Comer, Abnormal Psychology, 8th edition - PowerPoint PPT Presentation

About This Presentation
Title:

Comer, Abnormal Psychology, 8th edition

Description:

Title: Comer, Abnormal Psychology, 8th edition Author: Karen Clay Rhines, Ph.D. Last modified by: ptwickler Created Date: 7/24/2001 8:09:29 PM Document presentation ... – PowerPoint PPT presentation

Number of Views:2005
Avg rating:3.0/5.0
Slides: 50
Provided by: KarenCla102
Category:

less

Transcript and Presenter's Notes

Title: Comer, Abnormal Psychology, 8th edition


1
(No Transcript)
2
Treatments for Mood Disorders
  • Disorders of mood as painful and disabling as
    they tend to be respond more successfully to
    more kinds of treatments than do most other forms
    of psychological dysfunction
  • This range of treatment options has been a source
    of reassurance and hope for the millions of
    people who desire to regain some measure of
    control over their moods

3
Treatments for Unipolar Depression
  • Around half of persons with unipolar depression
    (major depressive or dysthymic disorder) receive
    treatment from a mental health professional each
    year
  • In addition, many other people in therapy
    experience depressed feelings as part of another
    disorder thus, much of the therapy being done
    today is for unipolar depression

4
Treatments for Unipolar Depression
  • A variety of treatment approaches are currently
    in widespread use
  • These can be divided into psychological,
    sociocultural, and biological approaches

5
Treatments for Unipolar Depression Psychological
Approaches
  • Psychological treatments used most often to
    combat unipolar depression come from three main
    schools of thought
  • Psychodynamic Widely used despite no strong
    research evidence of its effectiveness
  • Behavioral Primarily used for mild or moderate
    depression but practiced less than in past
    decades
  • Cognitive Has performed so well in research
    that it has a large and growing clinical following

6
Treatments for Unipolar Depression Psychological
Approaches
7
Treatments for Unipolar Depression Psychological
Approaches
8
Treatments for Unipolar Depression Psychological
Approaches
9
Treatments for Unipolar Depression Psychological
Approaches
10
Treatments for Unipolar Depression Psychological
Approaches
11
Treatments for Unipolar Depression Psychological
Approaches
12
Treatments for Unipolar Depression Psychological
Approaches
13
Treatments for Unipolar Depression Sociocultural
Approaches
  • Theorists trace the causes of unipolar depression
    to the broader social structure in which people
    live and to the roles they are required to play
  • Two groups of sociocultural treatments are now
    widely applied multicultural approaches and
    family-social approaches

14
Treatments for Unipolar Depression Sociocultural
Approaches
  • Multicultural treatments
  • Culture-sensitive approaches increasingly are
    being combined with traditional forms of
    psychotherapy to help maximize the likelihood of
    minority clients overcoming their disorders
  • It also appears that the medication needs of many
    depressed minority clients are inadequately
    addressed

15
Treatments for Unipolar Depression Sociocultural
Approaches
  • Family-Social Treatments
  • Interpersonal therapy (IPT)
  • This model holds that four interpersonal problems
    may lead to depression and must be addressed
  • Interpersonal loss
  • Interpersonal role dispute
  • Interpersonal role transition
  • Interpersonal deficits
  • Studies suggest that IPT is as effective as
    cognitive therapy for treating depression

16
Treatments for Unipolar Depression Sociocultural
Approaches
  • Family-Social Treatments
  • Couple therapy
  • The main type of couple therapy is behavioral
    marital therapy (BMT)
  • Focus is on developing specific communication and
    problem-solving skills
  • If marriage is filled with conflict, BMT is as
    effective as other therapies for reducing
    depression

17
Treatments for Unipolar Depression Biological
Approaches
  • Biological treatments can bring great relief to
    people with unipolar depression
  • Usually biological treatment means antidepressant
    drugs, but for severely depressed individuals who
    do not respond to other forms of treatment, it
    sometimes includes electroconvulsive therapy or
    brain stimulation

18
Treatments for Unipolar Depression Biological
Approaches
  • Electroconvulsive therapy (ECT)
  • One of the most controversial forms of treatment
  • It is used frequently because it is an effective
    and fast-acting intervention
  • The procedure consists of targeted electrical
    stimulation to cause a brain seizure
  • The usual course of treatment is 6 to 12 sessions
    spaced over 2 to 4 weeks
  • Treatment may be bilateral or unilateral

19
Treatments for Unipolar Depression Biological
Approaches
  • Electroconvulsive therapy (ECT)
  • The discovery of the effectiveness of ECT was
    accidental and based on a fallacious link between
    psychosis and epilepsy
  • The procedure has been modified in recent years
    to reduce some of the negative effects
  • For example, patients are given muscle relaxants
    and anesthetics before and during the procedure
  • Patients generally report some memory loss

20
Treatments for Unipolar Depression Biological
Approaches
  • Electroconvulsive therapy (ECT)
  • ECT is clearly effective in treating unipolar
    depression
  • Studies find improvement in 6080 of patients
  • The procedure seems particularly effective in
    cases of severe depression with delusions, but it
    has been difficult to determine why ECT works so
    well
  • Although effective, the use of ECT has declined
    since the 1950s because of the memory loss caused
    by the procedure, the frightening nature of the
    procedure, and the emergence of effective
    antidepressant drugs

21
Treatments for Unipolar Depression Biological
Approaches
  • Antidepressant drugs
  • In the 1950s, two kinds of drugs were found to
    reduce the symptoms of depression
  • Monoamine oxidase inhibitors (MAO inhibitors)
  • Tricyclics
  • These drugs have been joined in recent years by a
    third group, the second-generation antidepressants

22
(No Transcript)
23
Treatments for Unipolar Depression Biological
Approaches
  • Antidepressant drugs MAO inhibitors
  • Originally used to treat TB, doctors noticed that
    the medication seemed to make patients happier
  • The drug works biochemically by slowing down the
    body's production of MAO
  • MAO breaks down norepinephrine
  • MAO inhibitors stop this breakdown from occurring
  • This leads to a rise in norepinephrine activity
    and a reduction in depressive symptoms
  • Approximately half of patients who take these
    drugs are helped by them

24
Treatments for Unipolar Depression Biological
Approaches
  • Antidepressant drugs MAO inhibitors
  • MAO inhibitors pose a potential danger
  • People who take MAOIs experience a dangerous rise
    in blood pressure if they eat foods containing
    tyramine (cheese, bananas, wine)
  • In recent years, a new MAO inhibitor in the form
    of a skin patch has become available
  • Dangerous food interactions do not appear to be
    as common a problem with this kind of MAO
    inhibitor

25
Treatments for Unipolar Depression Biological
Approaches
  • Antidepressant drugs Tricyclics
  • In searching for medications for schizophrenia,
    researchers discovered that imipramine relieved
    depressive symptoms
  • Imipramine and related drugs are known as
    tricyclics because they share a three-ring
    molecular structure

26
Treatments for Unipolar Depression Biological
Approaches
  • Antidepressant drugs Tricyclics
  • Hundreds of studies have found that depressed
    patients taking tricyclics have improved much
    more than similar patients taking placebos
  • Drugs must be taken for at least 10 days before
    such improvement is seen
  • About 6065 of patients find symptom improvement

27
Treatments for Unipolar Depression Biological
Approaches
  • Antidepressant drugs Tricyclics
  • Most patients who immediately stop taking
    tricyclics upon relief of symptoms relapse within
    one year
  • Patients who take tricyclics for five additional
    months (continuation therapy) have a
    significantly decreased risk of relapse
  • Patients who take antidepressant drugs for three
    or more years after initial improvement
    (maintenance therapy) may reduce the risk of
    relapse even more

28
Treatments for Unipolar Depression Biological
Approaches
  • Antidepressant drugs Tricyclics
  • Tricyclics are believed to reduce depression by
    affecting neurotransmitter (NT) reuptake
    mechanisms
  • To prevent an NT from remaining in the synapse
    too long, a pumplike mechanism recaptures the NT
    and draws it back into the presynaptic neuron
  • The reuptake process appears to be too efficient
    in some people, drawing in too much of the NT
    from the synapse
  • This reduction in NT activity in the synapse is
    thought to result in clinical depression
  • Tricyclics block the reuptake process, thus
    increasing NT activity in the synapse

29
Reuptake and Antidepressants
30
Treatments for Unipolar Depression Biological
Approaches
  • Antidepressant drugs Tricyclics
  • There is growing evidence that when tricyclics
    are ingested, they initially slow down the
    activity of the neurons that use norepinephrine
    and serotonin
  • After a week or two, the neurons adapt to the
    drugs and go back to releasing normal amounts of
    the NTs, and the reuptake mechanism begins to
    have the desired effect
  • Today, tricyclics are prescribed more often than
    MAO inhibitors
  • They do not require dietary restrictions
  • Some patients show higher rates of improvement

31
Treatments for Unipolar Depression Biological
Approaches
  • Second-generation antidepressants
  • A third group of effective antidepressant drugs
    is structurally different from the MAO inhibitors
    and tricyclics
  • Most of the drugs in this group are labeled
    selective serotonin reuptake inhibitors (SSRIs)
  • These drugs increase serotonin activity
    specifically (no other NTs are affected)
  • This class includes fluoxetine (Prozac),
    sertraline (Zoloft), and escitalopram (Lexapro)
  • Selective norepinephrine reuptake inhibitors and
    serotonin-norepinephrine reuptake inhibitors are
    also now available

32
Treatments for Unipolar Depression Biological
Approaches
  • Second-generation antidepressant drugs
  • In effectiveness and speed of action of these
    drugs are on a par with the tricyclics, yet their
    sales have skyrocketed
  • Clinicians often prefer these drugs because it is
    harder to overdose on them than on other kinds of
    antidepressants
  • There are no dietary restrictions like there are
    with MAO inhibitors
  • They have fewer side effects than the tricyclics
  • These drugs may cause some undesired effects of
    their own, including a reduction in sex drive

33
Treatments for Unipolar Depression Biological
Approaches
  • As effective as antidepressant drugs are, it is
    important to recognize that they do not work for
    everyone
  • Even the most successful of them fails to help at
    least 35 percent of clients with depression

34
Treatments for Unipolar Depression Biological
Approaches
  • Brain stimulation
  • In recent years, three additional biological
    approaches have been developed
  • Vagus nerve stimulation
  • Transcranial magnetic stimulation
  • Deep brain stimulation

35
Treatments for Unipolar Depression Biological
Approaches
  • Vagus nerve stimulation
  • Depression researchers surmised they might be
    able to stimulate the brain by electrically
    stimulating the vagus nerve through the use of a
    pulse generator implanted under the skin of the
    chest
  • Research has found that the procedure brings
    significant relief to as many as 40 of those
    with treatment-resistant depression
  • As with ECT, researchers do not yet know
    precisely why this technique reduces depression

36
Vagus Nerve Stimulation
37
Treatments for Unipolar Depression Biological
Approaches
  • Transcranial magnetic stimulation
  • Another technique designed to stimulate the brain
    without the undesired effects of ECT, TMS has
    been found to reduce depression when administered
    daily for 2 to 4 weeks
  • Deep brain stimulation
  • Theorizing a depression switch located deep
    within the brain, researchers have successfully
    experimented with electrode implantation in the
    brain's Brodman Area 25

38
Treatments for Unipolar Depression Biological
Approaches
  • Brain stimulation
  • While such positive initial findings have
    produced considerable enthusiasm in the clinical
    field, it is important to recognize and remember
    that, in the past, certain promising
    interventions (e.g., lobotomies) later proved
    problematic and even dangerous upon closer
    inspection

39
How Do the Treatments for Unipolar Depression
Compare?
  • For most kinds of psychological disorders, no
    more than one or two treatments, if any, emerge
    as highly successful
  • Unipolar depression seems to be an exception,
    responding to any of several approaches

40
How Do the Treatments for Unipolar Depression
Compare?
  • Findings from a number of treatment outcome
    studies suggest that
  • Cognitive, cognitive-behavioral, interpersonal,
    and biological therapies are all highly effective
    treatments for mild to severe unipolar depression
  • Although cognitive, cognitive-behavioral, and
    interpersonal therapies may lower the likelihood
    of relapse, they are hardly relapse-proof

41
How Do the Treatments for Unipolar Depression
Compare?
  • Findings from a number of treatment outcome
    studies suggest that
  • When people with unipolar depression experience
    significant marital discord, couple therapy tends
    to be very helpful
  • Depressed people who receive strictly behavioral
    therapy have shown less improvement than those
    who receive cognitive, cognitive-behavioral,
    interpersonal, or biological therapy

42
How Do the Treatments for Unipolar Depression
Compare?
  • Findings from a number of treatment outcome
    studies suggest that
  • Traditional psychodynamic therapies are less
    effective than other therapies in treating all
    levels of unipolar depression
  • A combination of psychotherapy and drug therapy
    is modestly more helpful to depressed people than
    either treatment alone

43
How Do the Treatments for Unipolar Depression
Compare?
  • Findings from a number of treatment outcome
    studies suggest that
  • These various trends do not always carry over to
    the treatment of depressed children and
    adolescents
  • Among biological treatments, ECT appears to be
    somewhat more effective than antidepressant drugs
    and ECT seems to act more quickly
  • In addition, the newly developed brain
    stimulation treatments seem helpful for some
    severely depressed individuals who have been
    repeatedly unresponsive to drug therapy, ECT, or
    psychotherapy

44
Treatments for Bipolar Disorder
  • Until the latter part of the 20th century, people
    with bipolar disorders were destined to spend
    their lives on an emotional roller coaster
  • Psychotherapists reported almost no success
  • Antidepressant drugs were of limited help
  • These drugs sometimes triggered manic episodes
  • ECT only occasionally relieved either the
    depressive or the manic episodes of bipolar
    disorder

45
Treatments for Bipolar Disorder Lithium and
Other Mood Stabilizers
  • The use of lithium (a metallic element naturally
    occurring as mineral salt) and other
    mood-stabilizers has dramatically changed this
    picture
  • Lithium is extraordinarily effective in treating
    bipolar disorders and mania
  • Determining the correct dosage for a given
    patient is a delicate process
  • Too low no effect
  • Too high lithium intoxication (poisoning)
  • Given the effectiveness, around one-third of all
    persons with bipolar disorder seek treatment in a
    given year another 15 are monitored by family
    physicians

46
Treatments for Bipolar Disorder Lithium and
Other Mood Stabilizers
  • All manner of research has attested to the
    effectiveness of lithium and other mood
    stabilizers in treating manic episodes
  • More than 60 of patients with mania improve on
    these medications
  • Most individuals experience fewer new episodes
    while on the drug
  • Findings suggest that the mood stabilizers are
    also prophylactic drugs, ones that actually help
    prevent symptoms from developing
  • Mood stabilizers also help those with bipolar
    disorder overcome their depressive episodes to a
    lesser degree

47
Treatments for Bipolar Disorder Lithium and
Other Mood Stabilizers
  • Researchers do not fully understand how mood
    stabilizing drugs operate
  • They suspect that the drugs change synaptic
    activity in neurons, but in a different way from
    that of antidepressant drugs
  • Although antidepressant drugs affect a neuron's
    initial reception on NTs, mood stabilizers seem
    to affect a neuron's second messengers
  • These drugs also increase the production of
    neuroprotective proteins, which may decrease
    bipolar symptoms
  • Another theory is that mood stabilizers correct
    bipolar functioning by directly changing sodium
    and potassium ion activity in neurons

48
Treatments for Bipolar Disorder Adjunctive
Psychotherapy
  • Psychotherapy alone is rarely helpful for persons
    with bipolar disorder
  • Mood stabilizing drugs alone are also not always
    sufficient
  • 30 or more of patients don't respond, may not
    receive the correct dose, and/or may relapse
    while taking it
  • As a result, clinicians often use psychotherapy
    as an adjunct to lithium (or other
    medication-based) therapy

49
Treatments for Bipolar Disorder Adjunctive
Psychotherapy
  • Therapy focuses on medication management, social
    skills, and relationship issues
  • Few controlled studies have tested the
    effectiveness of such adjunctive therapy
  • Growing research suggests that it helps reduce
    hospitalization, improves social functioning, and
    increases clients' ability to obtain and hold a
    job
Write a Comment
User Comments (0)
About PowerShow.com