Behaviour and Cognitive Therapies According to Psychotherapy - Research Paper Example

The National Health Priority Areas Report on Mental Health defined mental health as: "the capa of individuals and groups to interact with one another and the environment, in ways that promote subjective wellbeing, optimal development and the use of cognitive, affective and relational abilities." A diverse range of social, environmental, biological and psychological factors can have an impact on an individual's mental health due to which , people can develop symptoms and behaviors that are distressing to themselves or others, and interfere with their social functioning and capacity to negotiate daily life. These symptoms and behaviors may require treatment, rehabilitation or in some cases even hospitalization. The National Survey of Mental Health and Wellbeing of Adults was conducted by the Australian Bureau of Statistics in 1997 using sample of 10,600 adults which was considered nationally representative. 18% of survey respondents reported that they had experienced the symptoms of a mental disorder at some time during the twelve-month period before interview. Women were more likely than men to have reported the symptoms of anxiety disorders (12% of women compared to 7% of men). Women were more likely to have reported affective disorders, such as depression (7% of women compared with 4% of men), and young women reported the highest rates (11% for those women aged 18-24). Men were more than twice as likely to have reported the symptoms of substance use disorders (11% of men compared with 4% of women). Young people are much more likely to report a mental disorder, and there is a substantial and steady decline across age groups. Young men reported the highest rate of substance use disorder, at 22% for those men aged 18-24.1 The National Minimum Data Sets (NMDSs) for Mental Health Care is a set of mental health care-related data factors that have been agreed for collection each year by Australian State and Territory governments. A fundamental strength inherent in any NMDS is that all data element definitions have been agreed in detail by the Health Data Standards Committee and the Statistical Information Management Committee to make sure that they are consistent with national health data standards. This provides a mechanism by which the data set can attain high levels of internal consistency and comparability. Mental disorders are real and disabling conditions that are experienced yearly by one in five Australians. The prevalence of mental illness among racial and ethnic minorities is generally similar to that for whites but disparities exist in access to, availability of, and quality of mental health services. While they are very common and disabling, 80-90% of mental disorders are also treatable because research has enabled us to recognize, diagnose, and treat these conditions. However, of those with diagnosable mental disorders, fewer than half of adults and only one-third of children get help. Stigma interferes with access and treatment, as do financial barriers, and cultural nuances of both patients and physicians. Generally, minority communities who are more likely to experience mental disorders than whites, have more stigmas regarding mental illness and are less likely to seek early treatment. Indeed, these communities more likely tend to be misdiagnosed, underdiagnosed, and undertreated. There are about 44 million adults and 13.7 million children with a diagnosable mental disorder whose basis is found in physical changes in the brain. Many of these disorders such as depression and attention deficit hyperactivity disorder (ADHD) begin in childhood, and others like, bipolar disease and schizophrenia develop in the late teens. An estimated 20% of children have mental disorders with at least mild functional impairment. One in ten Australian children and adolescents suffers from mental illness severe enough to cause some level of impairment in learning and social development. Malnourished children are more likely to suffer from mental illnesses. It is critical that children with mental disorders be recognized in whatever settings they manifest the disorder, be it home, school, church, child welfare, juvenile justice, or healthcare. Children need a seamless system of access to quality mental health services. The major barrier to early detection and quality care for the mentally ill is the failure to integrate mental healthcare into overall healthcare. Unfortunately, more is known about mental illness and how to treat it than about mental health and how to promote it. It is important to overcome the stigma and increase public awareness of effective treatments. There must be an adequate supply of mental health services and providers to deliver state of the art treatment along with facilitated entry into treatment and reduce financial barriers, including promoting insurance parity for mental health services. Treatments must be customized as per requirements depending on age, gender, race, and culture. Consider Julie, a fourteen year old who, over the past year has been suffering from major depression. Everyone experiences feelings of unhappiness and sadness occasionally. However, when these depressed feelings start to dominate everyday life and cause physical and mental deterioration, they become what are known as depressive disorders .Depression and depressive disorders (unipolar depression) are mental illnesses characterized by a profound and persistent feeling of sadness or despair and/or a loss of interest in things that once were pleasurable. Disturbance in sleep, appetite, and mental processes are common symptoms of depression.2 Major depressive disorder is a moderate to severe episode of depression lasting two or more weeks. In children, the major depression may often appear as irritability and may even have a preoccupation with death and suicide. While an imbalance of certain neurotransmitters-the chemicals in the brain that transmit messages between nerve cells-is believed to be the etiology of depression, external factors such as upbringing may be as important. It is speculated that, if an individual is abused and neglected throughout childhood and adolescence, a pattern of low self-esteem and negative thinking may emerge. From that, a lifelong pattern of depression may follow. Heredity also seems to play a role in development of depressive disorders. Common red flags that children may be experiencing a depressive disorder include a sudden decline in grades and/or disinterest in schoolwork, avoidance of friends, loss of interest in extracurricular activities, and withdrawal from family. Julie seems to be displaying these characteristic signs of major depression. The treatment strategy should be implemented with a very sensitive approach. In dealing with adolescents one might encounter numerous potential barriers in trying to establish a therapeutic relationship. An adolescent cannot be expected to be aware that he or she has a psychological problem and may refuse to talk, communicate or co-operate for any necessary investigations. Secondly, school goers may be burdened with social stigma and peer pressure which may make the approach even more difficult as the child may feel differently treated as compared to others. Last but most importantly, compliance from the child's parents is very essential in establishing diagnosis and implementing a treatment plan. Any child that is suffering from a depressive 'disorder' should have a solid support system both at home and at school, it is crucial that they feel safe and that they know that it is not their fault. Julie might be engaging is self-harm and suicidal tendencies due to lack of love and support from her family which could have resulted from domestic issues like divorce and separation. It is necessary to plan out a rehabilitation strategy for Julie involving counseling, personality development sessions, group therapy; self help exercises along with therapeutic medication. Early diagnosis and treatment, accurate evaluation of suicidal thinking, and limiting young people's access to lethal agents-including firearms and medications-may hold the greatest suicide prevention value. Although the scientific literature on treatment of children and adolescents with depression is far less extensive than that concerning adults, a number of studies-mostly conducted in the last four to five years-have confirmed the short-term efficacy and safety of treatments for depression in youth The diagnostic criteria and key defining features of major depressive disorder in children and adolescents are the same as they are for adults. However, recognition and diagnosis of the disorder may be more difficult in youth for several reasons. The way symptoms are expressed varies with the developmental stage of the child. In addition, children and young adolescents with depression may have difficulty in properly identifying and describing their internal emotional or mood states. For example, instead of communicating how bad they feel, they may act out and be irritable toward others, which may be interpreted simply as misbehavior or disobedience. Research has found that parents are even less likely to identify major depression in their adolescents than are the adolescents themselves.3 Joan , an 83 year old widow has been diagnosed with delirium after a road accident.Delirium is a medical term used to describe an acute decline in attention and cognition. Delirium is probably the single most common acute disorder affecting adults in general hospitals. There are several definitions (including those in the DSM-IV and ICD-10). However, there are some core features common to all like disturbance of consciousness (that is, reduced clarity of awareness of the environment, with reduced ability to focus, sustain, or shift attention) , change in cognition (e.g., memory impairment) or a perceptual disturbance , onset of hours to days, and tendency to fluctuate and intrusive abnormalities of awareness and affect, such as hallucinations or inappropriate emotional states. Delirium should be distinguished from psychosis, in which consciousness and cognition may not be impaired, and dementia which describes an acquired intellectual impairment usually resulting from a degenerative brain disease. Dementia ha s a sudden onset which fluctuating characteristics as opposed to depression which is insidious and progressive in nature. Psychomotor reflexes may be altered in delirium but are mostly normal in dementia. Delirium may be caused by severe physical or mental illness. Fever, poisons (including toxic drug reactions), brain injury, surgery, severe lack of food or water, drug and severe alcohol withdrawal are all known to cause delirium. . Based on the state of arousal, 3 types of delirium are described. Hyperactive delirium is observed in patients in a state of alcohol withdrawal or intoxication with to phencyclidine (PCP), amphetamine, and lysergic acid diethylamide (LSD). Hypoactive delirium is observed in patients in states of hepatic encephalopathy and hypercapnia. In mixed delirium, individuals display daytime sedation with nocturnal agitation and behavioral problems. In Joan's case physical trauma and surgery seems to be the primary etiology. The mechanism of delirium still is not fully understood. Delirium results from a wide variety of structural or physiological insults. Delirium can occur at any age, but it occurs more commonly in patients who are elderly and have compromised mental status. Therefore, noting that delirium can occur in a person with dementia is important. This diagnosis here requires not only a careful mental status but also a thorough history from the patient's family and the staff as well as a comprehensive chart review. A careful and complete physical examination including a mental status examination is necessary. Testing vital signs such as temperature, pulse, blood pressure, and respiration is mandatory. Schizophrenia is characterized by profound disruption in cognition and emotion, affecting the most fundamental human attributes: language, thought, perception, affect, and sense of self. The array of symptoms, while wide ranging, frequently includes psychotic manifestations, such as hearing internal voices or experiencing other sensations not connected to an obvious source (hallucinations) and assigning unusual significance or meaning to normal events or holding fixed false personal beliefs (delusions). No single symptom is definitive for diagnosis; rather, the diagnosis encompasses a pattern of signs and symptoms, in conjunction with impaired occupational or social functioning (DSM-IV). Jim has been give medications to treat schizophrenia. The class product in the primary medication is Benzodiazepine which has sedative mode of action, calms down the subject (anti anxiety) and also acts as an anti- depressant. Commonly occurring side effects of these medications are nausea, vomiting, withdrawal symptoms, and nephrotoxic side effects. Symptoms of schizophrenia can be described as positive or negative Delusions are firmly held erroneous beliefs due to distortions or exaggerations of reasoning and/or misinterpretations of perceptions or experiences. Delusions of being followed or watched are common, as are beliefs that comments, radio or TV programs, etc., are directing special messages directly to him/her. Hallucinations are distortions or exaggerations of perception in any of the senses, although auditory hallucinations ("hearing voices" within, distinct from one's own thoughts) are the most common, followed by visual hallucinations. Disorganized speech/thinking, also described as "thought disorder" or "loosening of associations," is a key aspect of schizophrenia. Disorganized thinking is usually assessed primarily based on the person's speech. Therefore, tangential, loosely associated, or incoherent speech severe enough to substantially impair effective communication is used as an indicator of thought disorder by the DSM-IV. Grossly disorganized behavior includes difficulty in goal-directed behavior (leading to difficulties in activities in daily living), unpredictable agitation or silliness, social disinhibition, or behaviors that are bizarre to onlookers. Their purposelessness distinguishes them from unusual behavior prompted by delusional beliefs. Catatonic behaviors are characterized by a marked decrease in reaction to the immediate surrounding environment, sometimes taking the form of motionless and apparent unawareness, rigid or bizarre postures, or aimless excess motor activity. Other symptoms sometimes present in schizophrenia but not often enough to be definitional alone include affect inappropriate to the situation or stimuli, unusual motor behavior (pacing, rocking), depersonalization, derealization, and somatic preoccupations. Negative Symptoms of Schizophrenia Affective flattening is the reduction in the range and intensity of emotional expression, including facial expression, voice tone, eye contact, and body language. Alogia, or poverty of speech, is the lessening of speech fluency and productivity, thought to reflect slowing or blocked thoughts, and often manifested as laconic, empty replies to questions. Avolition is the reduction, difficulty, or inability to initiate and persist in goal-directed behavior; it is often mistaken for apparent disinterest.Currently, discussion is ongoing within the field regarding the need for a third category of symptoms for diagnosis: disorganized symptoms (Brekke et al., 1995; Cuesta & Peralta, 1995). Disorganized symptoms include thought disorder, confusion, disorientation, and memory problems. While they are listed by DSM-IV as common in schizophrenia-especially during exacerbations of positive or negative symptoms (DSM-IV)-they do not yet constitute a formal new category of symptoms. Some researchers think that a new category is not warranted because disorganized symptoms may instead reflect an underlying dysfunction common to several psychotic disorders, rather than being unique to schizophrenia (Toomey et al., 1998). A focus on rehabilitation in shaping patient outcome was supported by one of the only direct comparisons between patient cohorts.. Patients' degree of recovery at followup after three decades was measured by global functional improvement and other functional measures .In summary, schizophrenia does not follow a single pathway. Rather, like other mental and somatic disorders, course and recovery are determined by a constellation of biological, psychological, and sociocultural factors. That different degrees of recovery are attainable has offered hope to consumers and families. 28 year old Judy is a lady with schizotypal personality disorder characterized by delusions which may be physical , mental and emotional . in this case Judy has a delusion that she has a relationship with her boss when in actuality, it does not exist. Her false beliefs may impact her professional prospects in a negative manner. She may jeopardize her reputation and may make her collegues uncomfortable with her inappropriate behavior and acts. Personality disorders form a class of mental disorders that are characterized by long-lasting rigid patterns of thought and behaviour. Because of the inflexibility and pervasiveness of these patterns, they can cause serious problems and impairment of functioning for the persons who are afflicted with these disorders. To make a diagnosis of a personality disorder, these criteria must be satisfied in addition to the specific criteria listed under the individually named personality disorders. Experience and behaviour that deviates markedly from the expectations of the individual's culture. This pattern is manifested in two (or more) of the following areas: 1. cognition (perception and interpretation of self, others and events) 2. affectivity (the range, intensity, lability, and appropriateness of emotional response) 3. interpersonal functioning 4. impulse control A pattern of peculiarities best describes those with schizotypal personality disorder. People may have odd or eccentric manners of speaking or dressing. Strange, outlandish or paranoid beliefs and thoughts are common. People with schizotypal personality disorder have difficulties forming relationships and experience extreme anxiety in social situations. They may react inappropriately or not react at all during a conversation or they may talk to themselves. They also display signs of "magical thinking" by saying they can see into the future or read other people's minds. There are many types of help available for the different personality disorders. Treatment may include individual, group, or family psychotherapy. Medications, prescribed by a patient's physician, may also be helpful in relieving some of the symptoms of personality disorders, including problems with anxiety and perceptions. Psychotherapy for patients with personality disorders focuses on helping them see the unconscious conflicts that are contributing to or causing their symptoms. It also helps people become more flexible and is aimed at reducing the behavior patterns that interfere with everyday living. In psychotherapy, people with personality disorders can better recognize the effects of their behavior on others. Behavior and cognitive therapies focus on resolving symptoms or traits that are characteristic of the disorder, such as the inability to make important life decisions or the inability to initiate relationships. Heather , a 28 year old lady separated from her husband is suffering from social phobia, a form of anxiety disorder. Anxiety disorders are the most common of all the mental health disorders. Considered in the category of anxiety disorders are: Generalized Anxiety Disorder, Panic Disorder, Agoraphobia, Social Phobia, Obsessive Compulsive Disorder, Specific Phobia, Post-Traumatic Stress. Social phobia (also sometimes called social anxiety) refers to an intense fear of being in social situations. The fear is so intense that someone with social phobia will avoid these situations whenever possible. And just like with other phobias, this fear isout of proportion to the actual danger that's present. Although many people fear being embarrassed in certain social situations, some people find it incredibly difficult to cope with this embarrassment. A person with social phobia is usually overrating the danger of embarrassmentwhile underrating his or her ability to get through the situation. Social phobia is much more than just normal shyness or the awkward feelings mostpeople have from time to time. Social phobia is shyness to the extreme, and this shyness is accompanied by anxiety that causes people to avoid doing things they might like to do or to avoid situations that might result in having to be with - or to talk with or in front of - others. Some people are born with a cautious personality style and have a tendency to be shy and sensitive to new situations. This may contribute to social phobia. Others may learn a cautious style depending on experiences they have, the way others react to them, or the behaviors they see in their parents and others. Low self-confidence and a lack of coping skills to manage normal stress can also play a role in social phobia. Those who tend to be worriers, perfectionists, and who have a hard time dealing with small mistakes may also be more likely to develop it. The most commonly prescribed anti-anxiety agent for this disorder has historically been benzodiazepines, despite a dearth of clinical research that shows this particular class of drugs is any more effective than others. Diazepam (Valium) and lorazepam (Ativan) are the two most prescribed benzodiazepines. Lorazepam will produce a more lengthy sedating effect than diazepam, although it will take longer to appear. Individuals on these medications should always be advised about the medications' side effects, especially their sedative properties and impairment on performance. Tricyclic antidepressants often are an effective treatment alternative to benzodiazepines and may be a better choice over a longer treatment period. Medication for this disorder should only be used to treat acute symptoms of anxiety. Medication should be tapered off when it is discontinued. Therapists can help people who have social phobia to develop coping skills to manage their anxiety. This involves understanding and adjusting thoughts and beliefs that help create the anxiety, learning and practicing social skills to increase confidence, and then slowly and gradually practicing these skills in real situations.One element of the therapy might include learning relaxation techniques (such as breathing and muscle relaxation exercises). Behavioral rehearsal can be helpful as well, during which the therapist and the teen might role play certain situations, trying outnew behaviors ahead of time. This can make it much easier and more automatic to put these behaviors into practice when the teen is faced with real situations. A person might also learn to correct self-talk that is leading to anxiety by learning self-talk that is more positive and that promotes self-confidence and builds coping skills. The teen may be guided by a therapist to tune into how he's thinking about particular situations and to modify certain thoughts, especially worry thoughts. Self-help methods for the treatment of this disorder are often overlooked by the medical profession because very few professionals are involved in them. Many support groups exist within communities throughout the world which are devoted to helping individuals with this disorder share their commons experiences and feelings of anxiety. Individuals should first be able to tolerate and effectively handle a social group interaction. Pushing an individual into a group setting, whether it be self-help or a regular group therapy experience, is counterproductive and may lead to a worsening of symptoms. References: http://en.wikipedia.org/wiki/Personality_disorder Sims, A. (1995) Symptoms in the mind: An introduction to descriptive psychopathology. Edinburgh: Elsevier Science Ltd. ISBN 0702026271 Dickens, C. (1837) The Pickwick Papers. Available for free on Project Gutenberg. Burns A, Gallagley A, Byrne J. (2004) "Delirium." Journal of Neurology, Neurosurgery and Psychiatry 75 (3), 362-367. http://en.wikipedia.org/wiki/Delirium http://en.wikipedia.org/wiki/Personality_disorder" http://www.aihw.gov.au/mentalhealth/faqs.cfm http://www.pbs.org/kcet/tavissmiley/special/roadtohealth/essays/david_satcher.html http://mentalhelp.net/poc/center_index.phpid=5&cn=5 Read More