dsm -iv -tr chapter three - faculty.tcu.edufaculty.tcu.edu/pstuntz/ab_slides/ab-ch3-slides.pdf ·...
TRANSCRIPT
Slide 1
Chapter Three
Treatment of Abnormal Behavior
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Slide 2 Classification and Assessment
DSM-IV-TR
Purpose: Classification system that allows
clinician to match their client’s problems the
form of treatment that is mot likely to be
effective. The system classifies disorders
according to a specific set of symptoms which
helps in diagnosis and stimulates research for
treatment and possible prevention of the
disorder.
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Slide 3 Diagnositc Manual
United States-DSM!V-TR
Five axis descriptive classification system with each
axis concerned with a different domain of information.
Axis one and two: clinical symptoms and Personality
Axis 3, 4 & 5: Medical and environmental factors
including overall level of function.
International Classification of Disease-ICD-
developed by the World Health organization.
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Slide 4 Major Domains of Information of
DSM IV-TR (text pg 109) Axis One -clinical disorders and other conditions-
includes all mental disorders except personality disorders.
Axis Two – Personality disorders and presence of mental retardation.
Axis Three- General Medical Condition
Axis Four- Psychosocial and environmental problems that could have an impact on diagnosis or treatment (e.g. divorce, unemployment)
Axis Five- Usually a number from 1-100 that asseses the person’s level of psychological, social and occupational function.
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Slide 5 Biological
Goal of Treatment: Alter biology to relieve
psychological distress.
Primary Methods: Diagnosis and
medication
Psychopharmacology--study of the use of
medications to treat psychological
disturbances.
• Psychotropic medications: chemical substances that
affect the psychological state.
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Slide 6 Treatment with Pharmacology
Neurotransmitter systems involved in
Pharmacological Treatment
Serotonin-Depression, Anxiety
Norepinephrine-Depression, Anxiety, OCD
Dopamine-Depression, Schizophrenia, ADD
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Slide 7 Synthesis of Serotonin
Tryptophan
5HTP
Serotonin
Inactivated by
MAO-A
5 HTP Decarboxylase
Tryptophan hydroxylase
MAO-inhibitors will stop
the breakdown of
serotonin and therefore
make serotonin
available at the
synapse longer
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Slide 8 Synthesis of NE
Dopamine
Norepinephrine
Beta-hydroxylase (enzyme)
Epinephrine
Phenethanolamine
N-methyltransferase
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Slide 9 Synthesis of Dopamine
Tyrosine
L-dopa
Tryosine
hydroxylase
(enzyme)
Dopamine
Aromatic amino acid
decarboxylase
3MT
Methylated by COMT
HVA
Converted by MAO-B
HVA is a catabolite which
are cleared from the brain
primarily by the CSF, also
found in urine and blood
Drugs that act upon any of
these metabolites or
enzymes can affect the
amount of NT available
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Slide 10 Biological
Primary Methods (cont)
Psychopharmacology
• Onset of effectiveness
• Effects in people with mental disorders vs. people
who are functioning normally.
• Psychotropics alleviate symptoms but are not a cure
for the underlying problem.
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Slide 11 Biological
Primary Treatment Methods (cont)
Electroconvulsive Therapy- deliberate induction
of a seizure by passing electricity through the
brain.
• Unilateral vs. bilateral
• Course of treatment
• Side effects
Psychosurgery-controversial treatment that
involves the surgical removal of specific
regions of the brain.
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Slide 12 Biological
Role of Therapist: Active, directive
diagnostician-psychiatrist
Length of visit: Brief with occasional
follow-up visits.
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Slide 13 Psychodynamic Therapies
Goal of Treatment- Gain insight into defenses and unconscious motives.
Primary Methods- Interpretation of defense mechanisms.
Freudian Psychoanalysis
Psychodynamic Psychoanalysis
Role of Therapist- Passive, non-directive interpreter.
Length of Treatment- Usually long term, some new short-term treatments.
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Slide 14 Cognitive-Behavior Therapy
Focuses on emotional, cognitive, and
behavior changes in the present and not
insight about the past.
Goal of Treatment- Learn more adaptive
behaviors and cognitions.
Primary Methods- Instruction, Guided
Learning, Homework
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Slide 15 Cognitive-Behavior Therapy
Exposure therapies- based on Pavlov’s theory of classical conditioning.
Systematic Desensitization-if fears could be learned they could be unlearned through learning relaxation techniques and systematic exposure.
Flooding-exposure to the feared stimulus all at once without any attempt to calm anxiety.
Aversion Therapy-create an unpleasant response to behaviors such as addiction via drugs or shock.
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Slide 16 Contingency Management- goal is to reward
desirable behavior and extinguish or punish
undesirable behavior.
Social Skills Training- goal is to teach clients new
ways of behaving that are both desirable and likely
to be rewarded in every day life.
Cognition Techniques- based on correcting
negative thinking.
Beck’s Cognitive Theory -Therapy challenges the
negative distortions by gently confronting client’s
cognitive errors in therapy.
Rational Emotive Therapy (RET)-also designed to
challenge cognitive distortions thought to be
caused by irrational beliefs.
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Slide 17 Humanistic Therapies
believe that emotional distress results from
the frustrations of human existence.
Goal of Treatment- Increase emotional
awareness.
Primary Methods-Empathy, Support,
Exploring Emotions.
Client Centered Therapy
Gestalt
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Slide 18 Humanistic Therapies
Role of Therapist- Passive, nondirective,
warm, supporter. Humanistic Therapist
endeavors to share in another human’s
experience and does not take the role of an
expert.
Length of Treatment-Varies, length not
typically structured.
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Slide 19 Research on Effectiveness of
Different Types of Therapy
Does Therapy Work?
Types of Psychotherapy Research
Psychotherapy Outcome Research
--meta-analysis-a statistical technique which
allows the results from different studies to be
combined and compared in a standardized way.
Psychotherapy Process Research: if it does
work, then how does it work
--common factors.
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Slide 20 Common Factors in Process of
Psychotherapy
Meta-analysis comparisons reveal few
differences in effectiveness of treatments.
Common Factors include:
Psychotherapy as social support
Psychotherapy as Social Influence
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Slide 21 Changing Social Systems: Couples,
Family & Group Therapy-
Social Interventions
Couples Therapy-
Family Therapy-
Group Therapy
Prevention-
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