Psychology Disorders and Treatments

1. Psychology Disorders and Treatments John R, Ziyad R, Andrew C, Adri D

2. GROUP DUTIES Adri: -Intro into abnormal psychology - Anxiety disorders Andrew: -Therapy/ treatments - Class notes John: -Personality Disorders Ziyad: -Schizophrenia

3. Abnormal Behavior -The American Psychiatric Association defines abnormal behavior in medical terms as: a mental illness that affects or is manifested in a person’s brain and can affect the way the individual thinks, behaves, and interacts with others. Abnormal behavior is… Deviant- Abnormal behavior is atypical or statistically unusual when atypical behavior deviates from what is acceptable in a culture. EX: A woman who washes her hands three to four times an hour and takes 7 showers a day is abnormal because it deludes from what we consider acceptable. Maladaptive- Maladaptive behavior interferes with a person’s ability to function effectively in the world. EX: A man who believes that he can endanger other people through his breathing may go to great lengths to avoid people so he won’t harm anyone. His belief separates him from society and prevents his everyday functioning. Personal distress- Abnormal behavior involves personal distress over a long period of time. The person engaging in behavior finds it troubling. EX: A woman who secretly makes herself vomit after every meal may never be seen by others as deviant, but this pattern of guilt may cause her to feel intense shame, guilt, or despair. (The context of where a behavior is happening is also important when deciding whether a behavior is abnormal or not) -Only one of the three traits above have to be present for the behavior to be labeled as “abnormal” but typically two or 3 are present. -When abnormal behavior persists, it may lead to the diagnosis of a psychological disorder.

4. The Biological Approach - The Biological Approach attributes psychological disorders to organic, internal causes which primarily focus on the brain, genetic factors, and neurotransmitter functioning as the sources of abnormality. -In this approach, the medical model is used (The view that psychological disorders are mental diseases with a biological origin) In this model abnormalities are called “mental illnesses” and the afflicted individuals are called “patients” and they are treated by doctors. The Psychological Approach - The psychological approach emphasizes the contributions of experiences, thoughts, emotions, and personality characteristics in explaining psychological disorders. (May focus on the influence of childhood experience or personality traits in development and the course of psychological disorders).

5. The Sociocultural Approach - Emphasizes the social contexts a person lives, including the individual’s gender, ethnicity, socioeconomic status, family relationships, and culture. EX: Individuals from low-income, minority neighborhoods have the highest rate of psychological disorders. -This approach stresses the ways that cultures influence the understanding and treatment of psychological disorders and takes into account that the frequency and intensity of psychological disorders vary and depend on social, economic, technological, and religious aspects of cultures.

6. The Biopsychosocial Approach - Abnormal behavior can be influenced by biological factors, (such a genes), psychological factors (such as childhood experiences) and sociocultural factors (such as gender). - These factors can operate alone, but they often act in combination with one another. -From this perspective, none of the factors considered is necessarily viewed as more important than another; rather they are all significant ingredients in producing both normal and abnormal behavior. -These different factors can combine in unique ways so that one depressed person might differ from another in terms of key factors associated with the development of the disorder.

7. Classifying Abnormal behavior -Classifying psychological disorders provides a common basis for communicating for Psychologists.. If one psychologist says that her client is experiencing depression, another psychologist understands that a particular pattern of abnormal behavior has led to the diagnosis. - A classification system can also help clinicians make predictions about how likely it is that a particular disorder will occur, which individuals are most susceptible, how the disorder progresses, and what the prognosis (or outcome) for treatment is. -Although a classification system may benefit the person suffering from a psychological symptoms by giving them a sense of relief from identifying the disorder, it may cause the potential for creating a stigma- a mark of shame that may cause others to avoid or to act negatively towards an individual.

8. DSM-IV Classification system - In 1952, the American Psychiatric Association (APA) published the first major classification of psychological disorders in the United states: The Diagnostic and Statistical Manual of Mental Disorders. -It’s current version the DSM-IV was introduced in 1994 and revised in 2000, producing the DSM-IV-TR. -Throughout the development of the DSM, the number of diagnosable disorders has increased dramatically. -The DSM-IV classifies individuals on the basis of five dimensions, or “axes” that take into account the individual’s history and highest level of functioning in the previous year -The five axes are: Axis 1: All diagnostic categories except personality and mental retardation Axis 2: Personality disorders and mental retardation Axis 3: General medical conditions Axis 4: Psychosocial and environmental problems Axis 5: Current level of functioning

9. Critiques of the DSM -The most controversial aspect of the DSM-IV is that the manual classifies individuals based on their symptoms, using medical terminology in the psychiatric tradition of thinking about medical disorders in terms of disease which implies that the abnormalities have an internal cause that is relatively independent of environmental factors. -The DSM-IV focuses strictly on pathology and problems. Critics argue that emphasizing strengths as well as weaknesses might be an important step towards maximising his or her ability to contribute to society. List of Disorders: -Anxiety disorders -Somatoform disorders -Factitious disorders -Dissociative disorders -Delirium, dementia, amnesia, and other cognitive disorders -Mood disorders -Schizophrenia and other psychotic disorders -Sexual and gender identity disorders -Sleep disorders -Impulse control disorders not elsewhere classified -Adjustment disorders

10. Are Psychological Disorders a Myth? - Some may think that mental illnesses are real while others do not. - In 1961 Thomas Szasz in his book “The Myth of Mental Illness” argued that psychological disorders are not illnesses and are better labeled as “problems of living”. Szasz said that it makes no sense to refer to a person’s problems of living as “mental illness” and to treat him or her through a medical model. Szasz’s argument still carries weight today - The National Alliance for the Mentally Ill (NAMI) The American Psychiatric Association, and the National Mental Health Association (NMHA) issued a statement declaring to critics like Szasz saying “While we respect the right of individuals to express their own points of view,they are not entitled to their own facts. Mental illnesses are real medical conditions that affect millions of Americans”. -In addition, the current controversy over ADHD (Attention deficit Hyperactivity Disorder) on whether it’s real or not, shows that no one wants to label inappropriately, to misdiagnose, or to mistreat people who are already suffering.

11. Generalized Anxiety Disorder (GAD) - Generalized anxiety disorder is a psychological disorder marked by persistent anxiety for at least 6 months in which the individual is unable to specify the reasons for anxiety. -People with this disorder are nervous most of the time. -They may worry about their work, relationships, or health. This worry can also take a physical toll, so that individuals with the disorder may suffer from fatigue, muscle tension, stomach problems, and have difficulty sleeping. -The biological factors involved in GAD are genetic predisposition, deficiency in the neurotransmitter GABA, sympathetic nervous system activity, and respiratory system abnormalities. -The psychological and sociocultural factors include having harsh (or even impossible) self standards, overly strict and critical parents, automatic negative thoughts when feeling stressed, and a history of uncontrollable traumas or stressors (such as an abusive parent).

12. Case study of GAD James is coping with generalized anxiety disorder, as was stated earlier. At 31, he is allowing this disorder to control his life which is leading to being emotionally and physically drained. Although he realizes that he is an intelligent and capable person, he knows to avoid any situation that may exacerbate the anxieties that he is experiencing. With minimal support from his family and friends, James feels that he is dealing with this all alone and just wants to lead a normal life. Perhaps the stress and strain of becoming a doctor led to James' anxiety disorder as it may have been dormant within his genetic makeup, and is now just surfacing. Work. This would affect James immensely because his whole life has been based around his becoming a doctor. Even his father wanted him to follow in his footsteps and have a prestigious career. • School. Although James did not experience anxieties until after he graduated from medical school, I'm sure he still felt anxious with tests and schoolwork. • Relationships. This would be dealing with James' parents as they are somewhat supportive but disappointed that his career has not been progressing. He also lost his relationship with his girlfriend of three years because of the stress. • Health. Because James is dealing with this disorder, his health is rapidly declining. He is having headaches, body aches and pains and is always tired. His emotional health is affected as well with feelings of laziness and worthlessness. • Financial. James is realizing that if he cannot work, he cannot earn a paycheck. He is living off a small trust fund set up for him by his great uncle, but that won't last forever. All of these things are considered threats and can cause James to worry excessively which is interfering with his life. James needs to be treated by a psychiatrist, not a family physician. He needs to be seen by someone who deals with psychological disorders daily and is educated with the treatments available. Psychological treatments work better in the long run and work just as well as prescription medication. Our textbook states that, 'as we learn more about generalized anxiety, we may find that helping people with this disorder to focus on what is actually threatening is useful.' (Durand, 2007 p.134).

13. Panic Disorder - A panic disorder is an anxiety disorder in which the individual experiences recurrent, sudden onsets of intense apprehension of terror, often without warning and no specific cause. -Panic attacks can produce severe palpitations, extreme shortness of breath, chest pains, trembling, sweating, dizziness, and a feeling of helplessness. -People with this disorder fear that they will die, go crazy, or do something they cannot control.They may feel like they are having a heart attack. -From a biological view, individuals that suffer from Panic Disorder may have an autonomic nervous system that is predisposed to be overly active. Another possibility is that it may stem from problems involving either or both of the two neurotransmitters: norepinephrine and GABA. -In terms of sociocultural factors, American women are twice as likely to have panic attacks, possibly due to biological differences in hormones and neurotransmitters. -Research also suggests that women may cope with anxiety-provoking situations differently than men.

14. Case study of Panic Disorder Sue, 30 years old, recently left the RAN after ten years of active service I remember my first panic attack like it was yesterday. I guess I’d always been an anxious type, but this was like nothing I’d ever experienced. I was at a football game about six years ago, big crowd, St Kilda getting hammered by the Pies. I think I was a bit edgy – I’ve never liked being hemmed in, stuck somewhere I couldn’t get out of easily. Then suddenly this thing just took me over. I got these pains in my chest and I couldn’t breathe. I was sure I was having a heart attack and was going to die. I was thinking about my daughter – she was two at the time – and thinking it can’t end like this, I’ve got to see her again. I was sweating, heart racing, trembling….I had to get out of there. I managed to push my way through the crowd and I saw a St John’s ambo. What a relief. He helped me to the ambulance and they took me straight to hospital, wired me up to all sorts of machines and then…..they told me there was nothing wrong, that it was all in my head. All in my head? Those pains were real, I can tell you. All they said was that I’d had a panic attack, and I was so happy to be alive, I didn’t ask them more about it. I just wanted to get home. But since then, my life has changed. I only went back to sea once (my skills are needed more on shore than at sea, thank God) but that was terrifying. I spent the whole time worrying about whether I’d have an attack while we were far from land and I avoided being below decks whenever I could. Since the first time, I’ve had about a dozen attacks and each one was terrifying. I’ve stopped going anywhere that I can’t get out of easily in case I have another one. No shopping centres. No cinemas. No football games. No public transport. No crowded places. I left the navy because I couldn’t face going to sea again. I managed to get in to see her and the first thing she told me was to only take the tablets when I absolutely had to. That annoyed me – one doctor tells you one thing, another tells you something else. But the more she explained what was happening, the more it made sense. The tablets help to stop the attacks when they’re happening, but they don’t do anything to prevent another one. She says I can only learn how to control them if I let myself risk having one. I think we’re on the right track. We’ve spent a lot of time talking about my breathing. She says I’m “hyperventilating”, that my body is getting ready for fight or flight when there’s no danger there. I’ve been practicing the exercises she gave me and I really do feel more in control.

15. Phobia Disorders -A phobia disorder or phobia is an anxiety disorder characterized by an irrational, overwhelming persistent fear of a particular object or situation. -Whereas individuals with generalized anxiety disorder cannot pinpoint the cause of their nervous feelings, individuals with phobias can. -A fear becomes a phobia when a situation is so dreaded that an individual goes to almost any length to avoid it. As with an anxiety disorder, phobias are fears that are uncontrollable, disproportionate and disruptive. -A snake phobia that keeps a city dweller from leaving his apartment is clearly disproportionate to the actual chances of encountering a snake. -Another phobic disorder, social phobia, is an intense fear of being humiliated or embarrassed in social situations. -Phobias usually begin in childhood and comes in many forms -Researchers have proposed that there is a neural circuit for social phobia that includes the thalamus, amygdala, and cerebral cortex and as well as a number of neurotransmitters (especially serotonin) -With regards to psychological factors, some theorists consider phobias as learned fears.

16. Phobia disorder case study This person, let’s call him Jack, was a 25 year old man. He had a good job that he liked and on the whole appeared like a ‘normal’ young man. However, he hadn’t led a normal life for about 8 years. He hated being around people, especially crowds, unless he absolutely had to. This had seriously affected his life. He could go to work but he couldn’t go out, or if he did, it was for a very short time and then he made excuses to leave early, and he’d never been to a cinema since he was a teenager. As you can imagine this limited his social life dramatically. He couldn’t even go to supermarkets. Supermarkets are horrendous places for someone with a social phobia as they often feel they may become ill (e.g. vomit or faint) whilst shopping and they also fear that people there are looking at them which increases their anxiety massively. Session 1 During our first session after the case history I discovered that his goal was to be able to go to places like supermarkets, pubs and generally feel relaxed in public places, and to stop the excessive sweating that often accompanies this condition. The next thing we did was to use Solution Focused questions to help him get focused on what he wanted. It’s interesting that most people are so absorbed in how things are now and why they don’t like it, that they have put themselves in a Symptom Trance. Next, we worked together to come to a small goal that he could do in the week to get out of his comfort zone. It’s very important that comfort zones are challenged in small ways. The goal was to deliberately go into the work canteen and eat something (something he never did). This may not sound like much to someone who hasn’t a problem being around people, but for a person with social phobia, it is really difficult. He agreed the goal. (Cured through shaping after a few sessions)

17. Obsessive-Compulsive Disorder (OCD) http://www.youtube.com/watch?v=-HIO0AK-MB8 -Obsessive-Compulsive Disorder is an anxiety disorder in which the individual has anxiety provoking thoughts that will not go away and/or urges to perform repetitive, ritualistic behaviors to prevent or produce some future situations. -Game show host Howie Mandel has coped with OCD, and David Beckham and Leonardo Dicaprio have each described mild cases of the disorder. -The most common compulsions are excessive checking, cleansing, and counting. An individual with OCD might believe that she has to touch the doorway with her left hand whenever she enters a room and count her steps as she walks across the room. If she does not complete this ritual, she may be overcome with a sense of fear that something terrible will happen. -In terms of biological factors, data has shown that the frontal cortex or basal ganglia are so active in OCD that numerous impulses reach the thalamus, generating obsessive thoughts or compulsive actions. The amygdala may be smaller in individuals that have OCD compared to those that don’t. Also, low levels of the neurotransmitters serotonin and dopamine likely are involved with the brain pathways linked with OCD. -In terms of Psychological factors, OCD sometimes occurs during a period of life stress. -According to the Cognitive perspective, is that individuals with OCD don’t have the ability to turn off negative, intrusive thoughts by ignoring or effectively dismissing them.

18. OCD case study The OCD started when he was about 7 or 8 years of age and has gradually got worse.When he was doing homework in secondary school he was checking again and again that everything was done. This made him lose a lot of time.As a child he used to have phobias of lifts and elevators and thunder and lightning. He got teased in throughout school, because of his anxiousness and behaviours.After finishing school he started working in a job, where he had to make sure that everything was clean and clear, that things were locked up when he was leaving. This made his job very difficult for him and as the OCD got worse he was not able to do his job anymore because he was much too slow. Also he used to have to stay longer hours to check that he had done his job right.He has to think about things in a certain sequence before getting up in the morning. This sequence might delay him for almost half an hour before he is able to get up. The sequence comes again about3 or 4 times daily. He has to check various things over and over again.Intervention: We started with Prozac 20mg mane, and then increased it to 40mg mane. After 5 months of medical treatment, with no significant relief, we started with Lyrica 150 mg BD.We also started a CBT programme, where he put the various checking in an order, from least frightening to most frightening and then we started the exercises. He had some success with checking when showering and turning the lights off, also checking taps. Leaving the house still takes him at least an hour before he has made sure that everything is the way it should be. The most difficultsymptoms are the intrusive thoughts, where he still has to think in a sequence.At present, with medication, the young man is still not able to work, but he has regained some qualityof life, where he can, at least enjoy his hobby and is able to socialise a little. Medication typically SSRI's or Clomipramine (a tricyclic SRI).2. Cognitive Behavioural Therapy. Desensitization and exposure therapy.

19. Post- Traumatic Stress Disorder (PTSD) -Post-Traumatic Stress Disorder is an anxiety disorder that develops through exposure to a traumatic event that has overwhelmed that person’s abilities to cope. -The symptoms of PTSD vary but include: -Flashbacks in which the ind. relieves the event. A flashback can make a person lose touch with reality and reenact the event for seconds, hours, or, very rarely, days. A flashback comes in the form of images, sounds, smells, and/or feelings-usually believes that the traumatic event is happening all over again. -Avoidance of emotional experiences and of talking about emotions with others. -Reduced ability to feel emotions, resulting in the inability to experience happiness, sexual desire, or enjoyable interpersonal relationships. -Difficulties with memory and concentration. -Impulsive outbursts of behavior, such as aggressiveness, or sudden changes in lifestyle. -PTSD can be associated with a variety of combat and war related traumas, sexual abuse and assault, natural disasters, and unnatural disasters such as plane crashes and terrorist attacks. -The factors that may increase one’s vulnerability toward the disorder include a history of previous traumatic events and conditions such as abuse and psychological disorders

20. PTSD case study Steve was a Royal Marine staff sergeant who had served in the Falklands War. Whilst on operational duty during that conflict he was blown up by a mortar. For over 20 years he had experienced a range of mild post traumatic stress disorder (PTSD) symptoms and these fully returned after being blown up by another mortar during a training exercise. When he saw me he was experiencing very intense PTSD symptoms which were affecting him, his career, and most notably his family. Together we utilised CBT and EMDR to help control and finally eliminate his PTSD symptoms completely. He returned to active duty and returned to being a happily married family man.

21. Schizophrenia Define - Mental disorder that makes it hard to tell the difference between what is and is not reality Symptoms - Tense or irritable feeling, Trouble concentrating, bizarre behaviors, isolation, reduced emotion, hearing or seeing things that are not there, delusions, reduced emotion

22. Schizophrenia Causes - Schizophrenia is a complex illness. Mental health experts are not sure what causes it. Genes may play a role.Schizophrenia occurs in just as many men as in women. It usually begins in the teen years or young adulthood, but it may begin later in life. In women, it tends to begin later and is a milder condition.Schizophrenia in children usually begins after age 5. Childhood schizophrenia is rare and can be hard to tell apart from other developmental problems such as autism Biological Factors - Biological factors later in life (during early childhood and adolescence) can either damage the brain further and thereby increase the risk of schizophrenia, or lessen the expression of genetic or neurodevelopmental defects and decrease the risk of schizophrenia http://www.explania.com/en/channels/health/detail/what-is-schizophrenia

23. Association of Genes with Schizophrenia - When people have a share 50% of genes with someone who has schizophrenia they are more likely to have it Psychological Factors- Diathesis-Stress Model view of schizophrenia emphasizing that a combination of biogenetic disposition and stress causes the disorder Sociocultural Factors - Not considered a cause of schizophrenia but they do affect how the disorder progresses.Individuals suffering from schizophrenia who live in non industrialized nations tend to have better outcomes than those who live in industrialized nations Schizophrenia Heredity - If a person in your family has schizophrenia the chances of you getting it are higher than in any other situation

24. Schizophrenia: Case study Jack is a 27 year old man diagnosed with schizophrenia. He has been referred to Top Quality Rehabilitation (TQP) to provide supported employment services. Jack graduated from high school and got a job working in a video store. After working for about 6 months Jack began to hear voices that told him he was no good. He also began to believe that his boss was planting small videocameras in the returned tapes to catch him making mistakes. Jack became increasingly agitated at work, particularly during busy times, and began "talking strangely" to customers. For example one customer asked for a tape to be reserved and Jack indicated that that tape may not be available because it had "surveilance photos of him that were being reviewed by the CIA". After about a year Jack quit his job one night, yelling at his boss that he couldn't take the constant abuse of being watched by all the TV screens in the store and even in his own home. Jack lived with his parents at that time. He became increasingly confused and agitated. His parent took him to the hospital where he was admitted. He was givenThorazine by his psychiatrist, this is a very powerful psychotropic medication. However, he had painful twisting and contractions of his muscles. He was switched toHaldol and had fewer side effects. From time to time Jack stopped taking his Haldol, and the voices and concerns over being watched became stronger. During the past 7 years Jack was hospitalized 5 times. He applied for and now receives SSI, and with the assistance of a case manager has moved into his own apartment. He is now a member of a psychosocial "clubhouse" for people with mental illness. He attends the clubhouse 3 times a week. He answers the phone, and helps write the clubhouse newsletter. He has a few friends at the clubhouse, but he has never had a girlfriend. Jack told his case manager he would like to get a job so he can earn more money and maybe buy a car. Jack is very worried about looking for a job. He doesn't know how to explain his disorder to a potential employer, and he is afraid of becoming overwhelmed. He likes movies and would like to work with them in some manner.qwe

25. Personality Disorder Define: Personality disorders are a group of mental health conditions in which a person has a long-term pattern of behaviors, emotions, and thoughts that is very different from his or her culture's expectations. • Symptoms vary widely depending on the type of personality disorder. • In general, personality disorders involve feelings, thoughts, and behaviors that do not adapt to a wide range of settings. • These patterns usually begin in adolescence and may lead to problems in social and work situations. • The severity of these conditions ranges from mild to severe.

26. Antisocial Personality Disorder Define: Antisocial personality disorder is a mental health condition in which a person has a long-term pattern of manipulating, exploiting, or violating the rights of others. This behavior is often criminal. • Be able to act witty and charming • Be good at flattery and manipulating other people's emotions • Break the law repeatedly • Disregard the safety of self and others • Have problems with substance abuse • Lie, steal, and fight often • Not show guilt or remorse • Often be angry or arrogant

27. Borderline Personality Disorder Borderline personality disorder (BPD) is a mental health condition in which a person has long-term patterns of unstable or turbulent emotions. These inner experiences often result in impulsive actions and chaotic relationships with other people. • Intense fear of being abandoned • Cannot tolerate being alone • Frequent feelings of emptiness and boredom • Frequent displays of inappropriate anger • Impulsiveness, such as with substance abuse or sexual relationships • Repeated crises and acts of self-injury, such as wrist cutting or overdosing

28. Therapy Biological Therapies- also called biomedical therapies, treatments that reduce or eliminate the symptoms of psychological disorders by alternating aspects of body functioning • Drug therapy is the most common form of biomedical therapy • Electroconvulsive therapy and psychosurgery are much less commonly used biomedical therapies • Psychotherapeutic drugs are used in 3 diagnostic categories • mood disorders • anxiety disorders • schizophrenia • 3 different drug types • antianxiety drugs • antidepressant drugs • antipsychotic drugs

29. Drug Therapy Antianxiety drugs- commonly known as tranquilizers, drugs that reduce anxiety by making the individual calmer and less excitable • Benzodiazepines are the antianxiety drugs that offer greatest relief but are potentially addicting • Work by binding receptor sites of neurotransmitters that become overactive during anxiety • Relatively fast acting • EX. Xanax, Valium, Librium • Nonbenzodiazepines are also antianxiety drugs commonly used to treat generalized anxiety disorder • Must be taken for 2-3 weeks for effects to begin taking place • EX. Buspirone, Buspar

30. Drug Therapy Antianxiety cont. • Effects • Benzodiazepines are more powerful and have greater risk for addiction • Nonbenzodiazepines are less powerful and have lesser chance of addiction • Side effects of benzodiazepines • Drowsiness, loss of coordination, fatigue, and mental slowing. • Hazardous when operating motor vehicle • Abnormalities in babies born with mothers on drug • Combination with alcohol, anesthetic, antihistamines, sedatives, muscle relaxants, and some prescription pain medication can lead to depression

31. Drug Therapy Antidepressant drugs- drugs that regulate mood • 4 main classes of antidepressants • tricyclics • tetracyclics • monoamine oxidase inhibitors (MAO inhibitors) • selective serotonin reuptake inhibitors • Work by affecting neurotransmitters in the brain • Allow brain to increase or maintain its level of important neurotransmitters, especially Serotonin and norepinephrine

32. Drug Therapy Antidepressants cont. • Tricyclics- named for 3 ringed molecular structure • Increase level of certain neurotransmitters, including norepinephrine and serotonin • Reduce symptoms in 60-70% of cases • 2-4 weeks for improvement • Side effects- restlessness, faintness, trembling, sleepiness, and memory difficulties • Tetracyclics- named for 4 ringed structure. Also called noradrenergic and specific serotonergic antidepressants • Effects both norepinephrine and serotonin, enhancing brain levels of these neurotransmitters • More effective than any other antidepressant

33. Drug Therapy Antidepressants cont. • MAO Inhibitors- work because they block the enzyme monoamine oxidase. Enzyme breaks down serotonin and norepinephrine. Allow neurotransmitters to stick around brain and regulate mood • Risky with use of other drugs, leading to high blood pressure and risk of stroke. • Selective Serotonin reuptake inhibitors- target serotonin, work by interfering only with the reabsorption of serotonin in the brain • Reduce depression with fewer side effects • Side effects include insomnia, anxiety, headache, and diarrhea • Impair sexual functioning and severe withdrawal symptoms • Widely prescribed = Prozac, Paxil, and Zoloft

34. Drug Therapy Antidepressants cont. • Antidepressant can often be used for anxiety disorders as well, including generalized anxiety disorder, panic disorder, OCD, social phobia, PTSD, and eating disorders • Lithium(lightest of the solid elements) is widely used to treat bipolar disorder • Thought to stabilize mood by influencing norepinephrine and serotonin • Exact mechanism of its effect is mostly unknown

35. Do antidepressants increase suicide risk in children? • FDA test conducted involving 4,300 children • Randomly selected children who would take either a placebo or antidepressant • 2% of children in placebo group had suicidal thoughts • 4% of children in antidepressant group had suicidal thoughts • In 2004, FDA required prescription antidepressants to have “black box” warning for possible risk of suicidal thoughts • caused prescription of antidepressants for children to drop by 20% • Shows drug therapy should not be first choice treatment. Adolescents and children respond better to psychotherapy

36. Drug Therapy Antipsychotic drugs- powerful drugs that diminish agitated behavior, reduce tension, decrease hallucinations improve social behavior, and produce better sleep patterns in individuals with a severe psychological disorder, especially schizophrenia. • Neuroleptics are most extensively used class of antipsychotic drugs. • Treat symptoms of the disorder, not its causes. • Side effects: • tardive dyskinesia- neurological disorder characterized by involuntary random movements of facial muscles, tongue, and mouth, as well as twitching of neck, arms, and legs • Atypical antipsychotic medications carry lower risk of side effects • Influence dopamine and serotonin • Clozaril and Risperdal are most widely used and reduce schizophrenia’s symptoms with side effects of neuroleptics

37. Drug Therapy Electroconvulsive therapy- also called shock therapy, a treatment, commonly used for depression, that sets off a seizure in the brain • Today used to treat severe depression and severe PTSD • Passing small electrical current of a second or less through 2 electrodes placed on the individuals head. Current excites neural tissue, stimulating seizure that lasts for a minute. Anesthesia and muscle relaxants given to minimize convulsions and risk of physical injury. • Treatment only for those who don’t respond to drug therapy • Possible side effects- memory loss and other cognitive impairments and generally more severe than drug side effects

38. Drug Therapy Deep Brain Stimulation- procedure for treatment-resistant depression that involves the implantation of electrodes in the brain that emit signals to alter the brain’s electrical circuitry • Transmission of high frequency electrical impulses to targeted areas of the brain • Treat individuals with treatment-resistant depression and OCD Psychosurgery- biological therapy with irreversible effects, that involves removal or destruction of brain tissue to improve the individual’s adjustment • Instrument inserted into the brain and rotated, severing fibers that connect the frontal lobe(important in high thought processes) and thalamus(emotion). • Also called prefrontal lobotomies • Alleviate symptoms for mental disorders • Can suffer permanent and profound brain damage

39. Sites for case studies Case study sites http://www.theravive.com/research/Generalized-Anxiety-Disorder-Case-Study%3A-James http://at-ease.dva.gov.au/veterans/resources/case-studies/case-study-panic-and-agoraphobia/ http://www.coachinginspirit.com/case-studies/a-case-of-social-phobia http://www.academia.edu/1348084/Case_Study_of_Severe_OCD http://www.ystc.co.uk/stress-trauma-case-studies-PTSD.html