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Chapter 5

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University of Toronto St. George
Martha Mc Kay

PSY240: chapter 5 Treatments for abnormality System of mental health services has four major sectors: speciality mental health sector includes: psychiatrist, psychologist, psychiatric nurses, and psychiatric social workers who are trained specifically to treat people with mental disorders. General medical or primary care sector includes health care professionals, such as internists, pediatricians and nurse practitioners, who may not be specifically trained in mental health treatment, but are often the initial point of contact, or the only source of mental health services, for people with mental health problems. Human services sector includes: social services, school-based counseling services, residential rehabilitation services, criminal justice services and religious professional counselors. Voluntary network sector includes: self-help groups, such as alcoholics anonymous (AA), is a growing component of the mental health treatment system. In Canada, it is estimated that approximately 3% of the adult population has attended an AA meeting. 37% of Canadians who suffer from mental disorders or substance dependence use some type of health care or community resources. However, most people who might benefit from treatment are getting no treatment at all. Proponents of biological theories of mental disorders most often prescribe medication. Psychotherapy: prescribed when psychological and some social approaches to abnormality. Psychotherapy can take many forms, but most involve a therapist (psychiatrist, psychologist, clinical social worker, or marriage or family counselor) talking with the person who has the disorder about his or her symptoms and what is contributing to these symptoms. Drugs and psychotherapy may work on different aspects of a disorder, and they are increasingly being used together in an integrated approached to disorders. Biological treatment: Antipsychotic drugs Reduce symptoms of psychosis (loss of reality testing, hallucinations, delusions) Antidepressant Reduce symptoms of depression (sadness, loss of appetite, sleep drugs disturbances) Lithium Reduce symptoms of mania (agitation, excitement, gradiosity) Antianxiety drugs Reduce symptoms of anxiety (fearfulness, worry, tension) Antipsychotic drugs: Chlorpromazine: a drug to treat the symptoms of psychosis. Psychosis involves the loss of touch with reality, hallucinations (unreal perceptual experiences) and delusions (fantastic, unrealistic beliefs) Chlorpromazine belongs to a group of chemical compounds called phenothiazines. Which has a chemical structure very similar to that of synthetic violet and blue dye products. They can act as antihistamines and thus were initially thought useful in the treatment of allergies. Phenothiazines also result in decrease in muscle tone, the reduction of nausea, and in some cases either sedation or euphoria. PSY240: chapter 5 Treatments for abnormality Physicians use phenothiazines to calm agitated patients, however, and to reduce tremors in patients with parkinsons disease. Can also reduce postsurgical shock, a neuroendocrine response to stress that can be fatal. Pain was reduced so greatly in some patients that they did not require morphine. Reduce hallucinations and delusions of some psychiatric patients. Reduce agitation, excitation, confusion and paranoia in psychotic patients. Labeled chlorpromazine as Neuroleptic: drug depresses the activity of the nervous system. Butyrophenone: another class of drugs that can reduce psychotic symptoms. However, phenothiazines and butyrophenone also produce a number of dangerous side effects. Side effects include: sedation, visual disturbances, tardive dykinesia, neurological disorder characterized by involuntary movements of the tongue, face, mouth or jaw. Drugs reduce levels of the neurotransmitter dopamine or influence receptors for dopamine in the brain. Drugs that relieve the symptoms of psychosis- led to a revolution in the treatment and lives of people with psychosis, who had been locked away in psychiatric hospitals and institutions, perhaps for life, often completely out of touch. Antidepressant drugs: Side effects: euphoria. Drugs are now called MAOIs. Inhibit the enzyme monoamine oxidase in the brain, which results in higher levels of a number of neurotransmitters such as norepinephrine. MAOIs has dangerous side effects include: throbbing headaches, jaundice, rise in blood pressure, especially mixed with certain types of food. Because of these side effects, other drugs are use more often. Until 1980s, antidepressants most often used were tricyclic antidepressants, energized patients and elevated their moods. Side effects: sedation, dry mouth, blurred vision. They work by inhibiting the reuptake of the neurotransmitters norepinephrine, serotonin and perhaps dopamine in the brain. Today more than 40 million people have taken Prozac. Antidepressant treatment rates for those diagnosed with major depression in Canada have been increasing. SSRIs, became popular that many people can tolerate the side effects of SSRIs, better than the side effects of the tricyclics. Side effects: nausea, diarrhea, headache, tremor, daytime sedation, failure to achieve orgasm, nervousness and insomnia. Newest antidepressants drugs are designed to target both serotonin and norepinephrine. People with depression are often given combinations of antidepressants drugs and lithium or antianxiety drugs. Antidepressant Use and Suicidality: Side effect from antidepressant use is increased suicidality, particularly in children and adolescents. Primary purpose of the label is to warn consumers of the heightened risk of suicidal thinking and behaviours in children, adolescents and young adults taking antidepressant medications, particularly in the first several months.PSY240: chapter 5 Treatments for abnormality SSRI did increase the risk of completed or attempted suicide among adolescents (18 to 24 years old), however, the risk was decreased among adults (25 and older). Among 65 and older, SSRI appeared to provide a protective effect. SSRIs was associated with increased risk in adolescence but decreased risk among adults and older people. Antidepressants also help to reduce depression and suicidality in others. Lithium and other mood stabilizers: Lithium: metallic element that is present in the sea, in natural springs, and in animal and plant tissue. It has been used to treat a number of medical disorders, with weak results. In the middle of the nineteenth century, it was widely used to treat rheumatism and gout. There was a relationship between these disorders and mania: a condition in which people experience agitated, excited and grandiose ideas. Lithium had a powerful calming effect. It could be used to treat mania. But it is a very dangerous substance and can have many severe side effects, even death. Anticonvulsants, and calcium channel blockers: are also being used in the treatment of mania. These drugs have fewer side effects than lithium. Antianxiety drugs: Anxiety and insomnia are the symptoms for which drugs are most often prescribed. Barbiturates: suppress the central nervous system, decreasing the activity of a variety of types of neurons. Although these drugs are effective for inducing relaxation and sleep
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