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Treatments

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Treatments For Mental Disorders BIOLOGICAL TREATMENTS Regards mental disorders as diseases that can be treated medically. Direct brain intervention Psychosurgery ... – PowerPoint PPT presentation

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Title: Treatments


1
Treatments
  • For Mental Disorders

2
BIOLOGICAL TREATMENTS
  • Regards mental disorders as diseases that can be
    treated medically.
  • Direct brain intervention
  • Psychosurgery
  • Electroconvulsive Therapy (ECT)
  • Transcranial magnetic stimulation (TMS)
  • Treating mental disorder with psychotropic drug
  • Antipsychotics
  • Antidepressants
  • Tranquilizers
  • Moodstabilizers
  • Anticonvulsants

3
Psychosurgery
  • Egas Moniz, first psychosurgeon was awarded the
    Nobel Prize in 1949.
  • Surgery to destroy selected areas of the brain
    thought to be responsible for emotional
    disorders.
  • Most famous form of psychosurgery is prefrontal
    lobotomy.
  • Never assessed scientifically.
  • Left patients with personality changes and/or
    unable to function.
  • Rarely used today.

4
Electroconvulsive Therapy (ECT) shock therapy
  • Used for treatment of the depressed patient, who
    is suicidal and cannot wait for antidepressants
    to take effect.
  • Used with chronic depression that do not improve
    with other treatments.
  • Critics claim that it is often used improperly
    and can cause brain damage.

5
Antipsychotic Drugs or Neuroleptics
  • Have transformed the treatment of schizophrenia
    and other psychoses.
  • Although they may lessen the most dramatic
    symptoms, they usually cannot restore normal
    thought patterns or relationships.
  • Allow people to be released from hospitals, but
    individuals may be unable to care for themselves
    or may stop taking medication.
  • Many end as homeless or in the prison system.
  • Overall success is modest.

6
Two types of Antipsychotics Drugs
  • Typical antipsychotics
  • (classical neuroleptics)
  • Atypical antipsychotiocs
  • (new generation)

7
Typical Antipsychotics
  • Thorazine (chlorpromazine)
  • Prolixin (fluphenazine)
  • Haldol (haloperidol)
  • Navane (thiothixene)
  • Mellaril (thioridazine)
  • Loxapac (loxapine)

8
Side Effects from Typical Antipsychotics
  • Most common side effects are
  • ExtraPyramidal Symptoms (EPS)
  • Tardive Dyskinesia (Involuntary, irregular muscle
    movements, usually in the face)
  • Akathisia (restlessness)
  • Dystonia (muscular spasms of neck, eyes, tongue,
    or jaw)
  • Parkinsonism (drug-induced)
  • Dry mouth, muscle stiffness, muscle cramping
    weight-gain.

9
Atypical Antipsychotic Drugs (second generation)
  • Clozaril (clozapine) (FDA-approval 1990)
  • Risperdal (risperidone) (FDA-approval 1993)
  • Zyprexa (olanzapine) (FDA-approval 1996)
  • Seroquel (quetiapine) (FDA-approval 1997)
  • Geodon (ziprasidone) (FDA-approval 2001)
  • Abilify (aripiprazole) (FDA-approval 2002)
  • Invega (paliperidone) (FDA-approval 2006)

10
Antipsychotic Medications
  • First line of therapy for schizophrenia and other
    psychoses.
  • Atypical antipsychotic medications are preferred
    over the typical antipsychotics.
  • Atypical antipsychotics are associated with a
    lower incident rate of extrapyramidal symptoms
    (EPS), although they are more likely to induce
    weight gain and obesity-related diseases.
  • Atypical and typical antipsychotics are generally
    thought to be equivalent in efficacy for the
    treatment of the positive symptoms of
    schizophrenia.
  • Recent reviews have suggested that typical
    antipsychotics, when dosed conservatively, may
    have similar effects to atypicals.
  • Aypicals are costly as they are still within
    patent.
  • Typical antipsychotics are available in
    inexpensive generic forms.

11
Antidepressants
  • Used primarily to treat depression, anxiety,
    phobias, and obsessive-compulsive disorder--come
    in three classes
  • Monoamine oxidase (MAO) inhibitors
  • Elevate levels of norepinephrine and serotonin by
    blocking or inhibiting the enzyme that
    deactivates these neurotransmitters.
  • Tricyclic antidepressants
  • Also elevate levels of norepinephrine and
    serotonin, but by blocking reabsorption or
    reuptake of these neurotransmitters.
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Specifically elevate levels of serotonin by
    preventing its reuptake.

12
Some SSRIs
  • Celexa (citalopram)
  • Lexapro (escitalopram)
  • Prozac (fluoxetine)
  • Luvox (fluvoxamine)
  • Paxil (paroxetine)
  • Zoloft (sertraline)
  • Zelmid (zimelidine)

13
Tranquilizers
  • Some are incorrectly prescribed for panic
    attacks, anxiety and insomnia.
  • Many people develop problems with tolerance and
    withdrawal.
  • In some cases cessation can result in rebound
    panic attacks.

14
Tranquilizers/Sedative-Hypnotics
  • Barbiturates
  • Amytal (amobarbital), Nembutal (pentobarbital),
    Seconal (secobarbital), Luminal (phenobarbitol )
  • Benzodiazepines ("minor tranquilizers")
  • Xanax (alprazolam), Lexotan (bromazepam ),
    Valium (diazepam) , Ativan (lorazepam), Serax
    (oxazepam), Restoril (temazepam), Librium
    (chlordiazepoxide )
  • Nonbenzodiazepine sedatives
  • Lunesta (eszopiclone), Sonata (zaleplon), Ambien
    (zolpidem)
  • Uncategorized sedative-hypnotics
  • Placidyl (ethchlorvynol ), Doriden (glutethimide)

15
Mood Stabilizers Anticonvulsants for Bipolar
Disorder
  • Lithium Carbonate and Lithium Orotate
  • Depakene (valproic acid)
  • Tegretol (carbamazepine)
  • Lamictal (lamotrigine)
  • Neurontin (gabapentin)

16
Other Considerations
  • Because a disorder may have biological origins
    does not mean the only appropriate treatment is
    with medications.
  • There is considerable pressure for physicians to
    prescribe drugs as a result of pressure from drug
    companies and managed-care organizations.
  • Many psychotherapies work as well and teach
    people how to cope.
  • Psychologists can not currently prescribe drugs,
    but are lobbying for prescription privileges.

17
Other Considerations
  • Placebo effects may account for some apparent
    effectiveness.
  • High drop-out rates from side effects.
  • People who take antidepressant drugs without
    learning how to cope with their problems are
    highly likely to relapse on discontinuing
    medication.
  • Some drugs have known risks when taken long term.
  • Long-term risks of taking other drugs, such as
    antidepressants, are not known.

18
Dosage Problems
  • To find the therapeutic window
  • the amount that is enough, but not too much
  • race, gender, and age all influence dosage

19
PSYCHOTHERAPY
  • Relational intervention used by psychotherapists
    to aid clients with problems of living.
  • The common goal of psychotherapies is to help
    clients think about their lives in new ways and
    find solutions for problems their problems.
  • This usually includes increasing individual sense
    of well-being and reducing subjective
    discomforting experience.

20
Psychotherapy
  • Different Modalities
  • Individual
  • Couples
  • Family
  • Groups
  • Different Theoretical Orientations
  • Psychodynamic approaches
  • Behavioral Cognitive approaches
  • Humanistic Existential approaches

21
Psychodynamic Therapy
  • Freuds original method was called
    psychoanalysis, it has evolved into psychodynamic
    therapies.
  • Probes the past and the mind to produce insight
    and emotional release which eliminates symptoms.
  • Many psychodynamic therapists use Freudian
    principles, but different methods.

22
Brief Psychodynamic Therapy
  • Does not go into whole personal history.
  • Focuses on a main issue, as well as
    self-defeating habits and recurring problems.

23
Behavior Cognitive Therapy
  • Behavioral and cognitive therapies focus on
    changing current behavior and attitudes rather
    than striving for insight.

24
Behavioral TechniquesDerived from Behavioral
Principles
  • Systematic Desensitization
  • A step-by-step process of desensitizing a
    client to a feared object or experience based on
    counterconditioning.
  • Aversive Conditioning
  • Substitutes punishment for the reinforcement that
    has perpetuated a bad habit.
  • Flooding or Exposure Treatments
  • Therapist accompanies client into the feared
    situation.
  • Behavioral Records and Contracts
  • Identify current unwanted behaviors and their
    reinforcers.
  • Skills training
  • Practice in specific acts needed to achieve
    goals.

25
Cognitive Techniques
  • Aim is to identify thoughts, beliefs, and
    expectations that might be prolonging a persons
    problems.
  • Albert Ellis Rational Emotive Behavior Therapy
  • Therapist challenges illogical beliefs directly
    with rational arguments.
  • Aaron Beck's Approach
  • Encourages clients to test their beliefs against
    the evidence.

26
Cognitive-Behavior TherapyCBT
  • Combines Behavioral Cognitive Therapy
  • The most common treatment.

27
Humanist and Existential Therapy
  • Assume that people seek self-actualization and
    self-fulfillment.
  • Do not search into the past.
  • Works with here and now
  • Help people feel better about themselves.

28
Carl Rogers Client-Centered or Nondirective
Therapy
  • Therapist offers unconditional positive regard to
    build self-esteem.
  • Therapists must be warm, genuine, and empathic.
  • Client adopts these views and becomes
    self-accepting.

29
Existential Therapies
  • Help clients explore the meaning of existence.
  • Utilize the power to choose a destiny to accept
    responsibility for life predicament.

30
Family Couples Therapy
  • Problems develop in a social context therefore,
    the entire context (usually the family) is
    treated.
  • Observing the family together reveals family
    tensions and imbalances in power and
    communication.
  • Family systems approach recognizes that if one
    member in the family changes, the others must
    change too.
  • Some use genograms
  • Family tree of psychologically significant
    events.
  • Identifies repetitive patterns across
    generations.

31
Group Therapy
  • Clients learn that their problems are not unique.
  • Often used in institutional settings, but also in
    other settings.
  • Different from self-help or personal growth
    groups.

32
Psychotherapy in Practice
  • Most psychotherapists use techniques from
    different approaches.
  • A common process in all therapies is to replace
    self-defeating narratives or life stories with
    ones that are more hopeful and attainable.

33
EVALUATING PSYCHOTHERAPY
  • The therapeutic alliance
  • Successful therapy depends on the bond between
    client and practitioner.
  • Personality traits of the client contribute to
    this relationship.
  • Cultural context contributes to relationship.

34
The Scientist-Practitioner Gap
  • Conflict between scientists and practitioners
    about the relevance of research findings to
    clinical practice.
  • Practitioners believe it is very difficult to
    study psychotherapy empirically.
  • Scientists want the effectiveness of
    psychotherapy scientifically demonstrated.
  • Short-term treatment is usually sufficient.

35
Which therapy for which problem?
  • For many specific problems and emotional
    disorders, behavioral and cognitive therapies are
    the method of choice--particularly effective for
    anxiety disorders, depression, health problems,
    and anger and impulsive violence.
  • Psychodynamic therapies may be more appropriate
    for less clearly defined therapeutic issues.
  • Cognitive-behavior therapies do not succeed well
    with personality disorders and psychoses, or
    people who are not motivated to carry out a
    cognitive and behavioral program.
  • For certain problems, combinations of medication
    and psychotherapy work best.
  • Other types of problems require use of a
    combination of psychotherapeutic approaches.

36
When Therapy Harms
  • Coercion by the therapist to accept
  • Sexual intimacy or other unethical behavior.
  • Bias on the part of a therapist who does not
    understand some aspect of the client.
  • Therapist-induced disorders
  • Unconsciously inducing the client to produce the
    symptoms they are looking for.
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