This class…

1. This class… Treatment

2. Care as a Social Issue What to do with the Severely Disturbed? • throughout history, people with mental disorders were often considered evil or otherwise degenerate and were treated accordingly

3. Attempts at Reform: In and Out of Asylums • Movement from religious (demonic possession) towards secular (degenerates) • at the beginning of the 19th Century, humanitarian reform of mental institutions really began

4. Attempts at Reform: In and Out of Asylums • at the beginning of the 19th Century, humanitarian reform of mental institutions really began • Philippe Pinel's treatment of people in mental hospitals, different from anything tried before, had huge effects on their mental health

5. Attempts at Reform: In and Out of Asylums • Dorothea Dix campaigned profusely as a leader of the moral-treatment movement in the US • Unfortunately, funding seldom held up for long • Titicut Follies

6. Attempts at Reform: In and Out of Asylums • In the absence of long-term good institutions, the deinstituionalization movement began • This was also partly inspired by the development of effective drug treatments for some disorders • In the early 70s, transition homes started cropping up

7. Attempts at Reform: In and Out of Asylums • This wasn't necessarily working out too well, either--just because you're out of the hospital doesn't necessarily mean you're cured

8. Hospital "Treatment" from a Patient's-Eye View: Rosenhan's Study • Rosenhan and some of his collaborators went into hospital emergency rooms, complaining of hearing voices saying "empty, hollow, thud" • They were honest in every other respect, acted normally while in hospital, and when asked about the voices, claimed not to hear them anymore

9. Hospital "Treatment" from a Patient's-Eye View: Rosenhan's Study • Other patients often detected them as imposters, but hospital staff never did, and sometimes even interpreted their normal behaviours in the context of a disorder

10. Hospital "Treatment" from a Patient's-Eye View: Rosenhan's Study • Their average time with psychiatrists and psychologists, including group meetings, was less than 7 minutes per day • They noticed that staff tended not to take patients seriously as thinking individuals

11. Bright Spots • social-learning wards have developed • residents (not "patients") here tend to: • be treated with respect • interact closely with staff • receive and accept responsibilities • take part in decision-making • engage in a lot of skill learning activities

12. Bright Spots • there's evidence of a high level of success in these programmes • there are also some community-based programmes out there now which reduce the need for hospitalization

13. Structure of the Mental Health System Places of Treatment • mental hospitals- provide custodial care for people who can't care for themselves or be cared for by family members at home • general hospitals - often used for patients whose stay will be short

14. Places of Treatment • nursing homes - usually for older patients; these usually don't employ specialized personnel for treating people with mental disorders

15. Places of Treatment • halfway houses - people go to these during transition from hospital back into the community; they often provide help in finding employment as well as a more homey-type experience

16. Places of Treatment • private office - run-of-the-mill psychologist visits; outpatient care • community mental health centres - cheaper versions of outpatient care

17. Providers of Treatment • psychiatrists • clinical psychologists • counseling psychologists • counselors • psychiatric social workers • psychiatric nurses

18. Recipients of Treatment • the number of people who’ve received treatment for mental disorders is much smaller (approx 1/4) than the number who’ve had a mental disorder • this is particularly the case for men • the number's a little better for college graduates, white people, and people with incomes over $35,000

19. Clinical Assessment • Assessment: the process by which a mental health professional gather and compiles information about a patient or client for the purposes of developing a plan of treatment • Diagnosis: the classifying and labeling of a disorder according to some standard set of guidelines

20. Assessment Interviews and Objective Questionnaires • assessment interview: basically a dialogue through which the clinician tries to learn about the client; by far, this is the most common assessment procedure • these range from quite structured to rather unstructured • Verbal and non-verbal information

21. Assessment Interviews and Objective Questionnaires • objective questionnaire: these vary widely in what they ask; some are multiple choice or checklists • in some ways they can be considered less biased than an assessment interview, but they require a client who is literate, reflective, and motivated to answer honestly

22. A Psychometric Personality Test: the MMPI • true-false questions that have been tested on inpatient and "normal" samples to determine what question distinguish between the two groups • This inventory also contains validity scales to help pick out people who may be trying to cover a disorder or maybe even trying to fake one

23. Projective Tests • Projective tests: designed to provide clues about the unconscious mind • Free association: Freudian technique that many projective tests stem from--he'd often have his patients clear their heads, free their minds of "shoulds", and say the first thing, give the first image, that came to their minds in response to words that he'd say to them

24. Projective Tests • Rorschach: classic ink-blot test; people are shown symmetrical ink blots and are asked what they see

25. Projective Tests • Thematic Apperception Test: here, people see a picture and are asked to make up a story to go with the scene

26. Behavioural Monitoring • this refers to any system for counting or recording actual instances of desired or undesired behaviors • self-monitoring: this is behavioural monitoring when it's the client who's keeping count

27. Assessment of Brain Damage and Neuropsychological Functioning • EEG - electroencephalogram - measures the pattern of electrical activity in the brain • CAT scan - computerized axial tomography - a series of x-rays are taken of the brain

28. Assessment of Brain Damage and Neuropsychological Functioning • MRI - magnetic resonance imaging - pictures of brain sections are taken using electromagnetic radiation given off by specific molecules in the brain when the brain is subjected to a strong magnetic field

29. Assessment of Brain Damage and Neuropsychological Functioning • PET scan - positron emission topography - measures the pattern of blood flow and rate of oxygen use across sections of the brain • There are also psychological tests, including things like perception and motor control, that can help identify brain damage

30. Biological Treatments Drugs • the right drug, matched with the right person, can be pretty much a miracle worker, but there are potential problems with overuse (i.e., unwarranted prescription), dependency, and side effects

31. Antipsychotic Drugs • most antipsychotics are aimed at reducing dopamine • a problem is that drugs often fail to relieve negative symptoms, and in some cases make them worse • also, possible side effects include • dizziness

32. Antipsychotic Drugs • nausea • dry mouth • blurred vision • constipation • sexual impotence (in males) • shaking • difficulty in controlling voluntary movements

33. Antipsychotic Drugs • in long-term users, tardive dyskinesia • there have also been suggestions that they might, in some people, reduce the chance of eventual full recovery • possible rebound effect

34. Antipsychotic Drugs • new drugs are constantly being developed and tested in efforts to find something that'll work without the treatment being as bad as the disease

35. Antidepressant Drugs • most are believed to work by increasing the availability of monoamines, especially serotonin and norepinephrine • Good effectiveness in treating depression

36. Antidepressant Drugs • there are, however (of course) side effects, including: • fatigue • dry mouth • blurred vision

37. Lithium for Bipolar Disorder • Mood Stabilizer: helps control both the manic and depressive phases of bipolar, especially mania • it's not really known how this drug works--most people believe it stabilizes either the level of or the sensitivity to monoamines

38. Lithium for Bipolar Disorder • side effects - serious dehydration, at high doses--an overdose of lithium can be lethal

39. Antianxiety Drugs • there are various types of these; barbiturates used to be common, but they've been replaced with safer drugs • drugs that are effective for GAD tend to not be very effective for phobias, OCD, or panic disorder • most antianxiety drugs augment GABA, which is an inhibitor

40. Antianxiety Drugs • side effects (yes, more) include: • drowsiness • decline in motor coordination • increases in the effects of alcohol--it's very dangerous to combine the two

41. Antianxiety Drugs • just in case that wasn't enough, these are also addictive; withdrawal symptoms include: • sleeplessness • shakiness • anxiety • headaches • nausea

42. Other Biologically Based Treatments • non-drug biological therapies aren't used that much for mental disorders anymore--we're not big on drilling holes in people's heads or scooping out parts of their brains • biological therapies typically as last resorts

43. Electroconvulsive Shock Therapy • usually used only in cases of severe depression when psychotherapy and antidepressant drugs are unsuccessful • this has changed over the years - now the patients are given drugs that block nerve and muscle activity so it doesn't hurt and they don't get injured by convulsions

44. Electroconvulsive Shock Therapy • an electric current passed through the brain touches off a seizure that lasts about a minute; this is usually administered every 2-3 days for about 2 weeks • there's remission, sometimes permanent, and sometimes lasting several months, in about 70% of cases

45. Electroconvulsive Shock Therapy • why it works is not understood • there are some temporary disruptions in cognition, especially memory

46. Electroconvulsive Shock Therapy • movement from bilateral to unilateral (the right hemisphere) shock has resulted in a treatment that causes little apparent memory loss, but there's some controversy about whether it's as effective that way

47. Psychosurgery • “I’d rather have a bottle in front of me than a frontal lobotamy”

48. Psychosurgery • this refers to the surgical cutting or production of lesions in portions of the brain to relieve a mental disorder; typically (now) the destruction of a very small area of the brain • prefrontal lobotomy is probably the best-known, but these are generally not done anymore

49. Psychosurgery • any sort of psychosurgery is rare and tends to be a last-ditch effort to help someone for whom all other treatment efforts have failed and who is suffering and desperate, often suicidal • psychosurgery is sometimes successful in reducing symptoms of major depression and OCD

50. Varieties of Psychotherapy • Psychotherapy: any formal, theory-based, systematic treatment for mental problems or disorders that uses psychological rather than physiological means and is conducted by a trained therapist