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Depersonalisation is associated with A. PTSD B. Schizophrenia C. Agoraphobia D. Ecstatic religious experience E.

All of the above

Remove Droperidol from the presentations

Disorders of thought form


Lack of association (lack of connection) Over inclusion Condensation

Vagueness, flights of ideas, incoherence, neologism

Difficulty to maintain boundaries for the idea or the topic.


Two ideas of something common are blended to be a false concept. Talks on the task in hands are interspersed with a stream of fantasy The stream of talk is deviated from the main topic to a side one Non necessary fine details are included on the topic

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

Clinical examination of memory


Immediate recall:

(5-7 digits or home address immediately) disturbed in Korsakoff syndrome


Short-term recall:

(5-7 digits or home address at 5 min)


Recent:

what patient did past several days lost in dementia


Recent past:

what patient did past few months, present President, recent news events
Remote:

Childhood events, past Presidents, historical events (years)

Clinical significance of Memory disturbance

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.

Family therapy. Marital therapy Sex therapy. Interpersonal psychotherapy.

Method of delivery of psychotherapy

Individual. Group therapy.

PSYCHOANALYSIS
AND ANALYTICALLY ORIENTED PSYCHOTHERAPY
Based on Freud's theories of dynamic unconscious and psychological conflicts.

Psychoanalysis and psychoanalytic psychotherapy

The major goal of these therapies is:


To help the patient develop insight into unconscious conflicts, which are based on unresolved childhood wishes and are manifested as symptoms. To develop more consciously adult patterns of interacting and behaving.

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.

Indication of psychoanalysis and patient criteria


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.

Psychoanalytically oriented psychotherapy

Based on the same principles and techniques as classic psychoanalysis but is less intense. Types:
Insight-oriented

or expressive

psychotherapy. Supportive or relationship psychotherapy.

Insight-oriented or expressive psychotherapy


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.

Supportive or relationship psychotherapy


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

Psychotic patients. Patients in a crisis situation, such as acute grief,

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

The basic assumption of this therapy is that:


Maladaptive behavior can change without insight into its underlying causes. Behavioral symptoms are taken at value and not as symptoms of a deeper problem.

Behavior therapy is based on the principles of learning theory, including operant and classic conditioning.

Operant conditioning is based on the premise that:

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.

Classical conditioning is based on the premise that:

Indications of behavior therapy


Behavior therapy is believed to be most effective for: Clearly delineated, circumscribed maladaptive behaviors, e.g.,

Phobias, Compulsions Overeating, Cigarette smoking Stuttering, Sexual dysfunctions.

Behavioral techniques are used to induce relaxation and decrease stresses

Behavioral techniques

Token economy. Aversion therapy. Systematic desensitization. Flooding. Exposure and response prevention.

2- Aversion therapy

It is form of negative reinforcement in which:


An aversive stimulus, g., A shock or unpleasant smell, is coupled with an undesired behavior. A controversial form, involves the patient imagining something unpleasant coupled with the undesired behavior.

The aversion is used to stop the undesired behaviour. Indicated in


Some cases of personality disorders. Sexual disorders Drug addiction.

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.

5- Exposure and response prevention

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.

Recognizing And Correcting Automatic Thoughts

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,

Range Of Group Function


Those that emphasize support and an increase in social skills, Those that emphasize specific symptomatic relief, To those that work through solved intra-psychic conflicts

Examples of homogeneous groups

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

Certain types of patients do not do well in certain types of groups

.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.

Special types of groups

A. Alcoholics Anonymous (AA). B. Milieu therapy. C. Multiple family groups (MFGs).

A. Alcoholics Anonymous (AA).

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.

C. Multiple family groups (MFGs)

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:

Problem closely related to faulty family function.


Marital disharmony Parent child conflict Behavioral problems in children.

In cases which family seeks help as a group


Death Divorce Immigration

Family therapy

Contraindications
Problems

unrelated to familial factors. If one of the key member is unwilling to participate in treatment

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