depressed mood, mental and motor retardation, anxiety, fear, confusion, agitation, guilt, suicidal thoughts, usually recurrent. Dysthymic disorder is a less severe form of depression, usually caused by a specific event or the loss of a loved one (depressive neurosis). Postpartum depression occurs within a month after childbirth. Seasonal depressive disorder (seasonal affective disorder) most often occurs in winter.

G. Anxiety disorders. Characterized by deep and persistent anxiety (generalized anxiety disorder), often reaching panic (panic disorder), fear of leaving the house (agoraphobia), fear of certain situations or objects (specific phobias), public speaking (social phobias), involuntary and persistent occurrence of - any thoughts, desires, urges or actions (obsessive-compulsive disorder). They also include post-traumatic stress disorder (PTSD) as a result of extreme life stress (war, catastrophe), which is characterized by anxiety, nightmares, agitation and sometimes depression; an acute reaction to stress - a disorder clinically similar to PTSD, but less prolonged (up to 4 weeks). May be caused by a medical condition such as hyperthyroidism or a psychoactive substance such as cocaine.

3. Somatoform disorders. They are characterized by a painful concern about their health, an excessive fear of getting sick with a particular disease. Subdivided into: somatic disorder - numerous somatic complaints without organic pathology; conversion disorder (hysteria, Briquet's syndrome) - a disease in which imaginary disorders occur, manifested by blindness, deafness, anosmia, loss of sensation, paresthesia, paralysis, ataxia, akinesia or dyskinesia; patients often show inappropriate carelessness and may try to gain some benefit from their actions; hypochondria (hypo-

Diagnosis and classification in psychiatry 19

chondric neurosis) - a state of excessive concern for one's own health and a stable false conviction that one or another disease exists in oneself; persistent somatoform pain disorder - a state of increased concern about pain, in which psychological factors play a role; dysmorphophobic disorder - a false belief that one or another part of the body is deformed.

I. Simulated disorders. Characterized by the deliberate inventing of psychotic, somatic, or both symptoms in order to appear ill (Munchausen's syndrome).

K. Dissociative disorders. Characterized by an unexpected temporary disturbance of consciousness or personality disorder. Dissociative (psychogenic) amnesia - loss of memory without any organic cause; dissociative (psychogenic) fugue - an unexpected flight from home; dissociative identity disorder (disorder in the form of multiple personality) - it seems to the patient that there are two or more personalities in him; depersonalization disorder - a feeling of alienation of one's own personality (emotions, thoughts, actions, etc.).

L. Sexual and gender identity disorders. Subdivided into disorders of sexual preference, gender identity disorders and sexual dysfunction. Disorders of sexual preference (paraphilias) are observed in patients whose interests in sexual life are directed primarily not to persons of the opposite sex, but to any objects, sexual activities not associated with coitus, or coitus under unusual circumstances. They include exhibitionism, fetishism, frotterism, pedophilia, masochism, sadism, fetish transvestism, and voyeurism. Sexual dysfunctions are associated with desire (disorder in the form of decreased sexual desire, disorder associated with sexual aversion), with arousal (sexual arousal disorder in women, erectile dysfunction in men), with orgasm (orgasmic disorder in women, for example anorgasmia, orgasm disorder in men, such as delayed or premature ejaculation) and sexual pain disorders (dyspareunia, vaginismus). Sexual dysfunction may be caused by a medical or neurological disease (such as multiple sclerosis) or substance abuse (such as phenamine).

Gender identity disorders (including transsexualism) are characterized by persistent discomfort associated with one's gender and the desire to change one's sexual characteristics, for example, by castration.

M. Eating disorders. They are characterized by eating disorders. They include anorexia nervosa (loss of body weight, refusal to eat) and bulimia nervosa (attacks of binge eating with or without subsequent vomiting).

N. Sleep disorders. Include. 1) dyssomnia, in which the patient has sleep disturbances, he cannot fall asleep (insomnia) or sleeps too much (hyper-somnia); 2) parasomnia, such as a disorder in the form of nightmares, somnambulism, or a disorder in the form of night terrors (the patient wakes up,

(Vengerov)

Big biographical encyclopedia. 2009 .

See what "Kaplan, G.A." in other dictionaries:

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Exist., Number of synonyms: 1 priest (65) ASIS Synonym Dictionary. V.N. Trishin. 2013 ... Synonym dictionary

kaplan- or CHAPLAN capelan m. Fish for cod bait. Luchinsky 1879 ... Historical Dictionary of Gallicisms of the Russian Language

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Books

• Leningrad. Anatoly Kaplan, Anatoly Kaplan. The lithographic cycle LENINGRAD by Anatoly Kaplan has long been recognized as one of the best examples of fine art dedicated to our city. Kaplan began work on the cycle immediately ...
• Leningrad. Anatoly Kaplan, Kaplan Anatoly. The lithographic cycle "Leningrad" by Anatoly Kaplan (1903-1980) has long been recognized as one of the best examples of fine art dedicated to the great city. To work on the Kaplan cycle ...