Clinical Psychiatry

About the book

About this book

This book is a systematic presentation of the modern standards of clinical psychiatry, brought together in a single format for everyday clinical work. The book is built on the 11th revision of the International Classification of Diseases (ICD-11) and integrates its structure, diagnostic criteria and treatment approaches in a way adapted to the clinical tradition of the post-Soviet psychiatric school.

The book has been prepared as a reference guide for practicing physicians — psychiatrists, psychotherapists, neurologists, primary care physicians, clinical psychologists, final-year medical students and residents.

What this book is and why it was written

This book is a clinical reference guide, not a theoretical psychiatry textbook. It presents the diagnostic criteria, clinical manifestations and treatment protocols for each mental disorder in a standardized format. A detailed pathophysiological, neurobiological or historical account of each topic lies beyond the scope of this book; the aim is to enable the physician to find the necessary information quickly and accurately in the presence of the patient.

The reasons for writing the book:

  • There is a lack of a modern reference guide in which the three classifications in current use are presented side by side. Much of the literature available to the practicing physician consists of translations or textbooks based on the school of the late twentieth century. The innovations of ICD-11 (in force since 2022) and DSM-5-TR (2022) have not been systematically reflected in such literature.
  • Bringing diagnostic classifications into a unified system. In clinical practice, physicians encounter ICD-10 (still used by the Ministry of Health for official statistics), ICD-11 (the new standard) and DSM-5-TR (the classification predominant in international scientific publications). This book presents all three systems in parallel so that the physician can use the correct code and terminology in different contexts.
  • Integration of the official clinical protocols of Azerbaijan. The protocols prepared by the Public Health and Reforms Center of the Ministry of Health and approved by decisions of the board of the Ministry of Health — schizophrenia, 2009; anxiety disorders, 2013; obsessive-compulsive disorder (OCD), 2015; depression — constitute the local clinical basis of this book. The concordances and differences between international recommendations — from the National Institute for Health and Care Excellence (NICE) of the United Kingdom, the American Psychiatric Association (APA), the World Federation of Societies of Biological Psychiatry (WFSBP) and the World Health Organization (WHO) — and the official Azerbaijani protocols are noted separately.
  • Legal and ethical guidance. The rights and duties of the physician — both psychiatrist and clinical psychologist — are presented in a separate section within the framework of the Law of the Republic of Azerbaijan “On Psychiatric Care” of 12 June 2001 and the Law “On Psychological Assistance”. Behavior towards a patient with suicidal ideation, the grounds for involuntary hospitalization and the rules for applying compulsory medical measures are real clinical situations that require an answer. This book answers them.

Why ICD-11?

WHO adopted ICD-11 in 2019, and its official implementation began in 2022. ICD-11 has brought profound paradigm changes in the chapter on mental disorders:

  • Complex post-traumatic stress disorder (cPTSD) (6B41) — a new official diagnosis;
  • Prolonged grief disorder (6B42) — an independent diagnosis added to ICD-11;
  • Transition of personality disorders from a categorical system to a dimensional system — a major conceptual innovation;
  • Replacement of somatoform disorders with bodily distress disorder (BDD);
  • Removal of gender incongruence from the psychiatric chapter;
  • Gaming disorder has been defined as an official diagnosis;
  • Compulsive sexual behavior disorder (CSBD) has been added as a new category;
  • Transfer of attention-deficit/hyperactivity disorder (ADHD) to the group of neurodevelopmental disorders;
  • Placement of hypochondriasis in the group of obsessive-compulsive and related disorders;
  • Abolition of the organic–functional dichotomy.

These changes require reassessment both in nosology and in treatment standards.

Structure of the book

The book consists of two main parts:

PART I — Introductory sections:

  • Preface (this section)
  • Table of contents — based on a hierarchy corresponding to the structure of ICD-11
  • Introduction to psychopathology — description of symptoms and syndromes (cognition, perception, thinking, mood, behavior, memory, volition, consciousness)
  • Clinical interview and assessment of mental status — clinical protocol procedure, standards for describing mental status
  • Legal and ethical aspects — practical guidance for the psychiatrist and clinical psychologist on the basis of Azerbaijani legislation, sample documents

PART II — Mental disorders (according to the structure of ICD-11):

All main groups of Chapter 6 of ICD-11 are presented in separate sections. The same standard structure is retained for each section (a brief overview of the main elements; the full 11-section scheme of the chapter is given in the section “Organization of the chapters”):

  • Definition and nosology (brief)
  • Etiology
  • Epidemiology
  • Clinical manifestations
  • Diagnosis (ICD-11 → ICD-10 → Diagnostic and Statistical Manual of Mental Disorders, DSM-5-TR — parallel comparison)
  • Differential diagnosis
  • Methods of examination (clinical, laboratory and instrumental)
  • Treatment (with evidence-based recommendation grades)
  • Prognosis
  • References

At the end — References and Appendices:

  • Complete list of all sources used (Azerbaijani sources, those from the countries of the Commonwealth of Independent States (CIS), international sources)
  • Clinical scales and questionnaires (Patient Health Questionnaire — PHQ-9, Generalized Anxiety Disorder scale — GAD-7, PTSD checklist — PCL-5, Edinburgh Postnatal Depression Scale — EPDS, Yale-Brown Obsessive Compulsive Scale — Y-BOCS, Columbia-Suicide Severity Rating Scale — C-SSRS and others)
  • Psychiatric emergencies (algorithm)
  • Rules of military medical assessment (in Azerbaijan)

Organization and features of the chapters

Organization of the chapters

Each clinical chapter consists of 11 sections:

  • Definition and brief description — the nature of the disorder, ICD-11 innovations;
  • History — the transition from classical concepts to the modern approach;
  • Epidemiology — prevalence, sex, age, comorbidity;
  • Etiology and pathogenesis — biological, psychological and social factors, the Popov-Vid approach;
  • Clinical manifestations — clinical forms (where relevant) or features of the clinical presentation;
  • Diagnosis — diagnostic criteria: ICD-11 Clinical Descriptions and Diagnostic Requirements (CDDR), ICD-10, DSM-5-TR — in comparison; differential diagnosis — in tabular format;
  • Examination and assessment — clinical interview, screening scales, and laboratory tests;
  • Treatment — general strategy, phased approach, psychotherapy, pharmacotherapy, and specific clinical situations;
  • Follow-up and prognosis;
  • Myths and misconceptions — etiology myths, harmful or ineffective “treatment” methods;
  • Sources — ICD-11 CDDR 2024, APA, NICE, WFSBP, ISTSS, ISSTD and other international clinical recommendations;

Terminology

Psychiatric terminology has been systematized and is used consistently throughout the book. Many terms reflect adaptations originating from classical Russian-Soviet psychiatry, on which psychiatric education across the post-Soviet space has traditionally been built. International terms are provided in English, with the note “Eng” in parentheses (for terminological clarity).

Integration of the Popov-Vid school

The book “Modern Clinical Psychiatry” by Yu.V. Popov and V.D. Vid (Saint Petersburg: Rech, 2006, 2nd edition) is a classic textbook of post-Soviet clinical psychiatry. Their method — classical nosology, the biopsychosocial model and practical clinical experience — has been integrated into this book wherever it is consistent with contemporary international recommendations. Where differences exist (e.g., the dimensional personality model of ICD-11), this is explicitly indicated.

Treatment standards

For each disorder, treatment is referenced to international clinical guidelines:

  • American Psychiatric Association (APA) clinical practice guidelines;
  • National Institute for Health and Care Excellence (NICE);
  • World Federation of Societies of Biological Psychiatry (WFSBP);
  • Canadian Network for Mood and Anxiety Treatments (CANMAT)/International Society for Bipolar Disorders (ISBD) — bipolar affective disorder;
  • International Society for Traumatic Stress Studies (ISTSS);
  • International Society for the Study of Trauma and Dissociation (ISSTD);
  • American Academy of Child and Adolescent Psychiatry (AACAP);
  • National drug lists and guidelines.

Drug names are given both by the international nonproprietary name (INN) and by the trade (brand) name, because drugs on the Azerbaijani market are mostly known by their trade names. Spelling follows American English; the titles of ICD-11 categories (headings, code tables and references) are reproduced in the WHO’s spelling — for example, “generalised”, “behavioural”, “aetiological”, “apnoea”.

The Azerbaijani clinical context

Where appropriate, notes specific to the Azerbaijani context are provided:

  • Issues of implementation in primary health care;
  • Cultural characteristics and stigma;
  • Legal and ethical frameworks;
  • Constraints on available resources;
  • Trauma disorders in veterans of the Second Karabakh War;
  • Instruments whose reliability has been validated in the Azerbaijani language.

Scales and instruments

Appendix B presents the most commonly used screening and assessment instruments either in full text (open-licensed) or in descriptive form (commercially licensed).

Sources and approach

Priority sequence of authoritative sources. For each topic, one principal authoritative guideline is presented first, after which other guidelines are introduced for comparison or supplementation. This approach aims to maintain a balance between academic precision and concreteness and to avoid duplication of information. Principal authoritative guideline selections for each disorder:

  • Schizophrenia: NICE CG178 (2014) + Clinical Protocol of the Ministry of Health of the Republic of Azerbaijan (2009)
  • Depression: NICE NG222 (2022) — “Depression in adults: treatment and management” guideline + Clinical Protocol of the Ministry of Health + APA Practice Guideline (2010)
  • Bipolar disorder: CANMAT/ISBD (2018, updated 2021)
  • Anxiety disorders: NICE Clinical Guideline 113 (2011/2020). “Generalised anxiety disorder and panic disorder in adults: management”. NICE CG113 (2011) + Clinical Protocol of the Ministry of Health (2013) + WFSBP (2012)
  • OCD: NICE Clinical Guideline 31 (2005). “Obsessive-compulsive disorder and body dysmorphic disorder”. NICE CG31 (2005, in force) + Clinical Protocol of the Ministry of Health (2015) + APA (2007)
  • PTSD: NICE NG116 (2018) + ISTSS Prevention and Treatment Guidelines (2019)
  • Eating disorders: NICE Guideline 69 (2017). “Eating disorders: recognition and treatment”. NICE NG69 (2017) + APA (2023)
  • Personality disorders: NICE Clinical Guideline 78 (2009). “Borderline personality disorder: recognition and management”. NICE CG78 (borderline personality disorder, 2009), CG77 (antisocial personality disorder, 2009) + APA (2024)
  • Neurodevelopmental disorders: AACAP Practice Parameters + NICE (NG87 — ADHD, 2018; CG128/CG170/CG142 — autism spectrum disorder)
  • Psychoactive substance use disorders: NICE CG115 (alcohol) + American Society of Addiction Medicine (ASAM) standards (2020)
  • Dementia: NICE Guideline 97 (2018). “Dementia: assessment, management and support for people with dementia and their carers”. NICE NG97 (2018)

Domestic authoritative sources:

  1. Clinical protocols developed by the Public Health and Reforms Center (PHRC) of the Ministry of Health of the Republic of Azerbaijan and approved by decisions of the Collegium of the Ministry of Health
  2. Law of the Republic of Azerbaijan of 12 June 2001 “On Psychiatric Care” (as subsequently amended)
  3. Law of the Republic of Azerbaijan “On Psychological Assistance”

The Commonwealth of Independent States (CIS) and the post-Soviet space:

  • Popov Yu.V., Vid V.D. Modern Clinical Psychiatry. Saint Petersburg: Rech, 2nd ed., 2006 — regarded as a classic post-Soviet source of clinical psychiatry.

How to use this book

Typical clinical use:

  • When a specific mental disorder is suspected in a patient, the relevant section is found in the table of contents.
  • Diagnosis (Section 6) — diagnosis is made using ICD-11 criteria.
  • Differential diagnosis (Subsection 6.4) — exclusion of other possibilities using the table.
  • Examination methods (Section 7) — a plan is drawn up.
  • Treatment (Section 8) — recommendations are given with the level of evidence indicated.

For the student:

The lesson topic is looked up in the table of contents.

  • In each section, the sequence Definition → History → Epidemiology → Etiology → Clinical manifestations → Diagnosis is followed.
  • Legislative issues are studied in the section on legal and ethical aspects.

For the clinical psychologist:

  1. The legal and ethical aspects section is of particular importance (conditions for involuntary hospitalization, limits of psychological assistance)
  2. The diagnostic sections are intended to help decide on referral of the patient to a psychiatrist.

Disclaimer

This book is a clinical reference guide, but when making a decision in an individual patient:

The individual clinical picture of the patient must always be taken into account

  • Treatment decisions should be made taking into account patient consent, comorbidities and the local availability of the drug
  • Drug doses must be confirmed against the current local prescribing information
  • In legal and ethical matters, the latest effective version of the relevant legislation must be checked.
  • This book does not replace individual medical advice

Knowledge in the field is updated regularly; the physician should follow updates in international and local recommendations.