The Dsm-Iv Essay, Research Paper
The major Mental Disturbances and Abnormal Behaviours listed in the DSM-IV (the Diagnostic and Statistical Manual of Mental Disorders) and their treatments are as follows:1. Anxiety disordersIt is the disorders characterized by anxiety and avoidance behaviour. Anxiety is a vague, general uneasiness or feeling that something bad is about to happen. It can be associated with a particular situation or object, or it may be free-floating i.e. not associated with anything specific. The examples of Anxiety disorders are generalized anxiety disorder, panic disorder, phobias, and obsessive-compulsive disorder.Treatment for Anxiety disorders:Many people with anxiety disorders can be helped with treatment. Therapy for anxiety disorders often involves medication or specific forms of psychotherapy. Although medications do not cure, but they can be very effective in relieving anxiety symptoms. There are more medications available than ever before to treat anxiety disorders, thanks to the research by scientists at NIMH and other research institutions. Most of the medications that are prescribed to treat anxiety disorders, the doctor usually starts the patient on a low dose and gradually increases it to the full dose. Every medication has side effects, but they usually become tolerated or diminish with time. The doctor may also advise the patient to stop taking the medication and to wait a certain time e.g. a week or longer for certain drugs, if the side effects become a problem. When one treatment is almost complete, the doctor will gradually decrease the dosage.Research has also shown that behavioural therapy and cognitive-behavioural therapy can be effective for treating several of the anxiety disorders. Behavioural therapy focuses on changing specific actions and uses several techniques to decrease or stop an unwanted behaviour. For example, one technique trains patients in diaphragmatic breathing, a special breathing exercise involving slow, deep breaths to reduce anxiety. It is necessary because people who are anxious often hyperventilate, taking rapid shallow breaths that can trigger rapid heartbeat, lightheadedness, and other symptoms. Another technique i.e. exposure therapy, gradually exposes patients to what frightens them and helps them cope with their fears.Cognitive-behavioural therapy teaches patients to react differently to the situations and bodily sensations that trigger panic attacks and other anxiety symptoms. However, patients also learn to understand how their thinking patterns contribute to their symptoms and how to change their thoughts so that symptoms are less likely to occur. This awareness of thinking patterns is combined with exposure and other behavioural techniques to help people confront their feared situations. For example, someone who becomes lightheaded during panic attack and fears he is going to die can be helped with the following approach used in cognitive-behavioural therapy. The therapist asks him to spin in a circle until he becomes dizzy. When he becomes alarmed and starts thinking, I m going to die, he learns to replace that thought with a more appropriate one, such as It s just a little dizziness—-I can handle it. 2. Somatoform disordersSomatoform disorders involve bodily symptoms that cannot be explained by known medical conditions. They are disorders in which physical symptoms are present that are due to psychological rather than physical causes. The examples of Somatoform disorders are Hypochondriasis, Pain disorder and Conversion disorder.Treatment for Somatoform disorders:The psychiatric assessment and treatment of somatoform disorders are intended to prevent additional medical intervention, develop a hypothesis for the appearance of somatoform symptoms, provide a means of physical recovery for the patient usually in conjunction with the physician, and begin a psychosocial intervention that will target appropriate concerns. At the time of psychiatric referral, families often see physicians in a negative light for failing to diagnose and treat the medical problem in their child. Occasionally, these families have long histories of difficult experiences with physicians and the medical profession, sometimes going back for generations. Treatment may suggest relationships between these preconceived notions of medicine and the development of the child’s somatic complaints. The clinician should be sensitive to these issues and not present the formulation as either purely organic or functional. In this process, the family is always free to pursue additional medical assessments as needed. The important caveat in this process is adequate communication between the designated primary medical care provider and the mental health professional. According to Leslie (1988) 85% of a pediatric sample with conversion disorder responded to either a combined pediatric-psychiatric or a purely psychiatric treatment plan.Treatment options that focus on the symptoms of somatoform disorder include individual psychotherapy, particularly as applied to self-management skills and relaxation training. Behavioral interventions, including positive and negative reinforcement, have been successful, as have biofeedback and hypnosis. Cognitive therapies have been effective in breaking the automatic cycle that maintains the symptoms one that includes repeated self-observation, false belief and continued fear. When patients are disease-phobic because they are afraid of contracting a fatal disease, exposure therapy has been successful. Exposure therapy gradually introduces patients into environments they consider dangerous because of contagion and teaches them relaxation techniques to relieve feelings of extreme anxiety. The presence of a major depressive disorder or anxiety disorder warrants treatment, and the addition of a plan to directly address these problems is likely to improve the patient’s physical condition as well. For example, the resolution of sleep-continuity disorders or appetite disturbances is likely to improve the child’s health. Children with somatoform disorders have been described as frequently having rigid, controlled and obsessive personality styles. Changing these styles is a challenge, particularly because the patient is unlikely to cooperate without the support and assistance of the family. Occasionally these traits are shared by one or both of the parents, indicating a need by the therapist to be supportive and nonjudgmental in his or her approach. The reduction of physical complaints as a treatment goal may be very anxiety-provoking for the child and will require much support from the parents to achieve. The addition of conjoint family therapy is recommended in a number of cases. Psychopharmacology is an effective adjunct when treating concomitant psychiatric disorders that contribute to the child’s presentation. 3. Dissociative disordersWe are consciously aware of who we are. Our memories, our identity, our consciousness, and our perception of the environment are integrated. But some people, in response to unbearable stress, develop dissociative disorder and lose this integration. Their consciousness becomes dissociated either from their identity or from their memories of important personal events. They are disorders in which, under stress, one loses the integration of consciousness, identity, and memories of important personal events. The examples of Dissociative disorders are Amnesia, Fugue and Identity disorder.Treatment for Dissociative disorders:The heart of the treatment of dissociative disorders is long-term psychodynamics/cognitive psychotherapy made by hypnotherapy. It is not uncommon for survivors to need three to five years of intensive therapy work. Setting the frame for the trauma work is the most important part of therapy. One cannot do trauma work without some destabilization, so the therapy starts with assessment and stabilization before any abreactive work. A careful assessment should cover the basic issues of history i.e. What happened to the person, How does he think or feel about himself, symptoms (e.g. depression, anxiety, hypervigilance, rage, flashbacks, intrusive memories, inner voices, amnesias, numbing, nightmares, recurrent dreams), safety (of himself, to and from others), relationship difficulties, substance abuse, eating disorders, family history (family of origin and current), social support system, and medical status.
After gathering important information, the therapist and client should jointly develop a plan for stabilization. Treatment modalities should be carefully considered. These include individual psychotherapy, group therapy, expressive therapies (art, poetry, movement, psychodrama, music), family therapy (current family), psychoeducation and phamacotherapy. Hospital treatment may be necessary in some cases for a comprehensive assessment and stabilization. The Empowerment Model for the treatment of survivors of childhood abuse which can be adapted to outpatient treatment uses ego-enhancing, progressive treatment to encourage the highest level of function ( how to keep your life together while doing work ). The use of sequence treatment using the above modalities for safe expression and processing of painful material within the structure of a therapeutic community of connectedness with healthy boundaries is particularly effective. Group experiences are critical to all survivors if they are to overcome the secrecy, shame, and isolation of survivorship. Stabilization may include contracts to ensure physical and emotional safety and discussion before any disclosure or confrontation related to the abuse, and to prevent any precipitous stop in therapy. Physician consultants should be selected for medical needs or psychopharmacologic treatment. Antidepressant and anti-anxiety medications can be helpful adjunctive treatment for survivors, but they should be viewed as adjunctive to the psychotherapy, not as an alternative to it.Developing a cognitive framework is also an essential part of stabilization. This involves sorting out how an abused child thinks and feels, undoing damaging self-concepts, and learning about what is “normal”. Stabilization is a time to learn how to ask for help and build support networks. The stabilization stage may take a year or longer–as much time as is necessary for the patient to move safely into the next phase of treatment.At the end of grieving process, creative energy is released. The survivor can reclaim self-worth and personal power and rebuild life after so much focus on healing. There are often important life choices to be made about vocation and relationships at this time, as well as solidifying gains from treatment.This is challenging and satisfying work for both survivors and therapists. The journey is painful, but the rewards are great. Successfully working through the healing journey can significantly impact a survivor’s life and philosophy. Coming through this intense, self-reflective process might lead one to discover a desire to contribute to society in a variety of vital ways.4. Schizophrenia and other psychotic disordersSchizophrenia is the most serious of the psychological disorders. It affects about one person in 100. It usually begins in adolescence or early adulthood, although it can appear later in life. It is the probably the most devastating of all the psychological disorders because of the social disruption and misery it brings to those who suffer from it and to their families. Different types of Schizophrenia are disorganized type, paranoid type, catatonic type, and delusional disorder, jealous type.Treatment for Schizophrenia and other psychotic disorders:Risperdal, or risperidone, is the newest medication for treating schizophrenia and psychotic disorders. It helps manage schizophrenia’s “positive symptoms” such as visual and auditory hallucinations, delusions, and thought disturbances. Risperdal may also help in treating so-called “negative symptoms” such as social withdrawal, apathy, lack of motivation, and inability to experience pleasure. Side effects are usually relatively minor, and blood monitoring is not necessary. Risperdal is the first new front-line treatment option in twenty years5. Mood DisordersMood disorders involve moods or emotions that are extreme and unwarranted. In the most serious disorders, mood ranges from the depths of severe depression to the heights of extreme elation. Mood disorders include major depressive disorder and bipolar disorder.Treatment for Mood Disorders:Treatment usually consists of medication, but psychotherapy can be of great benefit to people when combined with drug treatment. Because of the nature of the illness, a single drug may not be enough to control symptoms during a mood episode, so often a combination of medication is necessary depending on the phase of the illness and the severity of the symptoms. Mood stabilizers are the mainstay of drug treatment for bipolar disorder. They are used to treat manic, hypo manic and mixed episodes and are also used as long term, or maintenance treatment to prevent relapses and delay further mood episodes. Some mood-stabilisers may take a week or two to reach a therapeutic blood level and then they may take a few more weeks to take effect. In acute situations, another drug may be needed while the mood-stabiliser starts to take effect. The most commonly used mood stabilizer is lithium. This is the oldest and most widely used treatment and is usually the first drug you will be prescribed when diagnosed with bipolar disorder. Common side effects include : lethargy, diarrhea, nausea, frequent urination, tremor and weight gain. The blood level of lithium must be monitored regularly because the therapeutic blood level is quite close to the toxic level. Once a stable blood level has been established, blood tests can be done every 4-6 months. 6. Personality DisordersA personality disorder is a long-standing, inflexible, maladaptive pattern of behaving and relating to others. It usually begins in childhood or adolescence. People with this type of disorder tend to have problems in their social relationships and in their work; they may experience personal distress as well. Some realize that their behaviour is a problem, yet they seem unable to change. The different types of Personality disorder are Antisocial personality disorder, Histrionic personality disorder, Narcissistic personality disorder and Borderline personality disorder.Treatment for Personality Disorders:Treatment includes psychotherapy, which allows the patient to talk about both present difficulties and past experiences in the presence of an empathetic, accepting and non-judgemental therapist. The therapy needs to be structured, consistent and regular, with the patient encouraged to talk about his or her feelings rather than to discharge them in his or her usual self-defeating ways. Sometimes medications such as antidepressants, lithium carbonate, or antipsychotic medication are useful for certain patients or during certain times in the treatment of individual patients. Treatment of any alcohol or drug abuse problems is often mandatory if the therapy is to be able to continue. Brief hospitalization may sometimes be necessary during acutely stressful episodes or if suicide or other self-destructive behavior threatens to erupt. Hospitalization may provide a temporary removal from external stress. Outpatient treatment is usually difficult and long-term – sometimes over a number of years. The goals of treatment could include increased self-awareness with greater impulse control and increased stability of relationships. A positive result would be in one’s increased tolerance of anxiety. Therapy should help to alleviate psychotic or mood-disturbance symptoms and generally integrate the whole personality. With this increased awareness and capacity for self-observation and introspection, it is hoped the patient will be able to change the rigid patterns tragically set earlier in life and prevent the pattern from repeating itself in the next generational cycle.
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