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Chapter 17

PSYC 3390 Chapter Notes - Chapter 17: Borderline Personality Disorder, Reuptake, Lamotrigine


Department
Psychology
Course Code
PSYC 3390
Professor
Mary Manson
Chapter
17

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Chapter 17 12/7/2012 12:15:00 PM
An Overview of Treatment
- The belief that people with psychological problems can changecan learn
more adaptive ways of perceiving,evaluation and behaving; if the
conviction underlying all psychotherapy
Measuring Success in Psycotherapy
- Attempts at estimating clients gains in therapy generally depend on one
or more of the following sources of info: a therapists impression of
changes that have occurred; a clients reports of change; reports from the
clients family or friends; comparison of pretreatment and post treatment
scores on personality tests or on other instruments designed to measure
relevant facets of psychological functioning and measures of change in
selected overt behaviours
What Therapeutic Approaches Should be Used?
- When a pharmaceutical company develops a new drug, it must obtain
approval of the drug from HPB before that drug can be marketed in
Cnaada
- This involves demonstrating through research on human subjects that the
drug has efficacy (does what its supposed to do in curing or relieving
some target condition)
- These tests are called randomized controlled trials (RCTs) or efficacy
trials
- Half the patients are assigned the active drug and the other half to a
visually identical by physiologically inactive placebo and neither the
patient or prescriber is informed which is to be administered; that
information is recorded in code by a third party
- This double-blind procedure is an effort to ensure that expectations on
the part of the patient and prescriber play no role in the study
- Efforts to manualize therapy represent one way that researchers have
tried to minimize the variability in patients clinical outcomes that might
result from characteristics of the therapist themselvesalthough
manualized therapies originated principally to standardize psychosocial
treatments to fit the randomized controlled trial paradigm, some thrapists
recommend extending use of these manualized therapies to routine
clinical practice after efficacy for particular disorders has been established

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- Modern psychopharmacology has helped many individuals who would
otherwise require hospitalization to function in their family and
community settings
- 55% of patients receive both meds and psychotherapy
- in meds along treatments, 55% of patients did well and in psychotherapy
alone conditions, 52% did well
- with both treatments, 85% did well
Pharamalogical Approaches to Treatment
- antipsychotic drugs are used to treat psychotic disorders like schizo and
psychotic mood disorders
- they allievate or reduce intensity of delusions and hallucinations by
blocking dopamine receptors
- the half life of a drug is the time it takes for the level of active drug in the
body to be reduced by 50%--advangtages of a long half-life include the
need for less frequent dosing, less variation in the concentration of the
dtug in the plasma, and less sever withdrawal; disadvantages are the risk
that the drug will accumulate in the body as well as increased sedation
and psychomotor impairment during the day
- 60% of patients with schizo who are treated with traditional antipsychotic
meds have a resolution of their positive symptoms within 6 weeks,
compared to only 20% of those treated with placebo
- these drugs are also useful in treating other disorders with psychotic
symptoms like mania, psychotic depression, and schizoaffective disorder
and sometimes borderline personality disorder and schizotypal personality
disorder
- they are also useful in treating tourettes syndrome and delirium and are
sometimes used in the treatment of the delusions, hallucinations, paranoi
and aigation that can occur with AD
- a huge side effect from treatment with conventional antipsychotic meds
such as chlorpromazine is tardive dyskinesiamovement abnormaility
that is a delayed result of taking antipsychotic meds
- most antidepressants work by increasing the availability of serotonin,
norepinephrine or both; the SSRIs serve to inhibit the reuptake of
serotonin following its release into the synapse
- SSRIs are the preffered antidepressant srugs because they are thought to
be relatively safe
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- SSRIs are widely used in the treatment of panic disorder, social phobia
and generalized anxiety disorder as well as OCD
- Benzodiazepeines are the most important and widely used class of anti-
anxiety drugsdrug of choice for acute anxiety and agiation
- Patients can be psychologically and physiologically dependent on them;
withdrawal symptoms could include seizures
- Relapse rates are very high
- 60 to 80% of panic patients relapse following discontinuation of Xanax
- diazepam (valium), oxazepam (serzac) clonazepam (rivotril) alprazolam
(Xanax) and lorazepam (Ativam) are all benzodiazepines
- believed to work by enhancing the activity of GABA receptorswhich is
an inhibitory neurotransmitter that plays an important role in the way our
brain inhibits anxiety in stressful situations
- anti-anxiety drugs range of applications is very broad; they are used in all
manners where tension and anxiety are significant components, they are
also used for certain neurological disorders to control seizures, but they
have little effect on psychosis
- buspar (busiprone) is completely unrelated to the benzodiazepines and is
thought to act in complex ways on serotonergic functioning rather than
on GABAit is just as effective in treating GAD
- lithium, being a mineral salt, may affect electrolyte balances that may
alter theactivities of many neurotransmitter systems in the brain
- 70 to 80% of patients in a clear manic state show marked improvement
after 2 to 3 weeks of taking lithium; it also sometimes relieves
depression, although probably mainly in patients with bipolar depression
- the probability of relapse after discontinuation is estimated to be 28 times
higher after withdrawal than when the patient is on lithium with about
50% relapsing in 6 monhs
- side effects include increased thirst, gastrointestinal difficulties, weight
gain, tremor, and fatigue; it can also be toxic if the recommended dose is
exceeded or if the kidneys fail to excrete it from thebody at a normal rate
- lithium toxicity is a serious medical condition and can cause damage to
the neurons and even death
- other mood stabilizing drugs like Depakote and tegretol are treatments
for bipolar disorders as well as Neurontin, lamictal and Topamax
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