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Chapter 5

Chapter Five.docx

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York University
PSYC 3140
Joel Goldberg

Chapter Five  Psychotherapy: can take many forms but usually involves a therapist (psychiatrist, psychologist, marriage or family counsellor, social worker) talking with the person who has a disorder about the symptoms and what is contributing to these symptoms Drug Therapies for Mental Disorders: Type of Drug Purpose Examples Antipsychotic Drugs Reduce symptoms of psychosis (loss Clozaril (Clozapine; an atypical of reality testing, hallucinations, antipsychotic), Chlorpromazine (a delusions) phenothiazine), haloperidol (a butyrophenone) Antidepressant Drugs Reduce symptoms of depression Parnate (tranylcypromine sulphate; (sadness, loss of appetite, sleep a MAO inhibitor) amitriptyline (a disturbance) tricyclic) Prozac (fluoxetine; a SSRI) Lithium Reduce symptoms of mania Carbolith (Lithium carbonate) (agitation, excitement, grandiosity) Antianxiety Drugs Reduce symptoms of anxiety Valium (diazepam; a (fearfulness, worry, tension) benzodiazepine) pentobarbital (a barbiturate) Antipsychotic Drugs:  Phenothiazines: a chemical compound. Example: chlorpromazine. They reduce tremors in Parkinson’s, sedate and calm agitated patients. Reduces nausea, can cause euphoria. Reduces pain. Reduces symptoms of psychosis. And paranoia, excitation, confusion, agitation. Chlorpromazine was labelled a neuroleptic: implying that it depresses the activity of the nervous system. o Thorazine: the name for chlorpromazine  Butyrophenone: another class of drugs that reduces psychotic symptoms, the first in this class was haloperidol. Both Phenothiazines and butyrophenone have severe side effects  Side effects: severe sedation, visual disturbance, tardive dyskinesia (neurological disorder characterized by the involuntary movement of the tongue, face, mouth, or jaw)  Atypical antipsychotics: relieve symptoms without the side effects. Example: Clozaril. Antidepressant Drugs:  Monoamine oxidase inhibitors or MAOIs: like Nardil and Parnate. Inhibit the enzyme monoamine oxidase in the brain which results in higher levels of a number of neurotransmitters, such as norepinephrine. o Side effects: throbbing headaches, jaundice, precipitous rise in blood pressure. Due to these side effects other drugs are used more often.  Tricyclic antidepressants: most common until the 1980’s. Elavil, anafranil, tofranil: imipramine. It energized the patient. Inhibits reuptake of norepinephrine, serotonin, and maybe dopamine. o Side effects: sedation, dry mouth, blurred vision.  Selective serotonin reuptake inhibitors: Prozac, Zoloft, Paxil. More selectively works on serotonin, unlike tricyclic antidepressants. o Side effects: nausea, diarrhea, headache, tremor, daytime sedation, failure to achieve orgasm, nervousness, and insomnia.  People with depression are usually given a combination of antidepressant and lithium or anti-anxiety medications.  Effexor and Remeron are new antidepressants that also target norepinephrine.  Increased suicidality in people who use antidepressants Lithium:  Lithium: natural metallic element present in the sea, natural springs, animal and plant tissue. Was once used to treat rheumatism and gout. Powerful calming effect, treatment for mania. Very dangerous side effects but no other alternative to treating mania was available. It is partially replaced by anticonvulsants and calcium channel blockers which have fewer side effects than lithium. Still used though. o Side effects: very dangerous, death. Antianxiety drugs:  Barbiturates: first class of antianxiety drugs. Supress central nervous system and decrease the activity of a variety of types of neurons. Induces relaxation, and sleep. They are highly addictive and the withdrawal symptoms can be life-threatening.  Benzodiazepines: Librium, Serax, Valium. Reduce anxiety without interfering too much with daily functioning. Most frequently used in sleeping pills. o Side effects: both are highly addictive; withdrawal symptoms: increased heart rate, delirium, convulsions. Toxic reaction to alcohol (benzodiazepines). Addiction rate of benzodiazepines: 80% of those who take it 6 weeks or longer.  Electroconvulsive therapy: early 20 century. Originally to treat Schizophrenia. It was meant to calm and sedate them. It didn’t work for schizophrenia but it did for depression. It induces a brain seizure. 70 to 150 volts are passed through one side of the brain for half a second; the convulsion lasts about a minute. Treatments are 6-12 sessions. In severe cases of depression only.  Psychosurgery: frontal lobes of the brain were severed from the lower centers of the brain in people with psychosis: prefrontal lobotomy. Rarely used and highly controversial. Only used in very severe cases where no other treatment has worked; more precise and safe. o Side effects: permanent: inability to control impulses or loss of ability to initiate activity, loss of emotions or extreme listlessness, seizures, and death.  Repetitive Transcranial magnetic stimulation (rTMS): exposes patients to repeated, high intensity magnetic pulses focused on particular brain structures. For depression: left prefrontal cortex. Generally feel relief of symptoms after a week of treatment. o Side effects: minor headaches treatable by Aspirin. Psychological Therapies: Type of Therapy: Description: Psychodynamic therapies Help clients gain insight into unconscious motives and conflicts through analysis of free associations, resistances, dreams and transferences Humanistic therapy Helps client explore their own values and potentials and fulfill their potential more fully by providing a warm and supportive relationship Behaviour therapies Help clients extinguish unwanted behaviours or teach clients new, desired behaviours, with such techniques as systematic desensitization and response shaping Cognitive therapies Help clients change maladaptive thought patterns by challenging irrational thoughts and learning new skills  Psychodynamic therapies: uncover unresolved unconscious conflicts o Free association: clients are taught to talk about whatever comes to mind and not censor any thoughts o Resistance: reluctance to talk about certain things, the most important and threatening conflicts are the ones the ego tries hard to repress o Transference: occurs when client reacts to the therapist as if the therapist were an important person in the patient’s life. Example: patient gets angry and reacts extremely harshly when therapist is just a few minutes late because it reminds them of being abandoned as a child. o Working through: or going over and over painful memories and difficult issues help people understand them and move forward with their lives o Catharsis: expression of emotions connected to memories and conflicts; unleashes energy bound in unconscious; allows material to be incorporated into more adaptive self-views o Therapeutic alliance: empathic and supportive, non-judgemental and creating a trust between patient and therapist. Carefully timing confrontations  Differences between psychoanalysis and psychodynamic theories: psychoanalysis is three or four sessions a week over many years and main focus is interpretation of transferences and resistances. Psychodynamic can be as short as 12
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