October 16, 12
PSYCH – Week 6 Online Readings
Week 6: The Treatment of Psychological Disorders
Focus Question: What is the best form of psychological treatment?
Treatment of Mental Disorders in Ancient and Medieval Times
Treatments were typically extremely painful – starvation, trephining (drilling a hole in the
skull for evil spirits to escape through), exorcisms, beatings, etc. In Medieval times
people with disorders were considered to be in league with the devil and were put to
The Asylum Movement
Eventually there was a shift towards placing people in asylums where they were often
chained to walls in dark, damp cells. This served to protect the public from the mentally
Movement began in the 1950s as society shifted towards the belief that those with mental
disorders should be supported and live in regular homes, work in the community and
participate in social and leisure activities. Movement was largely made possible because
of the development of antipsychotic medication that controlled some of the odd
behaviours exhibited by some mentally ill people.
An obstacle to supporting these people is a lack of funding and appropriate resources.
The purpose of psychological treatment is to reduce or remove clinically significant
symptoms. These symptoms must be measured in a reliable and verifiable way before and
Individuals who may have a psychological disorder begin with an assessment designed to
elicit their personal history and presenting symptoms so the mental health professional
can arrive at a diagnosis and construct a treatment plan. Once the diagnosis and treatment
plan are complete, treatment begins.
Thorough interviews conducted by trained professionals designed to elicit information on
the client's history and presenting symptoms. Some interviews are structured, where the
clinician asks specific questions, and some are unstructured where the questions are
relevant to a specific client. Often clinicians use semistructured interviews.
Cognitive and Neuropsychological Tests October 16, 12
To assess clients with brain injuries, learning disabilities, intellectual disabilities,
dementia, or various other conditions, psychologists use cognitive or neuropsychological
tests to examine various aspects of cognitive functioning – intelligence, academic ability,
memory, processing speed, language functions, and executive functioning (the ability to
plan and reason).
For a suspected brain injury, medical imaging techniques may also help locate the
specific damaged area. Such techniques may include an EEG (electroencephalogram),
CAT scan (computerized axial tomography), MRI or fMRI scan (functional magnetic
resonance imaging), or PET scan (positron emission tomography).
Behavioural monitoring involves recording specific behaviours and the circumstances
around these behaviours. Recording is typically performed by the client, or sometimes by
staff if the client is in an inclient setting.
Clinical Interviews Professionals talk with clients and ask them questions.
Questionnaires and The client or people around the client answer questions in
paper tests writing.
Cognitive and Questionnaires or mechanical tests determine how the client’s
neurophysical tests brain is functioning.
Behaviour monitoring Clients are watched to see what actions they take, what leads to
these actions, and when these actions happen.
Mental Health Care Settings
Most people with mental disorders are able to seek treatment in a private practice or
community agency clinic, depending on health insurance and financial resources. Group
homes or halfway houses care for several people and are under the supervision of a
psychiatrist or psychologist. Psychiatrist hospitals, General hospitals, and nursing homes
are other options.
Who Can Provide Services?
Psychiatrists Psychiatrists have a medical degree with an additional specialization
in psychiatry and are the only mental health professionals who can October 16, 12
Clinical Clinical psychologists have a doctoral degree in clinical psychology
Psychologists with training in the assessment and treatment of mental disorders, as
well as training in statistics and research methods.
Counselling Counselling psychologists have a doctoral degree in counselling
Psychologists psychology, which is similar to clinical psychology but with less
focus on statistics and research methods and more focus on clinical
Psychiatric Social Psychiatric social workers typically have a master’s degree in social
Workers work with a specialization in psychiatric issues.
Psychiatric Psychiatric nurses typically have a nursing degree with specialized
Nurses training in psychiatric issues.
Psychological Psychological associates have a master’s degree in clinical
Associates psychology, but not a doctoral degree.
Counsellors/ The use of these terms is unregulated: Individuals with any
Psychotherapists educational background (or no educational background at all) can
technically call themselves a ‘counsellor’ or a ‘therapist’.
For those issues that are not clinically significant, individuals may still benefit from some
sort of support group, which are often led but a mental health professional and are
designed to help people work on issues such as parenting or weight loss to get the
individual back to a functional, healthy state.
Biology and Experience
Drug Therapy (also referred to as pharmacotherapy)
The use of medication to treat psychological disorders; most drug therapies for
psychological disorders focus on medications that affect the neurotransmitters that
convey information between nerve cells in the brain and body.
Dopamine – Involved in motor control, in memory, attention and problem solving, and in
the reward system of the brain, which attaches emotional value to external events, and
motivates individuals to perform certain activities
Excess dopamine is associated with schizophrenia; too little is associated with some
forms of depression (as well as with Parkinson’s disease).
Norepinephrine – Associated with alertness, arousal, and the “fightorflight” response.
Too little norepinephrine has been associated with depression, while an excess has been
associated with schizophrenia.
Serotonin – Plays a role in mood, sleep, appetite, and impulsive and aggressive
behaviour. Too little serotonin is associated with depression and some anxiety disorders,
especially obsessivecompulsive disorder. Some antidepressant medications increase the
availability of serotonin at the brain’s receptor sites. October 16, 12
GABA (gammaamino butyric acid) – Inhibits excitation and anxiety, induces
relaxation. Too little GABA is associated with anxiety and anxiety disorders.
Drugs and Disorders
The associations between neurotransmitters and psychological conditions are
correlations – they do not necessarily demonstrate a causeandeffect relationship. We
don’t know what other variables may be affecting both the neurotransmitter and the
mental illness, and we don’t know if the change in the neurotransmitter causes the illness,
or the illness causes the change in the neurotransmitter.
Yet, if a disorder is associated with dysregulation in neurotransmitter system X and
drug A normalizes neurotransmitter system X AND normalizes behaviour and cognition
(i.e., lessens symptoms), then we CAN say that the neurotransmitter dysregulation was
causing (or maintaining) the behavioural/cognitive manifestations (symptoms) of the
First generation treated positive symptoms for schizophrenia (hallucinations, delusions,
etc) but produced negative side effects. More recently new classes of these drugs also
reduce the negative symptoms of schizophrenia. Clozapine trets both the negative and
positive symptoms without motorrelated side effects (that the older medications
There are several forms of antidepressant drugs (Carlson, pp. 616617), including:
• Tricyclics, which block the reuptake of norepinephrine and serotonin.
• Monoamine oxidase inhibitors (MAOIs), which inhibit the enzyme oxidase that
breaks down dopamine and norepinephrine in cells.
• Selective serotonin reuptake inhibitors (SSRIs), which prevent the reuptake of
serotonin in the brain.
A number of newer classes of antidepressant drugs work on a variety of
neurotransmitters. Although each type of antidepressant drug has side effects, the newer
SSRIs appear to produce substantially fewer side effects and are much safer than the
older tricyclics and MAOIs.
The most effective antimanic drug for the treatment o