Introductory textbook of psychiatry pdf download

The Study Guide mirrors these strengths, and the resulting volume is accessible, easy to use, interesting, and highly readable.

The guide builds on the text's many case vignettes, useful clinical "pearls," and a multitude of self-assessment questions, covering everything a student new to psychiatry needs to know. The Introductory Textbook of Psychiatry is designed to provide medical students, beginning residents, and others with a solid foundation and orientation to the field, and the Study Guide is the perfect companion volume to the classic text, reinforcing critical concepts and testing retention of indispensable information.

The text has been honed over five editions and displays a fluency, authority and insight which is not only rarely found but makes the process of assimilating information as smooth and enjoyable as possible.

The book provides an introduction to all the clinical topics required by the trainee psychiatrist, including all the sub-specialties and major psychiatric conditions. Throughout, the authors emphasize the basic clinical skills required for the full assessment and understanding of the patient.

Discussion of treatment includes not only scientific evidence, but also practical problems in the management of patients their family and social context. The text emphasizes an evidence-based approach to practice and gives full attention to ethical and legal issues. Introductory chapters focus on recognition of signs and symptoms, classification and diagnosis, psychiatric assessment, and aetiology. Further chapters deal with all the the major psychiatric syndromes as well as providing detailed coverage of pharmacological and psychological treatments.

The book gives equal prominence to ICD and DSM classification - often with direct comparisons - giving the book a universal appeal. The Shorter Oxford Textbook of Psychiatry remains the most up-to-date secondary level textbook of psychiatry available, with the new edition boasting a new modern design and greater use of summary boxes, tables, and lists than ever before.

Subsequent chapters cover child psychiatry, the psychiatry of old age, intellectual disability, forensic psychiatry, substance misuse, suicide, and self-harm, and psychiatry in medical settings. After a new chapter on global mental health, two chapters cover psychological and psychopharmacological treatments: their indications, efficacy, side effects, and mechanisms. The final chapter describes how psychiatric services are organized. As mentioned Shorter Oxford Textbook of Psychiatry book is popular among all the med school students across the globe.

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Your email address will not be published. When not called circumstantial, these people are often referred to as long-winded. Although it may coexist with instances of poverty of content of speech or loss of goal, circumstantiality differs from poverty of content of speech in containing excessive amplifying or illustrative detail and from loss of goal in that the goal is eventually reached if the person is allowed to talk long enough.

It differs from derailment in that the details presented are closely related to some particular goal or idea and that the particular goal or idea must, by definition, eventually be reached unless the patient is interrupted by an impatient interviewer. Pressure of speech. The patient has an increase in the amount of spontaneous speech as compared with what is considered ordinary or socially customary. The patient talks rapidly and is difficult to interrupt.

Pressured speech is often seen in mania but can be found in other syndromes as well. Some sentences may be left uncompleted because of eagerness to get on to a new idea. Simple questions that could be answered in only a few words or sentences are answered at great length so that the answer takes minutes rather than seconds and indeed may not stop at all if the speaker is not interrupted.

Even when interrupted, the speaker often continues to talk. Speech tends to be loud and emphatic. Sometimes speakers with severe pressure will talk without any social stimu- 42 Introductory Textbook of Psychiatry lation and talk even though no one is listening. When patients are receiving antipsychotics or mood stabilizers, their speech is often slowed down by medication, and then it can be judged only on the basis of amount, volume, and social appropriateness. If a quantitative measure is applied to the rate of speech, then a rate greater than words per minute is usually considered rapid or pressured.

This disorder may be accompanied by derailment, tangentiality, or incoherence, but it is distinct from them. Distractible speech. Subject: Then I left San Francisco and moved to…where did you get that tie? I like the warm weather in San Diego. Is that a conch shell on your desk?

Have you ever gone scuba diving? The patient has a pattern of speech in which sounds rather than meaningful relations appear to govern word choice, so that the intelligibility of the speech is impaired and redundant words are introduced in addition to rhyming relationships. This pattern of speech also may include punning associations, so that a word similar in sound brings in a new thought.

If you can make sense out of nonsense, well, have fun. I have to make dollars. Catatonic Motor Behavior Catatonic motor symptoms are not common and should only be considered present when they are obvious and have been directly observed by the clinician or some other professional.

The patient has a marked decrease in reactivity to the environment and reduction of spontaneous movements and activity. The patient may appear to be aware of the nature of his or her surroundings. The patient shows signs of motor rigidity, such as resistance to passive movement. Interviewing and Assessment 43 Waxy flexibility catalepsy.

The patient maintains postures into which he or she is placed for at least 15 seconds. The patient has apparently purposeless and stereotyped excited motor activity not influenced by external stimuli. Posturing and mannerisms.

The patient voluntarily assumes an inappropriate or a bizarre posture. Manneristic gestures or tics also may be observed. These involve movements or gestures that appear artificial or contrived, are not appropriate to the situation, or are stereotyped and repetitive.

Patients with tardive dyskinesia may have manneristic gestures or tics, but these should not be considered manifestations of catatonia. Most typically, this manifestation of affective disturbance takes the form of smiling or assuming a silly facial expression while talking about a serious or sad subject. For example, the patient may laugh inappropriately when talking about thoughts of harming another person. Occasionally, patients may smile or laugh when talking about a serious subject that they find uncomfortable or embarrassing.

Although their smiling may seem inappropriate, it is due to anxiety and therefore should not be rated as inappropriate affect. Patients with alogia have thinking processes that seem empty, turgid, or slow. The two major manifestations of alogia are nonfluent empty speech poverty of speech and fluent empty speech poverty of content of speech. Blocking and increased latency of response also may reflect alogia. Poverty of speech. The patient has a restricted amount of spontaneous speech, so that replies to questions tend to be brief, concrete, and unelaborated.

Unprompted additional information is rarely provided. Replies may be monosyllabic, and some questions may be left unanswered altogether. When confronted with this speech pattern, the interviewer may find himself or herself frequently prompting the patient, to encourage elaboration 44 Introductory Textbook of Psychiatry of replies.

To elicit this finding, the examiner must allow the patient adequate time to answer and to elaborate his or her answer. Interviewer: Can you tell me something about what brought you to the hospital?

Subject: A car. Can you tell me something about them? Subject: I dunno. Poverty of content of speech. Language tends to be vague, often overabstract or overconcrete, repetitive, and stereotyped.

The interviewer may recognize this finding by observing that the patient has spoken at some length but has not given adequate information to answer the question. Alternatively, the patient may provide enough information but require many words to do so, so that a lengthy reply can be summarized in a sentence or two.

This abnormality differs from circumstantiality in that the circumstantial patient tends to provide a wealth of detail. Interviewer: Why is it, do you think, that people believe in God? Subject: Well, first of all because He, uh, He are the person that is their personal savior. He walks with me and talks with me. After a period of silence, which may last from a few seconds to minutes, the person indicates that he or she cannot recall what he or she has been saying or meant to say.

Blocking should be judged to be present only if a person voluntarily describes losing his or her thought or if, on questioning by the interviewer, the person indicates that that was his or her reason for pausing. What happened? I forgot what I was going to say. Increased latency of response. The patient takes a longer time to reply to questions than is usually considered normal. He or she may seem Interviewing and Assessment 45 distant, and sometimes the examiner may wonder whether he or she has heard the question.

Prompting usually indicates that the patient is aware of the question but has been having difficulty formulating his or her thoughts to make an appropriate reply. Interviewer: When were you last in the hospital? Subject: second pause A year ago. Interviewer: Which hospital was it? Subject: second pause This one. The patient persistently repeats words, ideas, or phrases so that once a patient begins to use a particular word, he or she continually returns to it in the process of speaking.

Interviewer: Tell me what you are like—what kind of person you are. She lives in Garwin, Iowa. Affective Flattening or Blunting Affective flattening or blunting manifests itself as a characteristic impoverishment of emotional expression, reactivity, and feeling. Other aspects of affect, such as responsivity or appropriateness, will not be affected, however.

Unchanging facial expression. His or her face appears wooden, mechanical, and frozen. Because antipsychotics may partially mimic this effect, the interviewer should be careful to note whether the patient is taking medication. T h e p a t i e n t s i t s q u i e t l y throughout the interview and shows few or no spontaneous movements. He or she does not shift position, move his or her legs, or move his or her hands or does so less than normally expected.

Paucity of expressive gestures. The patient does not use his or her body as an aid in expressing his or her ideas through means such as hand gestures, sitting forward in his or her chair when intent on a subject, or leaning back when relaxed. Paucity of expressive gestures may occur in addition to decreased spontaneous movements. Poor eye contact. The patient avoids looking at others or using his or her eyes as an aid in expression.

He or she appears to be staring into space even when he or she is talking. The interviewer should consider the quality as well as the quantity of eye contact. Affective nonresponsivity. The patient fails to smile or laugh when prompted. This function may be tested by smiling or joking in a way that would usually elicit a smile from a psychiatrically normal individual.

Lack of vocal inflections. While speaking, the patient fails to show normal vocal emphasis patterns. Speech has a monotonic quality, and important words are not emphasized through changes in pitch or volume. The patient also may fail to change volume with changes of content, so that he or she does not drop his or her voice when discussing private topics or raise it as he or she discusses things that are exciting or for which louder speech might be appropriate.

Avolition-Apathy Avolition-apathy manifests itself as a characteristic lack of energy and drive. Patients become inert and are unable to mobilize themselves to initiate or persist in completing many different kinds of tasks.

Unlike the diminished energy or interest of depression, the avolitional symptom complex in schizophrenia usually is not accompanied by saddened or depressed affect. The avolitional symptom complex often leads to severe social and economic impairment. Grooming and hygiene.

The patient pays less attention to grooming and hygiene than is normal. Clothing may appear sloppy, outdated, or soiled. He or she may bathe infrequently and not care for his or her hair, nails, or teeth—leading to manifestations such as greasy or uncombed hair, dirty hands, body odor, or unclean teeth and bad breath. Overall, Interviewing and Assessment 47 the appearance is dilapidated and disheveled.

In extreme cases, the patient may even have poor toilet habits. Impersistence at work or school. The patient has difficulty in seeking or maintaining employment or doing schoolwork as appropriate for his or her age and gender.

If a student, he or she does not do homework and may even fail to attend class. Grades will tend to reflect this. If a college student, he or she may have registered for courses but dropped several or all of them. If of working age, the patient may have found it difficult to work at a job because of an inability to persist in completing tasks and apparent irresponsibility.

He or she may go to work irregularly, wander away early, fail to complete expected assignments, or complete them in a disorganized manner. He or she may simply sit around the house and not seek any employment or seek it only in an infrequent or desultory manner.

If a homemaker or a retired person, the patient may fail to complete chores, such as shopping or cleaning, or complete them in a careless and half-hearted way. If in a hospital or an institution, he or she does not attend or persist in vocational or rehabilitative programs effectively. Physical anergia. The patient tends to be physically inert; he or she may sit in a chair for hours at a time and not initiate any spontaneous activity.

If encouraged to become involved in an activity, he or she may participate only briefly and then wander away or disengage himself or herself and return to sitting alone. He or she may spend large amounts of time in some relatively mindless and physically inactive task such as watching television or playing solitaire. It may express itself as a loss of interest in 48 Introductory Textbook of Psychiatry pleasurable activities, an inability to experience pleasure when participating in activities normally considered pleasurable, or a lack of involvement in social relationships of various kinds.

Recreational interests and activities. The patient may have few or no interests, activities, or hobbies. Although this symptom may begin insidiously or slowly, there will usually be some obvious decline from an earlier level of interest and activity. Patients with relatively milder loss of interest will engage in some activities that are passive or nondemanding, such as watching television, or will show only occasional or sporadic interest.

Patients with the most extreme loss will appear to have a complete and intractable inability to become involved in or enjoy activities.

The evaluation in this area should take both the quality and the quantity of recreational interests into account. How often do you do those things? Have you been attending recreational therapy? What have you been doing? Do you enjoy it? Sexual interest and activity. In extreme cases, the patient may not engage in sex at all. Single patients may go for long periods without sexual involvement and make no effort to satisfy this drive.

Whether married or single, patients may report that they subjectively feel only minimal sex drive or that they take little enjoyment in sexual intercourse or in masturbatory activity even when they engage in it. Have you been able to enjoy sex lately? What is your usual sexual outlet?

When was the last time you engaged in sexual activity? Ability to feel intimacy and closeness. The patient may be unable to form intimate and close relationships of a type appropriate for his or her age, gender, and family status.

In the case of a younger person, this area should be evaluated in terms of relationships with the opposite sex and with parents and siblings. In the case of an older person who is Interviewing and Assessment 49 married, the relationship with the spouse and with children should be evaluated, whereas unmarried individuals should be judged in terms of opposite- or same-sex relationships or relationships with family members who live nearby. Patients may show few or no feelings of affection to available family members, or they may have arranged their lives so that they are completely isolated from any intimate relationships, live alone, and make no effort to initiate contacts with family or others.

Relationships with friends and peers. Patients also may be relatively restricted in their relationships with friends and peers of either gender. They may have few or no friends, make little or no effort to develop such relationships, and choose to spend all or most of their time alone.

Are you very close to them? How often do you see them? What do you do together? Have you gotten to know any patients in the hospital? Attention Attention is often poor in patients with severe mental illnesses.

The patient may have trouble focusing his or her attention or may be able to focus only sporadically and erratically. He or she may ignore attempts to converse with him or her, wander away while in the middle of an activity or a task, or appear to be inattentive when engaged in formal testing or interviewing.

He or she may or may not be aware of the difficulty in focusing attention. Social inattentiveness. While involved in social situations or activities, the patient appears inattentive. He or she looks away during conversations, does not pick up the topic during a discussion, or appears uninvolved or disengaged. He or she may abruptly terminate a discussion or a task without any apparent reason. The patient may perform poorly on simple tests of intellectual functioning despite adequate education and intellectual ability.

Inattentiveness should be assessed by having the patient spell world or some equivalent five-letter word backward and by serial 7s at least a 10th-grade education or serial 3s at least a 6th-grade education for a series of five subtractions. Manic Symptoms Euphoric mood. The patient has had one or more distinct periods of euphoric, irritable, or expansive mood not due to alcohol or drug intoxication.

Increase in activity. The patient shows an increase in involvement or activity level associated with work, family, friends, sex drive, new projects, interests, or activities e.

The patient has the subjective experience that his or her thinking is markedly accelerated. Inflated self-esteem. The patient has increased self-esteem and appraisal of his or her worth, contacts, influence, power, or knowledge may be delusional as compared with his or her usual level. Persecutory delusions should not be considered evidence of grandiosity unless the patient feels persecution is due to some special attributes e. Decreased need for sleep. The patient needs less sleep than usual to feel rested.

This rating should be based on the average of several days rather than a single severe night. For example, the patient gets up and inspects some item in the room while talking or listening, shifts his or her topic of speech, and so forth.

Poor judgment. The patient shows excessive involvement in activities that have a high potential for painful consequences that are not recognized e. Depressive Symptoms Dysphoric mood. The patient feels sad, despondent, discouraged, or unhappy; significant anxiety or tense irritability also should be rated as a dysphoric mood. The evaluation should be made irrespective of length of mood. The patient has had significant weight change. This should not include change due to dieting, unless the dieting is associated with some depressive belief that approaches delusional proportions.

Insomnia or hypersomnia. Insomnia may include waking up after only a few hours of sleep as well as difficulty in getting to sleep. Patterns of insomnia include initial trouble going to sleep , middle waking in the middle of the night but eventually falling asleep again , and terminal waking early—e. What was it like? Do you have trouble falling asleep? Do you wake up too early in the morning? Have you been sleeping more than usual? How much sleep do you get in a typical hour period? Psychomotor agitation.

The patient is unable to sit still, with a need to keep moving. Do not include mere subjective feelings of restlessness. Objective evidence e. Psychomotor retardation. The patient feels slowed down and experiences great difficulty moving. Do not include mere subjective feelings of being slowed down.

Loss of interest or pleasure. The patient has loss of interest or pleasure in usual activities or a decrease in sexual drive. This may be similar to the anhedonia seen in psychosis. In the depressive syndrome, loss of interest or pleasure is invariably accompanied by intense, painful affect, whereas in psychosis, the affect is often blunted. Loss of energy.

The patient has a loss of energy, becomes easily fatigued, or feels tired. Feelings of worthlessness. In addition to feelings of worthlessness, the patient may report feelings of self-reproach or excessive or inappropriate guilt. Either may be delusional.

Diminished ability to think or concentrate. The patient complains of diminished ability to think or concentrate, such as slowed thinking or indecisiveness, not associated with marked derailment or incoherence. The patient has thoughts about death and dying, plus possible wishes to be dead or to take his or her life. Distinct quality to mood. If the patient has not lost a loved one, ask him or her to compare the feelings with those after some significant personal loss appropriate to his or her age and experience.

Nonreactivity of mood. The patient does not feel much better, even temporarily, when something good happens. Diurnal variation. Some patients feel terrible in the morning but feel steadily better as the day goes on and even near normal in the evening. Others feel good in the morning and worse as the day progresses. In the evening? Or is it about the same all the time?

Anxiety Symptoms Panic attacks. The patient has discrete episodes of intense fear or discomfort in which a variety of symptoms occur, such as shortness of breath, dizziness, palpitations, or shaking. In many patients, however, the fear is more generalized and involves being afraid of being in a place or situation from which escape might be difficult. Interviewing and Assessment 55 Social phobia.

The patient has a fear of being in some social situation in which he or she will be seen by others and may do something that he or she might find to be humiliating or embarrassing. Some common social phobias include fear of public speaking, fear of eating in front of others, and fear of using public bathrooms. Specific phobia. The patient is afraid of some specific circumscribed stimulus, such as animals e. The sight of blood? Air travel? Do you have any other specific fears?

The patient experiences persistent ideas, thoughts, or impulses that are unwanted and experienced as unpleasant. The patient tends to ruminate and worry about them.

The patient may try to ignore or suppress them but typically finds this difficult. Some common obsessions include repetitive thoughts of performing a violent act or becoming contaminated by touching other people or inanimate objects, such as a doorknob.

The patient has to perform specific acts over and over in a way that he or she recognizes to be senseless or inappropriate. The compulsions are usually performed to ease some worry or obsession or to prevent some feared event from occurring. For example, a patient may have the worry that he or she has left the door unlocked and must return to check it repeatedly. Obsessions about contamination may lead to repetitive hand washing. Obsessions about thoughts of violence may lead to ritualistic behavior designed to prevent injury to the person about whom violence has been imagined.

Describe several techniques that are important for concluding the initial interview with a patient. Enumerate the components of a standard psychiatric history, giving each of the main headings of the overall outline. Summarize the major components of the mental status examination. List and describe at least four of the positive symptoms of psychosis. Give examples of several typical kinds of delusions and hallucinations. List and describe at least four negative symptoms.

List and define some of the symptoms observed in depression. List and define some of the symptoms observed in mania.

List and define some of the symptoms observed in anxiety and phobic disorders. Chapter 3 The Neurobiology and Genetics of Mental Illness Men ought to know that from the brain, and from the brain only, arise our pleasures, joys, laughter, and jests, as well as our sorrows, pains, griefs, and fears. Through it, in particular, we think, see, hear. The human brain has created and invented the myriad achievements that surround us every day—skyscrapers, computers, complex economic markets, advances in medical science ranging from vaccines to antibiotics to magnetic resonance scanners, an understanding of quantum mechanics and chaos theory, and art, music, and literature.

These achievements have been accomplished because the human brain is one of the most complex systems in the universe. Composed of more than billion neurons more nerve cells than the stars in the Milky Way , the brain expands its communicating and thinking power by multiplying connectivity through an average of 1,—10, synapses per nerve cell.

The whole human brain system is composed of feedback loops and circuits composed of multiple neurons, further expanding the fine-tuning and thinking capacities.

The abilities that we all have to think, feel emotions, and relate to other people in normal ways depend on the activity of this complex organ. The disturbances in thought, emotion, and behavior that we observe in the 57 58 Introductory Textbook of Psychiatry mentally ill also are ultimately due to aberrations in the brain. Understanding those brain aberrations—and correcting them—is our ultimate challenge. Modern psychiatry stretches from mind to molecule and from clinical neuroscience to molecular biology as it attempts to understand how aberrations in thinking and behavior are rooted in underlying biological mechanisms.

During the past several decades neuroscience has grown to become one of the largest domains of scientific research. This chapter provides a selective overview of a few topics from neurobiology that are relevant to understanding either the symptoms or treatment of mental illnesses. The systems that are of special interest to psychiatry are those that represent circuitry or functions that are particularly disturbed in mental illnesses.

Three important anatomical systems are the prefrontal system, the limbic system, and the basal ganglia system. Important functional systems include the executive function, memory, language, attention, and reward systems. Any method for dividing the brain into parts or systems is somewhat arbitrary because the three anatomical systems are all interconnected with one another and work interactively. The functional systems are also highly interdependent with one another and with the prefrontal, limbic, and basal ganglia systems as well.

These oversimplifications are introduced purely for conceptual convenience, providing a strategy for reducing the overwhelming complexity of the central nervous system CNS to a level that permits discussion and analysis. Ultimately, however, a full understanding of the brain can only occur by an ongoing process of analysis or breakdown and simplification as well as synthesis or rebuilding and unifying.

One must add a word of caution about our existing level of ignorance. We do not as yet have a complete map of the human brain, sum- The Neurobiology and Genetics of Mental Illness 59 marizing accurately its various neural circuits and chemical anatomy. This process is ongoing and becoming much more sophisticated, particularly with the aid of neuroimaging techniques such as structural and functional magnetic resonance imaging sMRI and fMRI , diffusion tensor imaging DTI , magnetic resonance spectroscopy MRS , magnetoencephalography MEG , and positron emission tomography PET.

These technologies permit researchers to study the anatomy and physiology of the human brain in ways that were previously impossible. Prior to the availability of neuroimaging, our knowledge about circuitry and functional systems was based primarily on lesion and postmortem studies. Directly visualizing how the brain performs mental work with fMRI or PET imaging is clearly more accurate than trying to infer indirectly how it works by observing what it cannot do when parts are missing.

The Prefrontal System and Executive Functions The prefrontal system, or prefrontal cortex, is one of the largest cortical subregions in the human brain. The relative development of the prefrontal cortex in various animal species is shown in Figure 3—1. This huge association region in the brain integrates input from much of the neocortex, limbic regions, hypothalamic and brainstem regions, and via the thalamus most of the rest of the brain.

Its high degree of development in human beings suggests that it may mediate a variety of specifically human functions often referred to as executive functions, such as high-order abstract thought, creative problem solving, and the temporal sequencing of behavior.

Lesion and trauma studies, supplemented by experimental studies in nonhuman primates, have substantially added to this view of the functions of the prefrontal cortex. It is now clear that the prefrontal cortex mediates a large variety of functions, including attention and perception, moral judgment, temporal integration, and affect and emotion. The intactness of the prefrontal cortex can be assessed by a variety of cognitive tasks, and it has been explored through neuroimaging as well.

Introductory Textbook of Psychiatry Phylogenetic development of the prefrontal cortex. New York, Raven Press, The Neurobiology and Genetics of Mental Illness 61 duce frontal lobe activation. Because the negative symptoms of schizophrenia reflect impairment in many frontally mediated functions, researchers have proposed that some patients with schizophrenia might have frontal lobe abnormalities, a finding now supported in numerous anatomical and functional neuroimaging studies.

Abnormalities in frontal lobe structure and function have also been observed in many other disorders, such as mood disorders, obsessive-compulsive disorder, and autism spectrum disorders. There is still no consensus as to what constitutes a clear definition of the limbic system or its components.

As in other brain systems, boundaries can be defined on the basis of cytoarchitectonics, interconnections, or inputs. Walle Nauta later proposed, as a unifying concept, that the various structures in the limbic system share circuitry that connects them to the hypothalamus. He pointed out that the interconnections between the hypothalamus via the mamillary bodies , the amygdala, the hippocampus, and cingulate gyrus are reciprocal. The hypothalamus collects visceral sensory signals from the spinal cord and brainstem, while input also comes to this circuit through two major neocortical association regions, the prefrontal cortex and the inferior temporal association cortex.

The functions of the limbic system are of great importance to the understanding of human emotion. The various interconnections suggest functions related to integrating visceral sensation and the experience of the external environment through multiple modalities e. Lesion, animal, and neuroimaging studies have shown that the amygdala and hippocampus mediate aspects of learning and memory. The Basal Ganglia The major structures of the basal ganglia include the caudate, putamen, and globus pallidus, which are shown schematically in Figure 3—2.

A triplanar view of the caudate and other basal ganglia structures as seen with sMRI is shown in Figure 3—3. The substantia nigra, located in the midbrain, is not visualized.

Interconnections of the basal ganglia. It arches back posteriorly in a circular fashion and then curls forward again, ending in the amygdala bilaterally. Separated from it, and lateral to it, is the lentiform nucleus, so called because it is shaped like a lens.

The medial portion of the lentiform nucleus, which is darker and more densely full of gray matter, is the putamen, whereas the globus pallidus is lateral to it. The caudate is separated from the lentiform nucleus by the anterior limb of the internal capsule, but the sMRI scan shows clearly that bands of gray matter interconnect these two nuclei; posteriorly the lentiform nucleus is separated from the thalamus by the posterior limb of the internal capsule.

This brain region is of importance to the understanding of mental illness for several reasons. First, there are several major syndromes involving abnormalities in these regions that manifest psychiatric symptoms.

Severe dementia may also develop. Loss of pigmented neurons and a decrease in dopaminergic activity produce a variety of symptoms similar to the negative symptoms of schizophrenia, including affective blunting and loss of volition. The basal ganglia are also relevant to psychiatry because of their chemical anatomy.

The caudate and putamen contain a very high concentration of dopamine receptors, particularly D2 receptors. Because D2 receptors have a very high density in these regions, the caudate and putamen may be important sites for antipsychotic drug action. The Memory System The memory system is a major functional brain system that may be impaired in some mentally ill patients.

Deficits in learning and memory are the hallmark of the dementias. Although patients with psychotic disorders do not typically have severe memory deficits, some investigators have speculated that the neural mechanisms of delusions and hallucinations might be based on either abnormal excitability or abnormal connectivity in the neural circuitry used for the encoding, retrieval, and interpretation of memories.

The process of psychotherapy involves the process of learning, which is based in turn on memory; patients who successfully complete a course of psychotherapy have learned new ways of understanding their past experiences and relating to other people. Memory is in fact a diverse set of functions that are mediated in different ways.