Psychiatry Review and Canadian Certification Exam Preparation Guide This page intentionally left blank Psychiatry Review and Canadian Certification Exam Preparation Guide Edited by James A. Bourgeois, O.D., M.D., F.R.C.P.C. Usha Parthasarathi, M.B.B.S., F.R.C.P.C. Ana Hategan, M.D., F.R.C.P.C. Washington, DC London, England Note: The authors have worked to ensure that all information in this book is accurate at the time of publication and consistent with general psychiatric and medical standards and that information concerning drug dosages, schedules, and routes of administration is accurate at the time of publication and consistent with standards set by the U.S. Food and Drug Administration and the general medical community. As medical research and practice continue to advance, how- ever, therapeutic standards may change. Moreover, specific situations may require a specific therapeutic response not included in this book. For these reasons and because human and mechanical errors sometimes occur, we recommend that readers follow the advice of physicians directly involved in their care or the care of a member of their family. Books published by American Psychiatric Publishing (APP) represent the findings, conclusions, and views of the indi- vidual authors and do not necessarily represent the policies and opinions of APP or the American Psychiatric Associa- tion. If you would like to buy between 25 and 99 copies of this or any other American Psychiatric Publishing title, you are eligible for a 20% discount; please contact Customer Service at [email protected] or 800-368-5777. If you wish to buy 100 or more copies of the same title, please e-mail us at [email protected] for a price quote. Copyright © 2012 American Psychiatric Association ALL RIGHTS RESERVED Manufactured in Canada on acid-free paper 16 15 14 13 12 5 4 3 2 1 First Edition Typeset in Frutiger and Janson. American Psychiatric Publishing, Inc. A Division of American Psychiatric Association 1000 Wilson Boulevard Arlington, VA 22209-3901 www.appi.org Library of Congress Cataloging-in-Publication Data Psychiatry review and Canadian certification exam preparation guide / edited by James A. Bourgeois, Usha Parthasarathi, Ana Hategan. — 1st ed. p. ; cm. Includes bibliographical references and index. ISBN 978-1-58562-432-4 (alk. paper) I. Bourgeois, James. II. Parthasarathi, Usha. III. Hategan, Ana. [DNLM: 1. Psychiatry—Canada—Outlines. WM 18.2] 616.890076--dc23 2011051210 British Library Cataloguing in Publication Data A CIP record is available from the British Library. Contents Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Disclosure of Interests . . . . . . . . . . . . . . . . . . . . .xii Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv SECTION I BASIC CLINICAL SCIENCE 1 Functional Neuroanatomy . . . . . . . . . . . . . . . . . . .3 Brian T. Harel, Ph.D. Daniel Tranel, Ph.D. 2 Cultural Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Albert C. Gaw, M.D. 3 Psychiatry and the Law. . . . . . . . . . . . . . . . . . . . . 33 Robert I. Simon, M.D. Daniel W. Shuman, J.D. Ana Hategan, M.D., F.R.C.P.C. Usha Parthasarathi, M.B.B.S., F.R.C.P.C. 4 The Psychiatric Interview and Mental Status Examination. . . . . . . . . . . . . . 47 Linda B. Andrews, M.D. Fred Ovsiew, M.D. 5 Laboratory Testing in Psychiatry . . . . . . . . . . . . . 57 H. Florence Kim, M.D. Paul E. Schulz, M.D. Elisabeth A. Wilde, Ph.D. Stuart C. Yudofsky, M.D. 6 Clinical Neuroimaging . . . . . . . . . . . . . . . . . . . . . 79 Robin A. Hurley, M.D. Ronald E. Fisher, M.D., Ph.D. Katherine H. Taber, Ph.D. SECTION II PSYCHIATRIC DISORDERS 7 Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence . . . . . . . . 89 Amy M. Ursano, M.D. Paul H. Kartheiser, M.D. L. Jarrett Barnhill, M.D. 8 Delirium, Dementia, and Amnestic and Other Cognitive Disorders . . . . . . . . . . . . . . . . . 117 James A. Bourgeois, O.D., M.D., F.R.C.P.C. Jeffrey S. Seaman, M.S., M.D. Mark E. Servis, M.D. Ana Hategan, M.D., F.R.C.P.C. 9 Substance-Related Disorders . . . . . . . . . . . . . . . 145 Martin H. Leamon, M.D. Tara M. Wright, M.D. Hugh Myrick, M.D. Usha Parthasarathi, M.B.B.S., F.R.C.P.C. 10 Schizophrenia . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Michael J. Minzenberg, M.D. Jong H. Yoon, M.D. Cameron S. Carter, M.D. 11 Mood Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . 191 John A. Joska, M.D., M.Med.(Psych.), F.C.Psych.(S.A.) Dan J. Stein, M.D., Ph.D. Usha Parthasarathi, M.B.B.S., F.R.C.P.C. 12 Anxiety Disorders . . . . . . . . . . . . . . . . . . . . . . . . 215 Eric Hollander, M.D. Daphne Simeon, M.D. Usha Parthasarathi, M.B.B.S., F.R.C.P.C. 13 Somatoform Disorders . . . . . . . . . . . . . . . . . . . .255 Sean H. Yutzy, M.D. Brooke S. Parish, M.D. 14 Factitious Disorder and Malingering . . . . . . . . . 267 Barbara E. McDermott, Ph.D. Martin H. Leamon, M.D. Marc D. Feldman, M.D. Charles L. Scott, M.D. 15 Dissociative Disorders. . . . . . . . . . . . . . . . . . . . . 277 José R. Maldonado, M.D. David Spiegel, M.D. 16 Sexual Disorders . . . . . . . . . . . . . . . . . . . . . . . . . 293 Judith V. Becker, Ph.D. Jill D. Stinson, Ph.D. 17 Gender Identity Disorders and Paraphilias . . . . 305 Judith V. Becker, Ph.D. Bradley R. Johnson, M.D. Usha Parthasarathi, M.B.B.S., F.R.C.P.C. Ana Hategan, M.D., F.R.C.P.C. 18 Eating Disorders . . . . . . . . . . . . . . . . . . . . . . . . . 317 Katherine A. Halmi, M.D. Ana Hategan, M.D., F.R.C.P.C. 19 Impulse-Control Disorders Not Elsewhere Classified . . . . . . . . . . . . . . . . . . . . . . 331 Eric Hollander, M.D. Heather A. Berlin, M.P.H., Ph.D. Dan J. Stein, M.D., Ph.D. 20 Personality Disorders . . . . . . . . . . . . . . . . . . . . . 345 Andrew E. Skodol, M.D. John G. Gunderson, M.D. SECTION III TREATMENTS 21 Psychopharmacology . . . . . . . . . . . . . . . . . . . . . 369 Melissa Martinez, M.D. Lauren B. Marangell, M.D. James M. Martinez, M.D. Ana Hategan, M.D., F.R.C.P.C. 22 Nonpharmacological Somatic Treatments . . . . 427 Mark S. George, M.D. Ziad H. Nahas, M.D., M.S.C.R. Jeffrey J. Borckardt, Ph.D. Berry Anderson, B.S.N., R.N. Milton J. Foust Jr., M.D. 23 Psychodynamic Psychotherapy . . . . . . . . . . . . . 435 Robert J. Ursano, M.D. Stephen M. Sonnenberg, M.D. Susan G. Lazar, M.D. 24 Cognitive Therapy. . . . . . . . . . . . . . . . . . . . . . . . 449 Jesse H. Wright, M.D., Ph.D. Michael E. Thase, M.D. Aaron T. Beck, M.D. SECTION IV PRACTICE EXAM Exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 469 Answer Guide to Exam. . . . . . . . . . . . . . . . . . . . 495 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 567 Contributors Berry Anderson, B.S.N., R.N. Ronald E. Fisher, M.D., Ph.D. Clinical Research Manager, Central Study Coordinator Assistant Professor, Departments of Radiology and Neu- for National Institute of Mental Health Optimization of roscience, Baylor College of Medicine, Houston, Texas; Transcranial Magnetic Stimulation for the Treatment of Director of Nuclear Medicine, The Methodist Hospital, Depression (OPT-TMS Depression) Study, Brain Stimu- Houston, Texas lation Laboratory, Institute of Psychiatry, Medical Uni- versity of South Carolina, Charleston, South Carolina Milton J. Foust Jr., M.D. Assistant Professor of Psychiatry and Director, Electro- Linda B. Andrews, M.D. convulsive Therapy Program, Medical University of Associate Dean for Graduate Medical Education and As- South Carolina, Charleston, South Carolina sociate Professor, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Albert C. Gaw, M.D. Houston, Texas Clinical Professor, Department of Psychiatry, University of California, San Francisco, California L. Jarrett Barnhill, M.D. Professor of Psychiatry and Director of the Develop- Mark S. George, M.D. mental Neuropharmacology Clinic, Department of Distinguished Professor of Psychiatry, Radiology, and Psychiatry, Division of Child and Adolescent Psy- Neurosciences; Director, Center for Advanced Imaging chiatry, University of North Carolina, Chapel Hill, Research; and Director, Brain Stimulation Laboratory, North Carolina Medical University of South Carolina (MUSC), Charles- Aaron T. Beck, M.D. ton, South Carolina; Director, South Carolina Brain Im- aging Center of Excellence; Chairman, National Institute Professor of Psychiatry, University of Pennsylvania of Mental Health Optimization of Transcranial Magnetic School of Medicine, Philadelphia, Pennsylvania Stimulation for the Treatment of Depression (OPT-TMS Judith V. Becker, Ph.D. Depression) Study Professor of Psychology and Psychiatry, Department of Psychology, The University of Arizona, Tucson, Arizona John G. Gunderson, M.D. Professor of Psychiatry, Harvard Medical School, Boston; Heather A. Berlin, M.P.H., Ph.D. and Director, Psychosocial and Personality Research, Assistant Professor, Department of Psychiatry, Mount Si- McLean Hospital, Belmont, Massachusetts nai School of Medicine, New York, New York Katherine A. Halmi, M.D. Jeffrey J. Borckardt, Ph.D. Professor of Psychiatry, Weill Cornell Medical College, Assistant Professor, Departments of Psychiatry and Anes- White Plains, New York thesiology, Medical University of South Carolina, Charleston, South Carolina Brian T. Harel, Ph.D. Postdoctoral Fellow, Department of Neurology, Univer- James A. Bourgeois, O.D., M.D., F.R.C.P.C. sity of Iowa Hospitals and Clinics, Iowa City, Iowa Professor of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster Ana Hategan, M.D., F.R.C.P.C. University, Hamilton, Ontario, Canada Assistant Clinical Professor, Department of Psychiatry Cameron S. Carter, M.D. and Behavioural Neurosciences, Michael G. DeGroote Professor of Psychiatry and Psychology and Director, Im- School of Medicine, McMaster University, Hamilton, aging Research Center, University of California, Davis, Ontario, Canada School of Medicine, Sacramento, California Eric Hollander, M.D. Marc D. Feldman, M.D. Clinical Professor and Director, Compulsive, Impulsive, Clinical Professor of Psychiatry and Behavioral Sciences, and Autism Spectrum Disorder Program, Department of Department of Psychiatry and Behavioral Medicine, Uni- Psychiatry and Behavioral Sciences, Albert Einstein Col- versity of Alabama, Tuscaloosa, Alabama lege of Medicine, New York, New York ix