7/22/2019 Mastering Psychiatry 2014 (Final)1

1/355

sthrlemZsydo"#$%&'

! #$%& '&(')$$* +$% ,-.&%/%:.,:'&6

>&408- 9= ?

7/22/2019 Mastering Psychiatry 2014 (Final)1

2/355

!"#$%&'() +#,-.'"$&,/ -:&% $%6$>::4 0:& 8(9%&)&"9="$%#

?&9%9'4#0*+"8960=*?# :4 D*>48F 9;- :;237)8 :J+"=#>$8960=*?# :

7/22/2019 Mastering Psychiatry 2014 (Final)1

3/355

Ilrst punclsoh` le Tlemfparh le >:6> ny

Ghcvye ]N [ofem fe` ^amhr DG Oa, @hpfrtghet ai Zsydoacamldfc Gh`ldleh, Chvhc >?.

>e`H`ltlae punclsoh` le Tlemfparh le Kucy >:64

4r`H`ltlae punclsoh` le Tlemfparh le Kucy >:60

>:60 Ghcvye ]N [ofem, Dyrus TO Oa, ^aolt Tofebfr, Tfekhhv Tadbfclemfg, Gldofhc Dohem & ^amhr DG Oa

Dapyrlmot he`arsh` wlto Poh Tdrhhewrlthrs Fssadlftlae Tlemfparh & Tfguhc Thaw Cfw Darparftlae

Thrlfc Eugnhr; FT^>:6>/:::9

Fcc rlmots rhshrvh`. Ea pfrt ai tols puncldftlae ar hchdtraeld rhsaurdh gfy nh rhpra`udh`, starh` le f rhtrlhvfc systhg,

ar trfesgltth` le fey iarg sudo fs hchdtraeld, ghdofeldfc, poatadapylem, rhdar`lem wltoaut prlar phrglsslae ai toh

dapyrlmoth` awehrs.

]olcst toh f`vldh fe` leiargftlae le tols naab frh nhclhvh` ta nh truh fe` fddurfth ft toh `fth ai malem ta prhss,

ehltohr toh futoars ear toh prlethr dfe fddhpt fey chmfc rhspaeslnlclty ar clfnlclty iar fey hrrars ar aglsslaes toft gfy nh

gf`h. Le pfrtlducfr (nut wltoaut clgltlem toh mhehrfclty ai toh prhdh`lem `lsdcflghr) hvhry hiiart ofs nhhe gf`h ta dohdb

`rum `asfmhs2 oawhvhr lt ls stlcc passlnch toft hrrars ofvh nhhe glssh`. Iurtohrgarh, `asfmh sdoh`uchs frh daestfetcy

nhlem rhvlsh` fe` ehw sl`h-hiihdts rhdamelzh`. Iar tohsh rhfsaes toh rhf`hr ls straemcy urmh` ta daesuct toh `rum

dagpfelhs' prleth` lestrudtlaes nhiarh f`glelsthrlem fey ai toh `rums rhdagghe`h` le tols naab.

Eftlaefc Clnrfry ai Tlemfparh Dftfcamulem le Zuncldftlae @ftf.

F dftfcamuh rhdar` iar tols naab ls fvflcfnch irag toh Eftlaefc Clnrfry ai Tlemfparh

LTNE (Naab);

7/22/2019 Mastering Psychiatry 2014 (Final)1

4/355

Zrhifdh

QQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQ

Zsydolftry ls f nrfedo ai gh`ldleh toft iadushs ae toh `lfmeasls, trhftghet fe` prhvhetlae ai ghetfc fe`

hgatlaefc `lsar`hrs. Zsydolftry aiihrs gh`ldfc stu`hets f uelquh hxphrlhedh nhdfush psydolftrld

`lfmeasls ls hstfnclsoh` ny dcleldfc lethrvlhw nut eat nfsh` ae f cfnarftary thst ar fe _-rfy. Gh`ldfc

stu`hets gfy ehh` tlgh ta f`kust ta tols sphdlfcty nhdfush lt levacvhs trhftghet ga`fclty sudo fs

psydoatohrfpy ar hchdtradaevucslvh tohrfpy woldo frh eat iaue` le atohr gh`ldfc ar surmldfc `lsdlpclehs.

Poh `urftlae ai ue`hrmrf`ufth pastlem le psydolftry ls 9 whhbs fe` lt pashs f dofcchemh iar gh`ldfc

stu`hets ta gfsthr psydolftrld beawch`mh fe` sblccs le f soart phrla` ai tlgh. Poh ac` l`hacamy wfs ta stu`y

f cfrmh psydolftrld thxtnaab. Gh`ldfc stu`hets aithe rhfclsh toft gudo tlgh ofs hcfpsh` wltoaut

daesacl`ftlem tohlr beawch`mh prlar ta toh hxfgleftlae, chf`lem ta pfeld fttfdbs. Tagh stu`hets stu`y

thxtnaabs punclsoh` le toh XB fe` XT nut tohsh naabs gfy daetfle trhftghet rhdagghe`ftlaes woldo frh

eat rhchvfet ta toh Tlemfparh daethxt. ]h nhclhvh toft tols ehw naab, Gfsthrlem Zsydolftry; F darh

Phxtnaab iar Xe`hrmrf`ufths wlcc nh aeh ai toh gast fddhsslnch, drhftlvh fe` prfdtldfc

naabs le ue`hrmrf`ufth psydolftry ta nrl`mh toh mfps ai rhvlslae fe` fppcldftlae ai beawch`mh le toh

hxfgleftlaes fe` iuturh prfdtldh . Poh sblciuc armfelsftlae daghs toraumo ae hvhry pfmh fe` dfe`l`fths

dfe rhvlsh psydolftry le fe hiildlhet gfeehr.

Poh dofpthrs le tols naab frh nfsh` ae toh daggae syccfnus ai gast gh`ldfc sdoaacs warc`wl`h. ]h fcsa

ledarparfth toh mul`hclehs irag toh Glelstry ai Ohfcto (Tlemfparh) fe` toh Eftlaefc Lestltuth ai Dcleldfc

Hxdhcchedh (ELDH) (Xelth` Blem`ag). Poh gfthrlfcs ai tols naab frh nfsh` ae toh ue`hrmrf`ufth daursh

tfumot fe` toh whfcto ai dcleldfc hxphrlhedh mftohrh` ny ^O ft toh Eftlaefc Xelvhrslty Oaspltfc. ]ohehvhr

passlnch, toh daedhpts frh suppchgheth` wlto `lfmrfgs fe` sfgpch hxfg quhstlaes, wohrh toh rhf`hrs

gfy mfle f `hhphr leslmot, sa wolcst toh gfthrlfcs frh hfslcy fnsarnfnch, tohy fcsa pravl`h f sthpplemstaeh ta toh ATDH hxfgleftlae. ]h nhclhvh toft toh prhpfrftlae iar ATDH ls nfsh` ae dcleldfc vl`has fe`

f @Y@ ls pravl`h` ta ohcp dfe`l`fths ta prhpfrh iar toh ATDH. Iurtohrgarh, toh ATDH mrl` ohcps ta

daesacl`fth beawch`mh le f prfdtldfc fe` ghgarlsfnch gfeehr. Pols naab fcsa daetfles lgpartfet

leiargftlae rhqulrh` iar toh tohary pfphrs. ]h oaph toft wh ofvh pra`udh` fe fiiar`fnch naab toft clvhs

up ta toh olmo hxphdtftlaes irag toh rhf`hrs fe` yht ta rhvlsh psydolftry le fe hekayfnch fe` leiargftlvh

wfy.

]h ofvh strlvhe ta gfbh Gfsthrlem Zsydolftry; F darh thxtnaab iar ue`hrmrf`ufths felethrhstlem,

hekayfnch fe` ushiuc. ]h wauc` whcdagh daestrudtlvh drltldlsg fe` dagghets (hgflc ta

gfsthrlempsydolftryJmgflc.dag) `lrhdth` ft gfblem lgpravhghets ta iuturh h`ltlaes. ]h nhclhvh toft

rhf`hrs puttlem hiiart leta chfrelem psydolftry toraumo tols naab wauc` nh le f straem pasltlae ta lgprhss toh

hxfglehrs fe` tohlr dacchfmuhs.

^amhr Oa

Ghcvye [ofem

Dyrus TO Oa

Tlemfparh >:60

7/22/2019 Mastering Psychiatry 2014 (Final)1

5/355

H* 0"*0=" G6() ?">(#= 6==>"22"2F ()"6+ K#?6=6"2 #>$ ?">(#= )"#=() G*+E"+2

K.: >"\;% K'$. O%($"; ';;(%##%# "(9 9%2:$% $.%'& ;'2%# $: 'OH&:2% $.% R=";'$, :0 H#,-.'"$&'-

-"&%G

H* ?"$67#= 2('$">(2

K.: #$&'2% 0:& %6-%;;%(-% "(9 9%$%&O'(% $: H==% " O%9'-"; -"&%%& K'$.

7/22/2019 Mastering Psychiatry 2014 (Final)1

6/355

A'+ J>("+>#Z*>#= L$'7#Z*>#= !"#$2 V

7/22/2019 Mastering Psychiatry 2014 (Final)1

7/355

L'#-;"'O%

6) Poh purpash ai Gfsthrlem Zsydolftry ls ta pravl`h f irhh thxtnaab fe` irhh fddhss taf whnslth woldo daetfles slgucfth` vl`has. Pols ls f `h`ldftlae, chf` ny @r. Ghcvye]N [ofem fe` @r. ^amhr Oa le >:6>, ta gh`ldfc stu`hets irag toh \aem Caa Cle

Tdoaac ai Gh`ldleh, EXT hsphdlfccy toash stu`hets wlto ilefedlfc `liilducty fe` dfeeatfiiar` f iarhlme thxtnaab. Ttu`hets dfe poatadapy fe` rhpra`udh le fey iargft woldo

tohy prhihr nhdfush toh futoars wauc` clbh ta sofrh tohlr beawch`mh wlto gh`ldfcstu`hets le toh gast `lrhdt fe` daevhelhet wfy.

>) Poh futoars `a eat rhdhlvh fey ledagh irag tols naab. Pols naab ls f ougnch shtupwltoaut fddhss ta iucc typhshttlem shrvldh fe` ea punclsohr wfs levacvh` le toh puncldftlaepradhss. Fs f rhsuct, tols naab `ahs eat ofvh daetleuaus pfmh eugnhrlem fe` fe le`hx

ft toh nfdb iar drass-rhihrhedh fe` dfeeat nh dagpfrfnch wlto f naab punclsoh` ny fpunclsohr.

4) Pohrh frh vfrlaus psydolftry thxtnaabs le toh gfrbht. Xelvhrslty stu`hets frhhxphdth` ta ofvh toh wls`ag ta doaash tohlr prhihrrh` thxtnaabs. @liihrhet thxtnaabs frhwrltthe le `liihrhet stychs fe` tohy frh eat gutufccy hxdcuslvh. Gfsthrlem Zsydolftry

iaccaws toh iargft ai Nrltlso rhvlslae eaths iar gh`ldfc stu`hets. Lt flgs ta nh daedlsh fe`wrltthe le soart shethedhs ar palet-iargs.

0) Pohrh ofvh nhhe slmelildfet `lsdavhrlhs le psydolftrld beawch`mh. Poh futoars ofvhtrlh` tohlr vhry nhst ta ledcu`h toh gast up`fth` leiargftlae le tols naab woldo ls rhchvfet

ta dcleldfc prfdtldh le Tlemfparh. Pols naab flgs ta nh f dagpfelae iar ue`hrmrf`ufthstu`lhs fe` f rhihrhedh naab iar iuturh prfdtldh. Poh futoars ofvh olmoclmoth` glstfbhsfe` dcfrlilh` quhrlhs rflsh` ny prhvlaus gh`ldfc stu`hets. \au dfe ile` toash leiargftlae

le toh whnslth.

8) Pols naab ls eat lethe`h` ta rhpcfdh dcleldfc dchrbsolp. Ttu`hets frh f`vlsh` ta shh

pftlhets fe` cleb tohlr dcleldfc anshrvftlae wlto toh naab daethet. Le hxfgleftlae, tohrhfrh quhstlaes nfsh` ae dcleldfc sdhefrlas. Ttu`hets frh f`vlsh` ta ush tohlr dcleldfc

rhfsaelem ta shchdt toh nhst feswhrs. Lt soauc` eat eat f `lrhdt rhdfcc irag fey thxtnaab

wltoaut dcleldfc rhfsaelem.

9) ]h whcdagh daestrudtlvh ihh`nfdbs fe` quhrlhs ae Gfsthrlem Zsydolftry. \au dauc`she` yaur ihh`nfdb fe` hequlrlhs ta gfsthrlempsydolftryJmgflc.dag, ar daetfdt feyaeh ai toh Tlemfparh Chf` Futoars.

7/22/2019 Mastering Psychiatry 2014 (Final)1

8/355

Daethets & Fnrl`mh` Le`hx

QQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQPoh futoars

Zrhifdh

Iarhwar`

@h`ldftlaes

Garh fnaut Da-futoars

@lsdcflghrs

6. Zsydoa-pftoacamy

Zhrdhptlaes 6

Lccuslaes 6

Ofccudleftlaes >

Poaumot pradhss fe` sphhdo 4

@hcuslaes 0

Zsydoapftoacamy le gavhghet 0

Daggae Zsydolftrld sye`raghs 8

>. Dcleldfc Lethrvlhw, iargucftlae fe` gfefmhghet

Zsydolftrld olstary- 6:

Ghetfc stfth hxfgleftlae 64

Zoysldfc hxfgleftlae 68

@lfmeasls fe` olhrfrdoy ai `lfmeasls 69

Iargucftlae 69

Levhstlmftlaes, Gfefmhghet fe` guctl`lsdlpclefry fpprafdo -6=

4. Tdolzaporhelf, fetlpsydoatlds fe` rhcfth` `lsar`hrTdolzaporhelf 6>

Zoysldfc Hxfg, @liihrhetlfcs Zfmh >=

Gfefmhghet - >?

Fetlpsydoatlds 46

HZTH 4?

Zsydoasadlfc lethrvhetlae 4

Tdolzafiihdtlvh `lsar`hr 0>

Nrlhi Zsydoatld @lsar`hr 04

@hcuslaefc `lsar`hr 00

0. Gaa` `lsar`hrs@hprhsslvh `lsar`hr Zfmh 8>

@lfmeastld drlthrlf 80

@liihrhetlfcs, Levhstlmftlaes, Vuhstlaeeflrhs 8?

Gfefmhghet 88

@hphe`het phrsaefclty lsar`hr 6>=

Lgpucsh daetrac `lsar`hr - 6>?

=. Tunstfedh glsush fe` `hphe`hedhFcdaoac glsush fe` `hphe`hedh 64>

Aplal` glsush fe` `hphe`hedh 606

Ttlgucfets 604

Eldatleh fe` sgablem 60=

Tacvhets, sh`ftlvhs, dfiihleh fe` sthral`s 60

Mfgnclem `lsar`hr 68>

Lethreht f``ldtlae 684

?. Hftlem `lsar`hrsFearhxlf Ehrvasf 68=

Nuclglf Ehrvasf 69:

Nlemh hftlem `lsar`hr 696

Ghtfnacld sye`ragh 690

Tuldl`h / @hclnhrfth Thci Ofrg 6=4

@rum avhr`ash 6==

7/22/2019 Mastering Psychiatry 2014 (Final)1

10/355

Daethets & Fnrl`mh` Le`hx

QQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQ6:. Zsydoatohrfplhs

Prfesihrhedh, Dauethrtrfesihrhedh fe` @hihedh Ghdofelsgs Zfmh 6?4

Zsydoa`yfgld psydoatohrfpy 6?8

Dameltlvh nhofvlarfc tohrfpy 6?9

@lfchdtldfc nhofvlarfc tohrfpy 6?=j Lethrphrsaefc tohrfpy 6??

Ifglcy tohrfpy 6??

Mraup tohrfpy 6?=>

Fsphrmhrs - >=9

F@O@ - >=9

Dae`udt `lsar`hr fe` Appasltlaefc `hilfet `lsar`hr >=?4

Fdf`hgld `liilductlhs, sphdlild chfrelem `lsar`hrs >?4

Hchdtlvh gutlsg & Plds >?0

Eaearmfeld heurhsls >?8

Eaearmfeld hedaprhsls >?9

Atohr dolc`oaa` psydolftrld `lsar`hr >?9

Lethcchdtufc `lsfnlclty >

Ghetfc `lsar`hr fe` trhftghet fdt -4:4

Ghetfc dfpfdlty fdt 4:0

6?. Zsydolftry htoldsHtoldfc prledlpchs 4:?

Daeil`hetlfclty - 4::

Zsydoasls 4>6

@hprhsslae -4>4

HDP 4>0

Nlpacfr `lsar`hr 4>8

Cltolug fe` sl`h hiihdts 4>=

Tuldl`h rlsb 4>?

Fexlhty, pfeld fttfdbs fe` poanlf 4>

Fcdaoac 444

FE 448

Tchhp `lsturnfedhs 44?

DC Zsydolftry 44::4 0:& 8(9%&)&"9="$%#

_=& _(;'(% 1%#:=&-%f

KKKGO"#$%&'()H#,-.'"$&,G-:O

C"G O"#('+"2 *>=6>" K*+ ^TPX L$6Z*>,

j T'(4# $: 3%> /HH Y T'(4# $: 9:K(;:"9 /HH;% Y /(9&:'9 /HH

j I:OH&%.%(#'2% n'9%: n"=;$ :0 _MIA n'9%:#

j D'). ['%;9 1"H'9 1%2'#':( d='``%# J!Id#Z M/d#Z A!^#F

j N%K ^((:2"

7/22/2019 Mastering Psychiatry 2014 (Final)1

13/355

!"#$%&'() +#,-.'"$&,/ -:&% $%6$>::4 0:& 8(9%&)&"9="$%#

MO"&$H.:(% 3%>j>"#%9 /HH"2"';">;% (:K :( KKKGO"#$%&'()H#,-.'"$&,G-:O

MO"&$H.:(% N"

7/22/2019 Mastering Psychiatry 2014 (Final)1

14/355

Dofpthr 6 Zsydoapftoacamy

Zhrdhptlaes 6 Avhrvfcuh` l`hf, anshsslaes fe` `hcuslaes 0

Lccuslaes 6 Zsydoapftoacamy le gavhghet 0

Ofccudleftlaes > Daggae psydolftrld sye`raghs 8

Zsydoapftoacamy le toaumot pradhss 4 ATDH mrl` 9

Zsydoapftoacamy le sphhdo 4 ^hvlslae GDVs fe` GHVs =

Zhrdhptlaes fe` rhcfth` psydoapftoacamy

Zhrdhptlae ls f dagpchx pradhss levacvlem rhdhptlae ai leiargftlae irag shesary armfes, iaccawh` ny rhdameltlae,pradhsslem fe` rharmfelsftlae ai toh leiargftlae leta ghgary fe` f sunshquhet rhspaesh rhcftlem ta toh leiargftlae

rhdhlvh`.

Avhrvlhw ai phrdhptufc poheaghef

Drlthrlf Lgfmleftlae

(Ifetfsy)

Lccuslae Zshu`aofccudleftlae Ofccudleftlae ^hfc

phrdhptlae

Yacuetfry

ar

levacuetfry

Yacuetfry Levacuetfry Levacuetfry (hxdhpt

hl`htld lgfmhry)

Levacuetfry Levacuetfry

Ylvl`ehss Eat vlvl` Ylvl` Ylvl` Ylvl` Ylvl`

Tpfdh Leehr sunkhdtlvh

spfdh

Leehr

sunkhdtlvh

spfdh

Leehr sunkhdtlvh spfdh Authr spfdh Authr spfdh

Leslmot Letfdt Letfdt Letfdt Lgpflrh` Letfdt

Zsydolftrld

`lsar`hrs

Eargfc

hxphrlhedh

@hclrlug @hprhsslae Tdolzaporhelf Eargfc

hxphrlhedh

Lccuslaes

FeLccuslae ls fe levacuetfry ifcsh phrdhptlae le woldo f trfesiargftlae ai rhfc ankhdt tfbhs pcfdh (h.m. toh durtfle le toh

wfr` ls phrdhlvh` ny f pftlhet fs f ihgfch wltdo).

@hsdrlptlae ai daggae lccuslaes;

! Dagpchth lccuslae toh nrfles the`hedy ta ilcc toh glsslem pfrt ai toh ankhdt fe` ls nfelsoh` ny ftthetlae! Fiihdtlvh lccuslae addurs le `hprhssh` ar gfeld stfth.! Zfrhl`acld lccuslaels f typh ai lethesh lgfmhry toft phrslsts hvhe wohe toh sunkhdt caabs ft f rhfc ankhdt le toh

hxthrefc hevlraeghet (h.m. shhlem f wagfes ifdh wohe caablem ft toh dcau`). Pols lccuslae ls ledrhfsh` ny

ftthetlae. . Poh lgfmh fe` phrdhpt addur tamhtohr fctoaumo fe` toh lgfmh ls rhdamelsh` fs uerhfc.

! Kfgfls vu lccuslae ai ueifglclfrlty. Lt addurs le phapch wlto thgparfc canh hplchpsy fe` hxofustlae.! @k vu lccuslae ai ifglclfrlty! Gfdrapslf lccuslae aihxfmmhrftlae le slzh! Gldrapslf lccuslae ai rh`udtlae le slzh

7/22/2019 Mastering Psychiatry 2014 (Final)1

15/355

Fithrlgfmh fe` pfcleapslf;

Fe fithrlgfmh ls f vlsufc lccuslae toft rhihrs ta fe lgfmh daetleulem ta fpphfr le aeh's vlslae fithr toh hxpasurh ta toh

arlmlefc lgfmh ofs dhfsh`. Zfcleapslf ls f gh`ldfc dae`ltlae rhihrrlem ta toh poheagheae ai shhlem fithrlgfmh phrslsthetcy.

Fe` addurs le `hprhsslae, fexlhty, ofccudleamhe ush, Zfrblesaes `lshfsh fe` glmrfleh

Ofccudleftlaes

]oft ls f ofccudleftlae1Le nrlhi, f ofccudleftlae rhihrs ta phrdhptlae ai fe hxthrefc ankhdt wohe ea sudo ankhdt ls prhshet.

Fu`ltary ofccudleftlaes (f) Tlgpch/Hchghetfry fu`ltary ofccudleftlae (h.m. saue`s ar gusldfc) Hchghetfry fu`ltary ofccudleftlae dfe nh pfrt ai toh eargfc hxphrlhedh. Hpl`hglacamy; garh daggae le waghe2 ac`hr phapch. Fhtlacamy;fcdaoac glsush (fcdaoac ofccudleasls le dchfr daesdlausehss), `hfiehss, rlmot

thgparfc canh chslae

(n) Dagpchx fu`ltary ofccudleftlae (gaa` daemruhet)Hxfgpchs;

" Ttftlem `hprhsslvh ar gfeld tohghs le shdae` phrsae h.m.\au frh ushchss." Daggfe` ofccudleftlae; \au frh ushchss fe` yau soauc` ourt yaurshci." Addurrlem le `hprhsslvh `lsar`hr ar nlpacfr `lsar`hr. Daggfe` ofccudleftlaes dfe nh`femhraus.(d) Dagpchx fu`ltary ofccudleftlaes (gaa` ledaemruhet);

Hxfgpchs;

" Yaldhs `lsdusslem toh phrsae le tolr` phrsae. Yaldhs mlvlem f rueelem dagghetfry ae f phrsaes nhofvlaur. Poaumots spabhe aut cau` (Poaumot hdoa/ Hdoa `h cf phesh)

Dagpchx fu`ltary ofccudleftlae addurs le sdolzaporhelf fe` ls usufccy paarcy cadfclsh` le

spfdh. Poh valdh the`s ta ledrhfsh li shesary leput ls rhstrldth` ar toh phrsae ls `rawsy. Tagh

phapch wlto sdolzaporhelf try ta `lstrfdt tohgshcvhs irag toh dagpchx fu`ltary ofccudleftlaesny clsthelem ta gusld ar ghfelemiuc sphhdo.

Ylsufc ofccudleftlaes (f) Tlgpch/Hchghetfry vlsufc ofccudleftlae; (h.m. Icfso clmot)

Daggae le fduth armfeld `lshfshs fe` chslaes frh iaue` le toh addlpltfc darthx.

Fithr ohf` lekury, tohrh frh slgpch vlsufc ofccudleftlaes sudo fs icfsohs fe` stfrs shhe. Pohsh

slgpch vlsufc ofccudleftlaes frh beawe fs pasltlvh sdatagftf. @urlem glmrfleh fttfdb, toh

phrsae aithe shhs zlmzfm clehs. Poh ue`hrcylem pftoacamy ls `uh ta trfeslhet `lsturnfedh le

addlpltfc darthx.

(n) Dagpchx vlsufc ofccudleftlae(h.m. levacvlem phapch fe` felgfcs)

Addurrlem le armfeld `lshfshs fe` chslaes frh iaue` le toh thgparfc canh.

Clcclputlfe

ofccudleftlae (Ylsufc)

" Ofccudlefth` ankhdts, usufccy phapch, fpphfr mrhftcy rh`udh` le slzh (gldraptld)." Clcclputlfe ofccudleftlaes fcsa addur le psydolftrld stfths fssadlfth` wlto ihnrlch ar

letaxldftlem dae`ltlaes (h.m. fcdaoac). Lt dfe nh anshrvh` le toh fnshedh ai rhdamelzfncharmfeld `lsar`hrs.

Fcdaoacld ofccudleasls Lt ls f iarg ai fduth ofccudleasls shhe le phapch wlto fcdaoac `hphe`hedh iaccawlem hxdhssfcdaoac letfbh. Lt dfe fcsa nh pfrt ai toh wlto`rfwfc sye`ragh.

Pols poheagheae ls rfrh le waghe Lt ls whcc-cadfclsh`, `hramftary fe` le shdae` phrsae Fu`ltary ofccudleftlaes addur le f dchfr lethcchdtufc ilhc` wltoaut daeiuslae ar lethcchdtufc

lgpflrghet.

Lt ofs scaw rhdavhry fe` rhspae`s paarcy ta fetlpsydoatlds...^hdurrhedh ls irhquhet.OypeaMamld (Malem ta

schhp) fe`

oypeaZagpld (wfblem

uZ) ofccudleftlaes

Daesdlaus chvhc icudtufths daesl`hrfncy le `liihrhet stfmhs ai schhp, fe` nato typhs aiofccudleftlae pranfncy addur le f pofsh ai ledrhfslem `rawslehss wohe toh strudturh ai

toaumot, ihhclems, phrdhptlaes, ifetfslhs fe` shci-fwfrhehss nhdagh ncurrh` fe` ghrmh`

leta anclvlae.

7/22/2019 Mastering Psychiatry 2014 (Final)1

16/355

" Poh phrdhptlae gfy nh vlsufc, fu`ltary ar tfdtlch. Lt ls su``he le addurrhedh fe` toh sunkhdtnhclhvhs toft lt wabh olg up, iar hxfgpch f cau` valdh le toh strhht autsl`h, f ihhclem ai

saghaeh pusolem olg avhr toh nh`, ar shhlem f gfe daglem fdrass toh nh`raag.

Pohsh poheaghef gfy nh daesl`hrh` eargfc hvhe toaumo tohy frh rhfc ofccudleftlaes.

Futasdapy

(ofccudleftlae) Le futasdapy, toh phrsae shhlem aeh's "shci" ar "`aunch". Poh `aunch lgltfths toh

gavhghet fe` ifdlfc hxprhsslaes ai toh arlmlefc, fs li nhlem f rhichdtlae le f glrrar.

Poh `aunch typldfccy fpphfrs fs shgltrfespfrhet, fe` fssadlfth` fu`ltary, blefhstohtld, fe`hgatlaefc phrdhptlaes frh irhquhet.

Poh ofccudleftary hxphrlhedh rfrhcy cfsts caemhr tofe f ihw shdae`s. Poh gast daggae hgatlaefc rhfdtlaes frh sf`ehss fe` nhwlc`hrghet. Lt fcsa addurs le armfeld `lsar`hrs sudo fs pfrlhtaaddlpltfc chslaes, thgparapfrlhtfc canhs,

hplchpsy, sdolzaporhelf fe` sunstfedh glsush. Ehuracamldfc fe` psydolftrld `lsar`hr dfe

addur le 9:% ai dfshs

G; I 7 >;62 Ghfe fmh 7 0: yhfrs.Hxtrfdfgpleh

ofccudleftlae

Hxtrfdfgpleh ofccudleftlaels hxphrlhedh` autsl`h toh clglts ai shesary ilhc` ledcu`lem

vlsufc ilhc` fe` rfemh ai fu`lnlclty. Lt ls `liihrhet irag futasdapy fs toh phrsae aithe shhs

atohrs autsl`h toh shesary ilhc` nut eat aehs shci.

Blehstohtld

ofccudleftlae

Blehstohtld ofccudleftlae levacvhs toh shesh ai na`lcy gavhghet (h.m. f phrsae nhclhvhs

toft ols hcnaw kalet ls ratftlem levacuetfrlcy nut tohrh ls ea sudo slme ae poysldfc

hxfgleftlae).

Dhehstohtld

ofccudleftlae

F shesftlae ai fe fcthrh` stfth le f na`y armfe wltoaut darrhspae`lem rhdhptars woldo dfe

hxpcfle toh shesftlae le eargfc ougfe poyslacamy.

Zsydoapftoacamy le toaumot pradhss

Dlrdugstfetlfclty Poh sphhdo tfbhs f caem tlgh ta rhfdo toh palet nhdfush lt ledcu`hs f mrhft `hfc ai ueehdhssfry

`htflcs. Pols addurs le sdolzaporhelf, `hghetlf, thgparfc canh hplchpsy fe` eargfc phapch.

Pfemhetlfclty Poh strhfg ai toaumot `lvhrmhs irag toh tapld fe` toh sphhdo fpphfrh` ta nh uerhcfth` fe`

lrrhchvfet ft toh he`. Lt ls `uh ta caashelem fe` `liiushehss ai sphhdo. Lt addurs le phapch wltosdolzaporhelf fe` gfelf.

Iclmot ai l`hfs F daetleuaus sphhdo wohrh taplds kugp rfpl`cy irag aeh ta featohr fe` tohrh ls f camldfc cleb

nhtwhhe taplds. Lt addurs le gfelf fe` fddagpfelh` ny prhssurh ai sphhdo.

Caashelem ai

fssadlftlaes

F sphhdo wohrh taplds shhg ta nh `lsdaeehdth` fe` lt ls ofr` iar toh atohrs ta hstfnclso f camldfc

cleb nhtwhhe taplds. Poh sphhdo nhdaghs `liiush fe` ueiadush`.

Belmots gavh toleblem Tdolzaporhelf pftlhet dofemhs irag aeh tapld ta featohr nhtwhhe fnruptcy fe` tohrh ls ea

camldfc cleb nhtwhhe toaumots. Poh trfle ai toaumots ls slglcfr ta toh belmots gavhghet le

dohss.

Poaumot leshrtlae Hxthrefc toaumots frh leshrth` leta toh pftlhets gle` woldo `a eat nhcaem ta toh pftlhet.

Poaumot wlto`rfwfc Zftlhets toaumots frh nhlem tfbhe fwfy ny toh atohrs.

Poaumot nraf`dfstlem Zftlhets awe toaumots frh beawe ta toh atohrs toraumo nraf`dfstlem clbh f rf`la ar PY stftlae.

Zsydoapftoacamy le sphhdo

Camadcaelf Pols rhihrs ta spfstld rhphtltlae ai syccfnchs. Camadcaelf addurs le phapch wlto futlsg,

sdolzaporhelf, Fczohlghrs `lshfsh fe` Zfrblesae `lshfsh.

Camarroahf Camarroahf rhihrs ta hxdhsslvh vhrnfc pra`udtlae.

Ehacamlsg Ehacamlsg rhihrs ta toh levhetlae ai phrsaes awe war`s woldo dfeeat nh iaue` le toh Hemclsocfemufmh fe` gfblem dae`hesftlaes ai shvhrfc atohr war`s. (h.m. f pftlhet rhihrs cfgnrfle fs

dcau`s le toh sby nhdfush tohy caab clbh cfgns fe` pra`udh rfleifccs) Poh war` ofs f sphdlfc

ghfelem iar toh phrsae. Ehacamlsg addurs le phapch wlto sdolzaporhelf.

Ghtaeyg Ghtaeyg rhihrs ta fe fppraxlgfth nut rhcfth` thrg woldo ls ush` le fe l`lagftld wfy. (h.m. f

phrsae rhihrs sby sohhp fs toh dcau`s le toh sby nhdfush toh dcau`s caab clbh sohhp). Poh

war` ls iaue` le toh Hemclso cfemufmh. Ghtaeyg addurs le phapch wlto sdolzaporhelf fe`fssadlfth` wlto caashelem ai fssadlftlaes.

]ar` sfcf` ]ar` sfcf` rhihrs ta f kugnch ai war`s fe` porfshs, tassh` fraue` fs le f sfcf` nawc, wlto clttch

anvlaus daeehdtlae nhtwhhe tohg. Lt addurs le phapch wlto sdolzaporhelf fe` fssadlfth` wlto

caashelem ai fssadlftlaes.

7/22/2019 Mastering Psychiatry 2014 (Final)1

17/355

Gutlsg Gutlsg rhihrs ta toh stfth toft toh phrsae ls slchet fe` valdhchss. Armfeld dfushs ai gutlsg

ledcu`h dftftaelf, ohrphs slgpchx vlrus hedhpofcltls, cadbh`-le sye`ragh, gyfstohelf mrfvls fe`

pacla leihdtlae. Zsydoacamldfc dfushs ledcu`h daevhrslae `lsar`hr fe` gfclemhrlem.

Ttupar (Fblehtld

gutlsg)

Poh phrsae ls guth nut oh ar soh `ahs eat suiihr irag fpofslf. Poh phrsae ls uerhspaeslvh fe`

lgganlch fctoaumo oh ar soh ls iuccy daesdlaus. Ols/ohr hyhs frh fnch ta iaccaw fe ankhdt. Poh

aphelem fe` dcaslem ai hyhs frh ue`hr vacuetfry daetrac. Poh phrsae usufccy gfletfles f rhstlem

pasturh fe` ehuracamldfc hxfgleftlae aithe rhvhfcs eargfc rhichxhs.

Avhrvfcuh` l`hfs, anshsslaes fe` `hcuslaes

Avhrvfcuh` l`hf Zasslnch l`hf toft ls pursuh` nhyae` eargfc naue`frlhs fe` dfushs `lstrhss fe` iuedtlaefc

lgpflrghet ta toh pftlhet. Poh l`hf dfe nh dofcchemh` (h.m. f pftlhet nhclhvhs toft atohr phapch

le toh trfle frh caablem ohr fe` soh ihhcs vhry upsht. Lt ls passlnch toft toh phapch frh stfrlem ft

ohr nhdfush ai fneargfc dcatolem ar nhofvlaurs).

Anshsslae ^hphtltlvh fe` lrrftlaefc toaumots toft toh pftlhet rhdamelshs toash toaumots frh le`hh`

arlmlefth` irag ols ar ohr awe gle` fe` dfe nh dofcchemh`. Anshsslaes aithe chf` ta fexlhtyfe` dagpucslaes.

@hcuslae Ilrgcy gfletfleh` ifcsh nhclhi woldo ls daetrf`ldth` ny rhfclty. Lt ls l`lasyedrftld, ledarrlmlnch

fe` prhaddupylem. Zfrtlfc `hcuslaes frh iaue` wohe toh phrsae ls le toh pradhss ai rhdavhry.

Pyph ai `hcuslae ledcu`h phrshdutary (ofrg ny atohrs), elolclstld (toh pftlhet dhfshs ta hxlst),

rhihrhedh (gh`lf rhihrs ta pftlhet nut ea suppartlem hvl`hedh), mrfe`lash (hxfmmhrfth` pawhr

fe` lgpartfedh), khfcausy (nhclhvlem toh pfrtehr ls ueifltoiuc toraumo pftoacamldfc rhfsaelem).Zrlgfry `hcuslae F `hcuslae toft frlshs aut ai toh ncuh wlto ea hxpcfeftlae. Iar hxfgpch, f sdolzaporhelf gfe

su``hecy nhclhvhs toft oh ls irag Gfrs.

Thdae`fry `hcuslae F `hcuslae woldo ls shdae`fry ta atohr psydoapftoacamy sudo fs fu`ltary ofccudleftlae le

sdolzaporhelf ar mrfe`laslty le gfelf. Iar hxfgpch, f gfeld pftlhet nhclhvhs toft oh ls toh

prhsl`het ai f dauetry.

@hcuslaefc gaa` Lt daeslsts ai f dofemh le gaa` toft prhdh`hs toh hghrmhedh ai toh `hcuslae. Poh phrsae ihhcs

toft saghtolem slelsthr ls malem ta ofpphe.

@hcuslaefc phrdhptlae F rhfc phrdhptlae wlto `hcuslaefc lethrprhtftlae; ]ohe toh trfiild clmot tures mrhhe, Ma` fsbs

gh ta ma ta ohfvhe.

@hcuslaefc ghgary F rhfc ghgary wlto `hcuslaefc ue`hrstfe`lem; L of` fe fpphe`hdtagy 6: yhfrs fma fe` fclhes

put fe lgpcfet le gy na`y ta daetrac toh warc`.

Zsydoapftoacamy le gavhghet

Fgnlthe`hedy ^hphtltlvh nhofvlaur ai daaphrftlae fe` appasltlae. Lt addurs le sdolzaporhelf. Lt ls f iarg aifgnlvfchedh. Poh phrsae stfrts ta gfbh f gavhghet nut nhiarh dagpchtlem lt, oh/soh stfrts toh

appaslth gavhghet.

Gltmhohe Hxdhsslvh daaphrftlae fe` clgn gavhghet le rhspaesh ta sclmot prhssurh ai fe fppclh` iardh

hvhe toh phrsae ls tac` ta rhslst gavhghet. Lt addurs le dftftaelf.

Gltgfdohe Clgn gavhghet le rhspaesh ta fe fppclh` iardh ta fey `lrhdtlae wltoaut rhslstfedh. Lt addurs le

sdolzaporhelf.

]fxy ichxlnlclty Fneargfc gflethefedh ai pasturh le phapch suiihrlem irag dftftaelf. Iar hxfgpch, toh phrsae

gfletfles ols chit frg le toh flr fithr toh hxfglehr rflshs ols chit frg.

Futagftld anh`lhedh Poh phrsae usufccy suiihrlem irag dftftaeld sdolzaporhelf iaccaws toh hxfglehrs lestrudtlaes

ncle`cy wltoaut ku`mhghet fe` rhslstfedh.

Ehmftlvlsg Poh phrsae usufccy suiihrs irag dftftaelf fe` fdtlvhcy phriargs toh appaslth fdtlae ta tohlestrudtlae irag toh hxfglehr.

Tthrhatypy Eae mafc `lrhdth` rhphtltlvh gavhghets. (h.m. radblem iarwfr` fe` nfdbwfr`). Lt addurs le

phapch wlto sdolzaporhelf.

Gfeehrlsg Mafc `lrhdth` rhphtltlvh gavhghets. (h.m. f sphfbhr trlhs ta gavh ols ofe`s rhphtltlvhcy ta

daevhy ols ghssfmhs).

Hdoacfclf ^hphtltlae ai war`s ar porfshs spabhe ny featohr phrsae. Pols ls shhe le futlsg, sdolzaporhelf

fe` `hghetlf

Hdoaprfxlf ^hphtltlae ai gavhghet `hgaestrfth` ny featohr phrsae. Pols ls fcsa shhe le dftftaelf fe`

sdolzaporhelf.

7/22/2019 Mastering Psychiatry 2014 (Final)1

18/355

Dftfchpsy Fneargfc gflethefedh ai pasturhs le dftftaelf.

Dftfpchxy Phgparfry cass ai gusdch taeh le efrdachpsy.

Dagpucslae ^hphtltlvhcy fe` purpashiuc gavhghets woldo frh rhslsth` ny toh phrsae fs tohy frh sheshchss.

Dagpucslaes flg ta ehutrfclsh fexlhty mhehrfth` ny anshsslaes.

Daggae psydolftrld sye`raghs

Dofrchs `h Naeeht

sye`ragh

Zhapch suiihrlem irag tols sye`ragh hxolnlt dagpchx vlsufc ofccudftlaes. Pols sye`ragh ls

fssadlfth` wlto dhetrfc ar phrlpohrfc rh`udtlae le vlslae. Lt fcsa addurs le phapch woa frh ncle`

ar wlto pfrtlfc vlslae. Poh daethet ai ofccudleftlae levacvhs vlvl`cy dacaurh` phapch ar felgfcs.

Pohrh frh ea `hcuslaes fe` ea ofccudleftlaes le atohr ga`fcltlhs. Poh dagpchx vlsufc

ofccudleftlaes gfy cfst irag `fys ta yhfrs.

Iaclh `hux F `hcuslaefc `lsar`hr wohrh f `hcuslae ls trfesihrrh` irag f phrsae wlto f psydoatld `lsar`hr ta

featohr wlto woag oh ar soh ls le dcash fssadlftlae, sa toft tohy sofrh toh sfgh `hcuslae

Dfpmrfs sye`ragh @hcuslaefc glsl`hetlildftlae ai f ifglclfr phrsae fe` toh pftlhet nhclhvhs toft toh ifglclfr

phrsae ls rhpcfdh` ny fe lgpasthr ar f `aunch. Lt addurs le sdolzaporhelf, fiihdtlvh `lsar`hr ar

`hghetlf. Pols sye`ragh ls garh daggae le waghe.

Hratagfelf ar

@hDchrfgnfuct's

sye`ragh

Pols sye`ragh usufccy rhihrs ta f pftlhet woa cavhs f strfemhr ar f phrsae ai olmohr sadlfc

stftus, nut tohrh ls ea hvl`hedh ta suppart tohlr rhcftlaesolp (hxfgpch; f ihgfch dchfehr nhclhvh`toft toh DHA ls le cavh wlto ohr).

Irhmacl sye`ragh @hcuslaefc glsl`hetlildftlae ai fe ueifglclfr phrsae fs f ifglclfr phrsae. Lt addurs le

sdolzaporhelf ar `hghetlf.

Mfeshrs sye`ragh Le tols sye`ragh, fppraxlgfth feswhr lethrsphrsh` wlto darrhdt rhspaeshs, fppfrhet

`lsarlhetftlae, dcau`lem ai daesdlausehss, varnhlrh`he (tfcblem pfst palet), pshu`aofccudleftlae

fe` icudtuftlae ai sagftld sygptags. Poh phrsae gfy ofvh fgehslf iar toh `urftlae ai lccehss

fithr rhdavhry.

Atohcca sye`ragh ar

garnl` khfcausy

Le tols `hcuslaefc `lsar`hr, toh pftlhet ilrgcy nhclhvhs toft ols ar ohr spaush ar pfrtehr ls

ueifltoiuc. ]olch lt ls passlnch ta ofvh fe fiiflr, toh wfy toh phrsae rhfdohs toh daedcuslae ls

pftoacamldfc. Lt aithe fssadlfths wlto daeiraetftlae fe` vlachedh. Prhftghet levacvhs

mhamrfpoldfc shpfrftlae fe` fetlpsydoatld trhftghet.

Guedofushe sye`ragh Fbf oaspltfc f``ldtlae sye`ragh fe` pftlhet wfets ta nh f`gltth` ny hxfmmhrftlem ols ar ohr

sygptags. Guedofushe sye`ragh ny praxy rhihrs ta toh ifdt toft toh gatohr lgpashs ohr dolc`

ta nh f`gltth` fe` lt ls f iarg ai dolc` fnush

7/22/2019 Mastering Psychiatry 2014 (Final)1

19/355

ATDH mrl`

ATDH stftlae

F >:-yhfr-ac` uelvhrslty stu`het wfs nraumot le ny toh daueshccar ta toh hghrmhedy `hpfrtghet. Oh wfs iaue` slttlem le toh clit ai

toh rhsl`hetlfc ofcc toh woach `fy fe` rhiush` ta ftthe` dcfsshs. Oh dcflgs toft oh ohfrs valdhs tfcblem ta olg.

Pfsb;fsshss ols ofccudleftlaes.

**Zchfsh rhihr ta www.gfsthrlempsydolftry.dagaecleh vl`ha; Ghetfc Ttfth hxfgleftlae

ATDH mrl`; fpprafdo ta ofccudleftlaes;

Dfe`l`fths frh f`vlsh` ta fsb fnaut ofccudleftlaes le atohr ga`fcltlhs fs yau wlcc `lsdavhr garh leiargftlae. Pols phrsae gfy ofvh ush`

rhdrhftlaefc `rums dfuslem vlsufc ar tfdtlch ofccudleftlaes. Poh phrsae dfe nh pfrfeal` fe` suspldlaus ai `adtars. Dfe`l`fths ofvh ta

sphe` tlgh hstfnclsolem rfppart ft toh nhmleelem.

F) Fu`ltary

(shdae` phrsae

fu`ltary

ofccudleftlae

le hprhsslae

fe` gfelf)

F6) Letra`udtlae

]ohe phapch frh

ue`hr strhss, tohy

gfy ofvh ueusufc

hxphrlhedhs. L

ue`hrstfe` irag

yaur daueshcar toft

yau ofvh nhheohfrlem valdhs.

F>) Aphe quhstlaes

fnaut ofccudleftlaes

Dfe yau thcc gh garh

fnaut toh valdhs1

Dfe yau mlvh gh fe

hxfgpch1

F4) Efturh ai toh

valdhs

Oaw `a tohy

f``rhss yau1

@a tohy sphfb

`lrhdtcy ta yau1

F0) Daggfe`

ofccudleftlaes

@a tohy mlvh

yau ar`hrs1

@a yau anhy

tohg1

F8) Daemruhedh

wlto gaa`

@ahs yaur gaa`

leicuhedh toh

daethet ai toh

valdhs1 Iar

hxfgpch, wohe yau

frh sf`, yau ohfr tohvaldhs sfy sf`

tolems.

N) Fu`ltary

(tolr` phrsae

fu`ltary

ofccudleftlae

le

sdolzaporhelf)

N6) Eugnhr ai

valdhs

N6) @a yau ohfr

garh tofe aeh valdh

tfcblem fnaut yau1

N>) Daethet ai toh

ofccudleftlae

]oft `a tohy sfy1

N4) ^ueelem

dagghetfry

@a tohy dagghet

ae woft yau frh

`alem ar toleblem1

N0) Fu`lnch

toaumots

Frh toh valdhs

sfylem aut yaur

toaumots

fcau`1

N8) Hdoa `h cf

phesh

@a toash valdhs

hdoa yaur toaumots

fithr f ihw shdae`s1

D)

Daeilrgftlae

ai toh efturh

ai

ofccudleftlae

(ruch autpshu`aofccudle

ftlae)

D6) ]ohrh `a tohsh

valdhs dagh irag1

@a yau dagh irag

hxthrefc spfdh1

D>) @a toh valdhs

dagh irag lesl`h ar

autsl`h yaur ohf`1

D4) @a yau ihhc toft

toh valdhs frh rhfc1

Frh toh valdhs fs

dchfr fs gy valdh1

D0) Dfe yau

stap tohg1

Dfe yau

`lstrfdt

yaurshci iragtoh valdhs1

D8) ]ohe `a tohsh

valdhs addur1 ]hrh

yau ifcclem fschhp ar

wfblem up1 (ta ruch

aut oypefmamld fe`

oypeapagpldofccudleftlaes)

@)

Ofccudleftlaes

le atohr

ga`fcltlhs fe`

fsshss leslmot

@6) Ylsufc

ofccudleftlaes

Ofvh yau shhe

tolems toft atohr

phapch dfet shh1

]oft `a yau shh1

Dfe yau mlvh gh fe

hxfgpch1

@>) Acifdtary

ofccudleftlaes

Ls tohrh feytolem

wraem fnaut toh wfy

wh sghcc1

Dfe yau thcc gh garh

fnaut lt1

Li yhs, woa shet toh

mfs ta yau1

@4) Mustftary

ofccudleftlaes

Ofvh yau eatldh`

toft iaa` ar `rleb

shhgs ta ofvh f

`liihrhet tfsth

rhdhetcy1

@0) Pfdtlch /

ofptld

ofccudleftlaes

Ofvh yau of`

fey strfemh

ihhclems le yaur

na`y1

Oaw fnaut

phapch

taudolem yau1

Oaw fnaut

leshdts

drfwclem1

@8) Fsshss leslmot

@a yau ofvh fey

hxpcfeftlae ai

fnavh hxphrlhedh1

@a yau ehh` ohcp

(h.m. tfblem

gh`ldftlae ta

rh`udh toh valdhs1)

H) Daursh/ H6) Daursh ai H>) Fsshss lgpfdt H4) Fsshss atohr H0) Fsshss H8) ^lsb fsshssghet

7/22/2019 Mastering Psychiatry 2014 (Final)1

20/355

Dagarnl`lty/

rlsb

fsshssghet

ofccudleftlaes

Oaw caem ofvh yau

hxphrlhedh` toash

valdhs1

Oaw `ahs lt fiihdt

yaur clih

Oaw ls yaur gaa`1

Ofs yaur gaa` nhhe

fiihdth` ny toash

valdhs1

ilrst rfeb sygptags

@a yau warry toft

toash valdhs frh pfrt

ai f pcat1 (h.m.

ofrglem yau ar

daetracclem yau)

@a yau ihhc toft

yaur toaumots frh

nhlem lethrihrh`1

(h.m. toaumots frh

nhlem leshrth`,

wlto`rfwe ar

nraf`dfsth`)

sunstfedh

glsush

@a yau ush

rhdrhftlaefc

`rums ar

fcdaoac1

L dfe lgfmleh toft

yau frh strhssh` ny

toh valdhs. Tagh

phapch gfy wfet ta

mlvh up. @a yau

ofvh toaumot ai

he`lem yaur clih1

7/22/2019 Mastering Psychiatry 2014 (Final)1

21/355

Tfgpch GDVs fe` GHVs

6. F 4:-yhfr-ac` gfe wfs nraumot ta toh Fddl`het fe`

Hghrmhedy @hpfrtghet. Oh su``hecy ihcc `awe fithr

ohfrlem f cau` saue` ft f pfrty. Pohrh wfs ea cass ai

daesdlausehss. Poh psydoapftoacamy nhlem `hsdrlnh` ls;

F. Dftfchpsy

N. Dftfpchxy

D. Dftftaelf@. Zasturlem

H. ]fxy ichxlnlclty

Feswhr; N Dftfpchxy rhihrs ta toh thgparfry pfrfcysls

fe` cass ai fetlmrfvlty gusdch taeh wltoaut cass ai

daesdlausehss. Dftfpchxy ls aithe prhdlpltfth` ny

hgatlaefc hxdlthghet fe` fssadlfth` wlto efrdachpsy.

>. Fe hc`hrcy Dolehsh gfe dagpcfleh` toft Gy muts frh

ratthe fe` ncaa` ofs stapph` icawlem ta gy ohfrt. L fg

`hf`. Poh psydoapftoacamy nhlem `hsdrlnh` ls;

F. Fduth lethstlefc anstrudtlae

N. @hclrlugD. @hcuslae ai daetrac

@. Elolclstld `hcuslae

H. Oypadoae`rlfsls

Feswhr; @. Elolclstld `hcuslae ar Datfr` sye`ragh ls toh

nhclhi toft aeh ls `hf` ar toh hxthrefc warc` `ahs eat

hxlst. Lt dfe fcsa tfbh toh iarg ai nhclhvlem toft pfrts ai

toh na`y `a eat hxlst. Elolclstld `hcuslaes dfe nh

shdae`fry ta shvhrh `hprhsslae, sdolzaporhelf ar ta fe

armfeld `lsar`hr.

4. F 8:-yhfr-ac` gfe ls rhihrrh` irag vfsducfr surmhae

iar pusolem shesftlae le toh fn`aglefc fartf. Ohdagpcfles toft oh ihhcs saghaeh ls pusolem ols

fn`aglefc fartf fe` oh ls vhry `lsturnh` ny tols

shesftlae. Poh psydoapftoacamy nhlem `hsdrlnh` ls;

F. Dhehstohtld ofccudleftlae

N. @hcuslaefc phrdhptlae

D. Ofptld ofccudleftlae

@. Blehstohtld ofccudleftlae

H. Tagftld pfsslvlty

Feswhr; F. Dhehstohtld ofccudleftlae levacvhs f ifcsh

phrdhptlae ai fe fcthrh` stfth` le na`y armfes wltoaut

darrhspae`lem shesary rhdhptar ta hxpcfle toh shesftlae.

Blehstohtld ofccudleftlaes levacvh toh shesh ai gusdchs

ar kalets. Iar hxfgpch, toh pftlhet glmot ihhc clbh tohlrclgns frh nhlem twlsth`. Daggae dfushs ledcu`h

sdolzaporhelf fe` wlto`rfwfc stfth irag

nheza`lfzhplehs ar fcdaoac letaxldftlae.

0. F gfe shhs f ncuh dfr `rlvlem pfst olg fe` oh rhfclzhs

toft toh thrrarlsts frh malem ta blcc olg. Pols ls gast clbhcyta nh woldo ai toh iaccawlem;

F. @hcuslae ai oypadoae`rlfsls

N. @hcuslae ai pfsslvlty

D. @hcuslaefc phrdhptlae

@. @hcuslae ai phrshdutlae

H. Ylsufc ofccudleftlae

Feswhr; D. F `hcuslaefc phrdhptlae ls f eargfc

phrdhptlae ifcshcy lethrprhth` ny toh pftlhet fe` ohc` fs

nhlem slmelildfet ta olg. Lt ls aeh ai Tdoehl`hrs ilrst-

rfeb sygptags.

8. Garnl` khfcausy ls eat;

F. f glsl`hetlildftlae poheagheae

N. fssadlfth` wlto hrhdtlch `ysiuedtlae

D. fssadlfth` wlto vlachedh

@. hedfpsucfth`

H. garh daggae le ghe tofe waghe

Feswhr; F. Glsl`hetlildftlae sye`ragh rhihrs ta Dfpmrfs

fe` Irhmacl sye`ragh. Garnl` khfcausy ls f `hcuslaefc

`lsar`hr toft toh gfrltfc ar shxufc pfrtehr ls ueifltoiuc,

typldfccy fddagpfelh` ny lethesh shfrdolem iar hvl`hedh

ai leil`hclty fe` rhphfth` lethrramftlaes fe` `lrhdtfddusftlaes ai toh pfrtehr toft gfy chf` ta vlachet

qufrrhcs. Garnl` khfcausy ls garh daggae le ghe tofe

le waghe. Garnl` khfcausy ls fssadlfth` wlto hrhdtlch

`ysiuedtlae fe` fcdaoac glsush.

GHV

F >:-yhfr-ac` wagfe prhshets wlto psydoatld sygptags

sudo fs shhlem lgfmhs fe` ohfrlem valdhs woldo fsb ta

dut ohr wrlst iar 9 gaetos. Toh fcsa dagpcfles ai gaa`

swlems. Ohr pfrhets `lvardh` fe` soh wfs fnush` ny ohr

sthp-iftohr.

V6. ]oft frh toh `liihrhetlfc `lfmeashs16. Nlpacfr `lsar`hr wlto psydoatld ihfturhs.

>. Nar`hrcleh phrsaefclty `lsar`hr

4. Gfkar `hprhsslae wlto psydoatld ihfturhs

0. Tdolzaporhelf8. Tunstfedh glsush (h.m. ofccudleamhes, fgpohtfgleh)

V>. Ohr gatohr wfets ta beaw oaw yau wauc`

`liihrhetlfth sdolzaporhelf irag atohr `liihrhetlfc

`lfmeashs. \aur feswhr ls;

6. Tdolzaporhelf pftlhets usufccy ohfr tolr`-phrsae

fu`ltary ofccudleftlaes.

>. Fu`lnch toaumots, toaumot hdoa, fe` rueelem

dagghetfry usufccy addur le sdolzaporhelf.

4. Tdolzaporhelf pftlhets ofvh atohr ilrst rfeb sygptags

sudo fs toaumot lethrihrhedh, pfsslvlty fe` prlgfry`hcuslaes.

7/22/2019 Mastering Psychiatry 2014 (Final)1

22/355

HGLT;

Zsydoapftoacamy

F Dagpchtlae lccuslae

N @ysghmcapslf

D- Hxtrf-dfgpleh ofccudleftlaes

@ Ofptld ofccudleftlae

H Oypeamamld ofccudleftlaeI Oypeapagpld ofccudleftlae

M Blefhstohtld ofccudleftlae

O Clclputlfe ofccudleftlae

L Zfrhl`aclf

K Tyehstohslf

Vuhstlae6 ; Poh hxphrlhedh ai aehs efgh nhhe dfcch`

aut wohe aeh ls fnaut ta ifcc fschhp Fes; Oypeamamld

ofccudleftlae

Vuhstlae >; F yauem waghe ofs nhhe `lfmeash` wlto

ilrst hplsa`h psydoasls. Toh dcflgh` toft soh ls uefnch ta

daedhetrfth fs soh ohfrs ohr iftohr soautlem ft ohrdaetleuauscy irag ols icft > glchs fwfy Fes; Hxtrf-

dfgpleh ofccudleftlae

Vuhstlae 4; F dolc` wftdohs toh dcau`s fe` rhparts nhlem

fnch ta shh lgfmhs ai f dagputhr mfgh le toh dcau`s

Fes; Zfrhl`aclf

^hihrhedhs;Dfgpnhcc ^K.Zsydolftrld @ldtlaefry. Axiar`; Axiar` Xelvhrslty Zrhss,6.Tlgs F. Tygptags ai toh Gle`; Fe Letra`udtlae ta @hsdrlptlvh

Zsydoapftoacamy. Cae`ae; Tfue`hrs, >::4

7/22/2019 Mastering Psychiatry 2014 (Final)1

23/355

Dofpthr > Dcleldfc lethrvlhw, iargucftlae fe` gfefmhghet

Lethrvlhwlem thdoelquhs @liihrhetlfcs `lfmeasls fe` olhrfrdoy ai `lfmeasls

Zsydolftrld olstary Iargucftlae

Ghetfc stfth hxfgleftlae

Zoysldfc hxfgleftlae

^hchvfet levhstlmftlaes

Gfefmhghet fe` guctl-`lsdlpclefry fpprafdo

Lethrvlhwlem thdoelquhs

6) Aphe-he`h` quhstlaes;Dfe yau thcc gh woy yau whrh f`gltth`1Aphe-he`h` quhstlaes frh aithe ush` le toh

leltlfc pofsh ai toh lethrvlhw ta pra`udh spaetfehaus rhspaeshs irag toh pftlhet, woldo frh pathetlfccy woft ihhc

gast lgpartfet ta toh pftlhet. Pohy daevhy f shesh ai mheuleh lethrhst ta toh pftlhet.

>) Dcash`-he`h` Vuhstlaes; @l` yau ftthgpt ta he` yaur clih prlar ta f`glsslae1Dcash`-he`h` quhstlaes aithe

iaccaw aphe-he`h` quhstlaes ta hiildlhetcy hcldlt sphdlild `htflcs.4) Tuggftlaerhihrs ta toh nrlhi suggfry ai woft toh phrsae ofs sfl` sa ifr fe` ls `aeh phrla`ldfccy ta hesurh toh

lethrvlhwhr ue`hrstfe`s toh phrsae darrhdtcy. H.m. L wauc` clbh ta gfbh surh toft L ue`hrstfe` yau darrhdtcy sa ifr.

\au frh sfylem toft yau `a eat toleb yaur hxphrlhedh ls pfrt ai sdolzaporhelf nfsh` ae yaur awe rhf`lems (le f

gfe woa `ahs eat nhclhvh toft oh suiihrs irag sdolzaporhelf fe` wfets ta shhb f shdae` aplelae)

0) Prfesltlaels f ushiuc thdoelquh ta mhetcy leiarg toh phrsae toft toh lethrvlhw ls malem aeta featohr tapld.8) Hgpftold stfthghets daevhy toh ghssfmh toft toh psydolftrlst ile`s toh pftlhets daedhre ls lgpartfet fe`

fdbeawch`mh toh pftlhets suiihrlems. H.m. L dfe lgfmleh toft yau whrh thrrlilh` wohe yau rhfclzh` toft yau dauc`

eat gavh ofci ai yaur na`y (ta f gfe suiihrlem irag past-strabh `hprhsslae).

Zsydolftrld Olstary

Zurpash @hgaestrftlae

Letra`udtlae Nhiarh yau stfrt toh lethrvlhw, hesurh toh phrsae ue`hrstfe`s toh

purpash fe` gfbh toft tohrh ls ea ohfrlem lgpflrghet.

Ohcca, gy efgh ls @r. [ofem. Ofs

feyaeh tac` yau fnaut toh efturh aitols lethrvlhw1 Cht gh hxpcfle

L`hetliylem

Leiargftlae

fe``hgamrfpolds

Bhy `hgamrfpold `ftf ledcu`h;

6. Iucc efgh.

>. Fmh.

4. Mhe`hr.

0. Gfrltfc stftus; gfrrlh`, `lvardh`, slemch, wl`aw.

8. Addupftlae (li toh phrsae ls uehgpcayh`, toh lethrvlhwhrsoauc` hxpcarh prhvlaus kan fe` `urftlae ai uehgpcayghet2

li toh phrsae ls f oaushwlih, hxpcarh ohr spaush ar pfrtehrs

addupftlae.

9. Durrhet clvlem frrfemhghet; clvlem fcaeh, oaghchss, wlto

ifglcy.

=. Durrhet stftus; lepftlhet ar autpftlhet.

Nhiarh wh stfrt toh lethrvlhw, lt ls

lgpartfet iar gh ta hesurh toft L mat

yaur efgh rlmot Gfy L beaw yaurdurrhet fmh1

Hxfgpch iar prhshetftlae; Gr. Pfe ls

f 49-yhfr-ac` tfxl `rlvhr, gfrrlh` fe`

stfys wlto ols ifglcy le f 4-raag

O@N icft. Oh ls durrhetcy fe lepftlhet

ft wfr` 44, Eftlaefc Xelvhrslty

Oaspltfc.

7/22/2019 Mastering Psychiatry 2014 (Final)1

24/355

Zrhshetlem

dagpcflet

Poh prhshetlem dagpclfet dfe nh pfrt ai f ilrst hplsa`h ai lccehss

ar fs aeh ai f shrlhs ai hplsa`hs.

Iar pftlhets woa frh oaspltfclsh`, lt ls lgpartfet ta hequlrh

wohtohr tols f`glsslae ls vacuetfry ar ue`hr toh Ghetfc @lsar`hr

fe` Prhftghet Fdt. Thhb toh phrsaes vlhw le ols ar ohr awe

war`s fnaut toh f`glsslae.

Clst toh sygptags le cfy thrg le toh ar`hr ai `hdrhfslem shvhrlty

fe` stfth toh `urftlae `urlem prhshetftlae.

]oft ofvh nraumot yau ohrh ta tols

oaspltfc ar dcleld1 Dfe yau thcc gh

woft ofs ofppheh` nhiarh toft1

Hxfgpch iar prhshetftlae; Gr. Pfe

prhshets wlto fe lethetlae ta he` ols

clih, oaphchssehss, caw gaa`, paar

schhp, paar fpphtlth fe` paardaedhetrftlae iar 4 gaetos.

Olstary ai

prhshet

lccehss

Hequlrh toh prhdlpltftlem ifdtars, sygptags shvhrlty, `urftlae

fe` daethxt ai toh durrhet hplsa`h le f doraeacamldfc ar`hr.

Hequlrh gfletflelem fe` prathdtlvh ifdtars.

Fsshss lgpfdt ae rhcftlaesolps fe` iuedtlaelem.

Hequlrh slmelildfet ehmftlvhs (h.m. psydoatld sygptags le shvhrh

`hprhsslae).

Thhb ols ar ohr vlhws tawfr`s prhvlaus psydolftrld trhftghets,

fsshss hiildfdy fe` hxpcarh prhvlaus sl`h hiihdts.

Fsshss iar daggae psydolftrld dagarnl`lty fe` `liihrhetlfc

`lfmeasls fssadlfth` toh olstary ai prhshet lccehss.

Ttfrt wlto fccawlem toh phrsae ta tfcb

irhhcy iar 8 gleuths fe` `hgaestrfth

hfmhrehss ta ohfr toh phrsaes

daedhres.

Vuhstlaes clbh ]oft gf`h yau shhb

trhftghet tols tlgh1 gfy rhvhfcdurrhet strhssars2 fe` ]oft frh toh

pranchgs toft yaur lccehss ofs dfush`

yau1 fsshsshs iuedtlaefclgpflrghets. ]oft `a yau toleb gfy

ofvh dfush` yau ta ihhc clbh tols1

gfy rhvhfc pftlhets phrdhptlae ai

sygptags.

Zfst

psydolftrld

olstary

Hequlrh pfst psydolftrld `lfmeashs, pfst trhftghets (gh`ldftlae,

psydoatohrfpy ar HDP)2 sl`h hiihdts fssadlfth` wlto

psydoatrapld gh`ldftlaes, f`ohrhedh ta trhftghet, prhvlausoaspltfclzftlaes (ledcu`lem levacuetfry f`glsslaes) fe`trhftghet autdaghs.

Olstary ai suldl`h, shci-ofrg, vlachedh fe` oagldl`h ftthgpts ls

hsshetlfc ta prh`ldt iuturh rlsb.

Lt ls lgpartfet ta l`hetliy toh prhdlpltftlem fe` gfletflelem

ifdtars ai hfdo hplsa`h, fs tols wauc` pravl`h lgpartfet

leiargftlae le iargucftlae.

Hxfgpch iar prhshetftlae; Pols

durrhet hplsa`h ls le toh daethxt ai >:-

yhfr olstary ai `hprhsslvh lccehss. >:yhfrs fma, Gr. Pfe ilrst daesucth` fpsydolftrlst le prlvfth prfdtldh nhdfush

ai caw gaa`, paar schhp fe` cass ai

lethrhst iar 9 gaetos. Poh psydolftrlst

prhsdrlnh` f trldydcld fetl`hprhssfet

(fgltrlptycleh). Gr. Pfe dagpcfleh`

ai `ry gauto fe` daestlpftlae. @uh ta

ilefedlfc daestrflet, oh daesucth` f

psydolftrlst ft toh Eftlaefc Xelvhrslty

Oaspltfc..

Zfst gh`ldfc

olstary fe`rhvlhw ai

gfkar

systhgs

Hequlrh pfst fe` durrhet gh`ldfc pranchgs fe` poysldfc

sygptags, le pfrtlducfr pfle (h.m. glmrfleh), shlzurhs (h.m.thgparfc canh hplchpsy), strabh, ohf` lekury, he`adrleh `lsar`hrsfe` ohfrt `lshfshs. Le`ldfth gh`ldftlaes toft toh pftlhet ofs nhhe

prhsdrlnh` iar toh fnavh pranchgs.

Hequlrh pfst surmldfc pranchgs fe` surmhry rhdhlvh`.

Hxpcarh `rum fcchrmy (hsphdlfccy ta psydoatrapld gh`ldftlae fe`dcfrliy toh fcchrmld rhfdtlaes)

Hxfgpch iar prhshetftlae, Gr. Pfesuiihrs irag oyphrtheslae fe`

oyphrclpl`fhglf. Poh pacydcleld`adtar ofs prhsdrlnh` ftheacac 8:gm

AG fe` slgvfstftle 0:gm eadth. Gr.

Pfe ofs ea pfst olstary ai surmhry. Oh

ofs ea pfst olstary ai `rum fcchrmy.

7/22/2019 Mastering Psychiatry 2014 (Final)1

25/355

Poh poysldfc pranchgs gfy nh `uh ta toh gh`ldftlae hiihdt (h.m.

pracaemh` VPd rhsucth` irag fetlpsydoatlds).

Olstary ai

sunstfedh

glsush

Hequlrh typh (fcdaoac, nheza`lfzhpleh, fe` rhdrhftlaefc `rums),

fgauet, irhquhedy, aesht ai fe` pfst trhftghet iar sunstfedhglsush.

Hxpcarh nlacamldfc (h.m. `hclrlug trhghes/ ohf` lekury) fe`

psydoasadlfc dagpcldftlaes (h.m. `rueb `rlvlem, `aghstld

vlachedh) fssadlfth` wlto sunstfedh glsush.

Hxpcarh toh ush ai tanfdda (qufetlty fe` irhquhedy).

Caab iar `ufc `lfmeasls h.m. `hprhsslae wlto fcdaoac glsush.

Hxpcarh toh ilefedlfc fsphdt (l.h. toh iue`lem ai sunstfedh

glsush).

Gfletflelem f eae-ku`mghetfc fttltu`h

ls hsshetlfc le hequlrlem sunstfedhglsush.

Eargfclsh toh hxphrlhedh ai sunstfedhglsush, ]ohe phapch frh ue`hr

strhss, tohy gfy ush rhdrhftlaefc

`rums. L wauc` clbh ta ile` aut irag

yau wohtohr yau ofvh sudo

hxphrlhedh.

Fval` f `lrhdt quhstlae clbh, @a yauush `rums1 woldo gfy pragpt toh

phrsae ta `hey fey `rum ush.

Ifglcy

olstary

Hequlrh toh ifglcy psydolftrld fe` gh`ldfc olstarlhs.

Caab iar sunstfedh glsush (h.m. fcdaoac) fgaem ifglcy

ghgnhrs.

Caab iar hfrcy fe` ueefturfc `hftos woldo gfy le`ldfth suldl`h.

Nrlhicy fsshss toh qufclty ai lethrphrsaefc rhcftlaesolp le toh

ifglcy.

@hgaestrfth hgpftoy li f dcash

ifglcy ghgnhr suiihrs irag shvhrh

psydolftrld lccehss.

L`hetliy toh fhtlacamy ai psydolftrld

lccehss le ifglcy ghgnhrs. H.m. ]oft

gf`h yau toleb toft yaur gatohr gfy

suiihr irag `hprhsslae1

Nfdbmraue`

olstary ^hcftlaesolp ar gfrltfc olstary (durrhet fe` pfst)2 whccnhlem ai

dolc`rhe (h.m. dolc` prathdtlae lssuhs)2 psydoashxufc olstary

(shxufc arlhetftlae, TP@s li rhchvfet, lssuhs rhcfth` ta leihrtlclty,iar waghe, dfe`l`fth ehh`s ta hxpcarh toh cfst ghestrufc phrla`,

passlnlclty ai prhmefedy fe` ghtoa` daetrfdhptlae)2 sadlfc

olstary (durrhet clvlem sltuftlae, chvhc ai hxprhssh` hgatlae, pfst

hgpcayghet fe` rhclmlae).

Hequlrh `htflcs fnaut durrhet addupftlae; h.m. warblem oaurs,lethrphrsaefc rhcftlaesolp le toh warbpcfdh fe` strhss chvhc.

Hequlrh rhfsaes iar dofemlem kans (h.m. lethrphrsaefc pranchgswoldo rhichdts pftlhets phrsaefclty) Caab iar pathetlfc rlsb

fssadlfth` wlto fe addupftlae (h.m. fcdaoac glsush le f gfe

warblem le f nfr).

@hvhcapghetfc olstary; nlrto, dolc`oaa` `hvhcapghet,

rhcftlaesolp wlto pfrhets fe` slnclems, olstary ai poysldfc/shxufc

fnush, pracaemh` shpfrftlae, ueofppy dolc`oaa`.

Thhb phrglsslae irag toh pftlhet ta

hxpcarh shesltlvh lssuh, Lt ls lgpartfet

iar gh ta hxpcarh toh iaccawlem fsphdtfs lt gfy nh rhchvfet ta yaur dfsh.

Tagh ai toh lssuhs frh shesltlvh.

]auc` lt nh fcrlmot wlto yau1 Gfy L

beaw yaur shxufc arlhetftlae1

Vuhstlaes ta fsshss prhgarnl`

phrsaefclty;

Oaw wauc` yau `hsdrlnh yaur

dofrfdthr1

Oaw `a yau toleb yaur irlhe`s ar

rhcftlvhs wauc` `hsdrlnh yau1

Ofs yaur dofrfdthr dofemh` sledhyau nhdfgh uewhcc1

Dfe yau thcc gh yaur fttltu`h tawfr`s

7/22/2019 Mastering Psychiatry 2014 (Final)1

26/355

H`udftlae olstary; `htflcs ai sdoaaclem fmh toft sdoaaclem nhmfe

fe` stapph`. Li h`udftlae ls stapph` prhgfturhcy, hequlrh toh

rhfsaes. H`udftlae nfdbmraue` fiihdts phriargfedh ai toh Glel-

Ghetfc Ttfth Hxfgleftlae (GGTH).

Zrhgarnl` phrsaefclty; Fsb toh phrsae ta `hsdrlnh ols ar ohr

dofrfdthr, ofnlts, lethrhsts, fttltu`h ta shci ar atohrs fe` daplem

ghdofelsgs.

Iarhesld olstary; olstary ai aiihedhs, toh efturh ai aiihedhs,

durrhet stftus (daevldth` ar phe`lem daurt dfsh), prhvlaus

lgprlsaeghet fe` rhgarsh tawfr`s toh vldtlg.

atohr phapch clbh dacchfmuhs,

suphrvlsars fe` toh sadlhty1

^lsb

fsshssghet

Hequlrh suldl`fc fe` oagldl`fc l`hftlaes, fddhss ta cfrmh fgauet

ai gh`ldftlaes, sofrp ankhdts, ilrhfrgs fe` the`hedy ta vlachedh.

^lsb ls eat clglth` ta toh fnavh. Le yauem phapch wlto F@O@,dfe`l`fths ehh` ta fsshss toh rlsb ai fddl`hets `uh ta paar

lgpucsh daetrac fe` oyphrfdtlvltlhs.

Le ac` phapch wlto dameltlvh lgpflrghet, dfe`l`fths ehh` ta

fsshss rlsb ai ifcc, ilrh, fddl`hets fe` hxpcaltftlae.

Zhapch wlto suldl`fc ar oagldl`fc

l`hftlae frh aithe mufr`h` ta sofrh

wlto toh atohrs ae tohlr toaumots.

Dfe`l`fths soauc` nh hgpftohtld tatoh pftlhets fe` aiihr rhfssurfedh toft

tohy frh lethrhsth` le toh pftlhets whcc

nhlem fe` wfet ta aiihr ohcp fs gudofs passlnch. H.m. L fg sarry ta ohfr

toft yau ofvh maeh toraumo sa gudo

ofr`solp. Ofvh yau nhhe toleblem

fnaut `hfto ar he`lem yaur clih1

Dcaslem ]h gfy ehh` ta wrfp up toh lethrvlhw soartcy. L wauc` clbh ta

levlth yau ta fsb gh fey quhstlaes. L wlcc try gy vhry nhst ta

f``rhss yaur daedhres.

Fcwfys dcash ny tofeblem toh pftlhet.

Ghetfc stfth hxfgleftlae

^fppart fe` fttltu`h

ta toh lethrvlhw

Poh lethrphrsaefc efturh ai rfppart ledcu`h hstfnclsolem toh gutufc hxphrlhedh fe` fwfrhehss ai

toh prhshedh ai toh atohr, toh gutufc sofrlem ai toaumots fe` ihhclems, toh eatlae ai hgpftoy fe`

toh `hvhcapghet ai gutufc trust nhtwhhe toh lethrvlhwhrs fe` pftlhets.

Fpphfrfedh fe`

nhofvlaurs

Mhehrfc fpphfrfedh ledcu`hs toh anshrvftlae ai `rhss, mraaglem, ifdlfc hxprhsslae fe` fedlccfry

ankhdts (h.m. ofe`duiis, whfpaes, htd) aithe pravl`h leiargftlae fnaut fttltu`h fe` atohr eae-

vhrnfc daggueldftlaes rhchvfet ta rfppart.

Nhofvlaurs; Anshrvftlae ai eae-vhrnfc nhofvlaurs ledcu`hs dagghetlem ae toh hyh daetfdt,

mhsturhs fe` atohr ushiuc daggueldftlaes.

(f) @lsleolnltlae rhihrs ta nhofvlaurfc fe` sadlfc gfelihstftlaes ai ue`uh ifglclfrlty,

dafrshehss, fe` fmmrhsslvh nhofvlaurs.

(n) Gfeehrlsgs (rhphtltlvh nhofvlaurs wltoaut shrvlem fey purpash), sthrhatyplhs (rhphtltlvh

nhofvlaurs shrvlem f purpash) fe` uedaetracch` fmmrhsslae gfy le`ldfth lgpflrghet le

rhfclty thstlem.

(d) Dolc`clbh nhofvlaur ar rhmrhsslae; Pols gfy addur le fe f`uct wlto phrsaefclty `lsar`hr.Poh phrsae gfy oac` f tay ar stuiih` felgfc fs trfesltlaefc ankhdt.

Tphhdo (f) Poh rfth, vacugh fe` prhssurh ai sphhdo (h.m. ledrhfsh` rfth le gfelf fe` `hdrhfsh` rfth

le `hprhsslae).

(n) Cass ai taeh ls shhe le phapch wlto Fsphrmhrs sye`ragh.

(d) @ysfrtorlf levacvlem scurrh` sphhdo.

(`) @yspofslfs (h.m. ]hreldbhs fe` Nradfs `yspofslfs).

(h) Ttutthrlem fe` dcutthrlem ai sphhdo.

(i) Hxpcaslvh qufclty wlto iardh` vadfclzftlae (le fmltfth` fe` femry pftlhet).

(m) Zrhshrvftlvh ihfturhs le sphhdo (h.m. `liilducty le dofemlem taplds le phapch wlto iraetfc

7/22/2019 Mastering Psychiatry 2014 (Final)1

27/355

canh sye`ragh).

(o) Hchdtlvh gutlsg.

(l) Zavhrty ai sphhdo.

Poaumot Poh icaw ai toaumot;

6. Dlrdugstfetlfclty.

>. Pfemhetlfclty.

4. Iclmot ai l`hfs/ rfdlem toaumots (le gfeld pftlhets).

0. Poaumot ncadblem.

8. Caashelem ai fssadlftlaes.9. ]ar` Tfcf` le woldo toh sphhdo ls fe ledaohrhet fe` ledagprhoheslnch glxturh ai

war`s fe` porfshs

Poh iarg ai toaumot

6. Anshsslaes.

>. Avhrvfcuh` l`hfs.

4. @hcuslaes.

Poh daethet ai toaumot

6. Pols pravl`hs fe appartuelty ta fsshss toh dfpfdlty ai f phrsae ta hxprhss ols ar ohr

hxphrlhedhs fe` dcleldfc leiargftlae.

>. Daethet ai poanlf; draw`h` frhf (fmarfpoanlf), dhetrh ai ftthetlae (sadlfc poanlf) ar

ankhdt (h.m. spl`hr)4. Anshsslaefc tohghs; daetfgleftlae, ofrglem toh atohrs, lethcchdtufc fsphdts (h.m. purpash

le clih)

Poaumot lethrihrhedh; toaumot leshrtlae, wlto`rfwfc fe` nraf`dfstlem.

Avhrvfcuh` l`hfs.

@hcuslaes;

6. Zrlgfry `hcuslaes (h.m. garnl` khfcausy, phrshdutary, rhihrhedh)

>. Thdae`fry `hcuslaes (h.m. elolclstld, mrfe`lash)

4. Zfsslvlty poheaghef ar `hcuslae ai daetrac

0. @hcuslaefc glslethrprhtftlae

Fiihdt fe` gaa` Mhehrfc `hsdrlptlae ai fiihdt; ofppy, hupoarld, gfeld, `hprhssh`, thfriuc, fexlaus, femry ar`htfdoh`.

^femh ai fiihdt; lt dfe nh wltole eargfc rfemh, cfnlch fiihdt, ncueth` fiihdt, icft fiihdt ar fpftoy.

f. Cfnlch fiihdt; rfpl` icudtuftlae ai fiihdt (h.m. irag thfriucehss fe` cfumothr le f6:-gleuth lethrvlhw, shhe le pftlhets wlto nlpacfr `lsar`hr).

n. Ncueth` fiihdt; rh`udtlae le vfrlftlae le gaa` fe` hgatlaes.

d. Icft fiihdt; fcgast tatfc fnshedh ai vfrlftlae le gaa` fe` hgatlaes.

`. Fpftoy ghfes irhh`ag irag ihhclem ar f `ucch` hgatlaefc taeh. Lt fcsadaevhys toh shesh ai le`achedh fe` le`liihrhedh ta woft eargfccy hxdlths

hgatlae ar lethrhst. @htfdoghet ls aeh ai toh fsphdts ai fpftoy. Fpftoy ls f

ehmftlvh sygptag le sdolzaporhelf fe` fcsa shhe le pftlhets wlto `hghetlf.

>. Atohr `hsdrlptlaes ai fiihdt; stfnlclty toraumoaut toh lethrvlhw, daemruhet wlto toh

olstary ai prhshet lccehss fe` prhshet dagpcflet.

4. Gaa` rhihrs ta toh sunkhdtlvh hgatlaefc stfth `hsdrlnh` ny f pftlhet. Fsb toh phrsae ta

rfth ols ar ohr gaa` le f sdfch ai 6 ta 6: (6 ghfes vhry sf` fe` 6: ghfes vhry ofppy)

fe` caab iar daemruhedy wlto toh fiihdt anshrvh` ny toh dfe`l`fth.

Atohr ihfturhs fssadlfth` wlto fiihdt;

0. Fchxltoyglf rhihrs ta `liilducty le f phrsae ta vhrnfclsh ols ar ohr hgatlae.

8. Cfumothr ls f uelvhrsfc ougfe nhofvlaur fe` aithe f pchfsurfnch rhclhi ai theslae.Fppraprlfth cfumothr gfy nh f vhry ushiuc poheagheae ta anshrvh le toft lt daeilrgs toh

phrsaes rhfdtlvlty ai fiihdt, tohlr dfpfdlty iar hxolcfrftlae fe` gutufc hekayghet.

9. Drylem gfy addur le f wl`h rfemh ai eargfc sltuftlaes (h.m. mrlhi, rhclhi, pfle, ihfr,

7/22/2019 Mastering Psychiatry 2014 (Final)1

28/355

sofgh, mulct ar ouglclftlae) fs whcc fs le f eugnhr ai psydolftrld `lsar`hrs (h.m.

`hprhsslvh `lsar`hr, f`kustghet `lsar`hr, fduth strhss `lsar`hr).

Zhrdhptufc

`lsturnfedhs

6. Lccuslaes (fiihdt lccuslaes, dagpchtlae lccuslaes, fe` pfrhl`acld lccuslaes).

>. Ofccudleftlaes (fu`ltary, vlsufc, acifdtary, mustftary, tfdtlch fe` ofptld ofccudleftlaes).

4. Zshu`aofccudleftlaes.

Leslmot F psydolftrld pftlhet gfy ofvh lgpflrh` leslmot li;

6. Oh/soh nhclhvhs toft soh ls eat lcc.

>. Oh/soh `ahs eat nhclhvh toft ols/ohr slmes/sygptags frh `uh ta f psydolftrld dae`ltlae.4. Oh/soh `ahs eat nhclhvh toft psydolftrld trhftghet ls ohcpiuc.

Dameltlvh iuedtlae 6. Ttu`hets ehh` ta dagghet ae toh chvhc ai daesdlausehss fe` arlhetftlae. Li `hghetlf ls

susphdth`, stu`hets ehh` ta thst mhehrfc beawch`mh ai toh phrsae (h.m. toh efgh ai prlghglelsthr), soart-thrg ghgary (ny rhdfcc ai fe f``rhss ar 4 ankhdts) fe` ta phriarg Glel

ghetfc stfth hxfgleftlae (GGTH).

>. Fsshss arlhetftlae ta tlgh, pcfdh fe` phrsae.

4. Fsshss ftthetlae fe` daedhetrftlae. Ftthetlae ls toh fnlclty ai f phrsae ta gfletfle ols ar

ohr daesdlaus fwfrhehss ae fe hxthrefc stlgucus fe` ta sdrhhe aut lrrhchvfet stlgucl.

Daedhetrftlae rhihrs ta sustfleh` fe` iadush` ftthetlae

0. Chvhc ai daesdlausehss rhihrs ta fchrtehss fe` frausfc fe` fwfrhehss ai shci fe` hxthrefc

hevlraeghet fe` stlgucl

8. Fnstrfdt toleblem rhihrs ta toh gfelpucftlae ai daedhpts, daestrudts, l`hfs, toaumots arlgfmhs fe` cleb tohg le f ichxlnch wfy mlvlem rlsh ta rhcftlaesolps fe` ghfelem woldo

whrh eat clthrfc

Zoysldfc hxfgleftlae

Zoysldfc hxfgleftlae ls lgpartfet iar psydolftrld prfdtldh fe` stu`hets frh f`vlsh` ta caab iar thcc-tfch slmes iar ue`hrcylem

poysldfc dae`ltlaes.

Mhehrfc lesphdtlae

6. Mhehrfc whcc-nhlem fe` na`y slzh (h.m. dfdohxlf le fearhxlf ehrvasf, anhslty woldo gfy

summhst ghtfnacld sye`ragh).

>. Fneargfc hyhs (h.m. hxapotofcgas le Mrfvhs `lshfsh2 cl` cfm ls f slme le toyrataxldasls).

4. Ftypldfc ifdlfc ihfturhs gfy summhst sye`raghs fssadlfth` wlto chfrelem `lsfnlclty (h.m.@awes sye`ragh).

0. Hxtrhgltlhs; sdfrs ae toh frgs gfy le`ldfth `hclnhrfth shci-ofrg le phapch wlto

nar`hrcleh phrsaefclty `lsar`hr. Ehh`ch trfdbs gfy le`ldfth letrfvheaus `rum ush.

Ehuracamldfc

hxfgleftlae

6. Caab iar trhgar `uh ta toyrataxldasls, wlto`rfwfc irag fcdaoac, hxtrfpyrfgl`fc sl`h

hiihdts).

>. Caab iar levacuetfry gavhghets (h.m. rhstchssehss le cawhr clgns ls fcsa beawe fs

fbftolslf woldo ls le`udh` ny fetlpsydoatlds).

4. Caab iar fneargfc pasturlem (h.m. wfxy ichxlnlclty le dftftaelf).

0. Caab iar fneargfc mflt (h.m. souiiclem mflt le phapch wlto Zfrblesaes `lshfsh2 nraf`-

nfsh` mflt fs f dhrhnhccfr slme le phapch woa glsush fcdaoac).

Dfr`lavfsducfr

hxfgleftlae

8.

Zucsh; ohfrt rfth fe` pftthre.9. Ncaa` prhssurh fe` pasturfc dofemh le ncaa` prhssurh (sagh fetlpsydoatlds sudo fs

quhtlfpleh dfush pasturfc dofemh le ncaa` prhssurh).

=. Ohfrt saue` fe` gurgur.

Fn`aglefc

hxfgleftlae

6. Lesphdt iar sdfrs `uh ta prhvlaus aphrftlae.

>. Lesphdt iar cfeuma oflr (fssadlfth` wlto fearhxlf ehrvasf).

4. Zfcpfth iar ohpftaghmfcy.

7/22/2019 Mastering Psychiatry 2014 (Final)1

29/355

@lfmeasls fe` olhrfrdoy ai `lfmeasls

Ttu`hets frh f`vlsh` ta pravl`h toh `lfmeasls nfsh` ae toh @TG-LY-P^ ar LD@-6: drlthrlf. @TG-LY-P^ ushs toh ilvh fxls

fpprafdo (Fxls L gfle psydolftrld lccehss2 Fxls LL phrsaefclty `lsar`hr ar ghetfc rhtfr`ftlae2 Fxls LLL mhehrfc gh`ldfc

dae`ltlae2 Fxls LY psydoasadlfc fe` hevlraeghetfc pranchgs2 Fxls Y Mcanfc fsshssghet ai iuedtlaelem (MFI sdarh).

Ttu`hets frh f`vlsh` ta ruch aut toh dae`ltlaes ft toh upphr pfrt ai toh pyrfgl` nhiarh daedcu`lem toh dae`ltlaes ft tohnattag pfrt ai toh pyrfgl`. Poh dae`ltlaes ft toh upphr pfrt ai toh pyrfgl` frh mlvhe toh `lfmeastld prlarlty nhdfush tohsh

dae`ltlaes frh trhftfnch fe` rhvhrslnch ny nlacamldfc trhftghets.

Iargucftlae

Iargucftlae ai f dfsh dauc` nh nfsh` ae toh ue`hr-ghetlaeh` ga`hc;

Zrh`lspaslem ifdtars Zrhdlpltftlem ifdtars Gfletflelem ifdtars

Nlacamldfc

ifdtars

Mhehtlds (h.m. lgpartfet iar

sdolzaporhelf, nlpacfr

`lsar`hr, shvhrh `hprhsslvh

hplsa`h, anshsslvh dagpucslvh

`lsar`hr fe` Fczohlghrs

`lshfsh)

Hxfgpchs;

- ^hdhet poysldfc lccehss

chf`lem ta `hprhsslae.

- Tunstfedh glsush chf`lem ta

psydoasls.

- Tchhp `hprlvftlae chf`lem ta

gfelf.

Hxfgpchs;

- Doraeld gh`ldfc `lshfshs,

- Daetleuh` fcdaoac glsush.

Zsydoacamldfc

ifdtars

Zhrsaefclty fe` thgphrfghet. Hxfgpchs;

- ^hdhet cass fe` strhss.- Eae f`ohrhedh ta

gh`ldftlae.

Hxfgpchs;

- Poh prhshedh ai dameltlvh hrrars.- Cfdb ai ghfelemiuc fdtlvltlhs.

- Lgpflrh` leslmot.

Tadlfc ifdtars F`vhrslty le sadla-hdaeagld

stftus2 hfrcy shpfrftlae irag

pfrhets.

Hxfgpchs;

Clih hvhets; `lvardh ar

uehgpcayghet.

Hxfgpchs;

Cfdb ai ledagh ar sadlfc lsacftlae.

@hclrlug fe`

Armfeld `lsar`hrs

^hvhrslnch `hghetlf

Tdolzaporhelf

Gaa` `lsar`hrs

Ehurashs fe` fexlhty `lsar`hr

Tagftaiarg fe` phrsaefclty `lsar`hrs

7/22/2019 Mastering Psychiatry 2014 (Final)1

30/355

Levhstlmftlaes

6. ^autleh levhstlmftlaes le psydolftry; IND, CIPs, X & Hs ar ^IPs, PIPs, Xrleh `rum sdrhhe fe` HDM (ta caab iar

pracaemh` VPd).

>. Iurtohr levhstlmftlaes wlcc nh rhqulrh` nfsh` ae pftlhets olstary fe` pathetlfc `lfmeasls, h.m. DP ar G^L nrfle

sdfe, HHM, Y@^C, N6> fe` iacfth, OLY thstlem wlto pftlhets daeshet..4. ]lto toh pftlhets phrglsslae, toh psydolftrlst gfy antfle daccfthrfc olstary irag pfrtehr ar spaush, irlhe`s, ifglcy,

MZs fe` atohr praihsslaefcs.0. Levhstlmftlaes `a eat clglt ta toh dcleldfc shttlem. Poh trhftghet thfg gfy daesl`hr `alem f oagh vlslt ta

ue`hrstfe` toh lethrfdtlae nhtwhhe oagh hevlraeghet fe` durrhet psydolftrlst lccehss. Addupftlaefc tohrfplst dfe

fsshss toh fdtlvlty ai `flcy clvlem ai fe le`lvl`ufc wolch sadlfc warbhr dfe fsshss sadlfc suppart.

8. Li toh pftlhet rhqulrhs iurtohr psydoacamldfc fsshssghet, toh psydolftrlst ehh`s ta l`hetliy f dchfr mafc. Iar hxfgpch,

f nfshcleh ehurapsydoacamldfc fsshssghet ai f phrsae wlto rhdhet ohf` lekury fe` rhphft toh fsshssghet fithr slx

gaetos ai dameltlvh rhofnlcltftlae.

Gfefmhghet fe` guctl`lsdlpclefry fpprafdo

6. Prhftghet dfe nh `lvl`h` fs lggh`lfth, soart thrg, gh`lug thrg fe` caem thrg.

>. Lggh`lfth trhftghetledcu`hs oaspltfclsftlae fe` dcash suphrvlslae ta prhvhet suldl`h ftthgpt ar prhsdrlptlae ai

nheza`lfzhplehs ta prhvhet fcdaoac wlto`rfwfcs. Fppcldftlae ai Ghetfc @lsar`hr fe` Prhftghet Fdt ta f`glt tohpftlhets woa frh ft rlsb nut rhiush f`glsslae ta toh Lestltuth ai Ghetfc Ohfcto.

4. Toart thrg trhftghet gfy ledcu`hnlacamldfc trhftghets, rlsb gfefmhghet fe` `lsdofrmh pcfeelem.

f. Nlacamldfc trhftghets; `hphe`lem ae toh `lfmeasls, dagarnl`lty fe` `rum lethrfdtlaes, psydolftrlsts gfydaesl`hr fetlpsydoatlds, fetl`hprhssfets, gaa` stfnlclshrs, nheza`lfzhpleh fe` fetl-`hghetlf gh`ldftlae.

n. Daesuctlem atohr sphdlfclsts; li ehdhssfry, toh psydolftrlsts gfy antfle leput irag atohr hxphrts legh`ldleh, surmhry, pfh`lftrlds, mhrlftrlds, fe` ansthtrlds fe` myefhdacamy.

d. ^lsb gfefmhghet levacvhs ga`liylem fe` gfefmlem rlsb ifdtars. (H.m. trhft toh ue`hrcylem `hprhsslvh`lsar`hr ta prhvhet suldl`h fe` ta f`vlsh dfrhmlvhrs ta rhgavh sofrp lthgs ft oagh ta prhvhet shci-ofrg).

Lt ls lgpartfet ta prhvhet ofrg ta atohr phapch (iar hxfgpch, leiarg toh sadlfc fmhedy ta hesurh toh sfihty

ai toh pftlhets dolc`rhe).

`. Hstfnclso tohrfphutld fcclfedh iar iuturh psydoacamldfc tohrfpy. Zsydoah`udftlae fe` suppartlvhdaueshcclem dfe nh aiihrh` wolch toh pftlhet stfys le toh wfr`. Garh sapolstldfth` tohrfpy h.m. dameltlvhnhofvlaur tohrfpy rhqulrhs iurtohr warb fithr `lsdofrmh.

h. @lsdofrmh pcfeelem wlto fdtlvh daccfnarftlae wlto pftlhets rhcftlvhs, autpftlhet psydolftrlst, dfshgfefmhr (h.m. le Hfrcy psydoasls pramrfggh), MZ, fe` dagguelty psydolftrld thfg. Poh rhcftlvhs fe`

ghetfc ohfcto thfg dfe ohcp ta l`hetliy rhcfpsh fe` pcfys fe fdtlvh rach le toh daetlemhedy pcfe

0. Gh`lug fe` caem thrg trhftghet gfy ledcu`h psydoacamldfc fe` sadlfc trhftghets.

f. Zsydoacamldfc trhftghets gfy levacvh daueshcclem, suppartlvh psydoatohrfpy, dameltlvh nhofvlaurtohrfpy ar lethrphrsaefc tohrfpy. Le`lvl`ufcs gust hxpcarh pftlhets gatlvftlae, prhihrhedhs fe` prhvlaus

rhspaesh ta psydoacamldfc trhftghets.

n. Tadlfc trhftghets gfy levacvh gaeltarlem ny dagguelty psydolftrld eurshs, vadftlaefc fsshssghet,supparth` warb sdohghs, `agldlclfry shci dfrh trflelem, supparth` fddagga`ftlae fe` dolc` prathdtlae.

7/22/2019 Mastering Psychiatry 2014 (Final)1

31/355

GDVs

6. F 0:-yhfr-ac` wagfe ls rhihrrh` ny ohr MZ nhdfush

soh suiihrs irag `hprhsslvh `lsar`hr. @urlem toh

lethrvlhw, soh ofs `liilducty ta vhrnfclzh ohr

hgatlaes. Pols poheagheae ls nhst `hsdrlnh` fs;

F. FgnlvfchedhN. Fiihdtlvh icftthelem

D. Fchxltoyglf

@. Fcamlf

H. Feoh`aelf

Feswhr; D

Poh `liilducty ta hxprhss aehs hgatlae ls beawe fs

fchxltoyglf. Zrlgfry fchxltoyglf ls `hsdrlnh` fs f

phrsaefclty trflt, dofrfdthrlzh` ny `liilducty le l`hetliylem

aeh's hgatlaefc stfth, Thdae`fry fchxltoyglf ls f "stfth"

rhfdtlae `urlem shrlaus poysldfc lccehss fe` shvhrh

`hprhsslvh hplsa`h. @hihdtlvh lethrohglspohrld

daggueldftlae ar leolnltlae ai darpus dfccasug fdtlvltygfy chf` ta fchxltoyglf.

>. \au frh fsshsslem f 4:-yhfr-ac` gfe woa ls

fmmrhsslvh tawfr`s stfii le toh Fddl`het fe`

Hghrmhedy @hpfrtghet. Poh iaccawlem frh

fppraprlfth fpprafdohs hxdhpt;

F. F`apt eae-daeiraetftlae fpprafdo

N. F`vlsh pftlhet ta slt ehfr toh `aar

D. Glelglzh hyh daetfdt

@. Chfvh hxfgleftlae `aar aphe

H. Cawhr yaur awe valdh

Feswhr; N

Le tols sdhefrla, toh psydolftrlst soauc` slt ehfr toh `aar

ta hesurh tohrh ls fe hsdfph rauth. Pols wlcc fccaw toh

psydolftrlst ta ganlclzh rhsaurdhs hfslcy. Li toh pftlhet

slts ehfr ta toh `aar, oh ar soh dfe gfbh toh psydolftrlst f

oastfmh ny ncadblem toh hxlt.

4. ]oldo ai toh iaccawlem stfthghets fnaut ghetfc

stfth hxfgleftlae ls darrhdt1

F. @urlem toh ghetfc stfth hxfgleftlae, f psydolftrlst

soauc` fsb f cfrmh rfemh ai psydoapftoacamlhs ta davhr

hvhry `lfmeastld passlnlclty

N. @urlem ghetfc stfth hxfgleftlae, pranh quhstlaesfnaut psydoapftoacamy frh nhst irfgh` wlto thdoeldfc

quhstlaes

D. Ghetfc stfth hxfgleftlae ls nhst dae`udth` fs iargfc

hxhrdlsh woldo iaccaws f sdohgf

@. Thrlfc ghetfc stfth lethrramftlaes frh fe hxtrhghcy

rhclfnch ghtoa` ai ku`mlem toh pramrhss ai trhftghet ar

dofemhs le pftlhets ghetfc ohfcto

H. Poh nhst dcleldfc fpprafdo ta ghetfc stfth hxfgleftlae

ls f daevhrsftlaefc fe` leiargfc gfeehr

Feswhr; H

Xesblcch` lethrvlhwhrs aithe dae`udt toh ghetfc stfth

hxfgleftlae ls f rlml` sdohgf wlto f cat ai thdoeldfcquhstlaes. Pols wlcc prhvhet toh pftlhet irag aphelem up

fe` vacuethhrlem ehw leiargftlae. Lt fcsa hxpcfles woy

aptlae @ ls ledarrhdt. Aptlae F ls ledarrhdt nhdfush toh

psydolftrlst soauc` iadus ae passlnch psydoapftoacamy

nfsh` ae leiargftlae antfleh` le olstary-tfblem. Aptlae

N ls ledarrhdt nhdfush pranh quhstlaes fnaut

psydoapftoacamy frh nhst irfgh` wlto rhihrhedh ta

fdtlvltlhs fe` l`hfs toft frh ifglclfr ta toh pftlhet. Aptlae

@ ls ledarrhdt nhdfush stfth lethrramftlaes frh uerhclfnch

ghtoa`s ai ku`mlem toh pramrhss ai trhftghet ar dofemhs

le pftlhets ghetfc ohfcto.

HGLT;Dcleldfc Lethrvlhw

F Dlrducfr quhstlaelem

N Dcfrlildftlae

D - Dcash` quhstlaelem

@ -Daeiraetftlae

H Hgpftoy

I Lethrprhtftlae

M Aphe quhstlaelem

O ^hdfpltucftlae

L TuggftlaeK Tygpftoy

Iar hfdo ai toh stfthghets nhcaw, pchfsh shchdt toh gastclbhcy dcleldfc lethrvlhw thdoelquh ush`.

Vuhstlae 6; L fg sarry toft yau frh ihhclem tols wfy

Fes; Tygpftoy

Vuhstlae >; Ta, yau ofvh daetleuh` uslem schhplem plccs

`hsplth yaur iarghr `hdlslae ta stap uslem Fes;

^hdfpltucftlae

Vuhstlae 4; L ue`hrstfe` toft yau frh vhry irustrfth` wlto

yaur iftohr. L fg wae`hrlem li yau ncfgh ohr iar fcc toft

ofs ofppheh` ta yau Fes; Lethrprhtftlae

^hihrhedh; Zaach ^, Olmma ^.Zsydolftrld Lethrvlhwlem

fe` Fsshssghet. Dfgnrl`mh; Dfgnrl`mh Xelvhrslty

Zrhss, >::9.

Eaths;

7/22/2019 Mastering Psychiatry 2014 (Final)1

32/355

Dofpthr 4 Tdolzaporhelf, fetlpsydoatlds fe` rhcfth` `lsar`hrs

Hpl`hglacamy ai sdolzaporhelf Daggae sl`h hiihdts fe` fcthreftlvh fetlpsydoatlds

Fhtlacamy Poh ilrst mhehrftlae fetlpsydoatlds

Ehuranlacamy ai sdolzaporhelf Poh shdae` mhehrftlae fetlpsydoatlds

Tygptags ai sdolzaporhelf Hxtrfpyrfgl fc sl`h hiihdts fe` tfr`lvh ysblehslf.

ATDH mrl` iar psydoatld `lsar`hrs Zsydoasadlfc lethrvhetlae (GAO fe` ELDH mul`fedh)

Zoysldfc hxfgleftlae ,levhstlmftlae fe` quhstlaeeflrh Dftftaelf

@liihrhetlfc `lfmeasls Tdolzafiihdtlvh `lsar`hr

Gfefmhghet (GAO mul`hclehs) @hcuslaefc lsar`hrs

Fetlpsydoatlds; toh gast fe` toh chfst ^hvlslae GDVs, GHVs & HGLs

Hpl`hglacamy ai sdolzaporhelf

Ledl`hedh Zalet prhvfchedh Clihtlgh

rlsb

Gfch; Ihgfch

]arc`wl`h 68-8: phr 6::,::: papucftlae phr yhfr 6% 6% 6;6

TlemfparhRDoaem TF

>::0W

6:-0: ehw dfshs phr 6::,::: phr yhfr:.9% (>4>:: dfshsavhr 0 glcclae le

>::0)

:.=% 6;6

Fhtlacamy

Mhehtld rlsb

ifdtars

Poh gast lgpartfet rlsb ifdtar iar sdolzaporhelf ls ofvlem f rhcftlvh suiihrlem irag tols`lsar`hr.Poh rlsb ta `hvhcap sdolzaporhelf iar toh mhehrfc papucftlae ls :.8 - 6%, toh ilrst`hmrhh rhcftlvhs ai f sdolzaporhelf pftlhet ls 6:% fe` toh aiisprlem ai twa fiihdth`

pfrhets ls 09%.Ehurhmucle 6 mheh ae doragasagh ?, `ysnle`le mheh ae doragasagh ? fe` doragasagh>>q66 (Yhca-dfr`la-ifdlfc sye`ragh) frh lgpcldfth` le toh fhtlacamy ai sdolzaporhelf.

Fetheftfc fe`

phrleftfc rlsb

ifdtars

Thdae`-trlghsthr hxpasurh ta leicuhezf leihdtlaegfy ledrhfsh toh rlsb ai toh iahtus

sunshquhetcy hvhcaplemsdolzaporhelf. Fssadlftlaes ofvh fcsa nhhe iaue` wlto gfthrefcghfschs fe` runhccf leihdtlaes.

Pohrh ls f slmelildfet fssadlftlae nhtwhhe sdolzaporhelf fe` prhgfturh rupturh ai

:

8

6:

68

>:

>8

4:

48

0:

08

8:

Mrfe`dolc`rheZfrhetsTlnclemsDolc`rhe@lzymatld twlesGaeazymatld twle

%

Pyphs ai rhcftlvhs

Poh prhvfchedh ai sdolzaporhelf fgaem rhcftlvhs ai sdolzaporhelf pftlhets

60%64%

7/22/2019 Mastering Psychiatry 2014 (Final)1

33/355

ghgnrfehs, prhthrg cfnaur, caw nlrto whlmot fe` ush ai rhsusdltftlae `urlem `hclvhry.

Iahtfc oypaxlf `urlem `hclvhry prh`ldts rh`udh` mrhy gftthr toraumoaut toh darthx lephapch wlto sdolzaporhelf nuteat le daetracs.

Nlacamldfc rlsb

ifdtarsOhf` lekury; Pols gfy chf` ta pfrfeal` sdolzaporhelf.

Hplchpsy fe` thgparfc canh lshfsh;Poh gast daggae dfusftlvh ifdtar toft rhsucts le

nato sdolzaporhelf fe` hplchpsy glmot ofvh `hvhcaph` le toh uthrus.

Tunstfedh glsush; Dfeefnls gfy ledrhfsh toh rlsb ai sdolzaporhelf le phapch woa frhoagazymaus iar YFC/YFC fcchchs le DAGP mheatyphs.

Zftlhets suiihrlem irag rohugftal` frtorltls ofvh cawhr rlsb ta `hvhcap sdolzaporhelf(Aeh-tolr` toh rlsb ai toh mhehrfc papucftlae).

@hgamrfpold rlsb

ifdtarsFmh fe` mhe`hr;Gfch sdolzaporhelf pftlhets the` ta ofvh garh shvhrh `lshfsh, wltohfrclhr aesht, garh strudturfc nrfle lshfshs fe` warsh prhgarnl` f`kustghet dagpfrh` ta

toh ihgfch pftlhets.

F`vfedh` pfthrefc fmhft toh tlgh ai nlrto ls f rlsb ifdtar iar toh aiisprlem ta `hvhcap

sdolzaporhelf.

Tadlfc dcfss; Lt ls stlcc daetravhrslfc wohtohr caw sadlfc dcfss ls dfush` ny sdolzaporhelf ar

ls fe hiihdt ai toh daursh fe` toh efturh ai toh `lshfsh.6. Nrhh`hr oypatohsls; sadla-hdaeagld f`vhrslty prhdlpltfths sdolzaporhelf le

mhehtldfccy vucehrfnch le`lvl`ufcs.

>. Tadlfc `rlit hxpcfeftlae; phapch woa ofvh fe ue`hrcylem prh`lspasltlae tasdolzaporhelf frh garh clbhcy ta `rlit `awe toh sadlfc sdfch.

^urfc/urnfe `liihrhedh;Poh olmohr prhvfchedh ai sdolzaporhelf le urnfe frhfs ls `uh talethrfdtlae ai mhehtld ifdtars, glmrftlae, olmohr rfths ai sadlfc hprlvftlae fe` garh sadlfc

pranchgs le toh leehr dlty. Pohrh ls garh ifvaurfnch autdagh le eae-le`ustrlfclzh`

dauetrlhs fs dagpfrh` ta le`ustrlfclzh` dauetrlhs.

Htoeldlty; Fira-Dfrlnnhfe lgglmrfets ta toh XB ofvh olmohr rlsb ai sdolzaporhelf hvhe

le toh shdae` mhehrftlae.

Zsydoacamldfc rlsb

ifdtarsTtrhssiuc clih hvhetsfrh f prhdlpltfet ai toh ilrst hplsa`h psydoasls.Olmo hxprhssh` hgatlaedagprlslem avhr-levacvhghet, drltldfc dagghets fe` oastlcltyirag ifglcy ghgnhrs iar garh tofe 48 oaurs phr whhb ledrhfsh toh rlsb ai rhcfpsh ai

sdolzaporhelf.

7/22/2019 Mastering Psychiatry 2014 (Final)1

34/355

Ehura`hvhcapghetfc tohary ai sdolzaporhelf

Letrfuthrleh phrla` Dolc`oaa` fe` f`achsdhedh

\auem f`uctoaa`

Mhehtld, fetheftfc fe` phrleftfc rlsbifdtars dfush f `lsturnfedh le woldo

toh eargfc pftthre ai pramrfggh`dhcc `hfto ls dagpraglsh` fe` chf`sta f `hihdt le toh eargfc ar`hrcyglmrftlae ai ehuraes tawfr` toh

dartldfc pcfth. Pols ofs shrlausdaeshquhedhs iar toh hstfnclsoghet

ai f eargfc pftthre ai dartldfcdaeehdtlaes.

Daesthccftlae ai hfrcy slmes ledolc`oaa` ledcu`hs fneargfc hyh(sfddf`ld) trfdblem gavhghets,

ehurapsydoacamldfc `hildlts, saitehuracamldfc slmes (h.m.

dcugslehss, le-daar`leftlae areae-sphdlild HHM dofemhs) fe`fneargfc nhofvlaurs.

Dcfssldfc sdolzaporhelfsygptags hghrmh fs frhsuct ai fddugucfth`

letrfdhrhnrfc pftoacamyfe` spftlfc lsfrrfy ai

ehuraes wohe tohougfe nrfle rhfdohsdhrtfle chvhc aigfturlty.

Ehuranlacamy ai sdolzaporhelf

Mrass pftoacamldfc dofemhs le sdolzaporhelf;

6. Ftrapoy ai toh prhiraetfc darthx fe` thgparfc canh (`lsturnh` ehurfc ehtwarb le toh prhiraetfc fe`gh`lfc thgparfc canhs ls toh darh psydoapftoacamldfc ihfturh).

>. Dofemhs le toh darpus dfccasug.4. Ledrhfsh` vhetrlducfr slzh ft dagghedhghet ai `lshfsh (DP dofemhs le toh tolr` fe` cfthrfc vhetrldchs

fe` toh thgparfc oares).0. ^h`udtlae le toh avhrfcc nrfle vacugh.8. Tgfcchr tofcfgus.9. Garpoacamldfc fneargfcltlhs le Darpus Daccfsug

Olstacamldfc dofemhs le sdolzaporhelf;

6. Dhccucfr cass le toh olppadfgpus.>. ^h`udtlae ai toh eugnhr ai gh`la-`arsfc tofcfgld ehuraes.4. ^h`udh` ehuraefc `heslty le toh prhiraetfc, dlemucfth fe` gatar darthx0. Fneargfc pftthres ai gyhcleftlae le toh olppadfgpus fe` thgparfc canhs fs f rhsuct ai fneargfc

glmrftlae, fneargfccy slzh` ehuraes,

Ehuradohgldfc fneargfcltlhs; @apfgleh;`apfgleh le ghsaclgnld pftowfy fe` toh `apfgleh oypatohsls prapashs toft ledrhfsh`

chvhcs ai apfgleh dfush sdolzaporhelf.

Thrataele (8 OP); Pohrh ls fe lethrhstlem rhcftlaesolp nhtwhhe shrataele fe` `apfgleh. Poh twashrataele pftowfys woldo frh fiihdth` le sdolzaporhelf ledcu`h (6) toh prakhdtlaes irag `arsfc rfpoheudchl ta toh sunstfetlf elmrf fe` (>) toh prakhdtlaes irag toh rastrfc rfpoh eudchl fsdhe`lem leta toh

dhrhnrfc darthx, clgnld rhmlaes fe` nfsfc mfemclf. Poh 8OP>Frhdhptar fmaelsg leolnlts `apfglehrhchfsh. ]ohe tohrh ls hxdhss shrataele pra`udh` ny tohsh twa pftowfys, tohrh ls f rh`udtlae ai toh

fvflcfnlclty ai `apfgleh fe` toft dfe mlvh rlsh ta toh ehmftlvh sygptags ai sdolzaporhelf. Thdae`

mhehrftlae fetlpsydoatlds sudo fs rlsphrl`aeh, nle` ta toh @>, 8-OP>Ffe`>f`rhehrmld rhdhptars le

toh nrfle. ^lsphrl`aeh dagphths wlto shrataele fe` lts fetfmaelsg ft 8OP>Frhdhptars dfush fe ledrhfsh

le `apfgleh ta rhclhvh ehmftlvh sygptags. Fs rlsphrl`aeh fcsa ncadbs @>rhdhptars, toh pasltlvhsygptags frh rh`udh` ft toh sfgh tlgh.

7/22/2019 Mastering Psychiatry 2014 (Final)1

35/355

Dcleldfc Ihfturhs ai Tdolzaporhelf

Mhehrfc fpphfrfedh

Zftlhet gfy nh uebhgpt fe` tohrh

ls `hthrlarftlae le shci dfrh `uh ta`hdcleh le addupftlae fe` sadlfciuedtlae.

Poaumots;6. Poaumot leshrtlae>. Poaumot wlto`rfwfc4. Poaumot nraf`dfstlem0. Iargfc toaumot

`lsar`hrs (h.m.

ehacamlsg)

Fiihdt;

6. Icft ar lefppraprlfth

fiihdt

Ofccudleftlae;6. Yaldhs dagghetlem

>. Yaldhs lsdusslem arfrmulem

4. Fu`lnch toaumots0. Atohr phrslsthet

ofccudleftlaes li addursirhquhetcy ar

fddagpfelh` ny`hcuslaefc toleblem arsustfleh` avhrvfcuh`

l`hf.

@hcuslae;

6. @hcuslaefc phrdhptlae>. Zhrslsthet `hcuslaefc

nhclhis frh dagpchthcy

lgpasslnch.

Zfsslvlty/ @hcuslae ai daetrac;

6. Gf`h wlcc>. Gf`h fdts4. Gf`h fiihdt0. Tagftld pfsslvlty8. Poaumot lethrihrhedh

Lethrhst

6. Cass ai lethrhst(fvacltlae), flgchssehss,

l`chehss, f shci fnsarnh`fttltu`h fe` sadlfcwlto`rfwfc avhr aeh

yhfr (rhihrrh` ta fsslgpch sdolzaporhelf)

Tphhdo

6. Ledaohrhet ar lrrhchvfetsphhdo (iargfc toaumot

`lsar`hr)>. Zfudlty ai sphhdo

(fcamlf)

Nhofvlaur

6. Dftftaeld nhofvlaur>. Tadlfc lgpflrghet

@lsturnfedh gust cfst iar ft chfst 9 gaetos.

Tdoehl`hrs ilrst rfeb sygptags (FND@);F Fu`ltary ofccudleftlae (>

e`ar 4

r`phrsae2 toaumot hdoa2 rueelem dagghetfry2 valdhs lsdusslem pftlhet).

N Nraf`dfstlem (toaumot nraf`dfstlem, leshrtlae fe` wlto`rfwfc).D Daetrac (@hcuslae ai daetrac fe` pfsslvlty)

@ @hcuslaefc phrdhptlae

@TG-8 @lfmeastld Drlthrlf;

Tdolzaporhelf;

Zrhshedh ai > ar garh ai toh iaccawlem sygptags avhr f 6 gaeto phrla`;f. @hcuslaesn. Ofccudleftlaes

d. Fneargfc sphhdo`. @lsarmfelzh` nhofvlarh. Ehmftlvh sygptags

(ft chfst 6 ai woldo gust nh f, n ar d)Tudo toft fe le`lvl`ufcs prhgarnl` chvhc ai iuedtlaelem ls fiihdth` le shvhrfc gfkar `agfles ai clih.Pohrh gust nh daetleuaus lgpflrghet avhr f phrla` ai ft chfst 9 gaetos, `urlem woldo toh le`lvl`ufc glmot hxphrlhedh hltohr fdtlvh

ar rhsl`ufc sygptags.Pohsh sygptags gust eat nh `uh ta toh hiihdts ai sunstfedh usfmh ar fe ue`hrcylem gh`ldfc dae`ltlae

Poaumot-sphhdo fxls

Fiihdt-lethrhstfxls

Fpphfrfedh -nhofvlaur fxls

^hfcltyfxls

TDOL[AZO^HELF

7/22/2019 Mastering Psychiatry 2014 (Final)1

36/355

Iurtohr Avhrvlhw ai @TG 8

Eugnhr ai sygptags Poh @TG-8 sphdlilh` toft iar fe le`lvl`ufc ta iucilcc tols `lfmeasls, oh/soh gust ofvh ft chfst > ar garh ai toh

iaccawlem sygptags;

f. Ofccudleftlaes

n. @hcuslaes

d. Ledaohrhet fe` `lsarmfelzh` sphhdo

`. @lsarmfelzh` ar dftftaeld nhofvlaur

h. @lglelsoh` hgatlaefc hxprhsslae / ehmftlvh sygptags

Ai woldo ft chfst aeh ai (f), (n) ar (d) ls prhshet

Tygptags gust nh daetleuausiar ft chfst 6 gaeto le `urftlae avhr f 9 gaetos phrla` ai gfrbh` lgpflrghet le

prhgarnl` iuedtlaelem.

@hthrlarftlae le

addupftlaefc fe` sadlfc

iuedtlae

Lt ls f dagpucsary drlthrlae.

@urftlae ai sygptags Poh glelgug `urftlae ai `lsturnfedh ls ft chfst 9 gaetos. Poh glelgug `urftlae ai sygptags ls ft chfst 6

gaeto.

Ledcuslae ai slgpch

sdolzaporhelf fe`

sdolzaporheliarg

`lsar`hr

Tuntyphs ai sdolzaporhelf ofvh nhhe rhgavh` le @TG Y `uh ta clglth` `lfmeastld stfnlclty, vfcl`lty fe`

rhclfnlclty.

Tdolzaporheliarg `lsar`hr;

Poh @TG-8 sphdlilh` toft iar fe le`lvl`ufc ta iucilcc tols `lfmeasls, oh/soh gust ofvh, iar f `urftlae ai nhtwhhe6 ta 9 gaetos, toh iaccawlem sygptags;

f. Ofccudleftlaes

n. @hcuslaes

d. @lsarmfelzh` ar dftftaeld nhofvlaur

`. @lsarmfelzh` sphhdo

h. @lglelsoh` hgatlaefc hxprhsslae / ehmftlvh sygptags

Poh dcleldlfe soauc` ofvh daesl`hrh` fe` ruch` aut toh `liihrhetlfcs ai sdolzafiihdtlvh `lsar`hr, `hprhsslvh ar

nlpacfr `lsar`hr wlto psydoatld ihfturhs.

Atohr typhs aisdolzaporhelf

@TG-8 ofs rhgavh` toh suntyphs ai sdolzaporhelf woldo whrh prhvlauscy prhshet le @TG-LY P^.

Poh dcleldfccy rhchvfet suntyphs ai sdolzaporhelf woldo aeh gfy stlcc hedauethr fs nfsh` ae @TG LY P^

ledcu`hs;

6. Zfrfeal` typh (nhst prameasls)

>. @lsarmfelzh` typh

4. Dftftaeld typh

0. Xe`liihrhetlfth` typh

8. ^hsl`ufc typh (gflecy toh prhshedh ai ehmftlvh sygptags)

7/22/2019 Mastering Psychiatry 2014 (Final)1

37/355

Dftftaelf fssadlfth` wlto featohr ghetfc `lsar`hr

Poh @TG-8 sphdlilh` toft toh `lfmeasls ai dftftaelf ls gf`h wohe ft chfst 4 ar garh ai toh iaccawlem sygptags

frh prhshet;

@lsar`hrs ai Gavhghet;

f. Ttupar

n. Dftfchpsy

d. ]fxy Ichxlnlclty

`. Ehmftlvlsg

h. Zasturlem

i. Gfeehrlsg

m. Tthrhatypy

o. Mrlgfdlem

l. Hdoaprfxlf

k. Fmltftlae, eat leicuhedh` ny hxthrefc stlgucl

@lsar`hrs ai Tphhdo;

f. Gutlsg

n. Hdoacfclf

Atohr sphdlilh` sdolzaporhelf sphdtrug fe` atohr psydoatld `lsar`hr

@TG-8 rhshrvh` tols dfthmary ai `lfmeasls iar le`lvl`ufc prhshetlem wlto sygptags dofrfdthrlstld ai

sdolzaporhelf, nut ofs eat ght toh iucc `lfmeastld drlthrlf.

Hxfgpchs ledcu`h;

f. Tun-torhsoac` psydoatld sye`ragh

n. @hcuslaes wlto fssadlfth` gaa` `lsar`hrs

d. Zhrslsthet fu`ltary ofccudleftlaes le toh fnshedh ai fey atohr psydoatld ihfturhs

7/22/2019 Mastering Psychiatry 2014 (Final)1

38/355

Nrlhi psydoasls Poh @TG-8 sphdlilh` toft iar fe le`lvl`ufc ta iucilcc tols `lfmeasls, oh/soh gust ofvh, iar f `urftlae ai nhtwhhe

6 `fy ta 6 gaeto toh iaccawlem sygptags;

f. @hcuslaes

n. Ofccudleftlaes

d. @lsarmfelzh` sphhdo

`. Mrasscy `lsarmfelzh` ar dftftaeld nhofvlar

ai woldo ft chfst 6 ai tohsh gust nh (f), (n) ar (d)

Poh le`lvl`ufc soauc` nh fnch ta rhture ta prhgarnl` chvhc ai iuedtlaelem fithr toh daursh ai toh lccehss.

Dcleldlfes ehh` ta hxdcu`h `liihrhetlfcs clbh gfkar `hprhsslae ar nlpacfr `hprhsslae wlto psydoatld ihfturhs,

sdolzaporhelf fe` hxdcu`h toh passlnlclty ai toh sygptags nhlem `uh ta ue`hrcylem sunstfedh ush ar gh`ldfc

dae`ltlaes.

Nrlhi psydoatld `lsar`hr dauc` addur hltohr le toh prhshedh ar fnshedh ai strhssars.

Zast-sdolzaporhelf

@hprhsslae

Eat ghetlaeh`

Tdolzatypfc lsar`hr Pols `lsar`hr ls daesl`hrh` ta nh f phrsaefclty `lsar`hr nut @TG-8 fcsa clsts tols `lsar`hr ue`hr sdolzaporhelf. Lt

gust iucilc > darh drlthrlf iar phrsaefclty `lsar`hr; lgpflrghet le shci fe` lethrphrsaefc iuedtlaelem.

7/22/2019 Mastering Psychiatry 2014 (Final)1

39/355

ATDH; Lethrvlhw f pftlhet ta hstfnclso f `lfmeasls ai sdolzaporhelf

F >> yhfr ac` uelvhrslty stu`het ls nraumot ny ols daueshccar ta toh Fddl`het fe` Hghrmhedy @hpfrtghet. Oh

wfs shhe ny toh psydolftrlst ft toh Xelvhrslty dcleld fe` `lfmeash` ta suiihr irag sdolzaporhelf. \au frh tohrhsl`het warblem le toh Fddl`het fe` Hghrmhedy @hpfrtghet.

Pfsb; Pfbh f olstary ta hcldlt ilrst rfeb sygptags fe` atohr rhcfth` sygptags ta hstfnclso toh `lfmeasls aisdolzaporhelf.

**Zchfsh rhihr ta www.gfsthrlempsydolftry.dag ; Lethrvlhwlem f Zsydoatld Zftlhet

F.

Letra`udtlae

fe` fsshss

ofccudleftlaes.

F6. Letra`udtlae

L wauc` clbh ta fsb yausagh quhstlaes. Tagh aitohg gfy fpphfr f nlt

strfemh. Ls toft fcc rlmotwlto yau1 L mftohr toftyau of` nhhe toraumo fcat ai strhss rhdhetcy.

]ohe ue`hr strhsssaghtlghs phapch ofvhdhrtfle ueusufc

hxphrlhedhs. Ofvh yauof` sudo hxphrlhedhs1

F>. Fsshss fu`ltary

ofccudleftlaes

Ny ueusufc hxphrlhedh, L ghfe,iar hxfgpch, sagh phapch ohfrlemvaldhs wohe ea aeh fraue`. Li

yhs,@a toh valdhs sphfb `lrhdtcy tayau1 (>e` phrsae)@a tohy sphfb fgaem

tohgshcvhs1 (4r` phrsae)]oft sart ai tolems `a toh valdhssfy1

Gehgaelds; HF^

Hdoahs ai awe toaumots; @a tohvaldhs rhphft yaur toaumots1Frmulem valdhs levacvh ft chfst >valdhs.

^ueelem dagghetfry ae pftlhet;@a tohsh valdhs `hsdrlnh ardagghet upae woft yau frh

`alem ar toleblem1

@a toh valdhs thcc yau ta `a

tolems1 (daggfe` ofccudleftlaes)

F4. Atohr ofccudleftlaes

Ylsufc ofccudleftlaes; Ofvhyau hvhr of` hxphrlhedhs`urlem woldo yau sfw tolems

ar sof`aws toft atohrs dauc`eat shh1

Pfdtlch ofccudleftlaes; @a

yau ihhc toft tohrh frhstrfemh shesftlaes wltoleyau, fs li saghtolem ls

drfwclem wltole yaur na`y1

Acifdtary / mustftaryofccudleftlaes; Ofvh yauhvhr of` hxphrlhedhs `urlem

woldo yau sghcc ar

hxphrlhedh strfemh tfsths toftatohrs `a eat hxphrlhedh1

N. Fsshss

toaumot

lethrihrhedhs.

N6.Poaumot leshrtlae

Ls tohrh fey lethrihrhedh

wlto yaur toaumots1

@a atohrs put ar iardh

tohlr toaumots leta yaurgle`1

N>. Poaumot wlto`rfwfc

Dauc` saghaeh tfbh yaur

toaumots aut ai yaur ohf`1

N4. Poaumot nraf`dfstlem

@a atohr phapch beaw woft

yau toleb le yaur gle`1

@a yau ihhc toft yaur

toaumots frh nraf`dfsth` taatohr phapch1

D. @hcuslaes

leslmot, gaa`

fe` sunstfedh

glsush.

D6. @hcuslae ai daetrac

ar pfsslvlty hxphrlhedh.

Ofs tohrh nhhe fey`liilducty wlto ihhclems,

fdtlaes, ar na`lcyshesftlae1Ls tohrh saghaeh ar

saghtolem trylem tadaetrac yau le tohiaccawlem frhfs;

Gehgaeld ]HF;

D> Atohr `hcuslaes.

]ohe ue`hr strhss sagh phapchile` toft saghaeh ls pcfylem trldbsae tohg. Ofvh yau of` fey sudo

hxphrlhedhs1

@hcuslae ai Zhrshdutlae; Frh

tohrh sagh phapch woa try taofrg yau ar gfbh yaur clihglshrfnch1

@hcuslae ai rhihrhedh; @a yau

D4 Fsshss leslmot fe`

gaa`.

]oft `a yau toleb ls tohdfush iar tohsh hxphrlhedhs1

Dauc` yau suiihr irag felccehss le yaur gle`1

@a yau toleb trhftghetwauc` ohcp ta rh`udh toash

hxphrlhedhs1

7/22/2019 Mastering Psychiatry 2014 (Final)1

40/355

]- ]lcc (lgpucshs)

H Hgatlaes (Ihhclemsar fiihdt)F Fdtlaes (vacltlaefc)

toleb toft saghaeh ls wftdolem,

iaccawlem ar spylem ae yau1

@hcuslae ai mrfe`hur; @a yau

ofvh fey sphdlfc pawhrs arfnlcltlhs toft atohrs aet ofvh1

@hcuslae ai mulct; @a yau ihhcclbh yau `hshrvh puelsoghet iar

glstfbhs yau gf`h le toh pfst1Dfe yau thcc gh toh efturh ai tohglstfbhs fe` puelsoghet yau

`hshrvh1

Oaw `a yau `hsdrlnh yaur

gaa`1 @a yau ihhc sf`1

]ohe yau ihhc sf`, `a yau

ofvh toaumot ai ofrglemyaurshci1

L hedauethr sagh stu`hetsush rhdrhftlaefc rums wohe

tohy ma iar avhrshfshxdofemh ar pfrty. Ofvh yauush` rhdrhftlaefc rums

rhdhetcy1

@. Fsshss

ehmftlvh

sygptags fe`

fdf`hgld