21psychological theories of psychiatric disorders .pptx

psychiaatry

1. Cognitive behavioral theorists a classic conditioning approach a noxious stimulus (e.g., a panic attack) that occurs with a neutral stimulus (e.g., a bus ride) can result in the avoidance of the neutral stimulus ⚫ Catastrophic Misinterpretation of Benign Physical Sensations and Symptoms Avoidance and use of safety behaviors prevents habituation.

2. Psychoanalytic Theories Traumatic separations during childhood can affect children's developing nervous systems strong association with both parental separation and parental death before children reached the age of 10 seven- and fourfold times, respectively, more likely to be diagnosed with panic disorder with agoraphobia .

3. Psychoanalytic Theories Another etiological factor in adult female patients appears to be childhood physical and sexual abuse Approximately 60 percent of women with panic disorder have a history of childhood sexual abuse, compared with 31 percent of women with other anxiety disorders.

4. Psychoanalytic theories a higher incidence of stressful life events (particularly loss) than control subjects in the months before the onset of panic disorder the cause of panic attacks is likely to involve the unconscious meaning of stressful events

5. Prognosis chronic It is generally a disorder. 40 30 to percent of patients seem to be symptom free at long- term follow-up 50 about percent have symptoms that are sufficiently mild not to affect their lives significantly 20 percent about 10 to continue to have significant symptoms.

6. Treatment Pharmacotherapy SSRIs superior effect over the other medications Patients with panic disorder are particularly sensitive to the activating effects of SSRIs, particularly fluoxetine, so they should be given initially at small dosages and titrated up slowly. TCAs ⚫ Imipramine clomipramine and are the most effective ones. dosages must be titrated slowly upward Benzodiazepines It should be short term. cognitive potential for dependence, impairment, and abuse after long term use

7. pharmacological treatment should generally continue for 8 to 12 months. There is a high relapse rate after discontinuation of medication.

8. Treatment Cognitive behavioral therapy Psycho- education Cognitive therapy Behavioral therapy

9. Social phobia Epidemiology Prevalence: 3 to 13% peak age of onset: in the teens Comorbidity other anxiety disorders, mood disorders, substance- related disorders, and bulimia nervosa. avoidant personality disorder In addition, frequently occurs in persons with generalized social phobia.

10. Clinical features excessive and persistent fear of social situations and avoidance of these situations mainly of two kinds performance- type situations situations that involve doing something (i.e., performing) in the presence of others. Examples include speaking in public and eating, drinking, writing, working, and using public toilets in the presence of others interactional situations situations involves informal and formal interactions with other people Can be generalized or non generalized.

11. Clinical features Severity ranges from very mild, fear of one or a few performance-type situations, to quite severe and incapacitating, when patients are socially isolated and impaired in virtually all domains of functioning.

12. Etiology Biological theories Genetic evidences First- degree relatives of persons with social phobia are about three times more likely to be affected with social phobia

13. Etiology Biological theories Neurochemical evidences Adrenergic hypothesis Increased release of epinephrine and norepinephrine or increased sensitivity to adrenergic stimulation The effectiveness of propranolol for performance anxiety Dopamine The effectiveness of MAOIs better than TCAs. significantly lower homovanillic acid concentrations. single photon emission computed tomography (SPECT) demonstrated decreased striatal dopamine reuptake site density.

14. Cognitive theorists Aversive conditioning model especially the non- generalized subtype Traumatic conditioning For example, a sudden blushing or loss of voice during a performance may lead to the perception of a particular social situation as being embarrassing, humiliating, and therefore dangerous. ⚫ Underestimate their social performance, overestimate the probability of poor performance or other adverse social outcome, and overestimate the consequences of such an outcome Negative assumptions “I am boring”, “Others pay close attention to one's appearance”,

15. Psychodynamic approaches It may be related to the feeling of shame and fear of the superego. It may be a consequence of the projection of harsh, critical, or punitive parental introjects onto others, with the consequent expectation that others treat patients harshly. It has also been linked to exhibitionistic or narcissistic urges to make a perfect impression of oneself. A fear of being unable to make such an impression leads the person to anticipate narcissistic injury; to avoid this injury, the person resorts to avoidance of social interactions.

16. Psychobiological model Inborn traits – behavioral inhibition to the unfamiliar observable during the first year of life

17. Course and prognosis It has a chronic course. The generalized one especially seems to be a life long condition. The generalized one has worse prognosis than the non generalized one.

18. Poor prognostic factors Very early onset (before age 7 or 11 years) Greater initial severity, greater number of symptoms Co- occurring psychiatric disorders Presence of depression Presence of medical comorbidities Lower education

19. Treatment Pharmacotherapy selective serotonin reuptake inhibitors (SSRIs) Benzodiazepines Venlafaxine buspirone performance anxiety β- adrenergic receptor antagonists shortly before exposure to a phobic stimulus. The two compounds most widely used are atenolol, 50 to 100 mg every morning or 1 hour before the performance, and propranolol (20 to 40 mg).

20. Treatment Cognitive behavioral therapy Cognitive therapy Exposure based therapy Social skill training Group therapy Psychodynamic psychotherapy Work through the specific, underlying conflicts and issues that underlie this disorder