Is he mentally ill?

Antipsychotics—aka major tranquilizers, neuroleptics

• 60-80% show some improvement
• Thorazine-1955, Haldol-1960s—less sedation
• Side effects—extrapyramidal symptoms—Parkinsonism—shuffling gate, tremor, muscular weakness, rigidity
• Tardive dyskinesia—jerks, tics, twitches of the face and tongue—doesn’t appear for several years and is permanent
• Atypical antipsychotic—developed in 1980s and beyond—first Clozaril, now Risperdal, Abilify, Geodon, Zyprexa, Seraquel
• Newer meds are better at treating negative symptoms
• Side effects—weight gain, drooling, agranulocytosis (drop in white blood cells)

Monamine oxidase inhibitors—Parnate, Marplan—dev. as tx for TB, but people became less depressed

• Monamine oxidase inhibitors—Parnate, Marplan—dev. as tx for TB, but people became less depressed

• -slow activity of serotonin and norepinphine
• -work well, but decreases REM sleep, can’t eat foods with tyramine

• Tricyclics—Tofranil, Elavil, Anafranil, Pamelor

• Fewer serious side effects but—fatal in overdose

• SSRIs—1988-Prozac—most widely prescribed antidepressant in the world, others include Zoloft, Paxil, Celexa, fluvoxamine, Lexapro

• Less deadly in overdose
• Better tolerated but nervousness, insomnia, sexual dysfunction, long time to effectiveness
• 60-70% on antidepressants improve
• More effective for major depression, less effective for dysthymia
• Elderly are less able to metabolize

Mood stabilizers—lithium--some pts miss the highs 

• Mood stabilizers—lithium--some pts miss the highs 

• Anxiolytics—most prescribed class of psychoactive drugs

• At times, on top of all drugs prescribed
• Benzodiazepines—minor tranquilizers—prescribed by length of action or time to onset
• Long acting—valium, Librium
• Intermediate—ativan, klonopin
• Short acting—xanax, halcyon
• Side effects—rebound, addiction, drowsiness, fatigue, clouded thinking
• But they work—after 8 wks, 50-60% are free of panic

• Psychostimulants—ritalin, dexadrine, etc.

• Why might you not want to prescribe meds?

• Reliance on drugs
• Decreased self-efficacy

Why does it work?

• Why does it work?

• Common factors are not inert or trivial
• Hawthorne effect
• Placebo effect—phone call improvement

• Insight-oriented therapy—assumes beh, emo, and thoughts become disordered because people don’t understand what motivates them, esp. when needs and drives conflict

• Psychoanalytic therapy—remove repressions that have prevented the ego from helping the individual grow into a healthy adult.—unresolved, buried conflicts

• Focus of therapy is not on presenting problems such as anxiety, but conflicts in the psyche from childhood
• Techniques—free association
• Resistance—blocks to free association—come late, change subject, miss appointments. 
• Is it effective? Time consuming, expensive, no rigorous, controlled outcome studies of traditional analysis. Appears to have some utility. Newer forms of short-term psychoanalytic have had some outcome studies, look good.

Greater emphasis on freedom of choice

• Greater emphasis on freedom of choice

• Free will-most important characteristic—offers pleasure but also pain

•  Carl Rogers’ client centered therapy

• Techniques—
• Genuineness-spontaneity, openness, authenticity
• Unconditional Positive Regard—get rid of conditions of worth
• Accurate empathic understanding—accept, recognize, and clarify feelings
• Reflect back statements
• Inconsistent results

• Gestalt Therapy—Fritz Perls—originally an analyst; we react to people in the context of our needs. Clients are made aware of what is going on now in session.

• Techniques—I language; Empty chair; Reversal (beh. opposite)

• Evaluating Humanistic-Experiential therapies—

• Many of the ideas have had an impact on psychotherapy
• However, lack of agreed upon procedures, a bit vague
• More research these days—looks ok

Exposure therapy

• Exposure therapy

• Systematic desensitization

• Aversion therapy—pair negative stimuli with stimuli that are inappropriately appealing

• Token economy

• Premack principle

• Modeling

• Evaluating Behavior Therapy

• Achieves results in a short period of time—less distress, lower cost
• Methods are clearly delineated; results easily measured
• Works better with some problems than others—rarely used for complex personality disorders (except dialectical behavior tx for borderline)

Ellis—Rational Emotive Therapy

• Ellis—Rational Emotive Therapy

• Sustained emotional reactions are caused by internal sentences that people repeat to themselves—irrational beliefs
• Eliminate self-defeatingness by rational examination 

• Beck—Cognitive therapy

• Negative beliefs that people have about self, world and future cause disorders.

• Both behavioral and cognitive. 

• Ellis is more harsh and direct

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