Chapter 15: Treatment of Psychological Disorders

Purpose of Therapy

to cure/heal or to reduce distress and improve functioning.

Pharmacotherapy

using medication to treat psychological disorders.

Treatment

contains combination of multiple types of therapy (talking vs. psychotherapy)

Mental Health Professionals

• Psychiatrist

• Psychiatric Nurse

• Psychologist

• Clinical Social Worker

• Psychotherapist

Psychiatrist

a mental health profession who assesses and treat psychological disorders & prescribes medications.

• Medical degree (MD)

• Doctorate is not a 3rd cycle degree & is considered a undergrad degree

Psychiatric Nurse

a mental health profession who prescribe and manages psychiatric medications.

• Masters degree (MSN) or doctorate

• Registered nurse (RN), they need to get an extra license to work in psych-side

Psychologist

a mental health profession where they can diagnose, treat behavioural disorders, produce, and use research.

• Doctoral degree (PhD or PsyD)

• Can do anything a psychiatrist does except prescribing medications.

Clinical Social Worker

a mental health profession where they provide mental health care & engage in advocacy.

• Master’s degree in social work (MSW)

Psychotherapist

a mental health profession where they assess and treat psychological disorders.

• they can not diagnose (aka. say what the patient has)

Mental Health Treatments

Efficacy (testing treatment in lab for success) → Effectiveness (testing treatment in real world in small scale for success in large scale)

Biopsychosocial Model

Bio (psychiatrists, psychiatric nurses) → Psycho (psychologists, psychotherapists) → Social (clinical social workers)

History of Mental Health Treatment

• Outdated views attributed mental illness to witchcraft, demonic possession, deals with devil

• Early "treatments" included: prayer, incantations, exorcism, trepanation

• Institutionalization in asylums often continued inhumane treatment

  • Philippe Pinel & Dorothea Dix advocated for humane care

History of Pharmacotherapy

→ 1800s, syphilis was a major issue, no cure

• Causes hallucinations, paralysis, distorted thinking, death

• Wagner-Jauregg deliberately infected patients with malaria (high fever killed the heat-sensitive bacteria)

→ Late 1920s, Sakel (psychiatrist) used high dose of insulin.

• Discovered that high dosage had calming effects & helped reduce schizophrenia symptoms.

• Before was used to stimulate appetite of psychotic patients.

→ 1950s, anti-histamine medication research that led to the development of the first antipsychotic drug (chlorpromazine)

Psychopharmacotherapy for Schizophrenia

• Typical Antipsychotics

• Atypical Antipsychotics

Typical Antipsychotics

a psychopharcotherapy for schizophrenia:

• Block dopamine receptors in the brain

  • Dopamine related to pleasure, motivation, motor control

  • Gives calming effect (ex. Chlorpromazine, a drug that acts to block/slow down use of dopamine within the brain)

• Extrapyramidal symptoms

  • Difficulty to control own body (tremors)

  • Tardive dyskinesia; difficulty to move face, tongue, arms & persists even after medication is stopped.

 

Atypical Antipsychotics

a psychopharcotherapy for schizophrenia:

• Block dopamine and serotonin receptors in the brain

  • Serotonin related to mood & using energy

• Diseases white blood cell count

  • Susceptible to infections

• Difficulty with concentration, weight gain

Psychopharmacotherapy for Depression

• Antidepressants more effective with severe depression

  • Placebo effects for milder depression

  • Treats the symptoms but does not prevent next episode

• Studying Ketamine -> focuses on the glutamate neurotransmitter, glutamate increases brain activity)

• Antidepressant Medications:

  • Amphetamine

  • Monoamine Oxidase Inhibitors (MAOIs)

  • Tricyclic Antidepressants

  • Selective Serotonin Reuptake Inhibitors (SSRIs)

Amphetamine

a psychopharmacotherapy medication for depression that was used to improve mood but was too addictive and had too many side-effects.

Depression

is due to an imbalance in Monoamine Neurotransmitters (serotonin, norepinephrine, dopamine).

Monoamine Oxidase Inhibitors (MAOIs)

an antidepressant medication that stops MAO (the enzyme that normally breaks down monoamines, more neurotransmitter stays available).

• Last result prescription before lethal food (cheese, red wine, bc pills)

• Side Effects: dryness, constipation, vision troubles, sexual dysfunctions, heart problems

Tricyclic Antidepressants

a antidepressant medication that block the reuptake of serotonin & norepinephrine (the recycling process).

• Three-ring chemical structure, lots of side-effects

Selective Serotonin Reuptake Inhibitors (SSRIs)

the most common antidepressant medication that blocks the reuptake of serotonin.

• high effectiveness, less side-effects

Psychopharmacotherapy for Anxiety & Bipolar Disorder

• Anxiolytics

• Barbiturates

• Benzodiazepines

• Mood-stabilizing drugs

Anxiolytics

a psychopharmacotherapy for anxiety & bipolar disorders that contains sedatives acting on GABA (an acid, main inhibitor of the central nervous system responsible to calm the brain).

Barbiturates

a psychopharmacotherapy for anxiety & bipolar disorders that is highly toxic and it is not so much used nowadays.

• Phenobarbital

Benzodiazepines

a psychopharmacotherapy for anxiety disorders that are fast acting, highly addictive, and causes tolerance.

• Chlordiaepoxide

• Side effects: aggression, agitation, panic

Mood-stabilizing drugs

a commonly used psychopharmacotherapy for bipolar disorders involving severe, fluctuating mood swings. They help prevent and treat manic highs and depressive lows by balancing brain activity, may need high dosages.

• Lithium

• Side effects: weight gain, organ damage, reduced thyroid function

Pros & Cons of Psychopharmacotherapy

• Doesn't cure, just provides relief

• No one-size-fits all

• Issues with addictions

• Expensive

Non-Pharmacological Interventions

• Illness is treatment-resistance → we take a biological approach:

  • Electroconclusive Therapy

  • Transcranial Magnetic Stimulation

  • Psychosurgery

  • Deep Brain Simulation

Electroconclusive Therapy

a non-pharmacological intervention that is used for depression & schizophrenia. It sends an electrical current in the brain to cause seizures while patient is under sedation.

It may cause temporary memory loss & confusion.

Transcranial Magnetic Stimulation

a non-pharmacological intervention that uses electromagnetic currents to simulate portions of the brain. The magnetic pulses will increase or decrease neuronal activity.

It may cause mild headaches, fainting, and seizures.

Deep Brain Stimulation

a non-pharmacological intervention that implants electrodes in the brain to stimulate areas.

Psychotherapy

to change a person’s internal experience (thinking & feeling) as well as behaviours.

• most common form of psychotherapy is Individual Therapy.

Group Therapy

type of therapy where group dynamic is important, members share a common theme → Mutual-help group

• ex. Alcoholics Anonymous (AA)

• Efficacy of mutual help groups is not well studied/varies within groups

Couple’s and Family Therapy

• Working on thoughts, feelings, behaviours (focus on the difficulties) of all members of relationship/family unit.

• Therapist typically meets individuals at the same time

  • causes may come from infidelity, communication, sexual dysfunctions

  • Not always to save relationship

Telehealth

Psychotherapy delivered remotely, virtual therapy has proven effective that expands access for people in remote areas, schedule conflict, and reduces stigma barriers.

Insight Therapies

Identify reasons for thought, feelings, actions outside conscious awareness to explain why people think, feel, and act a certain way.

• Psychoanalysis

• Resistance

• Transference

Psychoanalysis

a form of insight therapy where clients engages in free association while lying on a couch.

• Dream Analysis

  • Manifest content → what the patient remembers

  • Latent content → what the patient doesn’t remember

Resistance

a response from insight therapy where the patient is not cooperating with the therapist.

Transference

a form of insight therapy where the patient redirect feelings for someone else to therapist.

Psychoanalysis

• Resistance is a challenge to progress (denial, regression, repression)

• Transference redirect feelings about others onto the therapist is a sign of progress

• Psychodynamic Psychology expanded on Freud's psychoanalysis

  • Jung, Adler, Freud

Behaviour Modification

1. BF Skinner

2. Applied Behaviour Analysis

3. Joseph Wolpe

BF Skinner

he created a behaviour modification therapy based on operant conditioning principles → token economy, typically used in school.

Applied Behaviour Analysis

a behaviour modification therapy that reduces inappropriate behaviours & increase effective communication, usually with children with autism.

Joseph Wolpe

a behaviour modification therapy that is based on classical/Pavolvian conditioning in a systematic desensitization way to treat anxiety (a type of relaxation skill).

• may develop fear of hierarchy.

• Flooding

Flooding

developed by Wolpe where an individual with anxiety being exposed to high anxiety-provoking stimulus from the beginning without being able to leave.

Counterconditioning

a behaviour therapy approach where an individual replaces undesirable response with desirable (ex. learning to stay calm around feared object).

Behavioural Activation

a behaviour therapy approach where an individual keeps a schedule of enjoyable and rewarding activities. Must follow this strict schedule, individual must do it even when they dread to do it.

Applied Behaviour Analysis (ABA)

a behaviour therapy approach where an individual accepts and commits to therapy (ACT) and self-management.

Carl Rogers

he created person-centered (humanistic) therapy where it considers unique human experiences and identified that real self is how we view ourselves and what we can do while ideal self is how we think we should be.

Person-Centered Therapy

• Actualizing

• Unconditional positive regard

• Empathy

• Congruence

• Non-directive

Gestalt Therapy

a humanistic therapy where patients should uncover hidden elements suppressed and focused on the whole. The therapist will challenge the patient to re-own them in the present.

Cognitive Therapy

type of therapy where treating disorder by teaching thought-management technique to dispel negative thinking patterns.

• ABC Approach

• Cognitive Distortions

ABC Approach

1. Adverse event: a situation triggers negative emotional/behavioural response

2. Beliefs: core beliefs associated with activating event

3. Consequences: emotional/behavioural outcome cause by beliefs.

Cognitive Distortions

Exaggerations/misperceptions of actual events.

• All or nothing thinking (partner doesn't want to go to dinner without, therefore you think that they are cheating on you)

• Discounting the positive (positive attributes and experiences do not count)

• Catastrophizing (making negative predictions about the future without considering other and more likely possibilities)

  • ex. they didn't text you back so they think that they got into a horrible car crash

Cognitive Behavioural Therapy

Founded by Aaron Beck that combines cognitive & behavioural therapy that usually last short term (12 weeks) and is action oriented.

• Targets cognitive triad; beliefs about the self, world, future

• Negative thoughts are changed through cognitive restructuring