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The American Psychiatric Association Publishing

TEXTBOOK of

PSYCHOSOMATIC MEDICINE
and CONSULTATION-LIAISON
PSYCHIATRY

THIRD EDITION
The American Psychiatric Association Publishing
TEXTBOOK of

PSYCHOSOMATIC MEDICINE
and CONSULTATION-LIAISON
PSYCHIATRY

THIRD EDITION

EDITED BY

James L. Levenson, M.D.

Note: The authors have worked to ensure that all information in this book is
accurate at the time of publication and consistent with general psychiatric and
medical standards, and that information concerning drug dosages, schedules, and
routes of administration is accurate at the time of publication and consistent with
standards set by the U.S. Food and Drug Administration and the general medical
community. As medical research and practice continue to advance, however,
therapeutic standards may change. Moreover, specific situations may require a
specific therapeutic response not included in this book. For these reasons and
because human and mechanical errors sometimes occur, we recommend that
readers follow the advice of physicians directly involved in their care or the care of
a member of their family.
Books published by American Psychiatric Association Publishing represent the
findings, conclusions, and views of the individual authors and do not necessarily
represent the policies and opinions of American Psychiatric Association Publishing
or the American Psychiatric Association.
If you wish to buy 50 or more copies of the same title, please go to
www.appi.org/specialdiscounts for more information.
Copyright © 2019 American Psychiatric Association Publishing
ALL RIGHTS RESERVED
Manufactured in the United States of America on acid-free paper
22 21 20 19 18 5 4 3 2 1
Third Edition
Typeset in Palatino and Helvetica Neue.
American Psychiatric Association Publishing
800 Maine Avenue S.W., Suite 900
Washington, DC 20024
www.appi.org
Library of Congress Cataloging-in-Publication Data
Names: Levenson, James L., editor.
Title: The American Psychiatric Association Publishing textbook of psychosomatic
medicine and consultation-liaison psychiatry / edited by James L. Levenson.
Other titles: American Psychiatric Publishing textbook of psychosomatic medicine
Description: Third edition. | Washington, D.C. : American Psychiatric Association
Publishing, [2019] | Preceded by American Psychiatric Publishing textbook of
psychosomatic medicine : psychiatric care of the medically ill / edited by
James L. Levenson. 2nd ed. 2011. | Includes bibliographical references and
index.
Identifiers: LCCN 2018023613 (print) | LCCN 2018024419 (ebook) | ISBN
9781615371990 (ebook) | ISBN 9781615371365 (hardcover : alk. paper)
Subjects: | MESH: Psychophysiologic Disorders—therapy | Psychophysiologic
Disorders—diagnosis | Psychosomatic Medicine—methods | Referral and
Consultation
Classification: LCC RC49 (ebook) | LCC RC49 (print) | NLM WM 90 | DDC 616.08
—dc23
LC record available at https://lccn.loc.gov/2018023613
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
 This book is dedicated to all of those from whom I have learned:

To my teachers and supervisors,

my colleagues in and outside of psychiatry and psychosomatic
medicine,
from whom I have learned to be a better psychiatrist and physician.

To my students, residents, and fellows,

from whom I have learned to be a better teacher.

To my patients,
from whom I have learned to be a better doctor and therapist.

To my family and friends,

from whom I have learned to be better in love and friendship.
 Contents

Contributors

Foreword
Wolfgang Söllner, M.D.

Preface
James L. Levenson, M.D.

PART I
General Principles in Evaluation and
Management

1 Psychiatric Assessment and Consultation

Felicia A. Smith, M.D.
James L. Levenson, M.D.
Theodore A. Stern, M.D.

2 Legal and Ethical Issues

Rebecca W. Brendel, M.D., J.D.
Ronald Schouten, M.D., J.D.
Ariana Nesbit, M.D., M.B.E.
James L. Levenson, M.D.
3 Psychological Responses to Illness
Mark S. Groves, M.D.
Philip R. Muskin, M.D., M.A.

PART II
Symptoms and Disorders

4 Delirium
Albert F.G. Leentjens, M.D., Ph.D.
David J. Meagher, M.D., MRCPsych, Ph.D.

5 Dementia
Antonio Lobo, M.D., Ph.D.
Pedro Saz, M.D., Ph.D.
Miguel Ángel Quintanilla, M.D., Ph.D.
Patricia Gracia-Garcia, M.D., Ph.D.

6 Aggression and Violence

Elizabeth A. Wise, M.D.
Constantine G. Lyketsos, M.D., M.H.S.
Chiadi U. Onyike, M.D., M.H.S.

7 Depression
Madeline Li, M.D., Ph.D., FRCPC
Joshua Rosenblat, M.D.
Gary Rodin, M.D., FRCPC

8 Suicidality
 John Michael Bostwick, M.D.
James L. Levenson, M.D.

9 Psychosis, Mania, and Catatonia

Oliver Freudenreich, M.D.
Andrew Francis, Ph.D., M.D.
Gregory L. Fricchione, M.D.

10 Anxiety Disorders
Ted S. Liao, M.D.
Steven A. Epstein, M.D.

11 Somatic Symptom Disorder and

Illness Anxiety Disorder
Peter Henningsen, M.D.

12 Deception Syndromes: Factitious Disorders and

Malingering
Charles V. Ford, M.D.
Loretta Sonnier, M.D.
Cheryl McCullumsmith, M.D., Ph.D.

13 Eating Disorders
Weronika Micula-Gondek, M.D.
Angela S. Guarda, M.D.

14 Sleep Disorders
Lois E. Krahn, M.D.
15 Sexual Dysfunctions
Rosemary Basson, M.D.
Peter M. Rees, M.D., Ph.D.

16 Substance-Related Disorders
Michael Weaver, M.D., DFASAM

PART III
Specialties and Subspecialties

17 Heart Disease
Peter A. Shapiro, M.D.

18 Lung Disease
Thomas Ritz, Ph.D.
Juliet Kroll, M.A.
Alexandra Kulikova, M.S.
Chelsey Werchan, M.A.
E. Sherwood Brown, M.D., Ph.D.

19 Gastrointestinal Disorders
Catherine C. Crone, M.D.
Jeanne M. Lackamp, M.D.
Andrew R. Alkis, M.D.

20 Renal Disease
Daniel Cukor, Ph.D.
James L. Levenson, M.D.
 Deborah Rosenthal-Asher, Ph.D.
Paul L. Kimmel, M.D.

21 Endocrine and Metabolic Disorders

James L. Levenson, M.D.
Alyson K. Myers, M.D.

22 Oncology
Kimberley Miller, M.D., FRCPC
Mary Jane Massie, M.D.

23 Hematology
Madeleine Becker, M.D., M.A.
David J. Axelrod, M.D., J.D.
Keira Chism, M.D., M.A.
Robert Bahnsen, M.D.

24 Rheumatology
James L. Levenson, M.D.
Michael R. Irwin, M.D.

25 Chronic Fatigue and Fibromyalgia Syndromes

Michael C. Sharpe, M.A., M.D., FRCP, FRCPsych
Patrick G. O’Malley, M.D., M.P.H., FACP

26 Infectious Diseases
James L. Levenson, M.D.
Christopher Kogut, M.D.
27 Dermatology
Madhulika A. Gupta, M.D., M.Sc., FRCPC
James L. Levenson, M.D.

28 Surgery
Sanjeev Sockalingam, M.D.
Raed Hawa, M.D.

29 Organ Transplantation
Andrea F. DiMartini, M.D.
Akhil Shenoy, M.D.
Mary Amanda Dew, Ph.D.

30 Neurology and Neurosurgery

Alan J. Carson, M.Phil., M.D., FRCPsych, FRCP
Adam Zeman, M.A., D.M., FRCP
Jon Stone, Ph.D., FRCP

31 Obstetrics and Gynecology

Donna E. Stewart, C.M., M.D., FRCPC
Simone N. Vigod, M.D., M.Sc., FRCPC

32 Pediatrics
Natacha D. Emerson, Ph.D.
Brenda Bursch, Ph.D.
Margaret L. Stuber, M.D.

33 Physical Medicine and Rehabilitation

 Jesse R. Fann, M.D., M.P.H.
Richard Kennedy, M.D.
Charles H. Bombardier, Ph.D.

34 Pain
J. Greg Hobelmann, M.D., M.P.H.
Michael R. Clark, M.D., M.P.H., M.B.A.

35 Medical Toxicology
J. J. Rasimas, M.D., Ph.D.

PART IV
Treatment

36 Psychopharmacology
James A. Owen, Ph.D.
Ericka L. Crouse, Pharm.D., BCPP, BCGP
Cynthia K. Kirkwood, Pharm.D., BCPP
James L. Levenson, M.D.

37 Psychotherapy
Elspeth Guthrie, M.B., Ch.B., FRCPsych, M.Sc., M.D.

38 Electroconvulsive Therapy and Other Brain

Stimulation Therapies
Keith G. Rasmussen, M.D.

39 Palliative Care
 Andrew Edelstein, M.D.
Yesne Alici, M.D.
William Breitbart, M.D.
Harvey Max Chochinov, M.D., Ph.D., FRCPC

Index
 Contributors
Yesne Alici, M.D.
Assistant Attending Psychiatrist, Clinical Director of the Psychiatry
Service, Department of Psychiatry and Behavioral Sciences, Memorial
Sloan-Kettering Cancer Center, New York, New York
Andrew R. Alkis, M.D.
Consultation-Liaison Psychiatrist, Psychiatry Inpatient Services,
Novant Health, Forsyth Medical Center, Winston-Salem, North
Carolina

David J. Axelrod, M.D., J.D.

Associate Professor, Department of Internal Medicine, Jefferson
Medical College; Director, Sickle Cell Program, Thomas Jefferson
University Hospital, Philadelphia, Pennsylvania

Robert Bahnsen, M.D.

Clinical Assistant Professor, Department of Psychiatry and Human
Behavior, Thomas Jefferson University, Philadelphia, Pennsylvania
Rosemary Basson, M.D.
Clinical Professor, Department of Psychiatry, University of British
Columbia, Vancouver, British Columbia, Canada

Madeleine Becker, M.D., M.A.

Director, Consultation Liaison Psychiatry and Hospital Psychiatry,
Thomas Jefferson University Hospital, Department of Psychiatry and
Human Behavior, Philadelphia, Pennsylvania

Charles H. Bombardier, Ph.D.

Professor, Department of Rehabilitation Medicine, University of
Washington School of Medicine, Seattle, Washington
John Michael Bostwick, M.D.
Professor of Psychiatry, Mayo Clinic College of Medicine, Rochester,
Minnesota
William Breitbart, M.D.
Chairman, Jimmie C. Holland Chair in Psychiatric Oncology,
Department of Psychiatry and Behavioral Sciences; Attending
Psychiatrist, Supportive Care Service, Department of Medicine,
Memorial Sloan-Kettering Cancer Center; Professor of Clinical
Psychiatry, Department of Psychiatry, Weill Medical College of Cornell
University, New York, New York

Rebecca W. Brendel, M.D., J.D.

Director of Law and Ethics, Center for Law, Brain, and Behavior, and
Psychiatrist, Massachusetts General Hospital, Boston, Massachusetts;
Director, Master of Bioethics Degree Program, and Assistant
Professor of Psychiatry, Harvard Medical School, Boston,
Massachusetts

E. Sherwood Brown, M.D., Ph.D.

Professor, Aradine S. Ard Chair in Brain Science, and Vice Chairman
for Clinical Research, Department of Psychiatry, The University of
Texas Southwestern Medical Center, Dallas, Texas

Brenda Bursch, Ph.D.

Professor, Departments of Psychiatry and Biobehavioral Sciences,
and Pediatrics, David Geffen School of Medicine at UCLA, Los
Angeles, California

Alan J. Carson, M.Phil., M.D., FRCPsych, FRCP

Dr Reader in Neuropsychiatry, Centre for Clinical Brain Sciences,
University of Edinburgh, Edinburgh, United Kingdom
Keira Chism, M.D., M.A.
Associate Director, Consultation Liaison and Hospital Psychiatry,
Transplant Psychiatry, Thomas Jefferson University Hospital,
Department of Psychiatry and Human Behavior, Philadelphia,
Pennsylvania

Harvey Max Chochinov, M.D., Ph.D., FRCPC

Distinguished Professor, Department of Psychiatry; Co-Director,
Psycho-Social Oncology Research Group; Director, Manitoba Palliative
Care Research Unit, Faculty of Medicine University of Manitoba,
Winnipeg, Manitoba, Canada

Michael R. Clark, M.D., M.P.H., M.B.A.

Chair, Department of Psychiatry & Behavioral Health, Inova Health
System, Falls Church, Virginia

Catherine C. Crone, M.D.

Associate Professor, Department of Psychiatry, George Washington
University School of Medicine, Washington, DC; Clinical Professor of
Psychiatry, Virginia Commonwealth University, Richmond, Virginia;
Vice Chair, Department of Psychiatry, Inova Fairfax Hospital, Falls
Church, Virginia

Ericka L. Crouse, Pharm.D., BCPP, BCGP

Associate Professor, Department of Pharmacotherapy and Outcomes
Science, Virginia Commonwealth University School of Pharmacy,
Richmond, Virginia

Daniel Cukor, Ph.D.

Associate Professor, Department of Psychiatry and Behavioral
Sciences, SUNY Downstate Medical Center, Brooklyn, New York

Mary Amanda Dew, Ph.D.

Professor of Psychiatry, Psychology, Epidemiology, Biostatistics, and
Clinical and Translational Science; Director, Clinical Epidemiology
Program, Western Psychiatric Institute and Clinic; Director, Quality of
Life Research, Artificial Heart Program Adult Cardiothoracic
Transplantation, University of Pittsburgh School of Medicine and
Medical Center, Pittsburgh, Pennsylvania

Andrea F. DiMartini, M.D.

Professor of Psychiatry and Surgery, Western Psychiatric Institute
and Clinics, University of Pittsburgh School of Medicine and Medical
Center, Starzl Transplant Institute, Pittsburgh, Pennsylvania
Andrew Edelstein, M.D.
Instructor in Clinical Psychiatry, Department of Psychiatry and
Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New
York, New York
Natacha D. Emerson, Ph.D.
Postdoctoral Fellow, Department of Psychiatry and Biobehavioral
Sciences, David Geffen School of Medicine at UCLA, Los Angeles,
California
Steven A. Epstein, M.D.
Professor and Chair, Department of Psychiatry, Georgetown
University School of Medicine and Physician Executive Director,
MedStar Behavioral Health, Washington, D.C.
Jesse R. Fann, M.D., M.P.H.
Professor, Department of Psychiatry and Behavioral Sciences, and
Adjunct Professor, Department of Rehabilitation Medicine, University
of Washington School of Medicine; Adjunct Professor, Department of
Epidemiology, University of Washington School of Public Health;
Director, Psychiatry and Psychology Service, Seattle Cancer Care
Alliance; Affiliate Investigator, Clinical Research Division, Fred
Hutchinson Cancer Research Center, Seattle, Washington
Charles V. Ford, M.D.
Professor, Department of Psychiatry and Behavioral Neurobiology,
University of Alabama at Birmingham, Birmingham, Alabama
Andrew Francis, Ph.D., M.D.
Professor of Psychiatry, Associate Director of Residency Training, and
Director of Neuromodulation Services, Penn State Medical School,
Hershey Medical Center, Hershey, Pennsylvania

Oliver Freudenreich, M.D.

Co-Director, Schizophrenia Clinical and Research Program,
Massachusetts General Hospital; Associate Professor of Psychiatry,
Harvard Medical School, Boston, Massachusetts

Gregory L. Fricchione, M.D.

Director, Benson–Henry Institute for Mind–Body Medicine,
Massachusetts General Hospital; Professor of Psychiatry, Harvard
Medical School, Boston, Massachusetts

Patricia Gracia-Garcia, M.D., Ph.D.

Psychiatrist, Hospital Universitario Miguel Servet, Zaragoza, Spain

Mark S. Groves, M.D.

Assistant Clinical Professor, Departments of Psychiatry and
Neurology, Icahn School of Medicine at Mt. Sinai, New York, New
York

Angela S. Guarda, M.D.

Associate Professor, Department of Psychiatry and Behavioral
Sciences; Director, Eating Disorders Program, Johns Hopkins
Medicine, Baltimore, Maryland

Madhulika A. Gupta, M.D., M.Sc., FRCPC

Professor, Department of Psychiatry, Schulich School of Medicine and
Dentistry, University of Western Ontario, London, Ontario, Canada
Elspeth Guthrie, M.B., Ch.B., FRCPsych, M.Sc., M.D.
Professor of Psychological Medicine, Institute of Health Sciences,
University of Leeds, Leeds, West Yorkshire, United Kingdom
Raed Hawa, M.D.
Associate Professor, Department of Psychiatry, University of Toronto,
Centre for Mental Health, University Health Network, Toronto,
Ontario

Peter Henningsen, M.D.

Professor and Chair, Department of Psychosomatic Medicine and
Psychotherapy, TUM University Hospital, Munich, Germany
J. Greg Hobelmann, M.D., M.P.H.
Chief Medical Officer, Ashley Addiction Treatment, Havre de Grace,
Maryland

Michael R. Irwin, M.D.

Distinguished Professor of Psychiatry and Biobehavioral Sciences,
UCLA David Geffen School of Medicine; Norman Cousins Chair for
Psychoneuroimmunology, UCLA Semel Institute for Neuroscience and
Human Behavior; and Director, Cousins Center for
Psychoneuroimmunology, Los Angeles, California

Richard Kennedy, M.D.

Assistant Professor, Division of Gerontology, Geriatrics, and Palliative
Care, Department of Medicine, University of Alabama at Birmingham,
Birmingham, Alabama

Paul L. Kimmel, M.D.

Clinical Professor of Medicine, Division of Renal Diseases and
Hypertension, Department of Medicine, George Washington
University, Washington, D.C.

Cynthia K. Kirkwood, Pharm.D., BCPP

Executive Associate Dean for Academic Affairs; Professor,
Department of Pharmacotherapy and Outcomes Science, Virginia
Commonwealth University School of Pharmacy, Richmond, Virginia

Christopher Kogut, M.D.

William and Ruth McDonough Professor in Graduate Psychiatric
Education and Director of Residency Education, Virginia
Commonwealth University School of Medicine, Richmond, Virginia
Lois E. Krahn, M.D.
Professor of Psychiatry, Mayo Clinic College of Medicine; Center for
Sleep Medicine, Mayo Clinic, Scottsdale, Arizona

Juliet Kroll, M.A.

Graduate Research Assistant, Clinical Psychology, Department of
Psychology, Southern Methodist University, Dallas, Texas
Alexandra Kulikova, M.S.
Clinical Research Coordinator, Department of Psychiatry, The
University of Texas Southwestern Medical Center, Dallas, Texas
Jeanne M. Lackamp, M.D.
Associate Professor, Department of Psychiatry, University Hospitals
Cleveland Medical Center, Case Western Reserve University School of
Medicine, Cleveland, Ohio

Albert F.G. Leentjens, M.D., Ph.D.

Associate Professor of Psychiatry, Department of Psychiatry,
Maastricht University Medical Center, Maastricht, The Netherlands

James L. Levenson, M.D.

Professor of Psychiatry, Medicine, and Surgery, Virginia
Commonwealth University School of Medicine, Richmond, Virginia
Madeline Li, M.D., Ph.D., FRCPC
Associate Professor, Department of Psychiatry, University of Toronto;
Clinician Scientist, Department of Psychosocial Oncology and
Palliative Care, Princess Margaret Hospital, Toronto, Ontario, Canada

Ted S. Liao, M.D.

Assistant Professor of Clinical Psychiatry, Georgetown University
School of Medicine; Associate Director of Consultation-Liaison
Psychiatry Fellowship and Associate Director of Psychiatry Residency
Training Program, MedStar Georgetown University Hospital,
Washington, D.C.

Antonio Lobo, M.D., Ph.D.

Emeritus Professor. Department of Medicine and Psychiatry,
University of Zaragoza, Aragon Health Research Foundation (IIS
Aragón), Zaragoza, Spain

Constantine G. Lyketsos, M.D., M.H.S.

Elizabeth Plank Althouse Professor, Department of Psychiatry and
Behavioral Sciences, Johns Hopkins University School of Medicine,
and Chair, Department of Psychiatry, Johns Hopkins Bayview Medical
Center, Baltimore, Maryland

Mary Jane Massie, M.D.

Professor of Clinical Psychiatry, Weill Medical College of Cornell
University; Attending Psychiatrist, Memorial Sloan-Kettering Cancer
Center, New York, New York
Cheryl McCullumsmith, M.D., Ph.D.
Associate Professor, Department of Psychiatry and Behavioral
Neuroscience, University of Cincinnati, Cincinnati, Ohio

David J. Meagher, M.D., MRCPsych, Ph.D.

Professor of Psychiatry, Graduate Entry Medical School, University of
Limerick, Limerick, Ireland

Weronika Micula-Gondek, M.D.

Assistant Professor, Department of Psychiatry and Behavioral
Sciences, Johns Hopkins Medicine, Baltimore, Maryland

Kimberley Miller, M.D., FRCPC

Assistant Professor, Department of Psychiatry, University of Toronto;
Attending Psychiatrist, Princess Margaret Cancer Centre, Toronto,
Ontario, Canada

Philip R. Muskin, M.D., M.A.

Professor of Psychiatry and Senior Consultant in Consultation-Liaison
Psychiatry at Columbia University Medical Center; Faculty, Columbia
University Psychoanalytic Center for Training and Research, New
York, New York
Alyson K. Myers, M.D.
Medical Director, Inpatient Diabetes, North Shore University Hospital,
Manhasset, New York; Assistant Professor, Donald and Barbara
Zucker School of Medicine at Hofstra/Northwell, East Garden City,
New York; and Assistant Professor, Merinoff Center for Patient-
Oriented Research at the Feinstein Institute, Northwell Health,
Manhasset, New York

Ariana Nesbit, M.D., M.B.E.

Forensic Psychiatry Fellow, Department of Psychiatry, Division of
Psychiatry and the Law, University of California, Davis Medical
Center, Sacramento, California
Patrick G. O’Malley, M.D., M.P.H., FACP
Professor of Medicine, Uniformed Services University of the Health
Sciences, Bethesda, Maryland
Chiadi U. Onyike, M.D., M.H.S.
Associate Professor, Department of Psychiatry and Behavioral
Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns
Hopkins School of Medicine, Baltimore, Maryland

James A. Owen, Ph.D. (Deceased)

Associate Professor, Department of Psychiatry and Department of
Pharmacology and Toxicology, Queen’s University; Director,
Psychopharmacology Lab, Providence Care Mental Health Services,
Kingston, Ontario, Canada

Miguel Ángel Quintanilla, M.D., Ph.D.

Attending Psychiatrist, Hospital Clínico Universitario; Instructor in
Psychiatry, Department of Medicine and Psychiatry, University of
Zaragoza, Zaragoza, Spain
J. J. Rasimas, M.D., Ph.D.
Associate Professor of Psychiatry & Emergency Medicine, University
of Minnesota Medical School; Director of Consultation-Liaison
Psychiatry, Hennepin County Medical Center, Minneapolis, Minnesota

Keith G. Rasmussen, M.D.

Professor, Mayo Clinic Department of Psychiatry and Psychology,
Rochester, Minnesota

Peter M. Rees, M.D., Ph.D.

Neurologist (retired), formerly at Burnaby Hospital, Burnaby, British
Columbia, Canada
Thomas Ritz, Ph.D.
Professor of Psychology and Director, Psychobiology of Stress,
Emotion, and Chronic Disease Research Program, Department of
Psychology, Southern Methodist University, Dallas, Texas

Gary Rodin, M.D., FRCPC

Professor, Department of Psychiatry, University of Toronto; Head,
Department of Supportive Care, Princess Margaret Cancer Centre,
Toronto, Ontario, Canada
Joshua Rosenblat, M.D.
Resident in Psychiatry, Clinician Scientist Program, University of
Toronto, Toronto, Ontario, Canada

Deborah Rosenthal-Asher, Ph.D.

Memory and Psychological Services, Inc., Brecksville, Ohio
Pedro Saz, M.D., Ph.D.
Professor of Psychiatry, Department of Medicine and Psychiatry,
University of Zaragoza, Zaragoza, Spain
Ronald Schouten, M.D., J.D.
Director, Law and Psychiatry Service, Massachusetts General
Hospital, and Associate Professor of Psychiatry, Harvard Medical
School, Boston, Massachusetts

Peter A. Shapiro, M.D.

Professor of Psychiatry, Columbia University Medical Center; and
Director, Consultation-Liaison Psychiatry Service, New York
Presbyterian Hospital–Columbia University Medical Center, New York,
New York

Michael C. Sharpe, M.A., M.D., FRCP, FRCPsych

Professor of Psychological Medicine, University of Oxford, Oxford,
United Kingdom

Akhil Shenoy, M.D., M.P.H.

Assistant Professor of Psychiatry, Columbia University College of
Physicians and Surgeons; Liaison to the Center for Liver Disease
and Transplantation, New York–Presbyterian Hospital Columbia
University Medical Center, New York, New York

Felicia A. Smith, M.D.

Chief, Psychiatric Consultation Service; Director, Division of
Psychiatry and Medicine, Massachusetts General Hospital; Assistant
Professor of Psychiatry, Harvard Medical School, Boston,
Massachusetts
Sanjeev Sockalingam, M.D.
Associate Professor, Department of Psychiatry, University of Toronto,
Centre for Mental Health, University Health Network, Toronto,
Ontario

Wolfgang Söllner, M.D.

President, European Association for Psychosomatic Medicine;
Professor of Psychosomatic Medicine and Psychotherapy, Paracelsus
Medical University, General Hospital Nuremberg, Germany
Loretta Sonnier, M.D.
Assistant Professor, Department of Psychiatry and Behavior Sciences,
Tulane University, New Orleans, Louisiana
Theodore A. Stern, M.D.
Chief Emeritus, Psychiatric Consultation Service, Massachusetts
General Hospital; Ned H. Cassem Professor of Psychiatry, Harvard
Medical School, Boston, Massachusetts

Donna E. Stewart, C.M., M.D., FRCPC

University Professor and Professor of Psychiatry, Obstetrics and
Gynecology, Anesthesia, Family and Community Medicine, and
Surgery, University of Toronto Faculty of Medicine; Senior Scientist,
Toronto General Hospital Research Institute; Director of Research,
University Health Network Centre for Mental Health, Toronto,
Ontario, Canada
Jon Stone, Ph.D., FRCP
Dr Reader in Neurology, Centre for Clinical Brain Sciences, University
of Edinburgh, Edinburgh, United Kingdom

Margaret L. Stuber, M.D.

Professor and Associate Chair, Medical Student Education,
Department of Psychiatry and Biobehavioral Sciences, David Geffen
School of Medicine at UCLA, Los Angeles, California

Simone N. Vigod, M.D., M.Sc., FRCPC

Associate Professor, Department of Psychiatry, University of Toronto;
Shirley A. Brown Memorial Chair in Women’s Mental Health,
Women’s College Research Institute, Women’s College Hospital,
Toronto, Ontario, Canada

Michael Weaver, M.D., DFASAM

Professor and Medical Director, Center for Neurobehavioral Research
on Addiction, Department of Psychiatry and Behavioral Sciences,
McGovern Medical School, Houston, Texas

Chelsey Werchan, M.A.

Graduate Research Assistant, Clinical Psychology, Department of
Psychology, Southern Methodist University, Dallas, Texas
Elizabeth A. Wise, M.D.
Geriatric Psychiatry Fellow, Department of Psychiatry and Behavioral
Sciences, Johns Hopkins University School of Medicine, Baltimore,
Maryland

Adam Zeman, M.A., D.M., FRCP

Professor of Cognitive and Behavioural Neurology, Cognitive
Neurology Research Group, University of Exeter Medical School, St.
Luke’s Campus, Exeter, United Kingdom

Disclosure of Interests
The following contributors to this textbook have indicated a financial
interest in or other affiliation with a commercial supporter,
manufacturer of a commercial product, and/or provider of a
commercial service as listed below:
E. Sherwood Brown, M.D., Ph.D. Research Grant: Otsuka.
Alan J. Carson, M.Phil., M.D., FRCPsych, FRCP Neither I nor my immediate
family have any links or financial conflicts of interest with pharmaceutical
companies or similar entities. I have given lectures on neuropsychiatric topics
at drug company symposia on approximately 10 occasions and received fees of
less than $250 dollars on each occasion. I never directly promoted a particular
agent. I have received fees for giving independent testimony in court on a
variety of neuropsychiatric topics (50% pursuer, 50% defender). I am listed at
 Companies House London as a director of Dr Jon Stone Ltd, which is a
personal services company through which any private medical earnings
exclusively for medicolegal work I have are collected and taxed (this is a
standard UK arrangement for payment). I am a paid editor of the Journal of
Neurology, Neurosurgery, and Psychiatry.
Oliver Freudenreich, M.D. Consultant (Advisory Board): Alkermes, Janssen, and
Neurocrine; Research Grants: Avanir, Janssen, Otsuka, and Saladax; Honoraria:
Global Medical Education (CME speaker and content developer), Neurocrine
(CME talk), and UpToDate (content developer and editor); Royalties: Wolters-
Kluwer (content developer), UpToDate (content developer and editor).
Patricia Gracia-Garcia, M.D., Ph.D. I have received honoraria, travel funds,
and subscriptions for a scientific meeting from Servier.
Miguel Ángel Quintanilla, M.D., Ph.D. Funding for congress from Lundbeck;
grants for survey from Servier.
Jon Stone, Ph.D., FRCP Neither I nor my immediate family have any links or
financial conflicts of interest with pharmaceutical companies or similar entities.
I have received fees for giving independent testimony in Court on a variety of
neuropsychiatric topics (60% pursuer, 40% defender). I am listed at
Companies House London as a director of Dr Jon Stone Ltd, which is a
personal services company through which any private medical earnings
exclusively for medicolegal work I have are collected and taxed (this is a
standard UK arrangement for payment). I receive royalties from UpToDate for
articles relating to conversion disorder. I run a self-help website
(www.neurosymptoms.org) that is free to users and carries no advertising or
sponsorship.
Simone N. Vigod, M.D., M.Sc., FRCPC Research Support: Canadian Institutes
for Health Research, Ontario Ministry of Health and Long-Term Care, University
of Toronto, and Women’s College Hospital in Toronto; Royalties: UpToDate
(writing of several chapters on maternal mental health).
Adam Zeman, M.A., D.M., FRCP I received an unrestricted grant of £15,132.53
from UCB in 2018 to fund development of our sleep disorders service though
creation of a “Clinical Physiologist Sleep Specialist” role. I undertake occasional
medicolegal work, and am sole Director of a company providing this service,
Azimuth Medical Consultants Ltd.

The following contributors stated that they had no competing

interests during the year preceding manuscript submission:
Andrew R. Alkis, M.D.; David J. Axelrod, M.D., J.D.; Robert Bahnsen, M.D.;
Rosemary Basson, M.D.; Madeleine Becker, M.D., M.A.; Charles H. Bombardier,
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