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Psychology - Psychopathology Treatment.docx

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York University
PSYC 2510
Richard N Lalonde

March 27, 2013 Psychology – Lecture 23 Psychopathology: Treatment & Therapy Who Seeks Treatment?  15% of U.S. population in a given year Types of Treatment  Most common presenting problems o (Anxiety & depression)  Biomedical treatment  Women more than men (targets biological functioning)  Behaviour therapies  Those with medical insurance  Insight therapies  Higher education level o Psychodynamic Who Provides Treatment? o Cognitive therapies  Clinical psychologists  Counselling psychologists  Psychiatrists In Ontario, the term psychologist applies to those who  Clinical social workers have completed a doctoral degree in psychology and at least one year of supervised professional practice as a  Psychiatric nurses provider of psychological services.  Counsellors Biological Treatments  Some disorders have genetic components or involve biochemical/neurological abnormality (cause-effect?) o Drugs o Surgery o Electroshock o DBS Drug Therapy Anti-anxiety drugs  Anxiolytics, tranquilizers  Benzodiazepines: Xanax (alprazolam), Valium (diazepam)  Increase activity of inhibitory neurotransmitters gamma-aminobutyric acid (GABA)  Treatment of mild/moderate anxiety  Often over-prescribed by GPs  Does not directly target depression Antidepressant Drugs  Monoamine oxidase inhibitors (MAOIs) o (eg. Nardil) elevate serotonin & norepinephrine by blocking enzyme that deactivates them  Tricyclic antidepressants o (eg. Elavil) boost serotonin & norepinephrine by preventing their reuptake  Selective serotonin reuptake inhibitors (SSRIs) o (eg. Prozac – fluoxetine) more specific targeting of serotonin synapses  Serotonin & norepinephrine reuptake inhibitors (SNRIs) o Effexor (venlafaxine) & Celexa (duloxetine) Mood stabilizers  Bipolar disorder  Lithium – Helps stabilize glutamate receptors  Valproic acid (eg. Depakote) & carbamazepine (eg. Tegretol) – targets GABA Antipsychotic Drugs  Schizophrenia  1 generation (typical) – haloperidol (eg. Haldol) & chlorpromazine (eg. Thorazine)  2 generation (atypical) – clozapine (eg. Clozaril)  Can lessen positive symptoms (eg. hallucinations), but ineffective for negative symptoms (eg. withdrawal)  May block or reduce sensitivity of dopamine receptors, but act widely Caution – Placebo Effects  Apparent success of treatment due to the patient’s expectation of hope Caution – Relapse & Dropout Rates  Patients may stop taking meds due to side effects  What happens if antidepressants stopped, without learning to cope with problems? o Combine intervention strategies Caution – Long-Term Risks  Antipsychotic drugs can be dangerous o Tardive dyskinesia  Little long term research on antidepressants  Long-term dangers overlooked when a drug shows short term benefits Caution – Dosage Problems  Therapeutic window – amount of medication that is enough but not too much  Drug metabolize differently o Metabolic rates – affected by age, gender, weight… Electroshock & Surgery  Electroconvulsive Therapy (ECT) o Used in cases of prolonged & severe major depression o A brief brain seizure is induced o Side effect: memory loss Experimental surgery – Toronto  Deep Brain stimulation (DBS)  Electrodes inserted in sadness centre (subgenual cingulate – Cg25) in frontal lobe o Area 25 is a junction box for circuits that control our mood  Depressed have too much activity there  20 patients: after 6 months, 60% showed great improvement (35% in remission)  Edi Guyton: one of the first patients to undergo this procedure Types of Psychotherapy  Many forms Behaviour Therapies  Behaviour therapies  Principles of classical & operant conditioning applied to  Insight therapies help people change problem behaviour o Psychoanalysis  Unlearning maladaptive behaviour & learning adaptive o Client-centred therapy ones o Cognitive therapies  Harry – self-abuse case  Family and couple therapies Aversion therapy  Combines drug (eg. Antabuse) with classical conditioning  Alcohol paired with nausea-inducing drug to create aversion to drinking Systemic desensitization  Step b
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