Seventh EditionNiraj Ahuja MBBS MD MRCPsych Consultant Psychiatrist Newcastle Upon Tyne, UK Formerly Associate Professor (Psychiatry) GB Pant Hospital and Associated Maulana Azad Medical College (MAMC) and Lok Nayak Hospital, New Delhi, India Formerly also at Department of Psychiatry Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry Lady Hardinge Medical College (LHMC) and Smt. SK Hospital, New Delhi All India Institute of Medical Sciences (AIIMS), New Delhi, India Contributing Editor Savita Ahuja MBBS DGO DFSRH DRCOG
Jitendar P Vij
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A Short Textbook of Psychiatry
© 2011, Niraj Ahuja
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition: 1990
Second Edition: 1992
Third Edition: 1995
Fourth Edition: 1999
Fifth Edition: 2002
Sixth Edition: 2006
Seventh Edition: 2011
Typeset at JPBMP typesetting unit
For Manisha and NehaPreface to the Seventh Edition
It is rather humbling to consider that it has been two decades that the Short Textbook of Psychiatry has enjoyed a wide distribution among the undergraduate medical students, interns, junior residents, postgraduate psychiatry students, nursing students, psychology and psychiatric social work students, occupational therapy and physiotherapy students, general medical practitioners, other physicians and health professionals in India and some other countries. I am really indebted to the many astute readers who have provided a very constructive and useful feedback, along with encouraging comments regarding the existing format and the contents of the book.
The seventh edition of the Short Textbook of Psychiatry has been once again extensively revised and updated. Significant changes have been made in almost all the chapters, especially in chapters on diagnosis and classification, psychoactive substance use disorders, psychopharmacology, schizophrenia, mood disorders and other biological methods of treatment. Coloured-shaded boxes have been added at various places in the text to highlight the important points in tables and figures. The chapter on psychiatric history and examination contains a summary of laboratory tests in psychiatry, in additions to other significant changes. The appendices have been revised and contain a glossary of common psychiatric terms.
The Short Textbook of Psychiatry sincerely hopes to retain its original aim of providing a brief yet comprehensive account of the psychiatric disorders and their allied aspects in a ‘user-friendly’ and ‘easy-to-follow’ manner.
I am grateful to Shri Jitendar P Vij, Chairman and Managing Director, Jaypee Brothers Medical Publishers (P) Ltd for his exquisite control over the production and distribution of the Short Textbook of Psychiatry over the last 20 years.
I hope you enjoy reading the book and I warmly welcome critical comments and constructive suggestions. Please send your comments by email to STBPsy@gmail.com.
Niraj AhujaPreface to the First Edition
Psychiatry, as a branch of Medicine, has been cold-shouldered by physicians for a long time. There are various reasons for such an attitude. But, the most important exposition is an unfamiliarity with the psychiatric disorders and their treatment. This is easy to understand in the light of the fact that an easily comprehensible, non-intimidating and concise text on psychiatry was not earlier available.
Recently too, the various postgraduate entrance examinations have laid an increasing emphasis on psychiatry and its related branches. Keeping this in mind, the Medical Examination Reviewabove the midpoint, on a —Psychiatry (Multiple Choice Questions with Explanatory Answers) was written, the new edition of which appears this year. Its tremendous success during the last four years and encouraging suggestions from the readers have been a source of stimulation for drafting this text.
The Short Textbook of Psychiatry aims to provide a brief yet comprehensive account of psychiatric disorders and their allied aspects. While striving to make the book simple and easy-to-follow, an attempt has been made to keep the book aligned to the most recent developments in classification, terminology and treatment methods.
The Short Textbook of Psychiatry is addressed to medical students, interested physicians and other health professionals. A postgraduate student in psychiatry will find the text elementary and basic, although a first year postgraduate will find it useful for a broad introduction to the subject.
I will like to put on record my deep appreciation for Shri Jitendar P Vij, Managing Director; Mr. Pawaninder Vij, Production Manager and their efficient staff at the Jaypee Brothers Medical Publishers (P) Ltd, New Delhi for bringing out this volume in a short time.
I welcome critical comments and constructive suggestions from the readers.