Manual Of Psychiatry Research Articles

Staging, réseaux de symptômes : les nouvelles approches cliniques de la schizophrénie

Debate on the clinic of psychiatric disorders has been, for several decades, largely occupied by nosographic considerations resulting from the work which led to the publication of the DSM in its third version in 1980. However, DSM is a nomenclature, not a psychiatry manual and researches focusing on the clinic of mental disorders are essential in the progress of knowledge. Recently, in the field of psychotic disorders, new clinical approaches were developed, having heuristic value and having an impact on clinical practices. The staging model and the network theory of schizophrenia will be successively evoked, which are two fertile areas of these new clinical perspectives. Recent works to validate the staging model in schizophrenia, in large retrospective and prospective cohorts, found out two clinical models, conceptually congruent, in which, stages of the illness can be discriminated using symptoms, functioning and episodes. Each model would need to be tested in other independent samples to evaluate their reliability and accuracy. One of the findings of these works is that patients can improve or deteriorate from one stage to another, but prediction of the evolution remains uncertain. The next goals of research are to combine clinical evaluation with biomarkers, and also to develop the use of innovative statistical tools and methodologies in the field, to operationalize the concept of precision staging. On the other hand, regarding the network theory of schizophrenia, recent works highlight the interest of identifying networks of highly interrelated symptoms to focus on target symptoms and to develop specific treatment strategies. Clinical approaches are the counterpart of the physiopathological and etiopathogenic researches on mental disorders, carried out in particular by research in the field of genetics and brain imaging. The staging model and the network theory have a heuristic virtue and contribute to a new approach not only to schizophrenia but to all psychiatric disorders. In the daily clinical practice, they allow a new approach to patients and their care. Their interest has led to the development of professional recommendations for the management of schizophrenia, based on the staging model and particularly useful for clinicians.

Increasing the Role of Phenomenology in Psychiatric Diagnosis-The Clinical Staging Approach.

Recent editions of diagnostic manuals in psychiatry have focused on providing quick and efficient operationalized criteria. Notwithstanding the genuine value of these classifications, many psychiatrists have argued that the operationalization approach does not sufficiently accommodate the rich and complex domain of patients’ experiences that is crucial for clinical reasoning in psychiatry. How can we increase the role of phenomenology in the process of diagnostic reasoning in psychiatry? I argue that this could be done by adopting a clinical staging approach in diagnostic reasoning in psychiatry. The approach has the resources to include the progressive nature of patients’ experiences to a much greater degree than is currently practiced. It can address the recent plea for increasing the role of phenomenology in psychiatric diagnosis by offering a model for clinical reasoning that goes beyond the operationalized, static criteria of diagnostic manuals, without depriving us of their benefits.

Software Educativo como herramienta de apoyo para niños autistas

We live in the digital age or computer age that offers new devices (computers, smart phones, and electronic tablets) and Electronic Applications (APPs) with enormous potential for the educational treatment of children with Autism Spectrum Disorder ( hereinafter ASD) defined by the DSM IV psychiatry manual as “a neurobiological developmental disorder that already manifests itself during the first three years of life and that will last throughout the entire life cycle.” (US ASSOCIATION OF PSYCHIATRY, 2002 ) After the analysis of the few centers of attention in the south of Veracruz for children with ASD and the ease offered by ICTs to create PPPs, the “ELY” software emerges that is divided into three important sections: Mental Activities, Social Activities and Social interaction activities. These sections contain activities that reinforce absent cognitive and social skills in children with ASD. In addition, with this tool the tutors did not require constant economic investment in teaching materials such as cardboard cards, colored pencils, geometric figures, among others. Participants who used the software in their treatment improved their recognition of emotions such as happiness, sadness and anger, also progressed by recognizing patterns and colors. This proves that Information and Communication Technologies (ICTs) in this research supported the specific teaching-learning processes of children with ASD, promoting communication, socialization and imagination, which are essential factors for relating to people who surround.

The DSM-ICD diagnostic approach as an essential bridge between the patient and the "big data".

The use of diagnostic manuals in psychiatry is generally necessitated by the lack of tests that would corroborate psychiatric diagnosis. Criticism towards the today prevailing DSM-ICD diagnosis traditionally regards among others such problems as hyponarrativity, biologism, "death of phenomenology", and a questionably valid over-fragmentation of diagnosis. Lately, and especially after the appearance of the 5th edition of DSM (2013), criticism focuses at such issues as lack of validity, having failed to adopt a dimensional model, not adequately relying on genetics and neurobiology, and impeding, rather than facilitating, research into the etiology of mental disorders, the DSM becoming an "epistemic prison". The former problems seem to derive from the fact that the operationalist criteria are often uncritically adopted as the ultimate authority in diagnosis, instead of being merely guides, as intended originally and explicitely; the latter problems have been made more evident since the emergence of the American RDoC research initiative, which not only points to an alternative, more valid classification of mental disorders, but also aspires to signal a move of psychiatry tοwards precision medicine, having as its main dogma that mental disorders are disorders of brain circuits, which are expressed as complex syndromes. In this paper, the historical and epistemological context of the emergence of DSM is examined; its achievement in terms of diagnostic reliability as well as clinical utility is not negligible, especially taken into consideration the climate of virtual diagnostic arbitrariness which characterized the (American) psychiatry before 1980, with obvious consequences for the authority of the specialty. Then, the potential of the new era of genetics, neurobiology and analysis of the "big data" for generating a novel approach to psychiatric diagnosis and classification is put into consideration, while it remains unknown in what way the findings of RDoC could lead and be translated into a new classification system. Moreover, the particularity of the psychiatric object, the clinical significance of the categorical approach to diagnosis, as well as the need for a "irreducible psychological level of explanation" are discussed. In our view, today, the DSM-ICD diagnosis lies between two different and potentially opposing demands and tendencies: on the one hand, the demand for the individual, subjective and phenomenological particularity of the mentally ill to be taken into consideration (a demand that sometimes underestimates the need for clinical communication); on the other hand, the (largely future) vision for more and more analysis of biological data in the name of a yet to be clarified personalized therapy (the very notion of diagnosis becoming potentially redundant). Finally, considering the particularity of the psychiatric object, we conclude that matthe DSM-ICD approach, with its categorical diagnoses and its descriptive operational criteria, despite its inherent imperfections and inadequacies, continues to have a place in psychiatry as an essential bridge/interface between clinic and research data, as a common clinical language, and as an epistemic hub; and that prerequisites for diagnostic validity should be sought both in the cells of RDoC and in those theoretical approaches which examine human subjectivity as such, included phenomenology and psychoanalysis.

Pharmaceutical Interventions for Tourette’s Syndrome

Tourette’s syndrome is a childhood-onset neuropsychiatric disorder characterized by motor and vocal tics that are chronic (duration of >1 year) (Kurlan N Engl J Med. 363:2332; Jankovic and Kurlan Mov Disord. 26:1149; Diagnostic and statistical manual of psychiatry. 4th ed.). Tics are commonly associated with obsessive–compulsive symptoms and disturbances of attention. In many children with Tourette’s syndrome, tics are mild and not disabling, and education about the condition with supportive counseling is sufficient. However, tics can be disabling by causing social embarrassment, school bullying, isolation, and sometimes conflict. Some tics are painful, and some can be self-injurious. When tics are disabling, tic-suppressing therapy is indicated which can be behavioral therapy and/or pharmacotherapy. Treatment of associated ADHD and OCD symptoms is also warranted when they are disabling.

The transdiagnostic dimension of psychosis: implications for psychiatric nosology and research.

SummaryIf psychosis is a transdiagnostic dimension, the expression of which is governed by a dynamic set of contextual and emotional factors that are amenable to treatment, current approaches in psychiatric nosology and therapeutic research may need to be revised. The dominant approach to date is to clinically and conceptually situate psychotic symptoms in the construct of schizophrenia. However, schizophrenia, which has a lifetime prevalence of 1%, only represents the poor outcome fraction of a much broader spectrum of psychotic disorders which have a lifetime prevalence of 3.5%. Therefore, research findings in schizophrenia may reflect mechanisms of prognosis rather than fundamental associations with psychosis and other symptom domains per se. Similarly, the discovery that up to 30% of individuals with non-psychotic common mental disorders have subthreshold psychotic symptoms that situate them on the transdiagnostic dimension of psychosis – and which impact clinical severity and treatment response – indicates that the rigid separation between ‘psychotic’ and ‘non-psychotic’ hampers both clinical practice and research. Diagnostic manuals in psychiatry would benefit from a system of transdiagnostic dimensions, including a transdiagnostic dimension of psychosis. Introduction of transdiagnostic dimensions allows for a system combining a nomothetic (i.e., group-specific) categorical diagnosis with an idiographic (i.e., person-specific) combination of dimensional scores. The advantage of such a system is that it encourages consideration of how symptoms dynamically interact with each other in a network of psychopathology, and of how this network is impacted by the social world.

Industry ties remain rife on panels for psychiatry manual

Industry ties remain rife on panels for psychiatry manual

In retrospect: The five lives of the psychiatry manual

Roy Richard Grinker describes the military origins of the key reference work for diagnosing mental illness.

EYE ON MENTAL HEALTH BIBLE

THE FIRST POTENTIAL revisions in more than a decade to an influential psychiatry manual are on the table, and drugmakers are taking notice. Any changes to the manual, known as the Diagnostic & Statistical Manual of Mental Disorders, that are adopted are likely to have an effect on how medications for the brain reach the market and are prescribed. The DSM has a reputation as the dictionary of mental health, and physicians, scientists, and insurers alike use it to determine what counts as a mental disorder and how patients should be treated. Among other things, the DSM helps companies select clinical trial endpoints—a measure of efficacy—and maps out unmet medical needs, explains David Bredt, vice president of neuroscience discovery and clinical research at Eli Lilly & Co. “This will impact most all that we do in psychiatric drug development,” he says. Four editions of the DSM have been published by the American Psychiatric Association, ...

Changes proposed to key psychiatry manual

Changes proposed to key psychiatry manual

The Doctor-Patient Relationship

(Reprinted with permission from Simon RI, Shuman DW: The doctor-patient relationship, in Clinical Manual of Psychiatry and Law. Arlington VA, American Psychiatric Publishing Inc. 2007; 17–36)

Clinical Manual of Psychiatry and Law

Clinical Manual of Psychiatry and Law

Clinical Manual of Psychiatry and Law

Back to table of contents Previous article Next article Book ForumFull AccessClinical Manual of Psychiatry and LawLIZA GOLD M.D.,LIZA GOLD M.D.Search for more papers by this author,Published Online:1 May 2007https://doi.org/10.1176/ajp.2007.164.5.837AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The writing partnership of Robert I. Simon, M.D., and Daniel W. Shuman, J.D., has been a felicitous one for the field of psychiatry. Dr. Simon, Clinical Professor of Psychiatry and Director of the Program in Psychiatry and Law at Georgetown University School of Medicine, and Professor Shuman, Professor of Law at Dedman School of Law, Southern Methodist University, teamed together to create the innovative book Retrospective Assessment of Mental States in Litigation: Predicting the Past(1) . Their recent publication, Clinical Manual of Psychiatry and Law, continues this working partnership, which is characterized by clarity and precision and provides yet another example of their academic and practical expertise. Clinical Manual of Psychiatry and Law untangles some of the knottiest legal issues that psychiatrists encounter in an organized and readable clinical manual and should be considered required reading for every psychiatric resident. As Dr. Simon and Professor Shuman state in the preface, clinicians cannot be expected to be as knowledgeable about the law as lawyers, but the understanding of how the law and psychiatry interact in common clinical situations should be a core competency for every clinician. This book provides easily referenced, well-formulated, and understandable discussions of the common legal issues psychiatrists face in their day-to-day clinical practice. Dr. Simon has devoted his teaching career to educating general psychiatrists in the legal issues that affect their practice. His first book on this subject, Clinical Psychiatry and the Law(2) was the first written by a psychiatrist to offer this subject matter to psychiatrists. Dr. Simon also edited and contributed multiple chapters to the comprehensive three-volume text American Psychiatric Press Review of Clinical Psychiatry and the Law(3) . In addition, Dr. Simon is the author of Psychiatry and Law for Clinicians(4) , a reference so useful that it has undergone three editions. Professor Shuman has also contributed significantly to the legal education of practicing clinicians. His books have covered specific forensic topics, such as Conducting Insanity Evaluations(5) as well as general clinical topics, such as Law, Mental Health and Mental Disorder(6) . Dr. Simon and Professor Shuman have built on this impressive body of work in Clinical Manual of Psychiatry and Law . The subject and chapter organization are comprehensive without being overwhelming. Topics covered are those with which all practicing psychiatrists should be familiar, such as the doctor-patient relationship, confidentiality, informed consent, seclusion and restraint, and maintaining treatment boundaries. Their up-to-date review of topics concerning legal issues involved in the treatment of suicidal and violent patients and involuntary hospitalization are especially welcome, as these are areas of mental health law that are constantly evolving. The chapter organization lends itself to the development of a working familiarity that can be easily incorporated into clinical practice. Each chapter addresses one specific clinical issue and includes an overview of the relevant law and a discussion of clinical management of legal issues pertinent to the chapter topic. Practical suggestions regarding such issues as termination of patients and suicide risk assessment will assist clinicians in effectively utilizing the insights and discussion of the subject matter. Each chapter also provides clinical and legal references for those interested in delving further into any given topic.Dr. Simon’s and Professor Shuman’s concise but thorough legal perspective on each of these clinical issues is particularly welcome. They bring their considerable expertise to subjects that fall outside clinical psychiatric training but which can profoundly affect practice, such as the standard of care, tort law and psychiatry, and the ever puzzling concept of proximate cause. These concepts at times prove difficult for experienced forensic clinicians and even some attorneys. The authors’ explanations are among the clearest provided for a clinical audience with a need to develop a basic understanding of these nonclinical but highly relevant legal topics. The legal glossary provided is also a great assist.Clinical Manual of Psychiatry and Law is an invaluable contribution for psychiatrists developing good clinical practices as well as those who may have such practices in place but are unaware of the legal bases upon which these practices rest. This book will strengthen the understanding of the legal and clinical reasons for these practices and clarify psychiatrists’ responsibilities while helping them assist their patients. Ultimately, and most importantly, our patients are the ones who benefit when we incorporate these insights into daily clinical practice, because in most cases, as the authors correctly point out, “good psychiatry and the law are complementary.” Arlington, Va.

Clinical Manual of Psychiatry and Law

Back to table of contents Previous article Next article Book ForumFull AccessClinical Manual of Psychiatry and LawLIZA GOLD M.D.,LIZA GOLD M.D.Search for more papers by this author,Published Online:1 May 2007https://doi.org/10.1176/ajp.2007.164.5.837AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The writing partnership of Robert I. Simon, M.D., and Daniel W. Shuman, J.D., has been a felicitous one for the field of psychiatry. Dr. Simon, Clinical Professor of Psychiatry and Director of the Program in Psychiatry and Law at Georgetown University School of Medicine, and Professor Shuman, Professor of Law at Dedman School of Law, Southern Methodist University, teamed together to create the innovative book Retrospective Assessment of Mental States in Litigation: Predicting the Past(1) . Their recent publication, Clinical Manual of Psychiatry and Law, continues this working partnership, which is characterized by clarity and precision and provides yet another example of their academic and practical expertise. Clinical Manual of Psychiatry and Law untangles some of the knottiest legal issues that psychiatrists encounter in an organized and readable clinical manual and should be considered required reading for every psychiatric resident. As Dr. Simon and Professor Shuman state in the preface, clinicians cannot be expected to be as knowledgeable about the law as lawyers, but the understanding of how the law and psychiatry interact in common clinical situations should be a core competency for every clinician. This book provides easily referenced, well-formulated, and understandable discussions of the common legal issues psychiatrists face in their day-to-day clinical practice. Dr. Simon has devoted his teaching career to educating general psychiatrists in the legal issues that affect their practice. His first book on this subject, Clinical Psychiatry and the Law(2) was the first written by a psychiatrist to offer this subject matter to psychiatrists. Dr. Simon also edited and contributed multiple chapters to the comprehensive three-volume text American Psychiatric Press Review of Clinical Psychiatry and the Law(3) . In addition, Dr. Simon is the author of Psychiatry and Law for Clinicians(4) , a reference so useful that it has undergone three editions. Professor Shuman has also contributed significantly to the legal education of practicing clinicians. His books have covered specific forensic topics, such as Conducting Insanity Evaluations(5) as well as general clinical topics, such as Law, Mental Health and Mental Disorder(6) . Dr. Simon and Professor Shuman have built on this impressive body of work in Clinical Manual of Psychiatry and Law . The subject and chapter organization are comprehensive without being overwhelming. Topics covered are those with which all practicing psychiatrists should be familiar, such as the doctor-patient relationship, confidentiality, informed consent, seclusion and restraint, and maintaining treatment boundaries. Their up-to-date review of topics concerning legal issues involved in the treatment of suicidal and violent patients and involuntary hospitalization are especially welcome, as these are areas of mental health law that are constantly evolving. The chapter organization lends itself to the development of a working familiarity that can be easily incorporated into clinical practice. Each chapter addresses one specific clinical issue and includes an overview of the relevant law and a discussion of clinical management of legal issues pertinent to the chapter topic. Practical suggestions regarding such issues as termination of patients and suicide risk assessment will assist clinicians in effectively utilizing the insights and discussion of the subject matter. Each chapter also provides clinical and legal references for those interested in delving further into any given topic.Dr. Simon’s and Professor Shuman’s concise but thorough legal perspective on each of these clinical issues is particularly welcome. They bring their considerable expertise to subjects that fall outside clinical psychiatric training but which can profoundly affect practice, such as the standard of care, tort law and psychiatry, and the ever puzzling concept of proximate cause. These concepts at times prove difficult for experienced forensic clinicians and even some attorneys. The authors’ explanations are among the clearest provided for a clinical audience with a need to develop a basic understanding of these nonclinical but highly relevant legal topics. The legal glossary provided is also a great assist.Clinical Manual of Psychiatry and Law is an invaluable contribution for psychiatrists developing good clinical practices as well as those who may have such practices in place but are unaware of the legal bases upon which these practices rest. This book will strengthen the understanding of the legal and clinical reasons for these practices and clarify psychiatrists’ responsibilities while helping them assist their patients. Ultimately, and most importantly, our patients are the ones who benefit when we incorporate these insights into daily clinical practice, because in most cases, as the authors correctly point out, “good psychiatry and the law are complementary.” Arlington, Va.

Gay Slang Lexicography: A Brief History and a Commentary on the First Two Gay Glossaries

Gay Slang Lexicography: A Brief History and a Commentary on the First Two Gay Glossaries i; Gary Simes "? 1910 and 1911, Magnus Hirschfeld's journal, the Jahrbuch Vfür sexuelle Zwischenstufen, which was devoted to the study of homosexuality and homosexuals from every perspective, published a long article in six parts on homosexuality in England by I. L. or Leo Pavia. Titled "Die männliche Homosexualität in England mit besonderer Berücksichtigung Londons" (= 'Male Homosexuality in England with Special Consideration of London'), the series displayed considerable acquaintance with both the contemporaneous scene and the history of homosexuality in England. The second part contains among other things what is probably the first English gay glossary (Pavia 1910, 39-41).* That a glossary could be made attests to the reality of a considerable and highly developed homosexual underworld in London and some other big cities. It was necessarily an underworld because of the criminal status of homosexual acts, which had been frighteningly re-affirmed some fifteen years before in the trial, conviction, and imprisonment of Oscar Wilde. But it was in some respects also a demi-monde because otherwise respectable people frequented it, secretly of course, in order not to impair or lose their respectability. Something of its nature can be 1I should like to diank Paul Knobel for making available to me a copy of Pavia's article. Dictionaries:Journal oftheDictionary Society ofNorth America 26 (2005) Gary Simes experienced directly from two publications of the day: Sins ofthe Cities ofthe Plains, or the Recollections ofa Mary-Ann (1881), which purports to be the memoirs of the historical rent-boy or Mary-Ann named Jack Saul, and the homo-erotic novel Teleny (1893), a part in the composition of which has been attributed, quite erroneously in my view, to Oscar Wilde. The best modern evocation of gay London in the mid- to late-Victorian period is to be found in Neil Bartlett's Who Was That Man? A Presentfor Mr Oscar Wilde (1988). But much can also be learned from the two books devoted to the Cleveland Street scandal of 1889-90, which involved the exposure of a male brothel in London with aristocratic and probably royal patrons (Chester and others [1976] and Hyde [1976] ). One of those interviewed by police wasJack Saul. The alleged royal connection is explored in Aronson (1994). Pavia's glossary was far from being the last. In fact, it inaugurated a rich and abundant sub-field of twentieth-century lexicography, conducted for the most part by amateurs but none the less interesting for all that. The next effort was made in the United States and came from the pen of a psychiatrist, Aaron J. Rosanoff, who added a short glossary to the sixth edition of his textbook, A Manual of Psychiatry (1927, 204), which was reprinted unchanged in the seventh edition (1938, 159-60). Rosanoff's knowledge of the lingo presumably came from homosexual patients, and that he felt a need to include a glossary of the words he had learned reflects the great expansion of the gay world in large American cities in the sexually freer years following the First World War. Perhaps the best view of that world is offered by "Robert Scully"'s campy novel, A Scarlet Pansy (1932), which takes its main characters, Fay Étrange (who comes from Kuntsville "in the lower Pennsylvania hills") , Henri Voyeur, and Percy Chichi, on a transcontinental grand tour of United States gaydom, showing them meeting Beaches and Bütsches and Beach-Bütsches wherever they go, and which incidentally provides the lexicographer with his best evidence from fiction of the gay slang of the period. The history of the New York scene at this time is covered in Chauncey (1994), while there is also much evidence of the period, despite the ostensible theme, in White (1993). Ullman (1995) uncovers a gay colony in southern California in 1914, who were the earliest known users of the word queer. Rosanoff's modest gathering of twenty-one terms was followed in 1941 by a far more substantial effort, "The Language of Homosexuality ," by the then twenty-four-year-old Gershon Legman, who went on to become the greatest erotic...

Validating Kraepelin's two types of depressive mixed states: ‘depression with flight of ideas’ and ‘excited depression’

SummaryDespite a venerable classic tradition going back to at least Kraepelin, depressive mixed states (DMX) are not represented in official diagnostic manuals in psychiatry. We have operationalised this condition as a major depressive episode (MDE) with three or more intra-episode hypomanic signs and symptoms (DMX3). Of 320 consecutive bipolar II outpatients, presenting for MDE treatment and interviewed using the Structured Clinical Interview for DSM-IV, modified to permit the systematic evaluation of hypomanic features during the index MDE, 200 met our criteria for DMX3 (62.5%). When compared with the remaining non-DMX bipolar II, they had significantly earlier age at onset, higher percentage of females, atypical features and bipolar family history. Multivariate logistic regression of intra-MDE hypomanic signs and symptoms found evidence supporting an “excited depression” subtype (defined by the core feature of psychomotor agitation, and further characterised by talkativeness, irritable mood and distractability) and a “depression with flight of ideas” subtype (defined by the core feature of racing/crowded thoughts, and further characterised by risky pleasurable impulses including, among others, those with intense sexual arousal). We thereby documented the existence of two distinct DMX subtypes which testify to the clinical acumen of Kraepelin (and his pupil Weygandt) who in 1899 described these two subforms of depressive mixed states in more severely ill hospitalised patients.

Medical education in a multilingual and multicultural world

Medical education in a multilingual and multicultural world

The foetus as a personality. By A.W. Liley, 1972.

I did not choose the title of this presentation. Had I done so, I would have been more careful in my selection of words. The foetus is part of my province of medical practice, and personality is part of yours. But whereas I am sure that you could all define, describe and even recognize a foetus, I am not so confident that I can define personality. One dictionary offers 'what constitutes an individual as a distinct person,' but does not define what the 'what' is. Another dictionary asserts 'the state of existing as a thinking intelligent being.' This definition might lead to the inference that personality increases pro rata with intelligence, or that some people may not have a personality at all if we followed Bertrand Russell's dictum that 'most people would rather die than think and many, in fact, do!' My copy of the late Ken Stallworthy's Manual of Psychiatry is more help with the definition that 'personality is the individual as a whole with everything about him which makes him different from other people,' because we can certainly distinguish foetuses from each other and from other people. With the next sentence-'personality is determined by what is born in the individual in the first place and by everything which subsequently happens to him in the second'-we are really in business. Not only can I tell you what is apparent of what is born in the foetus, but I can also describe the environment in which he lives, the stimuli to which he is exposed, and the responses which he displays. Therefore it might have been more apt to title this presentation 'A day in the life of the foetus,' and together we can revisit a stage of life which we all experienced but which, superficially at least, none of us remembers. Such a journey is justified for several reasons. For many centuries interest in foetal life was restricted to anatomical studies by embryologists or to mechanical problems in delivery as they presented to the accoucheur. The legacies of this era are well known-particularly the attitude that, apart from some aimless kicking which began in the fifth month, the foetus was a placid, dependent, fragile vegetable who developed quietly in preparation for a life which started at birth. In the present century, many disciplines have extended their interests to include the foetus, but in fields from surgery to psychiatry the tendency has been to start with adult life and work backwards-knowing what the adult state was, one worked back to what seemed a reasonable starting point to reach that goal. Therefore, in fields from physiology and biochemistry to education and psychology, there has grown up the habit of regarding the foetus and the neonate as a poorly functioning adult rather than as a splendidly functioning baby. Until recently, the human foetus in situ was inaccessible to study and this seclusion has had two further unfortunate results. First, much reliance has been placed on animal experiment in spite of the fact that there is more variation throughout the mammalian order in reproductive physiology than in the physiology of any other body function. second, for want of experimental verification or repudiation, theories have flourished without serious challenge. As a consequence, at one extreme, J.J. Rousseau and his pupils could regard the foetus as a witless tadpole with a mind like a cleanly washed slate-the tabula rasa-and at the other extreme some interpreters of dreams considered the foetus a skilled voyeur, spying on his parents having intercoursea sort of 'what the butler saw' through the cervix. If, with regret, we must abandon such fascinating conjecture, I hope that we can replace it with equally interesting fact, because recent advances in foetal diagnosis and therapy have provided both the technology and opportunity to piece together a new picture of the foetus. Far from being an inert passenger in a pregnant mother, the foetus is very much in command of the pregnancy. It is the foetus who guarantees the endocrine success of pregnancy and induces all manner of changes in maternal physiology to make her a suitable host. …

A Clinical Manual of Psychiatry

A Clinical Manual of Psychiatry

Foundations of Clinical Psychiatry; A Clinical Manual of Psychiatry

Back to table of contents Previous article Next article ArticleNo AccessFoundations of Clinical Psychiatry; A Clinical Manual of PsychiatrySTUART C. YUDOFSKYSTUART C. YUDOFSKYSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.140.1.119AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "Foundations of Clinical Psychiatry; A Clinical Manual of Psychiatry." American Journal of Psychiatry, 140(1), pp. 119–120 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited ByNone Volume 140Issue 1 January 1983Pages 119-120 Metrics PDF download History Published online 1 April 2006 Published in print 1 January 1983