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

• 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

• 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)

• Clozaril (clozapine) (FDA-approval: 1990) • Risperdal (risperidone) (FDA-approval: 1993)• Zyprexa (olanzapine) (FDA-approval: 1996)• Seroquel (quetiapine) (FDA-approval: 1997)• Geodon (ziprasidone) (FDA-approval: 2001)• Abilify (aripiprazole) (FDA-approval: 2002) • Invega (paliperidone) (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

• 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

• 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 self-defeating habits and recurring problems.

Behavior & Cognitive Therapy

• Behavioral and cognitive therapies focus on changing current behavior and attitudes rather than striving for insight.

Behavioral TechniquesDerived 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 TherapyCBT

• 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 self-accepting.

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.