Documenti di Didattica
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Interpenetration
Derailment
Circumstantiality
Hallucinations
Perception of non existed stimulus Types
Visual (most common in substance abuse) Auditory (most common in schizophrenia) Olfactory (most common in brain tumor) Tactile Gustatory
Disorders of Memory
Registration Retention Recall & Recognition
Any failure of one of these functions is regarded as memory disorders
what patient did past few months, present President, recent news events
Remote:
Anxious patient may complain of poor memory because of defective registration In Korsakoffs syndrome there is failure of retention so the patient has disturbed immediate recall In dementia the recall of recent events is disturbed.
PSYCHOTHERAPIES
Psychotherapy
1. Psychoanalysis and psychoanalytic psychotherapy. 2. Psycho educational. 3. Behavior therapy. 4. Cognitive therapy. 5. Specific therapies:
i. ii. iii. iv.
PSYCHOANALYSIS
AND ANALYTICALLY ORIENTED PSYCHOTHERAPY
Based on Freud's theories of dynamic unconscious and psychological conflicts.
Psychoanalysis
The most intensive and rigorous of this type of therapy.
The patient is seen 3-5 times a week, generally for a minimum of several hundred hours over a number of years. The patient lies on a couch with the analyst seated behind, out of the patients visual range. The patient attempts to say freely and without censure whatever comes to mind, to free associate, in order to follow as deeply as possible the train of thoughts to their earliest roots. This includes associating to dream material and to transference feelings that are evoked in the process. The analyst uses interpretation and clarification to help the patient work through and resolve conflicts that have been affecting the patients life, often unconsciously.
Neurotic patient. requires that the patient be stable, highly motivated, verbal, and psychologically minded. The patient also must be able to tolerate the stress generated by analysis without becoming overly regressed, distraught, or impulsive. Not indicated in personality disorder or psychotics.
Based on the same principles and techniques as classic psychoanalysis but is less intense. Types:
Insight-oriented
or expressive
Patients are seen 1 -2 times a week and sit up facing the psychiatrist. The goal of resolution of unconscious psychological conflict is similar to that of psychoanalysis, but there is a greater emphasis an day-to-day reality issues and a lesser emphasis on the development of transference issues. Patients suitable for this therapy include those suitable for psychoanalysis, as well as those with a wider range of symptomatic and characterological problems. Patients with personality disorders also are suitable for this therapy.
In supportive psychotherapy, the essential element is support, rather than the development of insight. This type of therapy often is the treatment of choice for patients with serious ego vulnerabilities, particularly
This therapy can be long term, lasting many years, especially in the case of chronic patients. Support can take the form of:
limit-setting, increasing reality testing, reassurance, advice, and help with developing social skills.
BEHAVIORAL THERAPY
Based on the principles of learning theory
Behavioral therapy
Behavior therapy is based on the principles of learning theory, including operant and classic conditioning.
Behavior is shaped by its sequences; that is, if behavior is positively reinforced it will increase, if it is punished it will decrease, and if it elicits no response it will be extinguished. Behavior is shaped by its being coupled with or uncoupled from anxiety-provoking stimuli. A person can be conditioned to feel fear in the situations that have come to be associated with anxiety. Uncouple the anxiety from the situation, the avoidant and anxious behavior will decrease.
Behavioral techniques
Token economy. Aversion therapy. Systematic desensitization. Flooding. Exposure and response prevention.
2- Aversion therapy
3- Systemic desensitization
Indications:
Patient with avoidant behavior and anxiety linked to a specific situations e.g., Heights or airplane travel, Patient is helped to construct a hierarchy of anxiety-provoking images in his or her imagination starting from the least to the most fearful situations,
Staying at each level of the hierarchy until anxiety disapears. Hierarchy construction often is associated with relaxation techniques, because it is felt that anxiety and relaxation are incompatible, thus leading to an uncoupling of the imagined images from anxiety (reciprocal inhibition).
Idea:
When this procedure is performed in real life rather than imagined, it is called graded exposure. The technique work through a combination of :
Positive reinforcement for confronting anxiety-provoking stimuli And the extinguishing of maladaptive behavior by the realization of an absence of negative consequences.
4- Flooding.
It is technique in which the patient is exposed immediately to the most anxiety-provoking stimulus, e.g. the top of a tall building if he or she is afraid of heights, instead of being exposed gradually or systematically to a hierarchy of feared situations. Flooding is thought to be the most effective behavioral treatment of such disorders as phobias, if the patient can tolerate the anxiety associated with it.
The patient is exposed to the undesired situation or the area of abnormality and is prevented from responding to situation. The patient who has compulsive hand washing due to anticipation of dirtiness is exposed to dirty or potentially dirty situation and is prevented from hand washing This behavior is encouraged by relaxation, assurance , token economy or even aversion
COGNITIVE THERAPY
Based on the theory that behavior is secondary to the way in which persons think about themselves and their roles in the world.
Therapy is short-term, generally 15-20 sessions over 12 weeks, during which: Patients are made aware of their own distorted cognitions and the assumptions on which the questions are based. Homework is assigned: patients are asked to record what they are thinking in certain stressful situations (such as, Im no good or no one cares about me) And to ascertain the underlying, often relatively unconscious, assumptions that fuel the negative cognitions.
Indications
Mild to moderate, non-psychotic depressions. Adjunctive treatment with substance abusers And in increasing compliance with medication. Obsessive compulsive disorders
GROUP THERAPY
Focus may be on a person within the context of a group, and interactions that occur among persons in the group,
Those for weight-reduction and smoking cessation, Groups whose members share the same medical or psychiatric problem, e.g.,
Patients with acquired immunodeficiency syndrome (aids), Posttraumatic stress disorder, Substance use disorders
.Psychotic patients who need structure and clear action do not do well in insight- oriented groups. Paranoid patients, antisocial personalities, and substance abusers do not do well in heterogeneous insight-oriented groups. In general, acutely psychotic or suicidal patients do not do well in groups.
An example of a large, highly structured, peerrun group that is organized around persons with a similar, central .problem. AA emphasizes a sharing of experience, role models, ventilation of feelings, and strong sense of community and mutual support. Similar groups include Narcotics Anonymous (NA) and Sex Addicts Anonymous (SAA).
B. Milieu therapy.
The multidisciplinary therapeutic approach used on inpatient psychiatric wards. The term milieu therapy reflects the idea that all activities on a ward are oriented toward increasing a patients ability to cope in the world and to relate appropriately to others. Milieu therapy generally involves groups and may include
Artistic therapy Occupational therapy, Activities of daily living groups, Community meetings, Group passes, And social events.
Composed of families of schizophrenic patients. The groups discuss issues and problems related to having a schizophrenic person in the family and share suggestions and means of coping. MFGs are an important factor in decreasing relapse rates among schizophrenic patients whose families participate in the groups
FAMILY THERAPY
Based on correction of the faults of family structure and function that affect the disease process of the child
Family therapy
Indications:
Family therapy
Contraindications
Problems
unrelated to familial factors. If one of the key member is unwilling to participate in treatment