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KAPLAN & SADOCK’S
Study Guide and Self-Examination
Review in Psychiatry
Ninth Edition
i
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ii
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KAPLAN & SADOCK’S
Study Guide and
Self-Examination Review
in Psychiatry
NINTH EDITION
Benjamin James Sadock, M.D.
MenasS.GregoryProfessorofPsychiatry,
NewYorkUniversitySchoolofMedicine;
AttendingPsychiatrist,TischHospital;
AttendingPsychiatrist,BellevueHospitalCenter;
HonoraryMedicalStaff,LenoxHillHospital,
NewYork,NewYork
Virginia Alcott Sadock, M.D.
ProfessorofPsychiatry,DepartmentofPsychiatry,
NewYorkUniversitySchoolofMedicine;
AttendingPsychiatrist,TischHospital;
AttendingPsychiatrist,BellevueHospitalCenter,
NewYork,NewYork
Pedro Ruiz, M.D.
ProfessorandExecutiveViceChairman,
DepartmentofPsychiatryandBehavioralSciences,
UniversityofMiamiMillerSchoolofMedicine,
Miami,Florida
President,WorldPsychiatricAssociation(2011–2014)
iii
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Preface
ThisnintheditionofStudyGuideandSelf-ExaminationReview ClinicalPsychiatrycoversjustthediagnosisandtreatmentofallpsy-
inPsychiatrystandsaloneasaseparatetextbook.Intheformof chiatricdisorders.Otherpartsofthesystemarethepockethandbooks:
questionsandanswers,itcanserveasaguidetotheentirefieldof PocketHandbookofClinicalPsychiatry,PocketHandbookofPsychiatric
psychiatryandthebehavioralsciences.Questionsaredesigned DrugTreatment,PocketHandbookofEmergencyPsychiatricMedicine,
andPocketHandbookofPrimaryCarePsychiatry.Thesebookscover
toexaminetheetiology,diagnosis,andtreatmentofeveryknown
thediagnosisandthetreatmentofmentaldisorders,psychopharmacol-
psychiatricdisorder.Athoroughdiscussioncoversnotonlycor-
ogy,psychiatricemergencies,andprimarycarepsychiatry,respectively,
rectanswersbutalsowronganswers.Bycarefullystudyingboth
andarecompactlydesignedandconciselywrittentobecarriedinthe
questionsandanswers,thereaderwillgainathoroughunder-
pocketbyclinicalclerksandpracticingphysicians,whatevertheirspe-
standing of material useful to prepare for examinations of all cialty,toprovideaquickreference.Finally,ComprehensiveGlossaryof
types. PsychiatryandPsychologyprovidessimplywrittendefinitionsforpsy-
Thisbookwaswrittentomeettheneedsofmedicalstudents, chiatristsandotherphysicians,psychologists,students,andothermental
psychiatricphysicians,andmentalhealthprofessionalsfromall healthprofessionals.Together,thesebookscreateamultipleapproach
fields.Itisdesignedespeciallytohelpthosepreparingforthe toteaching,studying,andlearningofpsychiatry.
UnitedStatesMedicalLicensingExamination(USMLE)andthe
AmericanBoardofPsychiatryandNeurology(ABPN);itwill HOW TO USE THIS BOOK
alsoproveofvaluetoallwhowanttotesttheirknowledgein
psychiatryaspartoftheircontinuingmedicaleducation. Eachchapterbeginswithanintroductionthatemphasizesareas
Theauthorshaveaddednewanddifferentquestionstoeach ofspecialsignificanceaboutwhichthestudentshouldbeaware.
editionofStudyGuideandmodifiedandupdatedmaterialfrom Theauthorshavealsopreparedlistsofhelpfulhintsthatpresent
earliereditions.ThisStudyGuidecontainsmorethan1,500ques- keytermsandconceptsessentialtoabasicknowledgeofpsy-
tions,morethananyotherbookofitskind,andtheformatofeach chiatry.Studentsshouldbeabletodefineanddiscusseachofthe
questionisstandardizedtofollowthatusedbytheUSMLEand termsindepthaspreparationforexaminations.
ABPN.Inaddition,theallocationoftopicsiscarefullyweighted ThesectionObjectiveExaminationsinPsychiatryprovides
withattentiontobothclinicalandtheoreticalissues. thestudentwithhelpfulhintsonhowtotaketheexaminations.If
TheauthorsofthelasteditionofStudyGuideareparticularly thestudentunderstandshowquestionsareconstructed,hisorher
pleasedthatPedroRuiz,M.D.,aclosepersonalandprofessional chancesofansweringcorrectlyaregreatlyimproved.Thisbook
associateandoutstandingacademician,hasjoinedthemasthird definesdistracters(wronganswers)aswellascorrectanswers
author.Dr.RuizisProfessorandExecutiveViceChairmanofthe ineachdiscussion.
DepartmentofPsychiatryandBehavioralSciencesattheUniver- Tousethisbookmosteffectively,thestudentshouldattempt
sityofMiamiMillerSchoolOfMedicine.Hewaspast-president toanswerallthequestionsinaparticularchapter.Byallowing
oftheAmericanPsychiatricAssociationandisthecurrentpres- about1minuteforeachanswer,thestudentcanapproximatethe
identoftheWorldPsychiatricAssociation.Hiscontributionsto timeconstraintsofanactualwrittenexamination.Theanswers
thiseditionofStudyGuideareimmeasurable. shouldbeverifiedbyreferringtothecorrespondinganswersec-
tion in each chapter. Pay particular attention to the discussion
ofthewronganswers,afeatureuniquetothisbook.Iffurther
COMPREHENSIVE TEACHING SYSTEM informationisneeded,thereaderisreferredtothecurrentedi-
tionsofeithertheSynopsisofPsychiatryortheComprehensive
StudyGuideformsonepartofacomprehensivesystemdevelopedby
TextbookofPsychiatry.
theauthorstofacilitatetheteachingofpsychiatryandthebehavioral
sciences.AttheheadofthesystemistheComprehensiveTextbookof
Psychiatry,whichisglobalindepthandscope;itisdesignedforandused ACKNOWLEDGEMENTS
bypsychiatrists,behavioralscientists,andallotherworkersinthemen-
TheauthorswishtothankNitzaJones-Sepulveda,ProjectEditor
talhealthfield.Kaplan&Sadock’sSynopsisofPsychiatryisarelatively
brief,highlymodified,original,andcurrentversionusefulformedical of Synopsis and Comprehensive Textbook of Psychiatry, who
students,psychiatricresidents,practicingpsychiatrists,andothermental assisted in the preparation of the book with the help of Sara
healthprofessionals.AspecialeditionofSynopsis,ConciseTextbookof Cain.
v
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vi Preface
We especially acknowledge James Sadock, M.D., and Finally, we want to express our deep thanks to Charles
Victoria Gregg, M.D., for their help in their areas of exper- Marmar, M.D., Chairman of Psychiatry at New York Univer-
tise,emergencyadultandemergencypediatricmedicine,respec- sity School of Medicine for his leadership of the Department
tively. andforhiscommitmenttoacademicexcellence.
WealsothankZe’evLevin,M.D.forhiscontributionstothe
previouseditionofthisbook.WealsowanttothankRanaZahiri B.J.S.
and Mainek Patel who served as assistants to the editors and V.A.S.
whomadevaluablecontributionstothetextinbothcontentand P.R.
organization.
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Contents
Preface v 10 Delirium,Dementia,andAmnestic
andOtherCognitiveDisordersand
MentalDisordersDuetoaGeneral
1
NeuralSciences 1 MedicalCondition 82
2 NeuropsychiatryandBehavioral 11 NeuropsychiatricAspectsofHIV
Neurology 9 InfectionandAIDS 97
3 ContributionsofthePsychosocial 12 Substance-RelatedDisorders 104
SciencestoHumanBehavior 13
13
Schizophrenia 117
4
ClinicalNeuropsychological
Testing 25
14
OtherPsychoticDisorders 132
5
TheoriesofPersonalityand
15
Psychopathology 35 MoodDisorders 142
6 16
ThePatient–DoctorRelationship AnxietyDisorders 156
andthePsychiatricInterview 45
17
SomatoformDisorders 168
7
ClinicalExaminationofthe
PsychiatricPatient 55
18
FactitiousDisorders 177
8
SignsandSymptomsinPsychiatry 65
19
DissociativeDisorders 185
9
ClassificationinPsychiatryand
20
PsychiatricRatingScales 73 HumanSexuality 193
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viii Contents
21 34
GenderIdentityDisorders 202 Psychotherapies 281
22
EatingDisorders 207
35
BiologicalTherapies 288
23
NormalSleepandSleep
36
Disorders 214 ChildPsychiatry:Assessment,
Examination,andPsychological
Testing 300
24
Impulse-ControlDisorderNot
ElsewhereClassified 224
37
MentalRetardation 310
25
AdjustmentDisorders 230
38
LearningDisorders 317
26
PersonalityDisorders 235
39
MotorSkillsDisorder:
DevelopmentalCoordination
27
PsychosomaticMedicineand Disorder 323
Consultation-LiaisonPsychiatry 241
40
CommunicationDisorders 326
28
NonconventionalApproachesin
MentalHealthCare 252
41
PervasiveDevelopmental
Disorders 331
29
PsychiatryandReproductive
Medicine 255
42
Attention-DeficitDisorders 337
30
RelationalProblems 260
43
DisruptiveBehaviorDisorders 342
31
ProblemsRelatedtoAbuse
44
orNeglect 264 FeedingandEatingDisorders
ofInfancyorEarlyChildhood 346
32
AdditionalConditionsThatMay
45
BeaFocusofClinicalAttention 269 TicDisorders 351
33 46
EmergencyPsychiatricMedicine 274 EliminationDisorders 356
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Contents ix
47 54
OtherDisordersofInfancy, ForensicIssuesinChildand
Childhood,orAdolescence 361 AdolescentPsychiatry 392
48
MoodDisordersandSuicidein
55
GeriatricPsychiatry 395
ChildrenandAdolescents 364
49
AnxietyDisordersofInfancy, 56
End-of-LifeCareand
Childhood,andAdolescence 367
PalliativeMedicine 401
50
Early-OnsetSchizophrenia 372
57
ForensicPsychiatry 408
51
AdolescentSubstanceAbuse 376
58
EthicsinPsychiatry 418
52
ChildPsychiatry:Additional
ConditionsThatMayBeaFocus
ofClinicalAttention 381 AppendixA:Objective
ExaminationsinPsychiatry 424
53
PsychiatricTreatmentof
ChildrenandAdolescents 384 Index 427
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x
