Introduction

The Fourth Edition of Treatments of Psychiatric Disorders appears nearly a quarter of a century after the idea for this project was first conceived. In 1982, Daniel X. Freedman, M.D., in his capacity as President of the American Psychiatric Association, appointed a Task Force on Treatment of Psychiatric Disorders. The charge to that task force was to produce a comprehensive statement describing current thinking on the optimal treatment of psychiatric disorders. Experts in the treatment of the major psychiatric disorders were collected in groups of panels that exhaustively reviewed the treatment literature in the service of reaching consensus. Outside consultants were contacted for additional opinions.

After an extensive review process, the First Edition of Treatments of Psychiatric Disorders was published in 1989 as the Task Force Report of the American Psychiatric Association. Encompassing four volumes, it was encyclopedic in scope and rapidly became the leading reference on treatment in American psychiatry. After Dr. Karasu declined to continue as Editor-in-Chief, I was invited to become the new Editor-in-Chief for the Second Edition. With an eye on reducing the volume by half, we were able to produce the Second Edition in two volumes in 1995, followed by a Third Edition, also in two volumes, in 2001. To streamline the text, we insisted that authors confine their contributions to treatment, with the intention that readers could familiarize themselves with diagnostic issues by reading other textbooks.

As we approached this Fourth Edition, I conferred extensively with Robert E. Hales, M.D., Editor-in-Chief of American Psychiatric Publishing, and John McDuffie, Editorial Director. To increase the usefulness of this book for our readers, we made a key decision to reduce the size of this edition from two volumes to one. We then deleted the introductory chapters on general considerations in treatment so that the reader would go directly to the heart of disorder-based treatments.

Further reduction in size required skilled editing and informed decision making about what aspects of the book could be deleted in the face of expanding knowledge in the field. To assist us in this challenge, I collected a group of outstanding section editors, all chosen because they are recognized experts in the disorders for which they are responsible. They include Elizabeth B. Weller, M.D., and John F. McDermott Jr., M.D., for disorders usually first diagnosed in infancy, childhood, or adolescence; Stuart C. Yudofsky, M.D., and Robert E. Hales, M.D., for delirium, dementia, and amnestic and other cognitive disorders; Herbert D. Kleber, M.D., and Marc Galanter, M.D., for substance-related disorders; Richard L. Munich, M.D., and Carol A. Tamminga, M.D., for schizophrenia and other psychotic disorders; A. John Rush, M.D., for mood disorders; Franklin R. Schneier, M.D., Lisa A. Mellman, M.D., and David Spiegel, M.D., for anxiety disorders, dissociative disorders, and adjustment disorders; Katharine A. Phillips, M.D., for somatoform and factitious disorders; Stephen B. Levine, M.D., and R. Taylor Segraves, M.D., for sexual and gender identity disorders; Allan S. Kaplan, M.D., and Katherine A. Halmi, M.D., for eating disorders; and John G. Gunderson, M.D., for personality disorders. Two sections, sleep disorders and disorders of impulse control, were small enough that they did not require section editors.

Working with the section editors, we looked for ways to consolidate the treatment information most needed by our readers without deleting essential information. This effort resulted in a leaner textbook that still provides what clinicians need to know about the state of the art of psychiatric treatment. Once again, we allowed section editors to organize their sections in the manner that was most “reader friendly,” such that in some sections, each major treatment modality comprises a chapter, while in others, chapters are organized according to disorder.

As in the preceding editions, we instructed the chapter authors to update their chapters with references since 2001, when the Third Edition appeared, up to the moment of submission for publication so that we could make this volume as current as possible. We asked them to delete older information no longer necessary, as a way of keeping the length to a minimum. We also provided them with strict word limits for their respective chapters. We maintained our tradition of emphasizing evidence-based treatment from randomized, controlled trials, when available, for all of the major disorders. However, we are also aware that data emerging from controlled trials are not always generalizable to naturalistic settings, and we encouraged our authors to include data from uncontrolled studies and accumulated clinical wisdom when there was little empirical research from which to draw. We recognize that the clinical judgment of the clinician must always be brought to bear in tailoring final treatment decisions to a particular patient.

This compendium does not represent an official policy statement of the American Psychiatric Association or any other body regarding which treatments must be used for which disorders. It is a collection of expert opinion—the accumulated wisdom and empirical knowledge that assist clinicians in constructing a treatment plan that makes sense for an individual patient. We recognize that complex comorbidity is common in psychiatric patients, and treatment information from this book must be used creatively to address multiple disorders in one patient.

The pleasure of preparing this text was marred just prior to going to press by the tragic and untimely death of one of our authors, Dr. Wayne Fenton. Dr. Fenton was a dedicated researcher and clinician who made significant contributions to our understanding of schizophrenia. We all will miss him, and we are honored to be able to include one of his last publications in this book.

Finally, I wish to express my heartfelt gratitude to the team of colleagues who worked with me on this project. The section editors did a great deal of work, and the chapter authors diligently tried to work within our guidelines. Tina Coltri-Marshall did a superb job of keeping all of us on track and informing section editors and authors when we were falling behind schedule. Robert Hales and John McDuffie served as both consultants and a support system for me on this project. My able assistant, Diane Trees-Clay, kept me on track when the task seemed overwhelming. I also wish to express my appreciation to the editorial staff of American Psychiatric Publishing: Rebecca Richters and Greg Kuny, who managed editing and production; Jennifer Molnar, who designed the cover and book interior; and Judy Castagna, who produced the book. These talented people were marvelous to work with.

Glen O. Gabbard, M.D.