Chapter 16: Treatment

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Chapter 16: Treatment by Mind Map: Chapter 16: Treatment

1. Categories of Treatment

1.1. Psychotherapy

1.1.1. provided by a range of mental health professionals, and the approaches tend to differ depending on who is providing treatment

1.1.2. can range from very brief interventions of 1 session to years

1.1.3. certified professionals that have completed extensive supervised training

1.1.3.1. psychologists have PhDs in psychology

1.1.3.2. psychiatrists have medical degrees, and further specialized psychiatric training

1.1.3.3. family doctor, psychiatric nurses, or social workers have some form of training but not expert like (^)

1.1.4. Insight therapy

1.1.4.1. include psychoanalysis (the Freudian approach) and humanistic approaches

1.1.4.2. based on the idea that there is something in the person’s unconscious or in their background that is causing the disorder

1.1.4.2.1. if the client can gain insight or understanding about that cause, then they can work toward a solution

1.1.5. Cognitive therapy

1.1.5.1. focus on thought processes that are associated with disorders

1.1.5.1.1. e.g.) challenge the way someone thinks about feared stimuli

1.1.6. Behavioral therapy

1.1.6.1. based on classical and operant conditioning

1.1.6.2. focus on the symptoms without worrying about the cause of behavior

1.1.6.2.1. e.g.) if someone is afraid of spiders then a behaviourist will focus on helping the person be calm around spiders without worrying why the person is afraid of spiders

1.1.7. Eclectic therapies

1.1.7.1. blends of other therapeutic approaches

1.1.7.1.1. Eclectic is a word that means ‘from a wide range of sources’

1.1.7.2. tend to be very personalized to the situation or to the needs of the client, rather than a theoretical perspective

1.2. Biomedical treatments (invasive)

1.2.1. tend to alter something about the person’s physiology rather than focusing on their thoughts or actions directly

1.2.2. Medicines

1.2.2.1. idea is to change the underlying physical problem to improve the psychological problem

1.2.2.1.1. but recall that not all disorders have a clear biological marker

1.2.2.2. tend to have side effects that can be dangerous or unpleasant

1.2.2.3. sometimes a drug will cause improvement but that doesn’t mean that it treated an underlying cause. It might just suppress the symptom while leaving other problems intact.

1.2.3. other last resort: electroconvulsive therapy and psychosurgery

2. Treatments for Mood Disorders

2.1. Psychotherapy (great for depressed and bipolar (minus manics))

2.1.1. Interpersonal therapy (influenced by Freud)

2.1.1.1. provides a lot of support and social skills training, and that one seems to be particularly beneficial for people with depressed symptoms.

2.1.2. Cognitive behavioral therapies

2.1.2.1. challenge the negative thoughts that are common in depression

2.1.2.1.1. Ellis’ Rational Emotive Behavioral Therapy, or Beck’s Cognitive Therapy

2.1.2.2. goal is to alter the existing behaviors and thoughts, in order to alter the emotional experience.

2.1.3. any therapy that is supportive and helps break the depressed patient out of the mental and behavioral patterns will help to improve symptoms

2.1.3.1. >>therapeutic alliance, is a better predictor of the success of these treatments than the type of therapy is

2.2. Medications

2.2.1. depression

2.2.1.1. selective serotonin reuptake inhibitors or SSRIs

2.2.1.1.1. prevent re-uptake of serotonin by the presynaptic neuron- leave serotonin in the synapse for longer, so that the next neuron has more time to use it = If the brain is low on serotonin, or the receptors for serotonin are damaged/not functioning properly, there are added chances for that serotonin to be effective.

2.2.2. bipolar disorder

2.2.2.1. no antidepressants because it can trigger a manic episode

2.2.2.1.1. Mood stabilizing lithium carbonate is used, as well as some anti-seizure medications that help to inhibit firing in the brain.

2.2.3. anxiety disorders

2.2.3.1. combination of medication and psychotherapy is the most effective

3. Treatments for Anxiety Disorder

3.1. Cognitive Behavioral Therapy (CBT)

3.1.1. Systematic desensitization

3.1.1.1. Main Components: 1. Hierarchy of Fear 2. Relaxation Training 3. Working through the hierarchy one step at a time

3.1.2. Exposure and response-prevention

3.1.2.1. client is prevented from doing the usual compulsive behavior

3.1.2.1.1. e.g.)patient has fear of germs has dirt poured on hands and cannot wash hands for period of time

3.1.3. some patients are effectively cured in one session while others take longer

3.1.3.1. still more efficient and quick compared to other therapies

3.2. Anxiolytic Medications (depressant drugs)

3.2.1. reduce firing throughout the brain by increasing the use of GABA (inhibitory neurotransmitter)

3.3. Antidepressants

3.3.1. used to regulate/improve the use of serotonin

3.3.1.1. Serotonin helps to keep moods stable and regulated

4. Treatments for Personality Disorders

4.1. often difficult to treat- poor scientific evidence about good treatments

4.1.1. borderline personality disorder-very resistant to treatment

4.2. CAN improve and get along with others but, traits make it difficult for patient to comply or even want treatment making it harder to improve

4.2.1. personality disorder affect efficacy of other disorder's treatments

4.2.1.1. if the person also has a comorbid personality disorder (personality disorder and other e.g.. depression) treatments that are known to be effective for depression will be less likely to work

4.3. symptoms make it difficult to form alliance with therapist/unlikely to stick to treatment

4.3.1. low conscientiousness and low agreeableness

4.3.1.1. associated with both borderline personality disorder and antisocial personality disorder

5. Treatments for Schizophrenia

5.1. does not respond well to psychotherapy alone or talk therapy alone

5.1.1. biological markers (enlarged ventricles, shrinking cortex, and hypofrontality)

5.2. With medication, behavior therapy is successful for helping to manage behaviors and keep emotions and social behaviors under control

5.2.1. >helping them live well with others and learn coping strategies to deal with the symptoms that the medication doesn’t handle

5.3. Behavior therapy doesn’t require a lot of conversation or explanation, unlike cognitive/insight therapy where you need to hold an actual conversation

5.3.1. only have to be able to respond to conditioning procedures (e.g.)punishment-reinforcement))

5.4. Token economy is popular for patients who can't live on their own

5.4.1. physical tokens, which could be coins, or buttons, or stickers on a chart, to indicate when the client has done a ‘good’ encouraged behavior

5.4.2. lose tokens for ‘bad’ behaviors that want to be eliminated

5.4.3. saved up tokens can be traded for special items or privileges

5.4.4. helps to increase the rate of behaviors that are positive or prosocial (like taking showers, or eating dinner with the group) and decrease the rate of behaviors that are aversive (like yelling, or hurting oneself).

5.4.4.1. entirely on operant conditioning, and is very useful for patients with limited self-control and limited cognitive abilities

5.5. Medications: antipsychotic medications, (or neuroleptic medications)

5.5.1. (first developed) typical or conventional antipsychotic medications

5.5.1.1. blocking dopamine receptors. reduces the positive symptoms of schizophrenia (hallucinations and delusions) but doesn’t help with the negative symptoms of schizophrenia (flat affect, absence of speech, and catatonia).

5.5.1.2. >unpleasant side effects: Dopamine is important for movement, especially initiating movement, when blocked can start having problems in that domain. One of the most notable side effects is called tardive dyskinesia= repetitive and involuntary movements of the face (might include lip-smacking, making odd faces, or sticking the tongue out)

5.5.1.3. -also sometimes used to treat the delusions associated with some manic episodes in bipolar disorder

5.5.2. (later developed) atypical antipsychotics

5.5.2.1. affect a wider range of neurotransmitters including dopamine, serotonin, norepinephrine and acetylcholine

5.5.2.1.1. seem to improve both positive and negative symptoms, and they have a lower risk of a number of the side effects caused by the conventional antipsychotics, including tardive dyskinesia.

5.5.2.2. >may increase the risk of diabetes or other metabolic problems, and patients may still experience some other side effects but they tend to be milder or more manageable