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Psych
Treatment of Psych Disorders
| Question | Answer |
|---|---|
| Who could use help | Probably lots of people: 46% of Americans have some sort of psychological disorder during lifetime, 26% in a given year |
| Who gets help | Not enough. Only 18% with a disorder received treatment during the year |
| Why do people not get help | Don’t think of it as a disorder Don’t know there’s a treatment Think they should handle it themselves Can’t find/afford/get-to a practitioner |
| Clinical Psychologist | Doctoral degree (Ph.D.) with a research component, at least a year of supervised clinical work, state licensing exam |
| Counseling Psychologist | Doctoral degree (Psy.D.), at least a year of supervised clinical work, state licensing exam |
| Psychiatrist | Medical degree (M.D.), residency training in mental disorders, can prescribe drugs |
| Other MDs | Can prescribe drugs, but no specialized training in mental health |
| Psychiatric Social Worker | Master’s degree (MSW), with extra training in mental health |
| School Counselor | Master's degree |
| Psychotherapy treatment | Treatment of emotional, behavioral, and interpersonal problems through the use of psychological techniques, designed to encourage understanding of problems and modify troubling feelings, behaviors, or relationships |
| Biomedical | The use of medications or other medical treatments to relieve the symptoms associated with psychological disorders |
| Psychodynamic | Explore childhood events and encourage individuals to use this understanding to develop insight into their psychological problem |
| Psychodynamic therapy techniques | Free association, dream analysis, interpretation, analysis of resistance |
| Psychodynamic therapy duration | Typically Several years, long duration |
| Evidence for effectiveness of psychodynamic therapy | Weak |
| Psychotherapy: Humanistic | Focus on present rather than past Emphasize conscious over unconscious thoughts Stress taking responsibility for one’s feelings and actions Assume inherent potential for self fulfillment and growth Includes Person-centered therapy and Gestalt therapy |
| Behavioral therapy | Designed to be short term (weeks to months), does not seek to explain psychological disorders, assumes that disordered behavior is learned, tries to change it through rewards and punishments |
| One behavioral therapy technique | Exposure therapy |
| Cognitive therapy | Tries to help identify and correct any distorted thinking about self, others, or the world |
| Basic premise of cognitive therapy | Irrational thoughts lead to negative emotions |
| Cognitive restructuring | Client is taught to question the automatic beliefs, assumptions, and predictions that lead to negative thinking with more realistic and positive belief |
| Mindfulness meditation | Teaches an individual to be fully present in each moment; to be aware of his or her thoughts, feelings, and sensations; and to detect symptoms before they become a problem |
| Should you ask people if they feel better to know if treatment works | No, because of natural improvement, placebo effect, and reconstructive memory |
| Natural improvement | People might have gotten better over time without treatment |
| Placebo effect | Sheer belief in treatment is helpful |
| Reconstructive memory | People overestimate how bad they were before treatment |
| How to tell if a treatment works | Recruit people, divide them into two groups, remeasure severity |
| Logic behind drug treatments | Change communication between neurons by changing the balance of different neurotransmitters |
| Types of neurotransmitters | Amino Acid NTs, (Glutamate and GABA) and Modulatory Its |
| Glutamate | Excitation, increases neural activity |
| GABA | Inhibition, decreases neural activity, opposes effect of glutamate |
| Benzodiazepines for Anxiety Disorder | Make it easier for GABA, the basic inhibitory neurotransmitter, to bind to its receptor so reduction in neural activity, side effects of drowsiness, memory problems, less slow wave sleep, they cause physical dependency |
| Modulatory NTs | Change how a neuron responds to the fast acting NTs Longer effect: minutes to weeks |
| Big 3 of modulatory neurotransmitters | Norepinephrine, Dopamine, Serotonin |
| Monoamine pathways | Small number of neurons in brainstem or midbrain Axons have many branches that reach most cortical areas |
| How can a drug change neurotransmission | Bind to receptor and prevent the normal NT from binding there: Decrease activity of that NT Antipsychotic drugs for SCHIZOPHRENIA work this way |
| Older antipsychotics | Block dopamine receptors |
| Newer better antipsychotics | Block both dopamine and serotonin receptors |
| Why do antipsychotic drugs have side effects | The same neurotransmitters are used in multiple brain areas that have different functions Reducing dopamine activity in one brain area might be good, but reducing dopamine activity in another brain area might be bad |
| Adverse effects/side effects of antidepressants | Sexual dysfunction Weight gain Adolescents & young adults: Increased risk of suicide Middle-age and older: Reduced bone density |
| Physical dependency leads to withdrawal symptoms | Dizzy/light-headed Vertigo Nausea Numbness, tingling sensations Others |
| Bipolar disorder treatment | Medication is standard & effective Antidepressants NOT the drugs of choice They can trigger a manic episode Instead, mood-stabilizers: Lithium, Valproate,Side effects: Kidney and thyroid problems |
| How do mood stabilizers work | Multiple actions, complicated, still being understood |
| Seasonal affective depression | Low mood during winter months w/ little sunlight The treatment is bright light: Typically 30-60 minutes with a special lamp in the morning (no prescription needed, no side effects |
| What does light do for seasonal affective depression | Stabilize circadian rhythms Bright light also has alerting effect – exact mechanism not well known |
| Disorders that include anxiety | Panic Disorder Obsessive-Compulsive Disorder Generalized Anxiety Disorder, Social Anxiety |
| Treatment of panic disorder | Cognitive-behavioral therapy (CBT) is effective A tricyclic antidepressant drug (imipramine) is effective, drugs are more effective over time |
| Treatment of OCD | Cognitive-behavioral therapy (CBT) is effective A tricyclic antidepressant drug (clomipramine) is effective |
| Treatment of Generalized Anxiety and Social Anxiety | Medications: Benzodiazepines,Antidepressants Cognitive behavioral therapy Research data not as extensive as for panic disorder and OCD, but looks like CBT as effective as medication Medications have side effects and withdrawal symptoms, CBT does not |
| DSM criteria for diagnosis | At least 6 symptoms from a long list. Prevalence in children: ~5% |
| ADHD treatment | most typical treatment medication Drugs block re-uptake of norepinephrine and dopamine from synaptic cleft Ritalin Concerta Adderall Strattera Medication generally reduce negative behavior, only mild benefit for positive behavior academic performance |
| Nonmedication ADHD treatment | Behavioral therapy not very effective by itself Adding behavioral training to medication lets people use lower drug dose |
| Autism symptoms | Communication deficits, verbal and nonverbal Avoid eye contact Difficulty ignoring sensory stimuli Restricted and repetitive patterns of behaviors, interests, or activities. |
| Consequences of these symptoms | Poor language learning Failure to learn from other people |
| Social Learning aids cognitive development | Vygotsky noted that interactions with other humans, not just objects, play a big role in cognitive development. |
| Infants start with three useful tools for learning from others | Joint Attention, Imitation, Social Referencing |
| Joint attention | Looking at what someone else is looking at |
| Imitation | Copying an action |
| Social referencing | Learning from another person’s reaction to an event |
| Autism treatment | Behavioral therapy based on operant conditioning (Applied Behavior Analysis), training joint attention, sympbolic play as a start to learning language: pretending that one thing is another |
| Behavioral therapy characteristics | Time and labor intensive – 40 hours a week is good Starting at younger age better than older Best if it occurs both at school and at home So... requires major commitment by family |
| Biological autism treatments | Various psychiatric drugs have been tested, outcomes not good Exploratory treatment: A hormone called oxytocin maybe promising for increasing social attention |
| Psychosurgery | disconnect prefrontal cortex from rest of brain,Patients have less negative emotion after But also: Less emotion of any sort, no initiative, planning & reasoning abilities impaired, sometimes speech or motor problems |
| Modern psychosurgery | Much smaller, more targeted surgeries performed rarely Relief from seizures |
| Herbal and dietary supplements | The basic problem: A substance that occurs in nature cannot be patented. So not much profit not much research on effectiveness or side effects of herbal/dietary products for psychological disorders |
| Electroconvulsive therapy | Having a seizure turns out to alleviate depression,Is effective. Benefit lasts for months. Used when antidepressants don’t work, and for mania. Side effect is memory problems |
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