psych unit 8

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abnormal behavior

patterns of emotion thought and action that are considered pathological (diseased or disordered) for one or more of these reasons: statistical infrequency, disability or dysfunction, personal distress, or violation of norms

medical model

- the perspective that diseases (including mental illness) have physical causes that can be diagnosed, treated and possibly cured
- developed by pinel

psychiatry

the branch of medicine that deals with the diagnosis, treatment, and prevention of mental disorders

szasz

- believed labels like "mentally ill" are self - perpetuating (person begins to behave according to diagnosed disorder)

7 psychological perspectives on abnormal behavior

1) sociocultural - problems reflect cultural values and beliefs
2) behavioral - inappropriate conditioning or modelling
3) evolutionary - exaggerated form of an adaptive reaction
4) humanistic - blocked personal growth
5) psychoanalytical / psychodynamic - unconscious unresolved conflict
6) cognitive - faulty thinking
7) biological - problems with brain function, genetic predisposition, biochemistry

diagnostic and statistical manual of mental disorders [DSM - IV - TR]

the classification system developed by the american psychiatric association used to describe abnormal behaviors; IV-TR indicates that it is the text revision (TR) of the fourth major edition (IV)

first axis of the DSM-IV-TR

axis 1 : clinical disorders - symptoms cause distress and impair social functioning. state disorders (ex) anxiety disorders, depression

Second axis of the DSM-IV-TR

axis 2 : personality disorders and mental retardation - chronic problems that persist throughout life and impair interpersonal or occupational functioning. trait disorders (ex) autism

third axis of the DSM-IV-TR

axis 3 : general medical condition - physical disorders that may be relevant to understanding or treating a psychological disorder. affect moods and mental health

fourth axis of the DSM-IV-TR

axis 4 : psychosocial and environmental problems - problems like interpersonal stressors and negative life events that can affect the diagnosis treatment, and prognosis ( expected cause and outcome) of psychological disorders

fifth axis of the DSM-IV-TR

axis 5 : global assessment of functioning - individuals overall level of functioning in social occupational and leisure activities (ex) 1 - serious attempt at suicide; 100 - happy and productive

anxiety disorders

a type of abnormal behavior characterized by unrealistic irrational fear

generalized anxiety disorder

characterized by chronic uncontrollable and excessive fear and worry that lasts at least 6 months and that is not focused on any object or situation
- develops headaches heart palpitations dizziness and insomnia - more common in women

panic disorder

- sudden but brief attacks of intense apprehension causing trembling, dizziness, and difficulty breathing
- happen after frightening experience or prolonged stress even after exercise
- leads to fear of future attacks

phobias

involve strong irrational fear and avoidance of objects or situations that are usually considered harmless

categories of phobias

1) agoraphobia
2) specific phobias
3) social phobias

Agoraphobia

- fear of certain activities because dont want to have a panic attack in crowded enclosed or open place.
- feel trapped/cannot receive help
- may refuse to leave home

Specific phobias

- fear of object or situation (ex) claustrophobia or acrophobia
- recognize fear as unreasonable but cant control anxiety and will do anything to avoid it (SPIDERS!!!!!)

social phobias

- irrationally fearful of embarrassing themselves in social situations
- fear public scrutiny and potential humiliation

obsessive-compulsive disorders (OCD)

- persistent unwanted fearful thoughts (obsessions) or irresistible urges to perform an act or repeated ritual (compulsions) which help relieve the anxiety created by the obsession
- equally common in men and women but onset in childhood occurs more in boys

causes of anxiety

- cognitive : faulty thinking make them prone to fear; tend to be hyper vigilant (scan for danger all the time and ignore safety) tend to over exaggerate threats and failures and hypersensitive to others opinions of them
- behavioral maladaptive learning results from conditioning. neural stimulus + scary event = conditioned stimulus. person avoids spider to reduce anxiety (negative reinforcement) results from modelling and imitation (over protective parents)
- biological fear of things dangerous to our ancestors or genetic predisposition
- sociocultural fast paced lives decreased well being in western countries. less identifiable causes of anxiety which make people prone to it (ex) japanese TKS : morbid dread of doing something to embarrass others

mood disorders

aka affective disorders are extreme disturbances in emotional states

major depressive disorder

long lasting depressed mood that interferes with ability to function feel pleasure or maintain interest in life for no apparent reason

bipolar disorder

repeated episodes of mania (unreasonable elation and hyper activity) and depression. may not sleep for days at a time and is not tired thinking speed up and changes abruptly to new topics "rapid flight of ideas" speech is rapid "pressured speech" constant talking

causes of bipolar disorder and depression

biological : structural brain changes, imbalance in neurotransmitters serotonin, norepinephrine and dopamine genetic predisposition. evolutionary: normal / healthy adaptive response to a very real loss.

psychosocial : environmental stressors and disturbances in persons interpersonal relationships thought processes self concept and history of learned behaviors

psychoanalytical : depression is anger turned inward against oneself when an important relationship or attachment is lost. anger from feelings of rejection

humanistic : person demands perfection of himself or herself when positive growth is blocked

learned helplessness theory of depression

when people are subjected to pain that they cannot escape, they develop sense of helplessness or resignation and afterwards dont attempt to escape painful experiences. unable to change things for better leads to depression

schizophrenia ("split mind")

a group of psychotic disorders involving major disturbances in perception, language, thought, emotion, and behavior. the individual withdraws from people and reality often into a fantasy life of delusions and hallucinations. equally prevalent in men and women but occurs earlier in boys

five areas of disturbance in schizophrenics

1) perception
2) language
3) thought
4) affect (emotions)
5) behavior

perceptual symptoms of schizophrenia

- senses maybe enhanced or blunted
- impaired sensory filtering and selection
- hallucinations : imaginary sensory perceptions that occur without an external stimulus. most commonly auditory

language/thought disturbances of schizophrenia

- words lose their usual meanings and associations
- impaired logic with bizarre thoughts
- mild disturbances cause person to jump from topic to topic
- severe disturbances person jumbles phrases and words together (word salad) or creates artificial words
- lack of contact with reality (psychosis)
- delusions : mistaken beliefs based on misrepresentations of reality

types of delusions

- delusion of persecution (ex) people trying to kill you
- delusion of grandeur (ex) believe they are jesus christ
- delusions of reference (ex) radio station is giving him/her a special message
^ unrelated events given special significance

the jerusalem syndrome

- dozens of tourists to jerusalem are hospitalized with this syndrome every year
- become obsessed with significance of jerusalem and have bizarre behavior like thinking they are jesus and transforming hotel linens into robes while reciting bible verses

affect [emotional] disturbances of schizophrenia

- emotions are exaggerated and fluctuate quickly
- emotions can be blunted even to the point of flattened affect (almost no emotional response of any kind)

types of schizophrenia

- originally 5 subtypes : paranoid, catatonic, disorganized, undifferentiated, and residual
- alternative classification of symptoms
- 1) positive schizophrenia symptoms (additions to thought and behaviors like hallucinations or delusions)
- 2) negative schizophrenia symptoms (loss of thought and behaviors like flattened affect or social withdrawal)
- 3) disorganization of behavior (rambling speech, erratic behavior, inappropriate affect)

paranoid schiz

dominated by delusions (persecution and grandeur) and hallucinations (auditory)

catatonic schiz

marked by motor disturbances (immobility / wild activity) and echo speech (repeating the speech of others)

disorganized schiz

characterized by incoherent speech, flat or exaggerated emotions and social withdrawal

undifferentiated schiz

meets criteria for schizo but is not any of the subtypes

residual

no longer meets full criteria for schizo but still shows some symptoms

biological causes of schizophrenia

prenatal viral infections, birth complications, immune responses, maternal malnutrition and advanced paternal age

genetics and schiz

- researchers identified specific genes related to schiz
- risk for schiz increases with genetic similarity to that of someone who is schiz

neurotransmitters and schiz

- dopamine hypothesis: overactivity of certain dopamine neurons in the brain causes schizo
- large doses of amphetamines increases amount of dopamine and produce positive symptoms of schizo
- drugs that reduce dopamine activity in brain reduce some symptoms of schizo

brain abnormalities of schiz

- abnormalities in brain function and structure
- larger cerebral ventricles (fluid filled spaces in brain) are visible in people with schiz
- lower level of activity in frontal and temporal lobes (areas involved in language attention and memory
- overall loss of grey matter (neurons in cerebral cortex)

psychosocial contributions of schiz

- diathesis-stress model : stress plays an essential role in triggering schizophrenic episodes in people with an inherited predisposition (aka diathesis)
- communication disorders in family members may also be a predisposing factor for schizophrenia (ex) unintelligible speech fragmented communication, frequently sending several contradictory messages to children
- patients whos families were critical and hostile or overly involved became worse

substance-related disorders

abuse or a dependance on a mood or behavior altering drug

2 categories of substance-related disorders

1) substance abuse - interferes with social or occupational functioning
2) substance dependance - when causes physical reactions like tolerance (requiring more of the drug to get the desired effects) and withdrawal (negative physical effects when the drug is removed)

cormorbidity

substance related disorders commonly coexist with other mental disorders including anxiety disorders, mood disorders, schizophrenia, and personality disorders

self-medication

- individuals drink or use drugs to reduce their painful or frightening symptoms
- can cause cormobidity

criteria for substance abuse

- failure to meet obligations
- repeated use in situations where it is physically dangerous
- continues use despite problems caused by the substance
- repeated substance-related legal problems

criteria for substance dependance

- tolerance
- withdrawal
- substance taken for a longer time or greater amount than intended
- lack of desire or effort to reduce or control use
- social, recreational, or occupational activities given up or reduced
- much time spent in activities to obtain substance
- use continued despite knowing psychological or physical problems are worsened by it

dissociative disorders

- amnesia, fugue, or multiple personalities resulting from avoidance of painful memories or situations
- individuals dissociate from core of their personality by failing to remember past experiences (dissociative amnesia)
- leave home and wander off (dissociative fugue)
- losing their sense of reality and feeling estranged from the self (depersonalization disorder)
- developing completely separate personalities (dissociative identity disorder)

dissociative identity disorder (DID)

- previously known as multiple personality disorder
- at least 2 separate and distinct personalities exist within a person at the same time
- each personality has unique memories, behaviors, and social relationships
- transition from one personality to another occurs suddenly and is often triggered by psychological stress
- personalities unaware of each others existence but aware of lost time
- diagnosed more in women than men; women average 15 or more personalities compared to men who average 8

personality disorders

inflexible maladaptive personality traits that cause significant impairment of social and occupational functioning

antisocial personality disorder

- used interchangeably with the terms sociopath and psychopath
- behavior so far outside ethical and legal standards of society; considered most serious of all mental disorders
- people with this diagnosis feel little personal distress (may not be motivated to change)
- maladaptive traits generally bring considerable harm and suffering to others [(ex) ruthless stock brokers]

4 hallmarks of antisocial personality disorder

1) egocentrism (preoccupation with oneself and insensitivity to the needs of others)
2) lack of conscience
3) impulsive behavior (no thought of consequences)
4) superficial charm

evidence of antisocial personality disorder

- impulsive poised when confronted about destructive behavior. contemptuous of anyone they can manipulate, change jobs/relationships suddenly, history of truancy from school and expulsion for destructive behavior
- charming, persuasive and have uncanny insight into needs and weaknesses of other people

biological / environmental / psychological causes of A.P.D

- genetic predisposition
- abnormally low autonomic activity during stress, reduced grey matter in frontal lobes, right hemisphere abnormal
- abusive parenting styles and inappropriate modelling
- emotional deprivation harsh and inconsistent disciplinary practices, antisocial parents

borderline personality disorder

- most commonly diagnosed personality disorder
- features are impulsivity and instability in mood, relationships and self image
- originally name implied person on border between neurosis and schizophrenia but no longer means that

people with BPD

- chronic feelings of depression / emptiness / intense fear of abandonment / destructiveness / impulsive / sexual promiscuity, drinking, gambling, eating sprees
- see themselves and others in absolute terms (perfect or worthless)
- constantly seek reassurance from others and can become angry at slightest sign of disapproval
- long history of broken friendships, divorce, lost jobs, neglect and emotional deprivation from parents
- physical / sexual / emotional abuse
- runs in families
- impaired functioning of brains frontal lobes and limbic system (regulate impulsive behavior)

Windigo Psychosis

- disorder among ojibwa cree and montagnais-nas-kapi first nations in canada
- characterized by delusions and cannibalistic impulses
- individual experiences loss of appetite, diarrhea, vomiting, and insomnia while people "turn into beavers and other edible animals" (seriously. wtf does beaver taste like)
- later on individual is obsessed with cannibalistic thoughts and may even attack and kill loved ones in order to devour their flesh, sometimes beg to die to end their obsession

women / men and depression

- women 2 to 3 times higher rate of depression
- biopsychosocial model : hormonal and genetic predisposition, reinforcement of societal pressure to be passive, dependent
- men can be showing depression through aggression and substance abuse and will be misdiagnosed

culture and mental disorders

- Nishimoto found 'culture-general symptoms' or symptoms that exist in only certain cultures
- Nishimoto found 'culture-general symptoms' that are useful in diagnosing disorders across all cultures
- north americans and europeans feel guilt when depressed while china has somatization (conversion of depression into bodily complaints)
- culturally-bound mental disorders like windigo are not universal

12 culture-general symptoms of mental health difficulties

1) nervous
2) weak all over
3) feel apart / alone
4) worry all the time
5) trouble sleeping
6) personal worries
7) cant get along
8) cant do anything worthwhile
9) low spirits
10) restless
11) hot all over
12) nothing turns out right

culture-bound disorders

- ataque de nervios (attack of nerves) - latin
- running amok - thai
- brainfag (brain tiredness) - west african
- possession by the zar - ethiopian
- koro - south chinese and vietnamese
- anorexia nervosa - westerners

psychotherapy

techniques employed to improve psychological functioning and promote adjustment to life

insight therapies

cognitive humanistic group and family therapies which seek to increase clients insight into their difficulties. goal is to help people gain control and improve their thoughts feelings and behaviors

psychoanalysis

freudian therapy designed to bring unconscious conflicts which usually date back to early childhood experiences into consciousness. also refers to freuds theoretical school of thought, which emphasizes unconscious processes

freud and abnormal behavior

- caused by unconscious conflicts among 3 parts of psyche: id - ego - super ego
- during psychoanalysis patient comes to understand his or her behavior and realizes childhood conditions under which conflict developed no longer exist and insight allows conflict to be resolved

catharsis

- becoming aware of previously hidden conflicts permits release of tension and anxiety
- traumatic incident, when relieved loses power to control persons behavior

5 major methods of psychoanalysis

1) free association
2) dream analysis
3) analyzing resistance
4) analyzing transference
5) interpretation

free association

- according to freud, when you let your mind wander and remove conscious censorship over thoughts
- interesting and even bizarre connections seem to spring into awareness
- first thing to come to a patients mind is often an important clue to what the persons unconscious wants to conceal
- having patient recline on couch with only the ceiling to look at is believed to encourage free association

dream analysis

- according to freud, defences are lowered during sleep and forbidden desires unconscious conflicts can be freely expressed
- even while dreaming conflicts are seen as unacceptable and need to be disguised as images w deeper symbolic meaning. (ex) riding a horse is interpreted as a desire for or concern about sexual intercourse

insight therapy overview

- psychoanalysis (freud) psychodynamic
- cognitive - rational emotive behavior therapy (ellis)
- cognitive - behavior therapy (beck)
- humanistic - client centered therapy (rogers)
- group / family / marital

behavior therapy overview

- classical conditioning - systematic desensitization and aversion therapy -> operant conditioning - shaping
- reinforcement
- punishment
- extinction -> observational learning - modelling

biomedical therapy overview

- psychopharmacology
- electroconvulsive therapy
- psychosurgery

analyzing resistance

- the inability or unwillingness to discuss or reveal certain memories / thoughts / motives or experiences
(ex) forget or change what they were saying

analyzing transference

- during psychoanalysis pts disclose intimate feelings and memories
- the relationship between therapist and patient becomes emotionally charged pts often unconsciously apply (transfer) some of their unresolved emotions and attitudes from past relationships to the therapist
- therapist help pt to relive their emotions in a safe setting

interpretation

- the core of all psychoanalytic therapy is interpretation
- during free association / dream analysis / resistance / transference the analyst tries to find patterns and hidden conflicts

psychoanalysis criticism

- theres an assumption that repressed memories and unconscious conflicts exist
- limited applicability / time consuming / does not work for severe mental disorder
- spending years chasing unconscious conflicts from the past allow pts to escape from responsibilities of adult life
- lack of scientific credibility therefore led to more streamlined forms of psychotherapy, collectively referred to as psychodynamic therapy

psychodynamic therapy

- a modern form of psychoanalysis that emphasizes internal conflicts / motives / and unconscious forces
- treatment briefer than psychoanalysis / no sitting in a couch, more direct
- focus less on unconscious early childhood roots and more on conscious processes and current problems
- more available and effective for more people

cognitive therapy

- therapy that focuses on changing faulty thought processes and beliefs to treat problem behaviors
- assumes that faulty thought processes and beliefs that are irrational / overly demanding / fail to match reality create problem behaviors and emotions
- exploring unexamined beliefs can produce insight into reasons for disturbed behaviors
- insight into negative self-talk is the most important as oppose to believing change in behavior occur because of insight or catharsis

interpersonal therapy (IPT)

is an influential brief form of psychodynamic therapy as the name implies, focuses almost exclusively on the clients current relationships. its goal is to relieve immediate symptoms and to help the client learn better ways to solve future interpersonal problems

cognitive restructuring

- cognitive therapists help clients to challenge their thoughts, change how the interpret events and change maladaptive behaviors (positive thinking)
- cognitive therapists assume many events and people in and out of the family influence beliefs

albert ellis

- developed rational-emotive therapy (RET)
- ABCD approach used to treat maladaptive thinking
- when people demand 'musts' and 'shoulds' they create emotional distress and behavioral dysfunction

the development and treatment of irrational misconceptions

1) activating even : individual is blocked from desired goal (ex) poor performance evaluation
2) irrational beliefs : individual interprets the frustration in an irrational erroneous manner (ex) "i always mess up"
3) emotional consequences : individual experiences negative feelings which reinforce the original irrational beliefs "im depressed"
4) disputing irrational beliefs : individual challenges irrational beliefs, which changes negative emotions (ex) "i can do well i just need to work harder"

rational-emotive behavior therapy

- unrealistic unproductive self-talk generally goes unexamined unless directly confronted
- ellis would tease and cajole pts and clients realized their self - defeating thoughts and work past them
- beck however would directly confront and change behaviors by providing clients with experiences inside and outside therapy session, which altered self-talk more positively (cognitive-behavior therapy)

becks maladaptive thinking patterns associated with depression

- selective perception : depression prone people tend to focus selectively on negative events while ignoring positive events
- over-generalization : depressed people over-generalize and draw negative conclusions about their self-worth 9ex) believe they are completely worthless because they lost a promotion or failed an exam
- magnification : depressed people tend to exaggerate the importance of undesirable events or personal shortcomings, seeing them as catastrophic and unchangeable
- all-or-nothing thinking : depressed people see things as black or white : totally good / right / a success or bad / wrong / failure

cognitive therapies (REBT) or cognitive-behavior therapy) uses :

depression / anxiety / bulimia nervosa / anger management / addiction / some symptoms of schizophrenia and insomnia

controversy of cognitive therapies

may employ behavior techniques rather than change underlying cognitive structures
- may ignore/deny clients past and overemphasize rationality

humanistic therapy

- therapy that seeks to maximize personal growth through affective restructuring (emotional adjustment)
- disruption of self concept is caused by obstacle that limits ability to become self-accepting and genuine

client-centered therapy

- developed by carl rogers
- encourages people to actualize their potential and relate to others in genuine ways
- explores thoughts / feelings as a way for clients to have insight into cause of behaviors
- rogerian therapists focus on providing accepting environment to encourage healthy emotional experiences
- clients responsible for own discover of maladaptive patterns

4 qualities of communication in client-centered therapy

1) empathy
2) unconditional positive regard
3) genuineness
4) active listening

empathy

- sensitive understanding and sharing of another persons inner experience, putting yourself into another shoes
- therapists use open ended statements rather than asking questions or offering explanations

unconditional positive regard

- genuine caring for people based on their innate values as individuals
- humanists believe human nature is positive and each person is unique
- avoids judgement and when client receives unconditional caring they become better able to value themselves in a similar way

genuineness

- authenticity; being aware of our true inner thoughts and feelings and sharing them honestly with others
- humanists believe when therapist is genuine client will develop self trust and honest self expression

active listening

- involves reflecting, paraphrasing, and clarifying what client say and means
- therapist communicates genuine interest

group therapy

form of therapy in which a number of people meet together to work toward therapeutic goals

self-help group

-variation on group therapy
- simply groups of people who share a common problem
- disadvantages are not getting individual attention found in one-on-one therapy
- advantages are : less expensive and broader base of support / can learn from one another and their mistakes / share coping strategies

family therapy

- treatment to change maladaptive interaction patterns within a family
- all members attend therapy sessions but therapist may choose to selectively see certain family members and not others
- "identified patient" many families go into therapy believing one member is the cause of all their problems rather than confronting their own problems

behavior therapy

- a group of techniques based on learning principles that is used to change maladaptive behaviors
- when insight doesnt solve the problem, focus is on the problem behavior itself rather than on an underlying cause
- therapist lists maladaptive behaviors present and adaptive behaviors missing
- draws on learning principles of classical conditioning, operant conditioning, and observational learning

2 classical conditioning techniques used in behavior therapy

1) aversion therapy
2) systematic desensitization

aversion therapy

uses principles of classical conditioning to create anxiety/negative associations to compete with pleasurable associations (ex) antabuse causes nausea when alcohol is consumed

systematic desensitization

relaxation training followed by imagining or experiencing various versions of a feared object while remaining deeply relaxed

virtual reality therapy

rather than using mental imaging or actual physical experience, modern therapy can use computer technology

3 steps of desensitization

1) client is taught to maintain state of deep relaxation that is physiologically incompatible with anxiety response

2) therapist and client construct hierarchy of anxiety-arousing images

3) relaxed client visualizes or physically experiences items in the hierarchy starting at the bottom and working up to the top (if client feels anxiety, clients stop and return to state of complete relaxation)

shaping and reinforcement

- providing rewards for successive approximations of the target behavior
- role playing with feedback and reinforcement
- tokens or immediate reinforcement for general actions then move on to specific actions eventually stopping because client has reward of feeling better

modelling therapy

a learning technique in which the subject watches and imitates models who demonstrate desirable behavior

criticism of behavior therapy

1) generalizibility - what happens after treatment stops / real world doesnt offer reinforcers / therapists try to change reward to typical rewards found in real life

2) ethics - unethical for one person to control anothers behavior / behaviorists believe rewards and punishments already control our behaviors

biomedical therapies

- the use of physiological interventions (drugs, electroconvulsive therapy, psychosurgery) to reduce or alleviate symptoms of psychological disorders
- based on premise that problem behaviors caused in part by chemical imbalances or disordered nervous system functioning
- physician prescribes biomedical therapies

3 aspects of biomedical therapies

1) psychopharmacology
2) electroconvulsive therapy (ECT)
3) psychosurgery

psychopharmacology

- study of drug effects on the brain and behavior
- canadian network for mood and anxiety treatments (CANMAT) has promoted research and education in pharmaceutical treatment of mental disorders

4 major categories of psychiatric drugs

1) anti-anxiety
2) anti-psychotic
3) mood stabilizer
4) anti depressant

antianxiety drugs

- aka "minor tranquilizers" or anxiolytics
- lower sympathetic activity of brain (fight or flight) so anxious response goes away or is prevented
- replaces anxiety with feelings of tranquility and calm

antipsychotic drugs

- or neuroteptics treat schizophrenia and other acute psychotic states
- referred to as "major tranquilizers" creating "mistaken" impression that they have strong sedation affect
- main effect is diminish / eliminate psychotic symptoms including hallucinations / delusions / withdrawal / and apathy not for sedating patient
- work by decreasing activity at a dopamine synapses in brain

mood stabilizer drugs

- (ex) lithium, help relieve manic episodes and depression for people with bipolar disorder
- lithium acts relatively slowly (can be 3 or 4 weeks before it takes effect) its primary use is in preventing future episodes and helping to break the manic-depressive cycle

anti depressant drugs

- used to treat people with depression
- 5 types of anti depressant :
1) tricyclics
2) monoamine oxidase inhibitors (MAOI's)
3) selective serotonin reuptake inhibitors (SSRI's)
4) serotonin and norepinephrin reuptake inhibitors (SNRI's)
5) atypical antidepressants
- each class of drug affects neurochemical pathways in the brain in slightly different ways [increase or decreasing availability of certain neurochemicals]
- SSRIs (paxil/prozac) most common antidepressants
- atypical antidepressants are a miscellaneous group of drugs used for pts who fail to respond to other drugs or people who experience side effects common to other antidepressants

electroconvulsive therapy (ECT)

- aka electroshock therapy (ESI) a moderate electrical current is passed through brain between 2 electrodes placed on outside of head
- triggers a firing of neurons resulting in a convulsion or seizure, produce many changes in central/peripheral nervous system, activates autonomic nervous system
- increases secretion of various hormones and neurotransmitters and changes in blood-brain barrier

modern use of GCT

- only 12 or fewer treatments sometimes applied only to the right hemisphere to cause less interference w verbal memories and left hemisphere functioning
- used primarily on pts with severe depression who do not respond to antidepressants or psychotherapy and on suicidal pts because it works faster than antidepressants

psychosurgery

- operative procedures on the brain designed to relieve severe mental symptoms that have not responded to other forms of treatment
- lobotomy no longer practiced
- cingulotomy : cingulum (small structure in brains limbic system known to be involved in emotionality) is partially destroyed; rare occasions used in debilitating obsessive-compulsive disorder and depression and chronic pain

criticism of psychopharmacology

- does not provide a cure only provides relief
- some pts become physically dependent on drugs and can cause side effects

repetitive transcranial magnetic stimulation (r TMS)

- delivers brief but powerful electrical current through a coil of wire placed close to the head
- strong current through brain and creates strong magnetic field applied to certain parts of brain
- for depression coil is placed on prefrontal cortex (regulate mood)

5 most common goals of therapy

therapy attempts to change:

1) disturbed thoughts
2) disturbed emotions
3) disturbed behaviors
4) interpersonal and life situation difficulties
5) biomedical disturbances

cultural issues in therapy

1) naming the problem
2) qualities of the therapist
3) establishing credibility
4) placing the problem in a familiar framework
5) applying techniques to bring relief
6) a special time and place

5 major concerns related to gender and psychotherapy

1) rates of diagnosis and treatment of mental disorder (higher in women)
2) stresses of poverty (women likely to be poorer)
3) stresses of multiple roles (women have more roles to fill)
4) stresses of aging (women live longer and have more age related dilemmas)
5) violence against women (sexual assault / harassment / eating disorders)

deinstitutionalization

- discharging pts from mental hospitals as soon as possible and discouraging admission
- alf. are encouraging community care and general hospitals to be equipped with special psychiatric units where acutely ill pts can receive in-pt care
- walk in clinics / crisis intervention services and rehab centers encouraged
- public mental institutions are reserved for most unmanageable pts

psychologists vs psychiatrists vs social workers vs psychotherapists

psychologists : doctoral degrees / diagnosis and treatment

psychiatrists : licensed medical doctors / prescribe drugs

social workers : masters degree in social work / provide counseling

psychotherapists : professional with masters in counseling / licensed by province

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