Transcript Treatments - Focus on Diversity

Treatments
For Mental Disorders
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
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Antipsychotics
Antidepressants
Tranquilizers
Moodstabilizers
Anticonvulsants
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.
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.
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.
Two types of Antipsychotics Drugs
• Typical antipsychotics
– (classical neuroleptics)
• Atypical antipsychotiocs
– (new generation)
Typical Antipsychotics
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Thorazine (chlorpromazine)
Prolixin (fluphenazine)
Haldol (haloperidol)
Navane (thiothixene)
Mellaril (thioridazine)
Loxapac (loxapine)
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.
Atypical Antipsychotic Drugs
(second generation)
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Clozaril (clozapine)
Risperdal (risperidone)
Zyprexa (olanzapine)
Seroquel (quetiapine)
Geodon (ziprasidone)
Abilify (aripiprazole)
Invega (paliperidone)
(FDA-approval: 1990)
(FDA-approval: 1993)
(FDA-approval: 1996)
(FDA-approval: 1997)
(FDA-approval: 2001)
(FDA-approval: 2002)
(FDA-approval: 2006)
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.
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.
Some SSRIs
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Celexa (citalopram)
Lexapro (escitalopram)
Prozac (fluoxetine)
Luvox (fluvoxamine)
Paxil (paroxetine)
Zoloft (sertraline)
Zelmid (zimelidine)
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.
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)
Mood Stabilizers & Anticonvulsants
for Bipolar Disorder
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Lithium Carbonate and Lithium Orotate
Depakene (valproic acid)
Tegretol (carbamazepine)
Lamictal (lamotrigine)
Neurontin (gabapentin)
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.
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.
Dosage Problems
• To find the therapeutic window
– the amount that is enough, but not too much
– race, gender, and age all influence dosage
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.
Psychotherapy
• Different Modalities
– Individual
– Couples
– Family
– Groups
• Different Theoretical Orientations
– Psychodynamic approaches
– Behavioral & Cognitive approaches
– Humanistic & Existential approaches
Psychodynamic Therapy
• Freud’s 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.
Brief Psychodynamic Therapy
• Does not go into whole personal history.
• Focuses on a main issue, as well as selfdefeating habits and recurring problems.
Behavior & Cognitive Therapy
• Behavioral and cognitive therapies focus
on changing current behavior and attitudes
rather than striving for insight.
Behavioral Techniques
Derived 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.
Cognitive Techniques
• Aim is to identify thoughts, beliefs, and
expectations that might be prolonging a person’s
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.
Cognitive-Behavior Therapy
CBT
• Combines Behavioral & Cognitive Therapy
• The most common treatment.
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.
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 selfaccepting.
Existential Therapies
• Help clients explore the meaning of
existence.
• Utilize the power to choose a destiny to
accept responsibility for life predicament.
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.
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.
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.
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.
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.
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.
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.