Table Of ContentHandbook of
Psychiatric
Diagnostic
Procedures
Handbook of
Psychiatric
Diagnostic
Procedures
Vol. II
RICHARD C. W. HALL, M.D.
Medical Director, Psychiatric Programs
Florida Hospital, Orlando
Director of Research, Monarch Health Corp.
Clinical Professor of Psychiatry
University of Florida, Gainesville
THOMAS P. BERESFORD, M.D.
Chief, Psychiatric Seryice
Veterans Administration Medical Center
Associate Professor of Psychiatry
University of Tennessee Center for the Health Sciences
Memphis, Tennessee
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PRESS LIMITED
International Medical Publishers
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Published in the US by
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Copyright © 1985 by Spectrum Publications, Inc.
Softcover reprint of the hardcover 1st edition 1985
All rights reserved. No part of this book may be reproduced in any form, by
photostat, microfilm, retrieval system, or any other means without prior written
permission of the copyright holder or his licensee.
ISBN-13: 978-94-011-6730-7 e-ISBN-13: 978-94-011-6728-4
DOl: 10.1007/978-94-011-6728-4
THIS BOOK IS DEDICATED TO:
Anne and Ryan
and
Carol, Eddie, Hal, and Charlie
v
Contributors
Suha A. Beller, M.D. Assistant Professor and Director of Clinical Services, Section
on Geriatric Psychiatry, Department of Psychiatry and Behavioral Sciences, Uni
versity of Texas Medical School at Houston, Houston, Texas
Thomas P. Beresford, M.D. Chief, Psychiatry Service, Veterans Administration
Medical Center; Associate Professor of Psychiatry, University of Tennessee Center
for the Health Sciences, Memphis, Tennessee
Fred S. Berlin, M.D., Ph.D. Assistant Professor of Psychiatry, Johns Hopkins
University School of Medicine; Co-Director, Biosexual Psychohormonal Clinic,
Baltimore, Maryland
Monte S. Buchsbaum, M.D. Professor of Psychiatry, Department of Psychiatry and
International Institute on Brain Function and Behavioral Visual Imaging Center,
University of California College of Medicine, Irvine, California
Todd W. Estroff, M.D. Assistant Director, Neuropsychiatric Unit, Fair Oaks Hos
.pital, Summit, New Jersey
Michael Feinberg, M.D., Ph.D. Assistant Professor of Psychiatry, Mental Health
Research Institute, University of Michigan, Ann Arbor, Michigan
Steven R. Gambert, M.D., F.A.C.P. Professor of Medicine; Director, Division of
Gerontology and Geriatric Medicine, Department of Medicine; Director of Center
for Aging and Adult Development, New York Medical College; Director of Gene
tics, Westchester County Medical Center, Valhalla, New York
Mark S. Gold, M.D. Director of Research, Fair Oaks Hospital, Summit, New Jersey
vii
viii Contributors
John F. Grecien, M.D. Professor of Psychiatry, and Director, Clinical Studies Unit,
Mental Health Research Institute, University of Michigan Hospital, Ann Arbor,
Michigan
Richard C. W. Hall, M.D. Medical Director, PsychiatriC Programs, Florida Hospi
tal, Orlando; Clinical Professor of Psychiatry, University of Florida, Gainesville;
Director of Research, Monarch Health Corporation, Marble Head, Massachusetts
Henry H. Holcomb, M.D. Staff Psychiatrist, Laboratory of Psychology and Psy
chopathology, Section on Clinical Brain Imaging, National Institute of Mental
Health, Bethesda, Maryland
Ismet Karacan, M.D., (Med)D.Sc. Professor of Psychiatry and Director of Sleep
Disorders and Research Center, Baylor College of Medicine; Associate Chief of Staff
for Research and Development, Veterans Administration Medical Center, Houston,
Texas
Alvin J. Levenson, M.D. Clinical Professor of Psychiatry, Baylor College of Medi
cine; Chief, Section on Geriatric Psychiatry, Department of Psychiatry and Behav
ioral Sciences, University of Texas Medical School at Houston, Houston, Texas
Dennis G. Low, M.D. Associate Chief, Primary Care, Department of Medicine,
Santa Clara Valley Medical Center; Clinical Assistant Professor of Medicine, Stan
ford University School of Medicine, Palo Alto, California
Thomas B. Mackenzie, M.D. Associate Professor of Psychiatry and Medicine, Uni
versity of Minnesota Medical School, Minneapolis, Minnesota
Michael K. Popkin, M.D. Professor of Psychiatry and Medicine, and Chief, Con
sultation/Liaison Section, University of Minnesota Medical School, Minneapolis,
Minnesota
Maurice Rappaport, M.D., Ph.D. Academic Administrator, Langley-Porter Insti
tute, University of California, San Francisco; Director, University of California
Brain Function Study Unit, Research Department, Agnews State Hospital, San
Jose, California
Bernard Saltzberg, Ph.D. Head, Information Analysis, Texas Research Institute
of Mental Sciences, Texas Medical Center; Professor of Psychiatry, University of
Texas Medical School at Houston; Adjunct Professor of Neurology, Baylor College
of Medicine; Adjunct Professor, Biomedical Engineering, Rice University, Houston,
Texas
Contributors ix
Fredrick W. Schaerf, M.D., Ph.D. Department of Psychiatry and Behavioral Sci
ences, Johns Hopkins University School of Medicine, Baltimore, Maryland
Frederick A. Struve, Ph.D. Professor of Psychiatry and Behavioral Science, Eastern
Virginia Medical School, Norfolk, Virginia; Hampton Veterans Administration
Medical Center, Hampton, Virginia
William L. Webb, Jr., M.D. Vice-President and Medical Director, The Sheppard
and Enoch Pratt Hospital, Baltimore (Towson), Maryland
Daniel R Weinberger, M.D. Chief, Clinical Neuropsychiatry Section, and Staff
Psychiatrist, Adult Psychiatry Branch, Intramural Research Program, National In
stitute of Mental Health, St. Elizabeth's Hospital, Washington, D.C.
Robert L. Williams, M.D. Chairman and Professor, Department of Psychiatry,
Baylor College of Medicine, Houston, Texas
Thomas N. Wise, M.D. Chairman, Department of Psychiatry, Fairfax Hospital;
Falls Church, Virginia; Professor of Psychiatry, Georgetown University Medical
Center, Washington, D.C.; Professor of Psychiatry, Johns Hopkins University
School of Medicine, Baltimore, Maryland
Preface
The first volume of this Handbook discussed neuroendocrine diagnostic tests
and the diagnostic use of central nervous system amine metabolites. That volume
further reviewed the toxicological evaluation of patients and the laboratory evalua
tion of treatment outcome. It suggested a system for evaluating newly admitted
psychiatric patients and dermed the scope of diagnostic procedures available in
the emergency department. Volume II focuses on the use and interpretation of
electro physiologic and radiologic diagnostic tests in psychiatry and then explores
the laboratory evaluation of special groups of patients.
The clinical sections of this volume are designed to assist the physician in in
stituting a proper workup for specific patients and defining tests which will assist
them in the differential diagnosis of various psychiatric disorders. Such workups
are critical to exclude possible organic disorders which can present with psychia
tric symptoms.
The workup suggested for the various classes of patients will assist the clini
cian with differential diagnosis, provide base-line information for long-term follow
up, delineate biological perimeters at the beginning of treatment, protect the pa
tient from unrecognized cardiac, renal, hepatic, or endocrine disorders which could
be adversely affected by the administration of medications, and provide a rational
sequencing of workup for particular disorders to insure the most thorough yet cost
efficient approach to the patient.
The final section of this volume deals with future directions in laboratory diag
nosis in psychiatry. It is meant to stimulate the reader's interest and curiosity con
cerning techniques that will likely be available to him in the near future, if not
currently.
It is hoped that these volumes will provide the practicing physician with a
state-of-the-art and clinically useful approach to laboratory diagnosis in psychiatry.
RICHARD C. W. HALL, M.D.
THOMAS P. BERESFORD, M.D.
xi
Contents
Contributors vii
Preface
ELECTROPHYSIOLOGIC DIAGNOSTIC TESTS
1. Clinical Electroencephalography as an Assessment Method
49
in Psychiatric Practice
Frederick A. Struve
2. Sleep Electroencephalography 73
Ismet Karacan and Robert L. Williams
3. Identification of Melancholia Using EEG Studies of Sleep 81
Michael Feinberg
4. Tests of Psychomotor Function 97
John F. Greden
5. Evoked Potentials 135
Maurice Rappaport
6. Special Electrophysiological Tests: Brain Spiking, EEG
Spectral Coherence 137
Bernard Saltzberg
RADIOLOGIC TESTS
7. The Role of X-Ray Computed Tomography (CT) 153
Daniel R. Weinberger
xiii
xiv Contents
LABORATORY EVALUATION FOR SPECIAL
GROUPS OF PATIENTS
8. The Alcoholic Patient 171
Dennis G. Low, Thomas P. Beresford, and Richard C. W. Hall
9. The Patient with Anorexia Nervosa or Bulimia 181
William L. Webb, Jr.
10. The Provisional Diagnosis of Dementia: Three Phases
of Evaluation 197
Michael K. Popkin and Thomas B. Mackenzie
11. The Comprehensive Evaluation of Cocaine and
Opiate Abusers 213
Mark S. Gold and Todd W. Estroff
12. Evaluation of the Geriatric Patient 231
Alvin J. Levenson and Suha A. Beller
m
13. Diagnostic Approaches to Sexuality in the Medically 237
Thomas N. Wise and Chester W. Schmidt, Jr.
14. Laboratory Assessment of the Paraphilias and Their
Treatment with Antiandrogenic Medication 273
Fred S. Berlin and Frederick W. Schaerf
FUTURE DIRECTIONS
15. The Endorphins 309
Steven R. Gambert
16. Computerized Psychiatric Practice 319
Thomas P. Beresford and Richard C. W. Hall
17. Positron Emission Transaxial Tomography 327
Monte S. Buchsbaum and Henry H. Holcomb
Index 345
