TherapyReview - THERAPY Bio-Psycho-Social talk therapy(CBT...

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Unformatted text preview: THERAPY Bio-Psycho-Social talk therapy (CBT) affects the front part of the brain Paxil works on primitive region, (back brain) (right, red) Psychopharmacology: 1. Antidepressants 2. Stimulants 3. Mood stabilizer 4.Antianxiety 5. Antipsychotics Antidepressants Serotonin Mood modulator Calm Sleep Dopamine Linked to pleasure Norepinephrine Arousal The "antidepressants" are divided up into several classes: A. SSRI B. Atypical Antidepressants C. Heterocyclic Antidepressants D. MAOI SSRI: (selective serotonin reuptake inhibitors) The SSRIs comprise 6 medications: Celexa Lexapro LuVox Paxil Prozac Zoloft Paxil (seroxat) SSRI: Clinical Effects on Depression major depression 60% to 80% respond SSRI: Clinical Effects Serotonin can also influence: Anxiety Impulsivity & Anger Affect Modulation SSRIs are often used to treat: Major Depression Dysthymia Generalized Anxiety Disorder Panic Disorder PTSD Social Anxiety Disorder Obsessive-Compulsive Disorder Borderline Personality Disorder Impulse Control Disorders Bulimia Nervosa SSRI: Side Effects SSRIs can cause: Nausea, diarrhea, constipation Headache, dizziness Insomnia or sedation Weight gain, weight loss Dry mouth, sweating, tremor Anxiety, restlessness Sexual side effects (function & libido) Suicidal ideation Are antidepressant drugs an accomplice in the Virginia Tech incident ???? SSRI: Discontinuation Syndrome These symptoms include: Dizziness Lethargy Nausea Irritability Headaches 1B. Atypical Antidepressant The antidepressants in this class include: Cymbalta Effexor Remeron Wellbutrin SSRIs effect the neurotransmission of 1 neurotransmitter: serotonin These medications effect the neurotransmission of 2 neurotransmitters Cymbalta serotonin & norepinephrine Effexor serotonin & norepinephrine Remeron serotonin & norepinephrine This side effect profile makes Remeron ideal for the patient who complains of: Depression Upset stomach Poor appetite Anxiety Insomnia Wellbutrin influence noreprinephrine dopamine Wellbutrin is indicated for: Depression Smoking cessation ADHD but not anxiety disorders Wellbutrin can cause seizures & hypertension, but it has several potential benefits: It has no sexual side effects It is stimulating There is no weight gain It is relatively safe in overdose There is no withdrawal syndrome It is not an affect modulator 2C. Heterocyclic Antidepressant old, too many side effects The antidepressants in this class include: Elavil Anafranil Aventyl As well as many others vary in their effect on serotonin noreprinphrine dopamine Side effects include: Dry mouth, blurred vision Urinary retention, constipation Dizziness Sedation, weight gain Cardiac effects, hypertension Seizures Sexual side effects Lethal in overdose Because of these side effects, which can be quite severe or bothersome, these medications are rarely prescribed today 1D. MAOI MAOI stand for "monoamine oxidase inhibitor" The medications in this class are called: Nardil Parnate Serotonin Norepinephrine Dopamine Effect tyramine which can result in dangerously elevated blood pressure Thus patients must be on a low tyramine diet & avoid certain medications They may be particularly useful with: Atypical depression Mixed anxiety & depressive disorders Panic disorder Eating disorders The good news is that a MAOI patch recently came out with minimal dietary restrictions 2. Stimulants The psychostimulants include: Dexedrine Adderall Ritalin These medications are all forms of amphetamine, which result in the release of norepinephrine, dopamine & serotonin Resulting clinically in: Increased concentration Energy Interest Feelings of well being Due to these clinical effects they are used to treat: ADHD Depression These medications are controlled substances, since they have a high risk of abuse Tolerance & psychological dependence can also develop, ...abrupt discontinuation can cause fatigue & depression Side effects include: Increased blood pressure Cardiac issues Insomnia Decreased appetite Irritability Dry mouth Psychosis Another medication to be aware of is Provigil Provigil increases wakefulness & is helpful for ADHD & in antidepressant augmentation It is well tolerated with few side effects 3. Mood Stabilizers Mood stabilizers include: Lithium Tegretol Depakote Lithium: decreases norepinephrine release & increases serotonin synthesis Tegretol: makes brain cells less excitable Depakote: especially used for rapid cycling Each of the medications have significant side effects, Weight gain Hair loss Liver damage Thyroid concerns Kidney concerns some of which are irreversible, so they are used with caution 4. Antianxiety: Benzodiazepines Because they reduce anxiety they are used to treat: GAD Panic disorder Social phobia Anxious depression Alcohol withdrawal These medications work because they Bind to the GABA receptor located on certain neurons GABA turns off rewardpleasure system Resulting in a decrease in that neuron's excitability Which translates clinically into sedation, relaxation & decreased anxiety some benzodiazepines last for a few hours, & others last for 12 hours or more Short acting: Xanax Medium acting: Ativan Long acting: Librium Klonopin Valium 3 or more weeks of chronic usage can result in: Tolerance Dependence medication cannot be abruptly stopped, or a withdrawal syndrome can occur The withdrawal syndrome consists of symptoms such as: increased anxiety tremor sweating insomnia seizures hypertension This syndrome is avoided if the medication is not abruptly stopped, but gradually tapered over 4 weeks 5. Antipsychotics These medications are also known as "neuroleptics" They are divided into 2 classes: "Typical" antipsychotics "Atypical" antipsychotics Traditionally these medications have been used to treat "psychotic" disorders such as: Schizophrenia Schizoaffective disorder Mood disorders with psychotic symptoms Brief psychotic disorder Delusional disorder The first antipsychotics to be developed were the "typicals" There are quite a few of them, but most are rarely used today Haldol Moban Prolixin Stelazine These medications work by blocking the dopamine D2 receptor at the synaptic cleft Which appears to result in a reduction in the positive symptoms of psychosis (hallucinations, delusions, etc.) Blocking the D2 receptor also results in side effects: Tardive dyskinesia: involuntary movements, often of the hand or face, that never resolve. Risk increases with prolonged exposure Dystonic reactions: acute involuntary muscle spasms, often of the neck, that resolve with discontinuation Parkinsonian symptoms: symptoms mimicking Parkinson's disease, that resolve with discontinuation Atypical antipsychotics $$$ The atypical antipsychotics are called: Abilify Clozaril Geodon Risperdal Seroquel Zyprexa These characteristics result in a medication that: Has fewer movement-related side effects Has antidepressant & mood stabilizing effects Is better tolerated But is very expensive Atypicals are now used for many purposes aside from treating overt psychosis: Mood stabilization for the borderline patient Mood stabilization for Bipolar I & II Antidepressant supplementation for treatment resistant depression SSRI supplementation for treatment of OCD The downside.................... Side effects include: Weight gain & risk of diabetes type II Some risk of tardive dyskinesia Sedation Increase in the hormone prolactin Dry mouth, constipation Tremor Nausea Loss of interest or apathy Expect to hear more & more & more about these medications in the future Biomedical Therapies (cont'd) (cont' Electroconvulsive Therapy (ECT) Mimics an epileptic seizure & somehow gets the neurotransmitters to the right places Biomedical Therapies (cont'd) (cont' Psychosurgery Prefrontal lobotomy Psychodynamic Include: INSIGHT Transference & defenses Unconscious Early developments Neuroscience Neuroscience Empathy Mirror neurons fire when observing another Among the ideas explored by recent researches are the following: "Consciousness" is limited (5-9 bits of information). .SNAIL OF THE MIND .SNAIL Compared to Emotional & Unconscious thinking (limbic system) Solms 2002 RABBIT of the MIND Levels of Consciousness According to Freud Conscious easily accessed by the conscious mind, but person may be unaware Preconscious: Unconscious The id (aggressive & (aggressive libidinal drives) The superego (moral/ethical code) The ego (partially conscious mediator between the id and superego) Internal perspective What experiencing What is going on in head Let me `be in mind' craziness mind' & understand together Classical Psychoanalytic THERAPY Case Study Johnny was apple of mother's eye mother' Brother Billy Johnny comes to therapy because his girlfriend threatens to break up unless he gets help Jealous Too Competitive (sports and classroom) Psychoanalysis Key Can't understand Can' problems today without understanding problems of early relationships (ex: with parents & siblings) Goal Bring whatever has been repressed (defense mechanisms too) into awareness By understanding the process (DYNAMIC) puts it under patient's control patient' Insight Psychoanalysis: Freud we can discover mind's unconscious functioning via Psychoanalysis Psychoanalysis Free Association Method for probing the unconscious by having patients talk freely about self, feelings & motives One thing leads to another We can observe "subjectively" from inside a mind Anna O Psychoanalysis Dream analysis Another way of getting at what might be repressed Dream work Latent content Manifest content Condensation displacement Psychoanalysis Resistance The blocking from consciousness of anxiety laden material Exactly where you need to dig Psychoanalysis Transference The patient's transfer to the patient' analyst of emotions linked with other relationships (such as love or hatred for the parent) Counter- transference: the entire body of feelings that the therapist has toward the patient History: Bad To be tolerated Useful Psychoanalysis Interpretation may be either focused on present issues intended to draw connections between the patient's past and the present or "dynamic" Psychoanalysis Working Through use the new understanding from interpretations to make changes in present life Self Psychology and many others that focus on insight I shape the world that is mine Behavior Therapies No insight Just change the behavior Opposite of psychoanalysis Behavior Therapies (cont'd) (cont' Behavior Modification 1. Identify target behavior 2. Monitor to establish baseline 3. Identify positive reinforces 4. Establish schedule of reinforcement 5. Enlist social support 6. Monitor & record progress Behavior Therapies (cont'd) (cont' Systematic Desensitization A type of counter conditioning that associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimulus Behavior Therapies Averse Conditioning A type of counter conditioning that associates an unpleasant state (such as nausea) with unwanted behavior (such as drinking alcohol) Modeling A process of observing and imitating a specific behavior Virtual Reality exposure therapy With technology, exposes pt to vivid simulations of a feared stimulus Behavior Therapies (cont'd) (cont' Flooding Large exposure to thing feared all in 1 session Cognitive Therapy Beck negative slant (interpretation) : Self World Future Interpretations dictate mood Fired (I'm a loser) Depressed Fired ( YAY, free to find my passion) Joy Cognitive Therapy (cont'd) (cont' By changing the way you think, you can alter your brain chemistry Refocus beliefs to alter thoughts Cognitive Therapy (cont'd) (cont' Cognitive Restructuring = reshaping thinking Focus on thinking & reasoning processes Beliefs Attitudes Expectations Interpretations Cognitive Therapy (cont'd) (cont' Cognitive Black Distortions & White Thinking: all or none thinking Cognitive Therapy Personalization Cognitive Therapy (cont'd) (cont' Rational Emotive Therapy Developed Direct by Albert Ellis form of therapy; most radical of the cognitive therapies Therapist is the expert Rational Emotive Therapy GOAL--to show how misinterpretations GOAL-- cause distress Stop Stop catastrophiz-ing awful-izing awful-izing Have the courage to be imperfect Stop blaming yourself!! Humanistic Therapy MOST Non-direct form of therapy Opposite of RET Client is the expert GOAL--become fully GOAL-- functioning person Humanistic Therapy (cont'd) (cont' Success depends on: Unconditional positive regard Openness & genuine respect Active listening Warmth & empathy Group Therapies Gives people the opportunity to explore their problem w/others who have the same problem Group Therapies (cont'd) (cont' Family Therapy Type of group therapy that helps families interact differently Group Therapies (cont'd) (cont' Marriage Therapy Tries to see the *dynamic* between the couple partners have to be willing to change themselves Both ECLECTIC In psychoanalysis, the therapist's therapist' feeling toward the patient is called: Counter-transference Transference Interpretation Working through SSRI stands for A. Student Savvy Recognition Investigation B. Serotonin Starvation Research Institute C. Selective Serotonin Reuptake Inhibitors D. Somatic Substitution Range Involvement ...
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