Theodoros Bargiotas

<p>This chapter discusses the aetiology of depression. It begins with an overview of reasons why the aetiology of depression has been and still is difficult to define, including its heterogeneity and the wider philosophical and methodological challenges involved. It then considers life events and social determinants of depression as well as psychological factors relevant to depression, including childhood development and early experiences, parenting style, and personality and personality disorders. It also examines cognitive behavioural theories of depression, neuropsychology, and psychodynamic theories, along with the role of unconscious processes and ego psychology in the aetiology of depression. Finally, the chapter describes the biological determinants of depression, paying attention to genetics, neurochemical changes in the brain, and stress and thyroid hormones.</p>

The focus of this chapter is the management of substance misuse and addiction on the psychiatric ward in patients who have presented with a psychiatric disorder. Some patients will display other forms of addictive behaviour such as gambling, sexual activity, or Internet use. Where this is not the primary focus, the same principles of broad-based biopsychosocial management apply. There are a number of guidelines available, such as those from the Department of Health (the ‘Orange Book’) and the National Institute for Health and Care Excellence, and prescribing advice, such as the British Association for Psychopharmacology guidelines and The Maudsley Prescribing Guidelines in Psychiatry, that are useful references for the treatment of patients with substance misuse disorders and addiction. This chapter does not seek to replicate this advice, but does include useful and common scenarios that will be encountered on the general psychiatric ward.

Diffusion tensor imaging (DTI) is a magnetic resonance imaging technique that is increasingly being used for the non-invasive evaluation of brain white matter abnormalities. In this review, we discuss the basic principles of DTI, its roots and the contribution of European centres in its development, and we review the findings from DTI studies in schizophrenia. We searched EMBASE, PubMed, PsychInfo, and Medline from February 1998 to December 2006 using as keywords ‘schizophrenia’, ‘diffusion’, ‘tensor’, and ‘DTI’. Forty studies fulfilling the inclusion criteria of this review were included and systematically reviewed. White matter abnormalities in many diverse brain regions were identified in schizophrenia. Although the findings are not completely consistent, frontal and temporal white matter seems to be more commonly affected. Limitations and future directions of this method are discussed.