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Chapter 17

Abnormal Psychology Chapter 17

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PSYC 3390
Mary Manson

Chapter 17 12/7/2012 12:15:00 PM An Overview of Treatment - The belief that people with psychological problems can change—can 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 themselves—although 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 - 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 dyskinesia—movement 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 - 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 drugs—drug 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 receptors—which 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 GABA—it 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
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