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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
• 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 .
recent news events • Remote: – Childhood events.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. past Presidents. historical events (years) .
Clinical significance of Memory disturbance • Anxious patient may complain of poor memory because of defective registration • In Korsakoff’s syndrome there is failure of retention so the patient has disturbed immediate recall • In dementia the recall of recent events is disturbed. .
. Specific therapies: i.Psychotherapy 1. Psychoanalysis and psychoanalytic psychotherapy. Behavior therapy. ii. Cognitive therapy. 2. Marital therapy Sex therapy. Family therapy. Psycho educational. 5. 4. iii. 3. Interpersonal psychotherapy. iv.
Group therapy. .Method of delivery of psychotherapy Individual.
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.
in order to follow as deeply as possible the train of thoughts to their earliest roots. often unconsciously. The patient attempts to say freely and without censure whatever comes to mind. . generally for a minimum of several hundred hours over a number of years. This includes associating to dream material and to transference feelings that are evoked in the process. out of the patient’s visual range. The patient is seen 3-5 times a week. The analyst uses interpretation and clarification to help the patient work through and resolve conflicts that have been affecting the patient’s life.Psychoanalysis The most intensive and rigorous of this type of therapy. The patient lies on a couch with the analyst seated behind. to free associate.
. requires that the patient be stable.Indication of psychoanalysis and patient criteria Neurotic patient. Not indicated in personality disorder or psychotics. or impulsive. and psychologically minded. verbal. highly motivated. distraught. The patient also must be able to tolerate the stress generated by analysis without becoming overly regressed.
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.
The goal of resolution of unconscious psychological conflict is similar to that of psychoanalysis. as well as those with a wider range of symptomatic and characterological problems. . Patients with personality disorders also are suitable for this therapy.Insight-oriented or expressive psychotherapy Patients are seen 1 -2 times a week and sit up facing the psychiatrist. Patients suitable for this therapy include those suitable for psychoanalysis. but there is a greater emphasis an day-to-day reality issues and a lesser emphasis on the development of transference issues.
the essential element is support. This type of therapy often is the treatment of choice for patients with serious ego vulnerabilities. . Support can take the form of: limit-setting. especially in the case of chronic patients. such as acute grief. and help with developing social skills. increasing reality testing. reassurance. lasting many years. rather than the development of insight. advice. Patients in a crisis situation. This therapy can be long term.Supportive or relationship psychotherapy In supportive psychotherapy. particularly Psychotic patients.
BEHAVIORAL THERAPY Based on the principles of learning theory .
. Behavior therapy is based on the principles of learning theory. Behavioral symptoms are taken at value and not as symptoms of a deeper problem.Behavioral therapy The basic assumption of this therapy is that: Maladaptive behavior can change without insight into its underlying causes. including operant and classic conditioning.
that is. Classical conditioning is based on the premise that: . Operant conditioning is based on the premise that: Behavior is shaped by its sequences. A person can be conditioned to feel fear in the situations that have come to be associated with anxiety. if it is punished it will decrease. Behavior is shaped by its being coupled with or uncoupled from anxiety-provoking stimuli. Uncouple the anxiety from the situation. and if it elicits no response it will be extinguished. if behavior is positively reinforced it will increase. the avoidant and anxious behavior will decrease.
Behavioral techniques are used to induce relaxation and decrease stresses . Phobias.g. Cigarette smoking Stuttering. Sexual dysfunctions. circumscribed maladaptive behaviors..Indications of behavior therapy Behavior therapy is believed to be most effective for: Clearly delineated. Compulsions Overeating. e.
. Systematic desensitization. Exposure and response prevention.Behavioral techniques Token economy. Aversion therapy. Flooding.
Sexual disorders Drug addiction.. The aversion is used to stop the undesired behaviour. A controversial form. .Aversion therapy It is form of negative reinforcement in which: An aversive stimulus. Indicated in Some cases of personality disorders. involves the patient imagining something unpleasant coupled with the undesired behavior.2. A shock or unpleasant smell. is coupled with an undesired behavior. g.
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. . Staying at each level of the hierarchy until anxiety disapears.Systemic desensitization Indications: Patient with avoidant behavior and anxiety linked to a specific situations e. 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. Idea: When this procedure is performed in real life rather than imagined. Hierarchy construction often is associated with relaxation techniques.3. it is called graded exposure. Heights or airplane travel. because it is felt that anxiety and relaxation are incompatible.g.. thus leading to an uncoupling of the imagined images from anxiety (reciprocal inhibition).
the top of a tall building if he or she is afraid of heights.Flooding.4. .g. It is technique in which the patient is exposed immediately to the most anxiety-provoking stimulus. e. 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. instead of being exposed gradually or systematically to a hierarchy of feared situations.
assurance . 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. token economy or even aversion .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.
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. . “I’m no good” or “no one cares about me”) And to ascertain the underlying. generally 15-20 sessions over 12 weeks. assumptions that fuel the negative cognitions. Homework is assigned: patients are asked to record what they are thinking in certain stressful situations (such as. often relatively unconscious. during which: Patients are made aware of their own distorted cognitions and the assumptions on which the questions are based.
Obsessive compulsive disorders .Indications Mild to moderate. non-psychotic depressions. Adjunctive treatment with substance abusers And in increasing compliance with medication.
and interactions that occur among persons in the group. .GROUP THERAPY Focus may be on a person within the context of a group.
Range Of Group Function Those that emphasize support and an increase in social skills. To those that work through solved intra-psychic conflicts . Those that emphasize specific symptomatic relief.
Posttraumatic stress disorder. Substance use disorders . Groups whose members share the same medical or psychiatric problem..g. e.Examples of homogeneous groups Those for weight-reduction and smoking cessation. Patients with acquired immunodeficiency syndrome (aids).
In general. acutely psychotic or suicidal patients do not do well in groups.oriented groups. antisocial personalities. and substance abusers do not do well in heterogeneous insight-oriented groups.Psychotic patients who need structure and clear action do not do well in insight.Certain types of patients do not do well in certain types of groups . . Paranoid patients.
Alcoholics Anonymous (AA).Special types of groups A. Milieu therapy. B. Multiple family groups (MFGs). C. .
A. Alcoholics Anonymous (AA). . Similar groups include Narcotics Anonymous (NA) and Sex Addicts Anonymous (SAA). AA emphasizes a sharing of experience. An example of a large. ventilation of feelings.problem. and strong sense of community and mutual support. central . highly structured. role models. peerrun group that is organized around persons with a similar.
Milieu therapy. Activities of daily living groups.B. Community meetings. And social events. The multidisciplinary therapeutic approach used on inpatient psychiatric wards. Group passes. Milieu therapy generally involves groups and may include Artistic therapy Occupational therapy. . The term “milieu therapy” reflects the idea that all activities on a ward are oriented toward increasing a patient’s ability to cope in the world and to relate appropriately to others.
MFGs are an important factor in decreasing relapse rates among schizophrenic patients whose families participate in the groups . The groups discuss issues and problems related to having a schizophrenic person in the family and share suggestions and means of coping. Multiple family groups (MFGs) Composed of families of schizophrenic patients.C.
FAMILY THERAPY Based on correction of the faults of family structure and function that affect the disease process of the child .
In cases which family seeks help as a group Death Divorce Immigration . Marital disharmony Parent – child conflict Behavioral problems in children.Family therapy Indications: Problem closely related to faulty family function.
Family therapy Contraindications Problems unrelated to familial factors. If one of the key member is unwilling to participate in treatment .
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