Download Psychological Disorders and Therapy

Psychological
Disorders and
Therapy
Ella Sternisha Kaley Slagle Jenna Ramsey
Rachel Simon
Kaitlyn Hocutt
Abnormal Behavior
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behavior that is deviant,maladaptive, or personally
distressful over a relatively long period of time
o Deviant- both atypical and abnormal behavior. Ex: a person
who flosses her teeth every 15 minutes
o Maladaptive- behavior that interferes with a person’s ability to
function effectively or behavior that presents a danger to the
person or those around him/her. Ex: a person who is afraid to
leave their house
o Personal distress- the person engaging in the behavior finds it
troubling. Ex: a man who often skips meals to lose weight
Abnormal Behavior
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Only needs one of these things to be considered
abnormal
depends on the setting
Approaches
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Biological
o Focuses on the brain, genetic factors, and neurotransmitter
 medical model- the view that psychological disorders are
medical diseases with a biological origin (Patient
Mental illness
Doctor)
Psychological
o emphasizes the mixture of thoughts, experiences, emotions
and personality characteristics. Focus on the rewards and
punishers in ones environment that determine ab. behavior
Approaches
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Sociocultural
o emphasizes social context in which a person lives, one’s gender,
ethnicity, socioeconomic status , family relationships, and culture.
o Socioeconomic status plays a bigger role than ethnicity
o cultures influences our understanding and treatment of
psychological disorders
Biopsychosocial
o must take into account a variety of interacting factors
o biological, psychological, and social factors are all important and
they work together to produce normal & abnormal behavior
Classifying Abnormal Behavior
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classifying helps not only patients but also
psychologists
o could create stigma
DSM-IV (Diagnostic and Statistical Manual of
Mental Disorders) list of 374 diagnosable disorders.
o Classifies on the basis of five axes that take into account one’s
history and highest level of functioning within the previous year
DSM-IV
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The five axes are
o 1- all diagnostic categories except personality disorders
and mental retardation,
o 2- Personality disorders,
 concerned with the classification,
o 3-general medical conditions,
o 4-Psychosocial and environmental problems,
o 5- current level of functioning
 not needed to diagnose a person, but included to get
an overview of a persons life
Critiques of DSM-IV
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focuses strictly on pathology and problems
o identifying a person strengths may help them in realizing their
ability to contribute to society
uses medical terminology, in traditional mind set
that mental disorders are diseases
o on reflects the medical model, does not consider other factors
that could lead to a disorder
Dissociative Disorders
Dissociative disorders are conditions that
involve disruptions or breakdowns of
memory, awareness, identity or perception.
Dissociation, a defense mechanism, is
used pathologically and involuntarily to cope
with trauma or other anxiety disorders.
Dissociative Identity Disorder
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Most subjects suffered severe abuse during
childhood
o Physical, sexual, and/or psychological
May feel other people talking inside your head
Commonly paired with
dissociative amnesia
Dissociative Identity Disorder
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Two or more personalities within an individual
At least two of the personalities take turns
controlling the individual's behavior
Can't recall important personal information
that is too extensive to be explained
by ordinary forgetfulness
Dissociative Identity Disorder - Case Study
In a case of dissociative identity disorder, a woman who had been physically
and sexually abused by her father throughout her childhood and
adolescence exhibited at least 4 personalities as an adult. Each
personality was of a different age, representing the phases of the woman's
experience – a fearful child, a rebellious teenager, a protective adult, and
the woman's primary personality. Only one of the personalities, the
protective adult, was consciously aware of the others, and during therapy
sessions was realized to have been developed to protect the woman
during the abusive experiences. When one of the secondary personalities
took over, it often led to dissociative amnesia, during which the woman
acted out. During intensive therapy sessions, each personality was called
upon as necessary to facilitate their integration.
Dissociative Fugue
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Creating physical distance from reality
Short duration
Starts and ends abruptly
No recollection of what happened during
episode
Dissociative Fugue - Symptoms
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Sudden unplanned travel
Inability to recall past events or important
information
Confusion or memory loss
about identity
Extreme distress interferes
with daily functioning
Dissociative Fugue - Case Study
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Post-traumatic stress induced amnesia
35-year-old businessman who disappeared
more than 2 years after narrowly escaping
from the World Trade Center terrorist
attack on September 11, 2001
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Leaving behind his wife and children
The man was missing for more than 6 months when
an anonymous tip helped police in Virginia identify
him
Dissociative Fugue - Treatment
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Often recover spontaneously
Psychotherapy
Hypnosis
Psychopharmacology
Dissociative Amnesia
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Inability to recall important personal
information
o More extensive than can be explained by normal
forgetfulness
Remembering is usually traumatic or
produces stress
Dissociative Amnesia - Symptoms
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Sudden inability to remember past
experiences or personal information
Confusion
Depression
Anxiety
Dissociative Amnesia - Case Study
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A 29-year-old female on an academic trip to China.
Found in a hotel bathroom unconscious, with no signs of structural or
neurologic abnormalities
Could not remember her any facts about her life
Amnesia persisted for 10 months, until the feeling of blood on the
woman's fingers triggered the recollection of events from the night of
onset of dissociative amnesia
o The woman finally remembered having witnessed a murder that
night
o She came to remember other aspects of her life; however, some
memories remain unretrievable.
Dissociative Amnesia - Treatment
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Psychotherapy
Cognitive therapy
Antidepressant or anti-anxiety medicine
Creative therapies
Clinical hypnosis
http://education-portal.com/academy/lesson/dissociative-disorders.html
Mood Disorders
A psychological disorder in which there is a
primary disturbance of mood: prolonged emotion
that colors the individual’s entire emotional state.
Depression-What is it?
• Most common of all psychological disorders
• Affects more than 100 million people
worldwide
• 8% of the population will experience
depression at some point in their life
Depression
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Most common of all psychological disorders
Major Depressive Disorder Must experience 5 of 9 listed symptoms to be
diagnosed, one of which must be one of the first 2 listed
o Persistent depressed mood for most of the day
o Loss of interest, pleasure in all/almost all activities
o Significant weight loss/gain due to changes in appetite
o Sleeping more or less than usual
o Speeding up/slowing down of physical/emotional reactions
o Fatigue, loss of energy
o Reduced ability to concentrate, make meaningful decisions
o Recurrent thoughts of death or suicide
Treatment
• Antidepressant medication-effective
• Psychotherapy or Cognitive Behavioral Therapy focused on
negative thinking
• Electroconvulsive Therapy: last resort
Dysthymic Disorder-What is it?
• Most commonly known as dysthymia
• Characterized as an overwhelming state of depression
• People are depressed for not only days and months, but
often years
Dysthymia
Individual must have two or more of the following
symptoms:
Poor appetite or overeating
sleep problems
low energy or fatigue
low self esteem
poor concentration
feelings of hopelessness
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Treatment
• Little research is shown on how to treat Dysthymic Disorder
• Patients respond to very few antidepressants
•Selective Serotonin Reuptake Inhibitors (SSRI) antidepressants
• Supportive psychotherapy and psychoeducation significantly
improve the patient compliance and family cooperation
Case Study
Rahim, Public Sector Lawyer
Rahim has been a moderately successful public sector lawyer for the last 20 years. In that time
(in fact, ever since he was a young child) Rahim does not remember a period where he has
been truly happy—he has always felt a sense of sadness about himself even though he has a
loving family.
Although intelligent, he suffers from low self-esteem and has always been plagued by poor
sleep and low levels of energy. Rahim is functional at work, however, he definitely feels that
he has not excelled in his career the way he could have, which he attributes largely to a
crippling talent for procrastination about making important decisions, as well as his difficulty
concentrating.
Although Rahim feels that he certainly isn’t a miserable as he could be, he feels burdened by a
nagging sense of hopeless about his situation and worries that he might get even worse one
day.
Biological Factors
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genetic influences
brain structures and neurotransmitters
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problem in regulation
Psychological Factors
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based on behavioral & cognitive theories
Behavioral: learned helplessness ( individuals can’t control stress)
Cognitive: thoughts & and beliefs that lead to this.
o what and how people think
o how individuals deeply reflect on certain negative events &
feelings
o Pessimistic attributional style “It’s my fault…”
Sociocultural Factors
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Areas with poverty, learned helplessness, & alcoholism
Found in Native American groups
Lower SES more likely to develop depression
Men & Women across cultures
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Women 2X more likely to get depression
o single & head of the household
o working in unsatisfying jobs
difference occurs in many countries
o minority women more likely
Depressed Children
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1.5-2.5% of children depressed
15-20% of adolescents
interference with development
higher risk of variety of problems (substance abuse & academic
issues)
Developmental Psychopathology: used to treat & prevent disorders
in children
Bipolar Disorder-What is it?
Bipolar Disorder is a mood disorder characterized by extreme mood
swings that include one or more episodes of mania.
Mania: person feels euphoric and on top of the world
Two Types: Bipolar I and Bipolar II Disorders
• Genetic influences play more of a role
Disorder associated with brain activity
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Case Study
A 29-year old married, mother of a young child age 2, presented with a history of recurrent and disabling depression and
headaches. Several weeks prior to presentation, she became severely depressed and had difficulty moving, had diminished
appetite, had crying spells much of the day and felt suicidal. At the time she presented, she was on Prozac 20 mg a day,
and described herself as getting “manicky” on the Prozac. By this, she meant that she was “rushing around, laughing a lot
and having more anxiety.” A past trial with Wellbutrin was poorly tolerated because of sweating episodes, insomnia and
agitation. Her depression was worsening despite the Prozac treatment.
There was a past history of concussion at age 18, when she suffered loss of consciousness. She also described a history of
mood swings for many years. There was also a history of alcohol abuse when she was a teenager. The diagnosis of major
depressive disorder was suspect, given the poor response to both antidepressants. Prozac was discontinued because it
appeared to be worsening the underlying mood swings.
Family history revealed severe mood swings in both her father and paternal grandmother. Grandmother at times would take to
bed for long spells, and she had been hospitalized for “unknown reasons” that the family refused to talk about, and the client
recalled that the secrecy was because of something “shameful” about her grandmother’s condition and behavior.
Because of the suggestion of Manic Depressive Disorder by personal and family history, she was placed on Seroquel 100 mg
at bedtime. Within one week’s time, she began to improve markedly, including clearer thinking, more productive work being
done, less depression and more energy. Within five weeks after the institution of Seroquel, the client was feeling “terrific.”
She was seen in supportive psychotherapy and provided advice on parenting her two year old daughter, which helped to settle
down the child’s behavior and gave the client more confidence and a feeling of control over her life.
Treatments
Aimed at managing symptoms and preventing episodes
•Combination of medication and psychotherapy
•Medications include:
–Mood stabilizers
–Antidepressants
–Antipsychotics
•Cognitive Behavioral Therapy (CBT)
Suicide
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Result of psychological disorder
thinking about suicide is normal, acting on it
is abnormal
3rd leading cause for death in U.S
Biological Factors
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genetic factors important
suicide runs in family linked with low levels of of serotonin
poor health is a risk factor
Psychological Factors
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mental disorders and traumas
90% of individuals who commit suicide have a psychological
disorder
immediate & highly stressful circumstance can lead to suicide
Sociocultural Factors
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chronic economic hardship
attempts vary across ethnic groups
major risk factor is alcohol abuse (esp. in adolescents)
women 3X more likely
women more likely to be diagnosed and men more likely to commit
Anxiety Disorders
Definition
Psychological Disorders involving fears that
are uncontrollable, disproportionate, to the
actual danger the person might be in, and
disruptive of ordinary life.
5 types of Anxiety Disorder
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Generalized Anxiety Disorder
Panic Disorder
Phobic Disorder
Obsessive-Compulsive Disorder
Post-Traumatic Stress Disorder
Generalized Anxiety Disorder
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Anxiety lasting for more than 6 months.
A person cannot find a reason behind their
persistent anxiety.
Symptoms include fatigue, muscle tension,
stomach problems, and difficulty sleeping.
Psychological and Sociocultural Factors
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Having harsh self standards
Dealing with overly strict and critical parents
(authoritarian)
Automatic negative thoughts when feeling
stressed
A history of uncontrollable traumas or
stressors (abusive memories)
Biological Factors
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Genetic predisposition
Deficiency in the neurotransmitter GABA
Overactive sympathetic nervous system
Respiratory system abnormalities
Panic Disorder
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Recurrent, sudden onsets of intense fear and
terror
Often occur without warning and no specific
cause
Symptoms include severe palpitations, extreme
shortness of breath, chest pains, trembling,
sweating, dizziness, and a feeling of helplessness
Can lead to agoraphobia
Biological Factors
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Genetic predisposition
Overactive sympathetic nervous system
Low on neurotransmitter GABA and
norepinephrine
Psychological and Sociocultural Factors
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Individuals misinterpret harmless indicators
of physiological arousal as an emergency.
American women are twice as likely to have
panic attacks over American men.
Possibly due to hormones.
Women deal with situations differently than
men.
Phobic Disorder
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Disorder characterized by an irrational,
overwhelming, persistent fear of a particular
object or situation.
A fear becomes a phobia when a situation is
so dreaded that an individual goes to any
length to avoid it.
Biological Factors
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Researchers have found that genes play a
role in phobias. There is a proposed neural
circuit that includes the thalamus, amygdala,
and cerebral cortex.
Levels of serotonin can affect phobias.
Psychological and Sociocultural Factors
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Phobias can be considered learned fears.
Example- a fear of falling off a building can
come from a fall earlier in life.
Obsessive Compulsive Disorder
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An individual has anxiety provoking thoughts
that will not go away and/or urges to perform
repetitive, ritualistic behaviors to prevent or
produce some future situation.
People dwell on normal doubts and repeat
their routines sometimes hundreds of times
a day.
Biological Factors
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The frontal cortex and basal ganglia are so
active in OCD that numerous impulses reach
the thalamus, generating obsessive
thoughts.
After treatment of OCD, the frontal cortex
shows much less activity.
Low levels of serotonin and dopamine.
Psychological and Sociocultural Factors
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OCD can occur during stressful times in life
like a change in marital status or the birth of
a child.
The inability to turn off obsessive thoughts or
dismiss them.
Post-Traumatic Stress Disorder
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Develops through exposure to a traumatic event that
has overwhelmed the person’s abilities to cope.
Includes flashbacks and avoidance of emotional
experiences.
Sudden outbursts of irrational behavior.
Stress can begin immediately or months after event
Biological Factors
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The only biological factor is how your brain
naturally responds to stress, since this
disorder is caused by a specific event.
Psychological and Sociocultural Factors
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Depends mainly on a traumatic event
Could become worse if person was sexually
or physically abused earlier in life.
Case Study
I remember my first panic attack like it was yesterday. I guess I’d always been an anxious type, but this was like nothing I’d ever experienced. I was at a football game about
six years ago, big crowd, St Kilda getting hammered by the Pies. I think I was a bit edgy – I’ve never liked being hemmed in, stuck somewhere I couldn’t get out of easily.
Then suddenly this thing just took me over. I got these pains in my chest and I couldn’t breathe. I was sure I was having a heart attack and was going to die. I was thinking
about my daughter – she was two at the time – and thinking it can’t end like this, I’ve got to see her again. I was sweating, heart racing, trembling….I had to get out of
there. I managed to push my way through the crowd and I saw a St John’s ambo. What a relief. He helped me to the ambulance and they took me straight to hospital,
wired me up to all sorts of machines and then…..they told me there was nothing wrong, that it was all in my head. All in my head? Those pains were real, I can tell you. All
they said was that I’d had a panic attack, and I was so happy to be alive, I didn’t ask them more about it. I just wanted to get home. But since then, my life has changed. I
only went back to sea once (my skills are needed more on shore than at sea, thank God) but that was terrifying. I spent the whole time worrying about whether I’d have an
attack while we were far from land and I avoided being below decks whenever I could. Since the first time, I’ve had about a dozen attacks and each one was terrifying. I’ve
stopped going anywhere that I can’t get out of easily in case I have another one. No shopping centres. No cinemas. No football games. No public transport. No crowded
places. I left the navy because I couldn’t face going to sea again.A month ago it came to a head, my daughter’s 8 th birthday. She wanted me to take her and a couple of
friends into the city on the train to see a movie. I told her I couldn’t and got angry with her – poor kid. Then I had a big fight with my husband. After we’d all had a bit of a
cry I decided I had to do something about it. I went along to see our GP – he told me I had panic disorder (which I guess I already knew) and something called
agoraphobia. That’s the part where I won’t go anywhere in case I have an attack. He gave me a script for some tablets and a referral to see a psychologist. I managed to
get in to see her and the first thing she told me was to only take the tablets when I absolutely had to. That annoyed me – one doctor tells you one thing, another tells you
something else. But the more she explained what was happening, the more it made sense. The tablets help to stop the attacks when they’re happening, but they don’t do
anything to prevent another one. She says I can only learn how to control them if I let myself risk having one.
Case Study Continued
I think we’re on the right track. We’ve spent a lot of time talking about my breathing. She says I’m “hyperventilating”, that my body is getting ready for fight or flight when
there’s no danger there. I’ve been practicing the exercises she gave me and I really do feel more in control. The next step is to start getting back to do the things I’ve been
avoiding. That’s very scary, but she says I can do it in small steps. And she’s started to talk about how my thoughts play a part.
I’m a long way from being cured, but I feel much more confident now. My husband says I’m much better. And I’m going to take my daughter to the city on her 9th birthday for
sure.
Treatment of Anxiety Disorders
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Cognitive Behavioral Therapy
o Helps change the way you think and deal with anxiety.
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Medication
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Prozac, Xanax, Valium, Paxil, Zoloft, SSRI’s.
Facing what scares you and coming to terms
with it
Biological Therapies
● Biological therapies (Biomedical therapies)- reduce symptoms of
psychological disorders by altering body functioning.
○ Ex. Drug therapy is most common
● Only psychiatrists can prescribe drugs as part of therapy.
● Covers three diagnostic categories: anxiety disorders, mood disorders,
and schizophrenia.
Antianxiety Drugs
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AKA tranquilizers
Reduces anxiety and make the individual calm.
Benzodiazepines greatest relief for anxiety symptoms in a matter of hours but
addictive. Side Effects include drowsiness, loss of coordination, fatigue, and mental
slowing.
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Nonbenzodiazepines- takes 2-3 weeks before feeling benefits; not as many side
effects.
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Antidepressant Drugs
Help alleviate depressed mood
Effect norepinephrine and serotonin in brain
o Tricyclics- 3 ring structure, works in 60-70% of cases, takes 2-4 weeks,
some side effects are memory difficulties and faintness.
o Tetracyclic- 4 ring structure; Remeron was most effective in reducing
depression.
o MAO Inhibitors- Blocks the enzyme monoamine oxidase. This enzyme
breaks down neurotransmitters in the brain. Blocking this enzyme will
allow neurotransmitters in the brain's synapses. More harmful to body.
o Selective Serotonin reuptake inhibitors- Interferes with the reabsorption
of serotonin in the brain and leaves excess in the synaptic gap. Drug with
Antipsychotic Drugs
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Diminish agitated behavior, reduce tension, decrease hallucinations, improve social
behavior, and better sleep patterns in people who have a psychological disorder.
Neuroleptics are the most commonly used; they block dopamine’s action in the
brain; they don’t cure its causes, only treats its symptoms. Can have severe side
effects like lack of pleasure and tardive dyskinesia- a neurological disorder
characterized by involuntary random movements. Up to 20% develop this disorder.
Atypical antipsychotic medications have a lower risk of side effects.
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The way these drugs work is unknown, but appears to influence dopamine and
serotonin
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Reduces schizophrenia's symptoms without the side effects of neuroleptics
Increase suicide risk in children
Could drugs being prescribed to children to get rid of depression increase their
suicidal thoughts? 4% of the antidepressant pill group, double of the placebo
group percentage, had random thoughts of suicide. This caused the FDA to
make sure all antidepressant drugs had the “black box” warning on them. This
warning said children could have increase thoughts of suicide. The black box
caused prescriptions to decrease dramatically. There are so many different
variables to teens suicidal thoughts like 17% think those thoughts in a year even
while not on antidepressant drugs. After the black box warning, a number of
case studies haven’t been able to link antidepressants and suicide.There have
been strategies to increase the effectiveness of these antidepressant drugs by
prescribing in smaller doses than normal and combining drug therapy with
psychotherapy.
Drug Chart
Electroconvulsive Therapy
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AKA shock therapy
Mainly used to treat severe depression
Involves passing a small electrical current of less than a second through two
electrodes placed on the individual's head. The current stimulates a seizure that
lasts for about a minute.
Used when drug therapy and psychotherapy doesn't work
Medication lets patients sleep through the procedure and awaken with no memory
of treatment.
Most rapid relief to a patient’s mood
Side effects include memory loss and other cognitive impairments
In deep brain stimulation doctors implant electrodes in brain that
Psychosurgery
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Used as a last resort
The removal or destruction of brain issue to improve the individual's symptoms.
Cannot be reversed.
Moniz first developed an operation that breaks the fibers connecting the
frontal lobe (thought process) to the thalamus (emotions).
Freeman developed a similar procedure that took only a couple minutes and worked
on thousands of people called lobotomies
These procedures cause major brain damage and were required in order to leave a
mental hospital
Lobotomies are no longer performed because of ethical concern
Nowadays psychosurgery is making a small cut in the amygdala or other part of
limbic system and used for OCD, depression, or bipolar disorders
Reference Slide
Textbook: The Science of Psychology: An
Appreciative View by Laura A. King