The Meaning of a Placebo Effect and Its Benefits - Assignment Example

Chapter Q1. What is the meaning of "a placebo effect"? Describe on example and elaborate on whether you believe placebos can be useful. A placebo effect is a clinical phenomenon characterized by a perceived or actual positive response to a specific substance with no known medical application for the condition (Enserink, 1999). This effect is usually driven by a strong belief of the patient (or even by the doctor) to the expected results purportedly provided by the placebo drug. Interestingly, whether a placebo may actually mimic a physiological effect comparable to a therapeutically equivalent drug has been argued in several cases. For instance, the body normally produces intrinsic pain- reducing substances such as endorphins when the body is inflicted with pain even without the administration of potent pain killers (Mayberg et al, 2002). With the intake of even just a starch pill, endorphins will still be produced in the body and not necessarily due to the pill itself. This reinforces the belief of some people in the clinical significance of using placebo that even medical committees on ethics have not provided a concrete stand on the issue and instead lay down dimensions to consider for the medical practitioner. Q2. How would you define the term "mentally ill"? Give at least one comparison between "normal" and “mentally ill"? The term “mentally ill” is a collective description used to refer to a person currently in an altered state of psychological functioning (Videbect, 2007). Oftentimes the description can include a wide range of clinical syndromes from a general chronic dissatisfaction of one’s current standard of living to that which include a more specific psychiatric diagnosis characterized by a distinct array of behaviors and physical manifestations. Thus, the continuum between mentally healthy and mentally ill poses great challenge to the diagnosis of a psychiatric condition. According to the American Psychiatric Association (APA, 2000), mental illness occurs only when the person in unable to cope with life’s circumstances and is causing a significant distress in his or her life. Unfortunately, there is no specific time- frame to readily consider a person’s current state to be a mental illness since the duration of disability differs with each condition (Sadock & Sadock, 2007). For instance, the diagnosis of major depressive disorder is considered when a sad mood or a general lack of interest persists for at least two weeks. Therefore, even if a normal individual shows signs of depression but only for a week, the diagnosis is still not apparent and the individual is relatively “normal”. Q3. Discuss ways that culture shapes the clinical presentation of mental disorders. Culture determines the types of social behaviors generally accepted in a specific geographic location. Aside from age, gender, physiologic, and neuroendocrine factors, the clinical diagnosis of every psychiatric disorder considers an individual’s cultural affiliation (Eshun & Gurung, 2009). In many cases, some behaviors can be well tolerated in one cultural affiliation but not in another. For example, bereavement and grieving process between families of different cultural ethnicity vary greatly that there may be no standard description of what is considered normal. Chapters 2, 3 and 4 History of Depression, Assessment and Diagnosis Depression is one of the few psychiatric conditions seen even in the prehistoric era (Alexander & Selesnick, 1966). In the medieval times, personality and temperament were believed to be generally influenced by the variation in the levels body fluids or humors. That is, an imbalance of which can cause mood disorders including depression and mania. In the Old Testament of the Bible, the story of King Saul demonstrates a classic example of a major depressive disorder with vivid manifestations that form part of the clinical diagnosis until now. The story of Ajax’s suicide in Homer’s Iliad also exemplifies the condition. Hippocrates first coined the terms mania and melancholia in 400 BC to describe mood disturbances that lasted for a long time and constituting a mental illness. In his work De re Medicina, a Roman physician Celsus (about 30 AD) proposed that melancholia was caused by black bile. Further studies about depression were only published several centuries later (Sadock & Sadock, 2007). The term depression was only coined in the 14th century from the Latin word deprimere which means “to bring down” (Spaner et al, 2007). Several revisions on the concept depression started along with the rise of original thinkers especially Freud when the influence of childhood and psyche on personality were considered. The modern concept of depression is elaborated in the DSM-IV-TR using the term “major depressive disorder” appearing in most psychiatric records today. It is characterized as a general lack of interest lasting for at least two weeks with a minimum of four other manifestations including changes in appetite and weight, changes in sleep and activity, anergia, feelings of guilt, difficulties in problem-solving and decision-making, and recurring thoughts of death or suicide. Many assessment tools are currently in use but the Beck Depression Inventory has been most widely used in clinics (Sadock & Sadock, 2007). Chapters 5 and 6 History Mr. Jumpy reports extreme irrational fear when he is in an elevator as evidenced by “freaking out” in addition to subjective account of his experience. He has been having the same symptom since he can remember but cannot recall a situation or an event in his life that could have precipitated his fear. He declares being workaholic and seemingly “always on the go”. In fact, he frequently experiences bouts of insomnia and inability to relax when extremely stressed by work. He consumes two to three bottles of vodka every night to achieve at least four hours of sleep. The clinical manifestations of the patient suggest that he might be suffering from claustrophobia, a type of anxiety disorder characterized by an extreme irrational fear of being in a closed space such as, in this case, inside an elevator. The possibility of a bipolar disorder may be part of the differential diagnosis but may not be evident as the patient does not have a history of depression. On the other hand, further evaluation of the patient’s bio-psycho-social dimensions should comprise assessment of his overall health status, his perception of the problem, and the status of his social functioning related to work and family relations (Cicchetti & Cohen, 2006). While it is important that the patient undergo a cognitive-behavioral therapy to therapeutically reduce his perceived fear, the problem with sleep deprivation should be prioritized since it can precipitate to more biological problems (Friedman, 1966). In fact, his chronic alcohol drinking already poses a significant health threat. Lastly, social assistance for the patient should focus on gaining support from the people in his environment including family members especially his wife to facilitate an improvement not only in his presenting problem but in his current status in general (Bromley et al, 2013). Chapter 7 Q1. Depression has been referred to as "the common cold" of mental disorders. Discuss why this is so; be specific with prevalence rates. In psychiatry, depression has been referred to as “the common cold” primarily because of its high prevalence rate worldwide. In the United States, 6.7% of the adult population is diagnosed as having a major depressive disorder in a 12-month period (Kessler et al, 2005). This does not include individuals who may have satisfied the clinical criteria for its diagnosis but did not seek a medical intervention. Thus, the actual prevalence may be higher. Q2. Differentiate between dysthymia, cyclothymia, major depression, bipolar I, and bipolar II disorders While dysthymia, cyclothymia, major depression, and bipolar I and II disorders all belong to the classification of mood disorders, each differ in the timing and clinical feature. Specifically, major depression presents as sad mood or a general lack of interest in the activities of daily living for at least 2 weeks duration and with a minimum of four other symptom which include anhedonia, changes in weight, changes in sleep patterns, lack of energy, lack of concentration, lack of decision-making, reduced self-esteem, and diminished life goals (Spaner et al, 2007). On the other hand, bipolar disorders are characterized by shifts of mood from a depressive episode to a mania. Bipolar I and II differ from each other depending on the degree of mania manifested. Manic episodes in Bipolar I can be extreme, but relatively milder in Bipolar II (Sadock & Sadock, 2007). Dysthymia, or dysthymic disorder, happens when there is a chronic mild depression that lasts most of the day associated with guilt, withdrawal, irritability, anger, lack of productivity and interest, and inactivity. Cyclothymia, or cyclothymic disorder, appears to be a milder form of Bipolar II disorder characterized by minor depressive episodes intermittently occurring with hypomania (Sadock & Sadock, 2007). Q3. Discuss the suicide risk factors for adolescents and how these still apply for college aged persons. Also comment on why more women attempt suicide but that more men complete suicide. Suicide is one of the leading causes of death in the 15 to 24 years old age group in the United States (Videbect, 2007). The risk factors for adolescents and college- aged persons include gender and age. Adolescents are particularly prone to commit suicide because of the immaturity of their coping mechanism. While women are more prone to attempt suicide when under extreme emotional distress, methods used by men are more fatal. The most common method used by women in committing suicide is overdosing on drugs while men use guns and bladed weapons (Sadock & Sadock, 2007). The issue that women may just be seeking attention by attempting suicide remains a controversy and an important topic for debate. This is particularly attributed on the general characteristic of women to be more expressive and open in their feelings. References Alexander, FG & Selesnick ST. (1966). The History of Psychiatry: An Evaluation of Psychiatric Thought and Practice from Prehistoric Times to the Present. New York: Harper & Row. American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders (4th Ed.) Washington, DC: American Psychiatric Association. Bromley, E, Gabrielian, S, Brekke, B, Pahwa, R, Daly, KA, Brekke, JS & Braslow, JT. (2013). Experiencing Community: Perspectives of Individuals Diagnosed as Having Serious Mental Illness, Psychiatric Services in Advance. doi: 10.1176/appi.ps.201200235 Cicchetti, D & Cohen, DJ. (2006). Developmental Psychopathology (2nd Ed.). New Jersey: John Wiley & Sons. Enserink M. (1999). 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Major Depressive Disorder. Acta Psychiatrica Scandinavica, 89 (376), pp. 7-15. DOI: 10.1111/j.1600-0447.1994.tb05786.x Videbect, SL. (2007). Psychiatric mental health nursing (4th ed). New York: Lippincott Williams and Wilkins. Read More