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Treating Mental Illness Bittu Majmudar September 25, 2007 Neuroethics Categories of Mental Illness • Anxiety Disorders – Generalized Anxiety Disorder – Post-Traumatic Stress Disorder (PTSD) – Obsessive-Compulsive Disorder (OCD) – Panic Disorder – Social Anxiety Disorder – Specific Phobias • Mood Disorders – Depression – Mania – Bipolar Disorder (Manic Depression) Categories of Mental Illness • Psychotic Disorders – Schizophrenia • Eating Disorders – Anorexia Nervosa – Bulimia Nervosa • Impulse Control & Addiction Disorders – Pyromania (starting fires) – Kleptomania (stealing) – Compulsive Gambling Categories of Mental Illness • Personality Disorders – Antisocial Personality Disorder – Obsessive-Compulsive Personality Disorder – Paranoid Personality Disorder • Adjustment Disorder • Dissociative Disorders – Dissociative Identity Disorder – Depersonalization Disorder • Somatoform Disorders • Tic Disorders – Tourette Syndrome Mental Health Care Practitioners • Psychiatrist – medical doctor • Psychologist – master’s or doctoral degree • Psychiatric Social Worker – specialized training in psychotherapy • Advanced Practice Psychiatric Nurse – training in behavioral health Mental Health Care Practitioners • Psychoanalyst – any of the previous with training in psychoanalysis • Mental Health Counselor – licensed professional counselors • Pastoral Counselor – additional religious or theological training • Psychotherapist – general practitioner that provides mental health care Treatments & Therapies • Drug Therapy • Electroconvulsive Therapy (ECT) • Psychotherapy – Supportive Psychotherapy – Psychoanalysis – Psychodynamic Psychotherapy – Cognitive Therapy – Behavior Therapy (Exposure Therapy) – Cognitive-Behavioral Therapy (Dialectical Behavior Therapy) – Group / Interpersonal Therapy Treatments & Therapies • • • • Biomedical Treatment Spiritual Treatment Self-Help Treatment Holistic Treatments – Yoga / Meditation • Alternative Treatments – Acupuncture – Biofeedback – Hypnosis / Dream Interpretation – Magnetic Stimulation Therapy Drug Therapy • Depression – tricyclics: imipramine, desipramine – monoamine oxidase inhibitors (MAOIs) – selective serotonin reuptake inhibitors (SSRIs): fluoxetine, sertraline, paroxetine, citalopram – new: bupropion • Schizophrenia – antipsychotic (neuroleptic) medications: clozapine, risperidone, olanzapine Drug Therapy • Bipolar Disorder – antimanic medications: lithium – antidepressants – anticonvulsants: valproic acid, carbamazepine, topiramate • ADD / ADHD – stimulant medications: amphetamine, methylphenidate – non-stimulant medications: atomoxetine Drug Therapy • Obsessive-Compulsive Disorder – buspirone, propranolol – antianxiety medications: benzodiazepines – antidepressant medications: fluoxetine, paroxetine, sertraline Electroconvulsive Therapy (ECT) • severe depression accompanied by psychosis, suicidal intent, or refusal to eat • mania that does not improve with medications • schizophrenia when symptoms are severe or medications aren’t enough Psychotherapy • • • • • • depression bipolar disorder personality disorders dissociative disorders anxiety disorders impulse control & addiction disorders Questions to Contemplate… • What criteria should be used to define mental illness and abnormal v. normal behavior? • Does refusal to accept treatment indicate a lack of decision-making capacity? • At what point is informed consent inapplicable and involuntary treatment necessary?