1 Mental and Behavioral HealthChapter Thirteen Mental and Behavioral Health Mastering Healthcare Terminology/Chapter 13

2 Quote “Health is not a static condition, but rather is manifested indynamic responses to the stresses and challenges of life. The more complete the human freedom, the greater the likelihood that new stresses will appear - organic and psychic - because man himself continuously changes his environment through technology, and because endlessly he moves into new conditions during his restless search for adventure.” – René Jules Dubos Life is stressful! Can anyone think of how stress is expressed mentally and physically?

3 Introduction 25% of Americans are diagnosed with a mental disorderMore than 25% of the top 100 medications prescribed are psychiatric drugs Approximately 40 million Americans are diagnosed with anxiety The fourth most common diagnostic category for inpatient admissions is substance-related mental disorders Is anyone surprised at these statistics? Many individuals assume that mental illness is rare, but indeed, the statistics show that not to be true. Mastering Healthcare Terminology/Chapter 13

4 Behavioral and Mental HealthBehavioral health: the term reflects an integration of the interaction between mind and body “Behavior” is observable and measurable Mental health: an ability to cope with stresses of everyday living DSM IV-TR The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, is an official listing of the diagnosable mental disorders in the Untied States. The codes in the DSM are coordinated with the International Classification of Diseases, which provides acceptable billing codes. Major revisions to the DSM occur approximately at 10 year intervals. The current DSM is in a text revision (TR) and is in the fourth revision, DSM IV-TR. DSM-V is due to release in 2011 or later. Mastering Healthcare Terminology/Chapter 13

5 Specialties/SpecialistsSpecialty Psychology Psychiatry Specialist Psychologist Psychiatrist A psychologist (psych/o = mind + -logist = one who specializes in the study of) is a health care professional who works with the diagnosis and treatment of mental health disorders. Psychology is the study of the mind. A psychiatrist is a medical doctor who specializes in the treatment of mental disorders. The psychiatrist can prescribe medications (as a medical doctor), while the psychologist cannot. The discipline of psychiatrists is psychiatry. Be careful! Don’t confuse psychiatry, the treatment of mental disorders, with physiatry, the treatment of physical disorders. Mastering Healthcare Terminology/Chapter 13

6 Clicker Question What is the name of the official listing of psychological disorders? A. CPT-4 B. DSM IV-TR C. ICD9 D. ICD10 B. DSM IV-TR

7 Terms Related to General SymptomsAkathisia Amnesia Anhedonia Catatonia Akathisia (a- = lack of + kathis/o = sitting + -ia = condition) is an inability to remain calm, still, and free of anxiety. Amnesia is an inability to remember either isolated parts of the past or one’s entire past; it may be caused by brain damage or severe emotional trauma. Anhedonia (an- = without + hedon/o = pleasure + -ia = condition) is the absence of the ability to experience either pleasure or joy, even in the face of causative events. Catatonia (cata- = down + ton/o = tension + -ia = condition) is a paralysis or immobility from psychological or emotional rather than physical causes. Mastering Healthcare Terminology/Chapter 13

8 Terms Related to General Symptoms (cont’d)Delusion Illusion Hallucination A delusion is a persistent belief in a demonstrable untruth or a provable inaccurate perception despite clear evidence to the contrary. A hallucination is any unreal sensory perception that occurs with no external cause. An illusion is an inaccurate sensory perception based on a real stimulus; examples include mirages and interpreting music or wind as voices (think of the mirages of water in the desert). Be careful! Don’t confuse delusion, a persistent belief in an untruth, with illusion, an inaccurate sensory perception based on a real stimulus. Mastering Healthcare Terminology/Chapter 13

9 Terms Related to General Symptoms (cont’d)Confabulation Defense mechanism Delirium Confabulation is an effort to conceal a gap in memory by fabricating detailed, often believable stories. It is usually associated with alcohol abuse. Defense mechanisms are unconscious mechanisms for psychological coping, adjustment, or self-preservation in the face of stress or a threat. Examples include denial of an unpleasant situation or condition and projection of intolerable aspects onto another individual. Delirium is a condition of confused, unfocused, irrational agitation. In mental disorders, agitation and confusion may also be accompanied by a more intense disorientation, incoherence, fear, and illusions, hallucinations, and delusions. Mastering Healthcare Terminology/Chapter 13

10 Did You Know? The term delirium is taken from the Latin de-, meaning away from, and lira, meaning a furrow. Thus someone who is mentally confused cannot “plow a straight furrow.”

11 Terms Related to General Symptoms (cont’d)Dementia Echolalia Libido Psychosis Somnambulism Dementia is a progressive loss of memory, personality alterations, confusion, loss of touch with reality, and stupor (seeming unawareness of, and disconnection with, one’s surroundings). Echolalia (echo- reverberation + -lalia = condition of babbling) is a repetition of words or phrases spoken by others. Libido is a normal psychological impulse drive associated with sensuality, expressions of desire, or creativity. Abnormality occurs only when such drives are excessively heightened or depressed. Psychosis (psych/o = mind + -osis = abnormal condition) is a dissociation with or impaired perception of reality. Psychosis may be accompanied by hallucinations, delusions, incoherence, akathisia, and/or disorganized behavior. Somnambulism (somn/o = sleep +ambul/o = walking + -ism = condition) is the medical term for sleepwalking. Mastering Healthcare Terminology/Chapter 13

12 Terms Related to Mood/Affective DisordersBlunted Flat Labile Full/wide range An affect is an observable demonstration of emotion that can be described in terms of quality, range, and appropriateness. Common examples of conditions of affect are: Blunted: a moderately reduced range of afffect. Flat: greatly decreased or complete loss of emotional expression. It may be be seen in schizophrenia, mental retardation, and some depressive disorders. Labile: multiple, abrupt changes in affect. It is seen in schizophrenia and bipolar disorder. Full/wide range: a generally appropriate emotional response. Mastering Healthcare Terminology/Chapter 13

13 Terms Related to Mood/Affective Disorders (cont’d)Anxiety Dysphoria Euphoria Euthymia Anxiety is an anticipation of impending change and dread accompanied by restlessness, tension, tachycardia (rapid heartbeat), and breathing difficulty not associated with an apparent stimulus. Dysphoria (dys-= abnormal + -phor/o = to carry, to bear) is a generalized negative mood characterized by depression. Euphoria (eu- = good, well) is an exaggerated sense of physical and emotional well-being not based on reality, deproportionate to the cause, or inappropriate to the situation. Euthymia (eu- = good, well + -thymia = condition of the mind) is a normal range of moods and emotions. Be careful! The suffix –thymia means a condition of the mind, but thym/o refers to the thymus gland or to the mind. Mastering Healthcare Terminology/Chapter 13

14 Did You Know? The term euphoria comes from eu-, meaning good or well, and –phonia, a condition of carrying or bearing. Originally from the Greek meaning well-bearing, it now has the connotation of an inappropriate sense of elation, or an exaggerated sense of well-being.

15 Clicker Question Which of the following is a term of a healthy psychological condition? A. echolalia B. euthymia C. euphoria D. akathisia b. euthymia

16 Terms Related to Disorders Usually Diagnosed in ChildhoodAsperger disorder Attention deficit/hyperactivity disorder (ADHD) Autism Conduct disorder ODD Rett disorder Tourette syndrome Asperger disorder is one of the psychological disorders that is first diagnosed in childhood. It is characterized by an impairment of social interaction and repetitive patterns of inappropriate behavior. Autism (auto- = self + -ism = condition) is a condition of an abnormal development of social interaction, impaired communication, and repetitive behaviors. It originally got its name from the fact that the individual appeared to be more absorbed in his or her own inner world than in his or her place in a social world that included others. Conduct disorders are characterized by patterns of persistent aggressive and defiant behaviors. Oppositional defiant disorder (ODD) is characterized by hostile, disobedient behavior. Rett disorder is characterized by initial normal functioning followed by a loss of social and intellectual functioning. Tourette syndrome is a group of involuntary behaviors that include the vocalization of words or sounds (sometimes obscene) and repetitive movements; it is a vocal and multiple tic disorder. Mastering Healthcare Terminology/Chapter 13

17 Terms Related to Disorders Usually Diagnosed in Childhood (cont’d)Mental retardation Mild Moderate Severe Profound IQ stands for intelligence quotient, a measure of an individual’s intellectual functioning compared to that of the general population. Mental retardation is a condition of subaverage intellectual ability, along with impairments in social and educational functioning. Mental retardation is divided into the following levels: Mild mental retardation: IQ range of ; learning difficulties result. Moderate mental retardation: IQ range of ; support is needed to function in society. Severe mental retardation: IQ range of ; continuous support is needed to live in society. Profound mental retardation: IQ less than 20; there are severe self-care limitations. Mastering Healthcare Terminology/Chapter 13

18 Terms Related to Substance AbuseAcute intoxication Delirium tremens (DTs) Dependence syndrome Harmful use Tolerance Withdrawal states Substance abuse disorders are on the rise and include alcohol, tobacco, stimulants (including caffeine), inhalants, opioids, hallucinogens, cocaine, etc. Acute intoxication (in- = in + toxic/o = poison + -ation = process of) is an episode of behavioral disturbance following ingestion of alcohol or psychotropic drugs. Delirium tremens (DTs) is an acute and sometimes fatal delirium induced by the cessation of ingesting excessive amounts of alcohol over a long period of time. Dependence syndrome is difficulty in controlling the use of a drug. Harmful use is a pattern of drug use that causes damage to a person’s health. Tolerance is a state in which the a body becomes accustomed to the substances ingested; hence the user requires greater amounts to create the desired effect. A withdrawal state is a group of symptoms that occurs during cessation of the use of a regularly taken drug. Mastering Healthcare Terminology/Chapter 13

19 Clicker Question Initial normal behavior followed by a loss of social and intellectual functioning is: A. Asperger disorder B. mental retardation C. Rett disorder D. Tourette syndrome C. Rett disorder

20 Schizophrenia, Schizotypal, and Delusional DisordersAcute and transient psychotic disorders Persistent delusional disorders Acute and transient psychotic disorders are a heterogeneous group of disorders characterized by the acute onset of psychotic symptoms, such as delusions, hallucinations, and perceptual disturbances, and by the severe disruption of ordinary behavior. Acute onset is defined as a crescendo from a normal perceptual state to a clearly abnormal clinical picture in about 2 weeks or less. For these disorders, there is no evidence of organic causation. Perplexity and puzzlement are often present, but disorientation to time, place, and person is not persistent or severe enough to justify a diagnosis of organically caused delirium. The disorder may or may not be associated with acute stress (usually defined as stressful events preceding the onset by 1 or 2 weeks). Persistent delusional disorders are a variety of disorders in which longstanding delusions constitute the only, or the most conspicuous, clinical characteristic and cannot be classified as organic, schizophrenic, or affective. Mastering Healthcare Terminology/Chapter 13

21 Schizophrenia, Schizotypal, and Delusional Disorders (cont’d)Schizophrenic disorders Catatonic schizophrenia Disorganized schizophrenia Paranoid schizophrenia Schizotypal disorder Schizophrenia (schiz/o = split + phren/o = mind + -ia = condition) is a series of disorders that are characterized by fundamental distortions of thinking and perception, coupled with affects that are inappropriate or blunted. The patient exhibits a characteristic inability to recognize an appropriate perception of reality. The patient’s intellectual capacity is usually intact. Symptoms may include hallucinations, delusions, and thought disorders. Be careful! The combining form phren/o can mean mind or diaphragm. Catatonic schizophrenia is dominated by prominent psychomotor disturbances that may alternate between extremes, such as hyperkinesis and stupor, and may be accompanied by a dreamlike (oneiric) state and hallucinations. Disorganized schizophrenia is characterized by prominent affective changes, fleeting and fragmentary delusions and hallucinations, and irresponsible and unpredictable behavior. A shallow, inappropriate mood, flighty thoughts, social isolation, and incoherent speech are also present. Paranoid schizophrenia is dominated by relatively stable, persistent delusions, usually accompanied by auditory hallucinations and perceptual disturbances in affect, volition (will), and speech. Schizotypal disorder, although sometimes described as borderline schizophrenia, has none of the characteristic schizophrenic anomalies. Patients may exhibit anhedonia, eccentric behavior, cold affect, and social isolation. Students may have seen the movie A Beautiful Mind about John Nash (the famous mathematician) and his struggle with schizophrenia. Schizophrenia From Stuart: Principles and practice of psychiatric nursing, ed 8, Mosby Mastering Healthcare Terminology/Chapter 13

22 Terms Related to Mood DisordersDepressive disorder Dysthymia Hypomania Depressive disorder (depression) is typically characterized by its degree (minimal, moderate, severe) or number of occurrences (single or recurrent, persistent). Patients who are depressed exhibit dysphoria, a reduction of energy, and a decrease in activity. Symptoms include anhedonia, lack of an ability to concentrate, and fatigue. Patients may experience parasomnias (abnormal sleep patterns), diminished appetite, and loss of self-esteem. Dysthymia (dys- = difficult + -thymia = condition of the mind) is a mild, chronic depression of mood that lasts for years but is not severe enough to justify a diagnosis of depression. Hypomania (hypo- = decreased + -mania = condition of madness) is a disorder characterized by an inappropriate elevation of mood that may include positive and negative aspects. The patients may report increased feelings of well-being, energy, and activity, but may also report irritability and conceit. Define and decode where appropriate. Discuss -thymia and remind students not to confuse this with a disorder of the thymus gland. Mastering Healthcare Terminology/Chapter 13

23 Terms Related to Mood Disorders (cont’d)Bipolar disorder (BP) Cyclothymia Seasonal affective disorder (SAD) Persistent mood disorders Bipolar disorder (BP) is a disorder characterized by swings between an elevation of mood and increased energy and activity (hypomania and mania) and a lowering of mood and decreased energy and activity (depression). Cyclothymia (cycl/o = recurring) is a mood disorder characterized by recurring episodes of mild elation and depression that are not severe enough to warrant a diagnoses of bipolar disorder. Seasonal affective disorder (SAD) is a weather-induced depression resulting from decreased exposure to sunlight in autumn and winter. Persistent mood disorders are a group of long-term cyclic mood disorders in which the majority of the individual episodes are not sufficiently severe to warrant being described as hypomanic or mild depressive episodes. Does anyone know the former name for bipolar disorder? (manic depression) Note that SAD is an acronym. Mastering Healthcare Terminology/Chapter 13

24 Terms Related to Anxiety DisordersAcrophobia Agoraphobia Anthropophobia Claustrophobia Does anyone know what a phobia is? (Explain that these are not normal fears but fears that prevent an individual from having a normal life.) Students may have heard of the movie Arachnophobia (meaning “fear of spiders”). If time allows, have them research other terms for phobias and share them with the class. Acrophobia (acro-= heights, extremes + -phobia = condition of fear) is a fear of heights. Agoraphobia (agora- = marketplace) is a fear of leaving home and entering crowded places. Anthropophobia (anthrop/o = man) is a fear of scrutiny by other people. It is also referred to as a social phobia. Claustrophobia (claustr/o = a closing) is a fear of enclosed spaces. Mastering Healthcare Terminology/Chapter 13

25 Terms Related to Anxiety Disorders (cont’d)Generalized anxiety disorder (GAD) Obsessive-compulsive disorder (OCD) Panic disorder (PD) Posttraumatic stress disorder (PTSD) Generalized anxiety disorder (GAD) is one of the most common diagnoses assigned, but is not specific to any particular situation or circumstance. GAD is NOT an acronym. Symptoms may include persistent nervousness, trembling, muscular tensions, sweating, lightheadedness, palpitations, dizziness, and epigastric discomfort. Obsessive-compulsive disorder (OCD) is characterized by recurrent, distressing, and unavoidable preoccupations or irresistible drives to perform specific rituals (e.g., constantly checking locks, excessive hand washing) that the patient feels will prevent some harmful event. Panic disorder (PD) is recurrent, unpredictable attacks of severe anxiety panic that are not restricted to any particular situation. Symptoms may include vertigo, chest pain, and heart palpitations. Posttraumatic stress disorder (PTSD) is an extended emotional response to a traumatic event. Posttraumatic pertains to after (post-) trauma. The symptoms may include flashbacks, recurring nightmares, anhedonia, insomnia, hypervigilance, anxiety, depression, suicidal thoughts, and emotional blunting. Mastering Healthcare Terminology/Chapter 13

26 Terms Related to Adjustment, Dissociative Identity, and Somatoform DisordersAdjustment disorder Dissociative identity disorder Somatoform disorder Adjustment disorder is a disorder that tends to manifest during periods of stressful life changes (e.g., divorce, death, relocation, job loss). Symptoms include anxiety, impaired coping mechanisms, social dysfunction, and a reduced ability to perform normal daily activities. Dissociative identify disorder is a maladaptive coping method caused by severe stress and resulting in the development of one or more separate personalities. A less severe form, dissociative disorder or dissociative reaction, results in identity confusion accompanied by amnesia, a dreamlike state, and somnambulism . A somatoform disorder is any disorder that has unfounded physical complaints by the patient, despite medical assurance that no physiologic problem exists. One type of somatoform disorder is hypochondriacal disorder, which is the preoccupation with the possibility of having one or more serious and progressive physical disorders. Students may have heard of Sybil, a movie about an individual with what was formerly termed multiple personality disorder—now known as dissociative identity disorder. Mastering Healthcare Terminology/Chapter 13

27 Terms Relating to Eating DisordersAnorexia nervosa Bulimia nervosa How is anorexia nervosa different from anorexia? (The first is a mental disorder; the second is a simple loss of appetite.) Anorexia (an- = without + orex/o = appetite + -ia = condition) nervosa is a prolonged refusal to eat adequate amounts of food and an altered perception of what constitutes a normal minimum weight caused by an intense fear of becoming morbidly obese. This disorder primarily affects adolescent females, but can affect males and other age groups as well. The disorder results in emaciation and amenorrhea. Bulimia nervosa is an eating disorder in which the individual eats large quantities of food and then purges the body through self-induced vomiting or inappropriate use of laxatives. Body image Mastering Healthcare Terminology/Chapter 13

28 Did You Know? Anorexia has the highest mortality rate of any psychiatric disorder (7% to 24%).

29 Clicker Question A fear of heights is: A. acrophobia B. agoraphobiaC. anthropophobia D. claustrophobia acrophobia Acro- = heights, extremes

30 Terms Related to Sleep DisordersParasomnia Sleep terrors Parasomnia (para- = abnormal + somn/o = sleep + -ia = condition) is an abnormal activation of physiologic functions during the sleep cycle. Examples include sleep terrors, in which repeated episodes of sudden awakening are accompanied by intense anxiety, agitation, amnesia, and somnambulism (sleepwalking). Mastering Healthcare Terminology/Chapter 13

31 Terms Related to Sexual DysfunctionHypoactive sexual desire disorder Nymphomania Satyriasis Premature ejaculation Sexual anhedonia Hypoactive sexual desire disorder is an indifference or unresponsiveness to sexual stimuli and an inability to achieve orgasm during intercourse. It was formerly called frigidity. Discuss the change in terminology from frigidity to hypoactive sexual desire. Nymphomania (nymph/o = woman + -mania = condition of madness) is a relentless drive to achieve sexual orgasm in the female. In the male, the same condition is referred to as satyriasis. Premature ejaculation is an involuntary, anxiety-induced ejaculation of semen during sexual activity. Sexual anhedonia (an- = without + hedon/o = pleasure + -ia =condition) is an inability to enjoy sexual pleasure. Mastering Healthcare Terminology/Chapter 13

32 Terms Related to Personality DisordersBorderline personality disorder Dissocial personality disorder Paranoid personality disorder Schizoid personality disorder A borderline personality disorder is characterized by impulsive, unpredictable mood and self-image resulting in unstable interpersonal relationships and a tendency to see and respond to others as unwaveringly good or evil. Dissocial personality disorder is a disorder in which the patient shows a complete lack of interest in social obligations, to the extreme of showing antipathy to other individuals. Patients frustrate easily, are quick to display aggression, show a tendency to blame others, and do not change their behavior even after punishment. Paranoid personality disorder is a state in which the individual exhibits inappropriately suspicious thinking, self-importance, a lack of ability to forgive perceived insults, and an extreme sense of personal rights. Schizoid personality disorder is a condition in which the patient withdraws into a fantasy world, with little need for social interaction. Most patients have a limited capacity to experience pleasure or to express their feelings. Explain the differences between each of the varieties. Mastering Healthcare Terminology/Chapter 13

33 Terms Related to Habit and Impulse DisordersKleptomania Pyromania Trichotillomania Kleptomania (klept/o = to steal + -mania = condition of madness) is an uncontrollable impulse to steal. Pyromania (pyr/o = fire ) is an uncontrollable impulse to set fires. Trichotillomania (trich/o = hair + till/o = pulling) is an uncontrollable impulse to pull one’s hair out by the roots. Mastering Healthcare Terminology/Chapter 13

34 Terms Related to Paraphilias and Disorders of Sexual PreferencePedophilia Exhibitionism Fetishism Sadomasochism Voyeurism Paraphilias (para- = abnormal + phil/o = attraction + -ia = condition) are literally abnormal attractions. Pedophilia (ped/o) is a sexual preference, whether real or imagined, for children as a means of sexual gratification. Exhibitionism is a condition in which the patient derives sexual arousal from the exposure of his or her genitals to strangers. Fetishism is reliance on an object as a stimulus for sexual arousal and pleasure. Sadomasochism is preference for sexual activity that involves inflecting or receiving pain and/or humiliation. Voyeurism is a condition in which an individual derives sexual pleasure and gratification from surreptitiously looking at individuals engaged in intimate behavior. Mastering Healthcare Terminology/Chapter 13

35 Clicker Question Which of the following is an uncontrollable impulse to steal? A. kleptomania B. parasomnia C. trichotillomania D. pyromania A. kleptomania

36 Age Matters Pediatrics Geriatrics Asperger ADHD AutismConduct disorders Mental retardation Rett disorder Depression Substance abuse Eating disorders Geriatrics Depression Anxiety Dementia Childhood has an impressive list of psychiatric disorders. Although none of the disorders on the list is common in childhood, each of these causes special challenges for this population. Depression, anxiety, and dementia are the mental disorders that are most commonly seen in the elderly. Mastering Healthcare Terminology/Chapter 13

37 Diagnostic ProceduresDiagnostic criteria DSM IV-TR multiaxial assessment diagnosis Mental status examination Laboratory tests Imaging PET scans CT MRI PET scan of brain The DSM IV-TR multiaxial assessment diagnosis is a measure of the mental health of an individual across five axes. The first three (if named) are diagnostic codes. The fourth axis is a statement of factors influencing the patient’s mental health (examples include lack of social supports, unemployment). The fifth axis is a numeral score that summarizes a patient’s overall functioning. A mental status examination is a diagnostic procedure to determine a patient’s current mental state. It includes assessment of the patient’s appearance, affect, thought processes, cognitive function, insight, and judgment. Laboratory tests may be done to determine underlying pathology. Urinalyses with drug screens, blood alcohol levels, screening tests for syphilis, thyroid function panels, and complete blood counts with differential and blood chemistry are examples. Imaging can be helpful to rule out neurologic disorders. Computed tomography and magnetic resonance imaging can be used to screen for brain lesions. Positron emission tomography scans can be used to examine and map the metabolic activity of the brain. From Stuart and Laraia: Principles and practice of psychiatric nursing, ed 8, Mosby Mastering Healthcare Terminology/Chapter 13

38 Diagnostic Procedures (cont’d)Psychological testing Bender Gestalt Test Draw-a-Person (DAP) test Minnesota Multiphasic Personality Inventory (MMPI) Rorschach Thematic Apperception Test (TAT) Wechsler Adult Intelligence Scale (WAIS) The Bender Gestalt test measures visuomotor and spatial abilities. It is useful for children and adults. The Draw-a-Person (DAP) test is an analysis of a patient’s drawings of male and female individuals. It is used to assess personality. The Minnesota and Multiphasic Personality Inventory (MMPI) is an assessment of personality characteristics through a battery of forced-choice questions. The Rorschach is a projective test using inkblots to determine the patient’s ability to integrate intellectual and emotional factors into his or her perception of the environment. The Thematic Apperception Test (TAT) has patients make up stories about pictures they are shown. This test may provide information about a patient’s interpersonal relationships, fantasies, needs, conflicts, and defenses. The Wechsler Adult Intelligence Scale (WAIS) is a measure of verbal IQ, performance IQ, and full-scale IQ. Note that the WAIS is an acronym for a test that most students have probably taken at least once in their lives. Mastering Healthcare Terminology/Chapter 13

39 Terms Related to PsychotherapyBehavioral therapy Cognitive therapy Psychoanalysis Behavioral therapy is a therapeutic attempt to alter an undesired behavior by substituting a new response or set of responses to a given stimulus. Cognitive therapy is a wide variety of treatment techniques that attempt to help the individual to alter inaccurate or unhealthy perceptions and patterns of thinking. Psychoanalysis is a behavioral treatment developed initially by Sigmund Freud to analyze and treat any dysfunctional effects of unconscious factors on a patient’s mental state. This therapy uses techniques that include analysis of defense mechanisms and dream interpretation. Mastering Healthcare Terminology/Chapter 13

40 Did You Know? The Office of Alternative Medicine at the National Institutes of Health (NIH) discusses several therapies not included in this chapter. Notable are culturally based therapies (e.g., acupuncture, yoga, Native American traditional practices, and cuentos, or Puerto Rican folk tales), relaxation and stress reduction techniques, pastoral counseling, self-help groups, expressive therapies, and diet and nutrition.

41 Terms Related to Psychotherapy (cont’d)Terms related to other therapeutic methods Detoxification Electroconvulsive therapy (ECT) Light therapy Detoxification is the removal of a chemical substance (drug or alcohol) as an initial step in the treatment of a chemically dependent individual. Electroconvulsive therapy (ECT) is a method of inducing convulsions to treat affective disorders in patients who have been resistant or unresponsive to drug therapy. Light therapy is an exposure of the body to light waves to treat patients with depression due to seasonal fluctuations. Light therapy Courtesy of Apollo Light Systems Mastering Healthcare Terminology/Chapter 13

42 Did You Know? Frontal lobotomy (incision and/or removal of the frontal lobes of the brain) was a popular treatment in the 1940s for patients with depression or schizophrenia. Although most of the negative symptomatology was diminished, patients appeared to have diminished emotional range. When Thorazine, a tranquilizer without sedative properties, was developed in the 1950s, the number of lobotomies declined dramatically. Today the surgery is seldom performed.

43 Clicker Question Which of the following tests is used to measure intelligence? A. Bender Gestalt B. Rorschach C. Thematic Apperception Test D. WAIS WAIS Wechsler Adult Intelligence Scale

44 Pharmacology Antialcoholics AntidepressantsAntipsychotics/neuroleptics Anxiolytics Cholinesterase inhibitors Antialcoholics are drugs intended to discourage use of alcohol. Naltrexone (Revia) can be used for alcohol and narcotic withdrawal. Disulfiram (Antabuse) is used to deter alcohol consumption. Antidepressants are medications intended to relieve symptoms of a depressed mood. Many classes are available, including SSRIs, tricyclics (TCAs), monoamine oxidase inhibitors (MAOIs), and some newer unclassified agents. Examples include fluoxetine (Prozac), ertraline (Zoloft), mirtazapine (Remeron), tranylcypromine (Parnate), bupropion (Wellbutrin), and venlafaxine (Effexor). Antipsychotics or neuroleptics are medications intended to control psychotic symptoms such as hallucinations and delusions. Haloperidol (Haldol) and chlorpromazine (thorazine) are examples of typical antipsychotics; olazapine (Zyprexa) and risperidone (Risperdal) are examples of the newer atypical antipsychotics. Anxiolytics are drugs that relieve symptoms of anxiety. These drugs are often used as sedatives or sedative-hypnotics as well. Examples are lorazepam (Ativan), buspirone (Buspar), and alprazolam (Xanax). Have students note the anti- prefixes and the –lytic (pertaining to breaking down) suffix. Cholinesterase inhibitors are drugs that combat the cognitive deterioration seen in disorders characterized by dementia. Examples are donepezil (Aricept) and galantamine (Reminyl, Razadyne). Mastering Healthcare Terminology/Chapter 13

45 Pharmacology (cont’d)Hypnotics Mood stabilizers NMDA receptor antagonists Sedatives/sedative-hypnotics Stimulants Hypnotics are drugs that promote sleep. Hypnotics, sedatives, sedative-hypnotics, and anxiolytics are often similar in effect and may be used interchangeably. Zolpidem (Ambien), zaleplon (Sonata), and flurazepam (Dalmane) are examples of hypnotics. Mood stabilizers are drugs that balance neurotransmitters in the brain to reduce or prevent acute mood swings (mania or depression). Lithium (Lithobid) is the best known mood stabilizer. Some anticonvulsants such as valproic acid (Depakote) and lamotrigine (Lamictal) are also considered mood stabilizers. NMDA receptor antagonists are agents used to preserve cognitive function in patients suffering from progressive memory loss. Memantine (Namenda) is the first available drug of this new class. Sedatives and sedative-hypnotics are overlapping classes of central nervous system depressant drugs that exert a calming effect with or without inducing sleep. The most commonly used agents are benzodiazepines and barbiturates. Stimulants are drugs that generally increase synaptic activity of targeted neurons to increase alertness. Examples include methylpenidate (Tialin) and caffeine. Mastering Healthcare Terminology/Chapter 13

46 Clicker Question Fluoxetine is an example of a/n: A. antialcoholicB. antidepressant C. antipsychotic D. anxiolytic antidepressant Fluoxetine is the generic name for Prozac Mastering Healthcare Terminology/Chapter 13

47 Sort these terms into their correct categories1. Rorschach 2. cyclothymia 3. psychoanalysis 4. detoxification 5. confabulation Categories __ Pathology __ Diagnostic Procedures __ Therapeutic Interventions Pathology--cyclothymia, confabulation Dx --Rorschach Tx--psychoanalysis, detoxification

48 Parting Thought “Preconceived notions are the locks on the doorto wisdom.” –Merry Brown This quote is especially true for this discipline. Science is continually updating our knowledge of the causes of mental illness. Mastering Healthcare Terminology/Chapter 13