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	<title>psychological-treatment &amp;laquo; WordPress.com Tag Feed</title>
	<link>http://en.wordpress.com/tag/psychological-treatment/</link>
	<description>Feed of posts on WordPress.com tagged "psychological-treatment"</description>
	<pubDate>Wed, 22 May 2013 11:29:25 +0000</pubDate>

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<title><![CDATA[Patients Lie in Coffins to “Die” as Part of Chinese Psychological Treatment]]></title>
<link>http://amandadeviana.wordpress.com/2012/12/20/patients-lie-in-coffins-to-die-as-part-of-chinese-psychological-treatment/</link>
<pubDate>Thu, 20 Dec 2012 09:19:57 +0000</pubDate>
<dc:creator>amandatomato</dc:creator>
<guid>http://amandadeviana.wordpress.com/2012/12/20/patients-lie-in-coffins-to-die-as-part-of-chinese-psychological-treatment/</guid>
<description><![CDATA[Most people would consider lying in a coffin and having the lid shut over them to be a traumatic exp]]></description>
<content:encoded><![CDATA[<p>Most people would consider lying in a coffin and having the lid shut over them to be a traumatic experience, a special psychotherapy service in Shenyang, China is using it as therapy to treat psychological problems and heavy stress.</p>
<p>The Shenyang Evening News reports over 1,000 patients have so far been”reborn” by simulating death with the help of psychologists. Tang Yulong, a consultant at this unique psychotherapy clinic in Shenyang, says people who suffer from psychological problems can be helped by simulating death. People go in a 5-square-meter ”death experience room”, write down their last words, lie down into a coffin in the floor and are covered with a white cloth. To make this “dying” experience even more realistic, the “deceased” can even hear a dirge being played in the room. After five minutes of “serene time”, the sound of a baby crying breaks the silence, and a consultant opens the coffin with a cheery tune playing in the background. This rebirth apparently helps people get a new outlook on life.</p>
<p><img title="rebirth-therapy" alt="" src="http://www.odditycentral.com/wp-content/uploads/2012/11/rebirth-therapy.jpg" height="281" width="500" /></p>
<p>“In the past 35 years, I thought what I pursued were what I needed, such as money and a high position. However, after this special therapy, I find out that what I need is not a house, but a home,” said Huang, a 35-year-old manager, said after going through the unique therapy. He tried to commit suicide four times, in the past, but was stopped by family or colleagues. Now, after going through this treatment, he has asked for demotion and has become involved with various charities, to help those less fortunate. ”This therapy makes use of suggestion theory in psychology,” consultant Tang said. ”However, it’s only part of the psychotherapy and is not suitable for everyone. We will choose proper ones to receive this death-experience therapy,” he added.</p>
<p><img title="rebirth-therapy2" alt="" src="http://www.odditycentral.com/wp-content/uploads/2012/11/rebirth-therapy2.jpg" height="455" width="500" /></p>
<p>&#160;</p>
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<title><![CDATA[Memories and Miracles]]></title>
<link>http://privatepains.wordpress.com/2012/12/11/memories/</link>
<pubDate>Tue, 11 Dec 2012 05:38:42 +0000</pubDate>
<dc:creator>Miriam R</dc:creator>
<guid>http://privatepains.wordpress.com/2012/12/11/memories/</guid>
<description><![CDATA[I was reluctant to return to therapy. I&#8217;ve found that it dredges up memories that hurt me to t]]></description>
<content:encoded><![CDATA[<p>I was reluctant to return to therapy. I&#8217;ve found that it dredges up memories that hurt me to this day. I know, I&#8217;m a therapy cliché, suppressing memories in an effort to get on with my life. Unfortunately, I have been to a multitude of therapists in my short lifetime and each one has made the following two claims.</p>
<p>#1 the previous therapist was an idiot who didn&#8217;t know what they were doing.</p>
<p>#2 the current therapist does know what they are doing and therefore will fix the problem.</p>
<p>This frustrates me because I feel like I am constantly picking on a scab with endless people so that it just can&#8217;t heal. I want to be able to talk about my past without crying. I want to be able to move on with my life without my past haunting my every moment. I want I want I want. In the Chanukah season, I hope for a miracle.</p>
<p>My past will not leave me alone. I recall a sharp memory from my teenage years. It was the night following Rosh Hashanah, and we had just finished with yuntev. My Aunt had been staying by our house per usual. Also per usual, the string of criticism and screaming didn&#8217;t end. This particular Aunt had subsequently criticized how I didn&#8217;t wear make-up or tight clothing.She believed that those are necessary in order to have self-esteem and be asked out. Since I did not espouse her beliefs she was frustrated with me.</p>
<p>You see, I had told my mother I would be wiling help whatever was needed on Yuntev as long as I was able to read a book for school on the 2nd day of yuntev afternoon. Therefore, when my sister needed someone to walk her to a friend’s house I declined to go instead of my mother in order to read my book. Let&#8217;s call her Aunt C, had this conversation with me.</p>
<div>
<p><i>Aunt C: A </i><em>Good </em><i>daughter wouldn&#8217;t make her mother go out when she&#8217;s tired.&#8221;</i></p>
</div>
<div>
<p><i>Me: Well, I know I&#8217;m a good daughter and I need to read this book for school</i><em> </em></p>
<p><i>Aunt C: All I know is that a </i><em>good </em><i>daughter wouldn&#8217;t do that</i></p>
<p><i>Me: I helped my mother all yuntev, I really need to read this book.</i></p>
<p><i>Aunt C: Well a </i><em>good </em><i>daughter would put her mother&#8217;s needs before her own.</i></p>
<p><i>Me: Insinuating that I am not a good daughter isn&#8217;t going to make me help</i></p>
<p><i>Aunt C: I&#8217;m not trying to insinuate anything, if </i><em>you</em><i> </i><i>have a guilty conciseness, that&#8217;s on you. </i></p>
</div>
<p>After many repetitions of this, I finally caved in and agreed to walk my sister and Aunt C to the friend’s house. The entire walk was plagued by “conversation” (really Aunt C’s monologue) about how I was a terrible person who didn’t appreciate anything. I replied that just because I didn’t take her (unsolicited) advice didn’t mean I didn’t respect her opinions. Aunt C angrily replied that I was a spoiled brat and she wouldn’t speak to me as a result.</p>
<p>I silently celebrated thinking I was free from criticism and yelling for the rest of the holiday. How I wish I was…</p>
<p>After the holiday ended, I began to work on the multitude of assignments I had to do. As a junior in high school I needed to work on my SAT prep, write a paper on the book I didn’t finish reading and finalize my schedule for work. Aunt C, her anger festering over the holiday burst into the room and began yelling at me more. My parents were out of the house on some errand so there was no adult to stop her fury. She furiously picked up the cell phone I earned by cleaning my entire house for peasach by myself and smashed it on the ground. She proceeded to yell about how I don’t appreciate all that was done for me.</p>
<p>Then, she hit me.</p>
<p>That hurt. It didn’t hurt as much as what happened next though. My parents came home a few minutes later. I was hurt, but at least expecting a mother’s fury. Something along the lines of “how dare you lay a hand on my daughter” or at the very least some motherly sympathy. Instead, as soon as she pulled up, Aunt C ran outside to tell my mother about the horrible person I was. My mother stormed in, walked up to me and yelled</p>
<blockquote><p>“What did you do?!”</p></blockquote>
<p>The betrayal I felt at that moment summed up the rest of my interactions with my mother. My own mother was not willing to stand up for her daughter. I did see my mother’s fury after I was hit, but unfortunately it was directed at me.  I am crying as I write this because not only was it a painful time but it was in that instant that I realized how little my mother cared about me. She didn’t care if I was happy or even in pain. She just wanted to know what new problem I caused.</p>
<p>Even if that problem was my face getting in the way of my Aunt’s hand.</p>
<p>If you have some shred of hope dear reader that my Mother and Aunt had an epiphany and asked for forgiveness (especially since it was the day after Rosh Hashanah) I apologize. When my Aunt visited the following month, she proceeded to call me a monster in front of the two friends I had sleeping over. Needless to say, I didn’t have many friends after that. No one wants to be friends with a monster after all. I forgave both of them for that night, for my sake and not for theirs.</p>
<p>Uncovering this memory I carefully suppressed is something that happens every time I seek therapy. I hope that uncovering it this time leads to a greater step of progress in my vaginismus.  Perhaps like the maccabeas, I will be able to  take the pain of something being taken away and turn it into a victory.</p>
<p>I ask you readers to please comment . I really appreciate comments.</p>
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<title><![CDATA[The helping profession.]]></title>
<link>http://lifeintheblueridges.wordpress.com/2012/09/20/the-helping-profession/</link>
<pubDate>Thu, 20 Sep 2012 21:41:22 +0000</pubDate>
<dc:creator>ameliaclaire92</dc:creator>
<guid>http://lifeintheblueridges.wordpress.com/2012/09/20/the-helping-profession/</guid>
<description><![CDATA[I&#8217;ve been glued to On Being a Therapist by Jeffrey A. Kottler for the past 2 days, taking in e]]></description>
<content:encoded><![CDATA[<p>I&#8217;ve been glued to <em>On Being a Therapist </em>by Jeffrey A. Kottler for the past 2 days, taking in each and every word with excitement and wonder. Since I want to be a counselor, any book or article that talks about the helping profession is music to my ears. As if I need any more reasons or drive to be a counselor, I went to a Psychology talk at my university today that was given by one of the professors in the Psychology department here, Dr. Wetter. The talk was titled, <em>Mechanisms of Change: Why do people improve in therapy? </em>Just as the current book I&#8217;m reading has captivated me, I was pulled in so deep to the talk today that I was actually a bit sad when it ended. Ways to measure success in therapy and many well-established therapy techniques (like Cognitive Behavioral Therapy, Interpersonal Therapy, Behavior Therapy etc.) were discussed. What I found most interesting though were the reasons why people improve in therapy. That isn&#8217;t to say that all people do improve, but the talk looked at those people who did improve to try to figure out what factors went in to their improvement in therapy. The factors included common factors (such as a healing setting, expectations of improvement, a treatment ritual, and the therapeutic relationship. Not surprisingly, the therapeutic relationship is the most important), specific factors (such as cognitive restructuring, challenging negative automatic thought, behavior activation, and exposure), therapist variables (such as age, sex, race/ethnicity, amount and type of training, professional experience, and interpersonal style), and client variables (such as severity of diagnosis, co-occurring diagnoses, age, sex, race/ethnicity, expectations for change, and preoperations for change). Though it was a lot of information to take in, I was hooked from the very beginning!</p>
<p>I didn&#8217;t need yet another reason to be a counselor because I already have so many that I might burst from happiness. However, it is exciting that I have found something that I am passionate about. After Dr. Wetter&#8217;s talk, I made sure to go up to her and tell her how much I enjoyed her talk. Plus, I also wanted to introduce myself and see what classes she&#8217;d be teaching next semester. She&#8217;s teaching theories of personality as well as a class on trauma disorders. I told her that she could count on me to take both. Before I spoke with her, another student was asking her if there were any undergraduate research opportunities that were related to therapy. Even though there were not any undergraduate research opportunities specifically related to therapy, Dr. Wetter did say that next semester she will be continuing her research on trauma disorders and she&#8217;d be welcoming students. Not only did I attend a Psychology talk today that I absolutely loved, which furthered my drive to be a counselor, but I also may have gotten a potential undergraduate research opportunity out of it. Not too shabby. Not too shabby at all! <img src='http://s0.wp.com/wp-includes/images/smilies/icon_smile.gif' alt=':)' class='wp-smiley' /> </p>
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<title><![CDATA[Should Those Who Download Child P_rn Pay the Victims, Rapists Seeking Custody]]></title>
<link>http://eassurvey.wordpress.com/2012/08/28/should-those-who-download-child-p_rn-pay-the-victims-rapists-seeking-custody/</link>
<pubDate>Tue, 28 Aug 2012 02:44:15 +0000</pubDate>
<dc:creator>eassurvey</dc:creator>
<guid>http://eassurvey.wordpress.com/2012/08/28/should-those-who-download-child-p_rn-pay-the-victims-rapists-seeking-custody/</guid>
<description><![CDATA[Pricing Amy: Should Those Who Download Child Pornography Pay the Victims? Sep 1, 2012 By Lorelei Lai]]></description>
<content:encoded><![CDATA[<p><strong>Pricing Amy: Should Those Who Download Child Pornography Pay the Victims?</strong><br />
Sep 1, 2012 By Lorelei Laird</p>
<p>&#8230;.It started like so many other instances of child exploitation: Amy’s uncle showed her pornography and then began raping her on a regular basis.</p>
<p>Amy recalls telling him the penetration hurt, but it kept happening. And like most child victims, she trusted him when he told her it was a normal thing adults do with children, that he loved her and that it was their special secret, according to her victim impact statement. The uncle was eventually arrested and incarcerated. Amy grew into her teenage years and, with the help of therapy, seemed to be growing into a relatively happy, healthy, normal teenager, according to court documents. Then the other shoe dropped: Amy learned that her uncle had photographed the abuse and put the images online, creating a permanent record of her agonizing abuse.</p>
<p>It’s not exactly clear when Amy’s pictures began circulating online, but court records indicate the digital images date back to as early as 1998.</p>
<p>Amy, now in her early 20s, began sliding backward in her recovery. Court filings indicate that she suffers from depression, is withdrawn and anxious, and has a history of alcohol abuse. She’s been unable to succeed in college or work and is reluctant to socialize. While some experiences still trigger bad memories, she’s more concerned about being recognized in public by people who downloaded “her” images&#8230;.</p>
<p>Under the Crime Victims’ Rights Act, the government must notify Amy and other child pornography victims anytime anyone is arrested by federal authorities for possessing their images. Her attorney, James Marsh of New York City, says his office has received at least 1,500 required notices of federal prosecutions for possession of those images. “The day after we were retained in 2008, we had someone open up all these notices she received in the calendar years 2006 and 2007,” Marsh says. “It took two days just to open the envelopes.”&#8230;.</p>
<p>Almost any time Marsh receives a notice of prosecution on Amy’s behalf, he files a formal request for more than $3 million to cover all of Amy’s psychological treatment, lost income and attorney fees. Marsh believes Amy is the first child pornography victim to use federal crime victim restitution laws in this way, and one of a very few nationwide. He knows of two other victims pursuing this strategy, including “Vicky,” another young woman whose victimization as a child is recorded in widely traded images. A third victim’s lawyer pursuing a similar strategy did not return calls for this article&#8230;.</p>
<p>Masha’s Law, part of the 2006 Adam Walsh Child Protection and Safety Act, which permits young adults to sue those who download images of their childhood sexual abuse&#8230;..<br />
<a href="http://www.abajournal.com/magazine/article/pricing_amy_should_those_who_download_child_pornography_pay_the_victims/">http://www.abajournal.com/magazine/article/pricing_amy_should_those_who_download_child_pornography_pay_the_victims/</a></p>
<p><strong>American Bar Association Journal—Pricing Amy: Should Those Who Download Child Pornography Pay the Victims? </strong>By James R. Marsh on August 27, 2012</p>
<p>This feature article about the Marsh Law Firm&#8217;s efforts to secure restituiton for victims of child pornography appears in this month&#8217;s American Bar Association Journal which is read by over one million attorneys and corporate counsel worldwide. Here are several excerpts from Pricing Amy: Should Those Who Download Child Pornography Pay the Victims?</p>
<p>It’s not exactly clear when Amy’s pictures began circulating online, but court records indicate the digital images date back to as early as 1998.</p>
<p>Amy and her lawyer are, however, fighting back. Her battle is part of a series of cases—now wending their way through the federal courts—trying to help the victims of child pornography by seeking financial restitution, not from the perpetrator but from the untold number of people who subsequently download their pornographic images.</p>
<p>Amy could be considered the leader in this legal trend. Her pictures are among the most widely traded in the underground world of online child pornography.</p>
<p>Using the restitution provisions of the Violence Against Women Act, Marsh has begun utilizing the courts to request financial restitution from those convicted of possessing images of Amy’s child sexual abuse.<br />
<a href="http://www.childlaw.us/2012/08/aba-journal-pricing-amy-should.html">http://www.childlaw.us/2012/08/aba-journal-pricing-amy-should.html</a></p>
<p><strong><br />
Imagine You Were Raped. Got Pregnant. Then Your Rapist Sought Custody.</strong><br />
It happens—and in many states there are no laws to keep rapists from terrorizing their victims all over again. Read on, Todd Akin.<br />
—By Dana Liebelson and Sydney Brownstone  Fri Aug. 24, 2012</p>
<p>The debate over Rep. Todd Akin&#8217;s widely condemned comments on &#8220;legitimate rape&#8221; has largely centered on abortion and Republican efforts to outlaw the procedure, even in cases of rape. But the controversy has also uncovered a little-discussed issue: When some rape victims do choose to give birth to a child conceived through sexual assault, they find that the legal door is left wide open for their victimization to continue. It sounds unfathomable, but in many states the law makes it possible for rapists to assert their parental rights and use custody proceedings as a weapon against their victims&#8230;.</p>
<p>Part of the problem is that many rapes go unprosecuted. According to the Rape, Abuse and Incest National Network, only 9 out of every 100 rapes are prosecuted and just 5 lead to a felony conviction. But of the 19 states that have laws addressing the custody of rape-conceived children, 13 require proof of conviction in order to waive the rapist&#8217;s parental rights. Two more states have provisions on the issue that only apply if the victim is a minor or, in one of those cases, a stepchild or adopted child of the rapist. Another three states don&#8217;t have laws that deal with custody of a rapist&#8217;s child specifically, but do restrict the parental rights of a father or mother who sexually abused the other parent.<br />
<a href="http://www.motherjones.com/politics/2012/08/rapist-seeks-child-custody-shauna-prewitt">http://www.motherjones.com/politics/2012/08/rapist-seeks-child-custody-shauna-prewitt</a></p>
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<title><![CDATA[Mindless]]></title>
<link>http://dfsk.wordpress.com/2012/07/24/mindless/</link>
<pubDate>Wed, 25 Jul 2012 03:58:57 +0000</pubDate>
<dc:creator>Dancing Fingers Singing Keypad</dc:creator>
<guid>http://dfsk.wordpress.com/2012/07/24/mindless/</guid>
<description><![CDATA[The &#8220;Colorado Movie Massacre&#8221; as it has come to be known, wherein a riot-gear clad man o]]></description>
<content:encoded><![CDATA[<p style="text-align:justify;">The &#8220;Colorado Movie Massacre&#8221; as it has come to be known, wherein a riot-gear clad man opened fire in a crowded midnight movie screening of the new Batman movie &#8220;The Dark Knight Rises&#8221; killing twelve people and injuring fifty nine was very shocking, sad and sickening. Eyes widened further when it came to be known that the shooter was a twenty-four-year old neuroscience PhD student with a good background. How could such a person commit this heinous crime?</p>
<p style="text-align:justify;">From outward appearance his profile seems normal but deep beneath the surface churn murky waters. An online search turns up reports from people who say that there was something weird about him while others describe him as normal. The diseased mind seems to be a funny entity then, acting normal in some cases, strange in others and therefore consistently unpredictable. Tormented by the event, I tried to find online what psychology experts had to say. It seems like they have yet to do a proper diagnosis in this particular case, but I came across an article by a psychiatrist: <a href="http://www.psychologytoday.com/blog/reading-between-the-headlines/201207/the-colorado-shooter-psychotic-victim-or-evil-killer">http://www.psychologytoday.com/blog/reading-between-the-headlines/201207/the-colorado-shooter-psychotic-victim-or-evil-killer</a> and an old blog post by him where he has given an example of another shooter: <a href="http://drdalearcher.com/imjustsayin/its-the-mental-illness-stupid">http://drdalearcher.com/imjustsayin/its-the-mental-illness-stupid</a></p>
<p style="text-align:justify;"><a href="http://dfsk.files.wordpress.com/2012/07/blog_post_pic1.jpg"><img class="alignleft  wp-image-2200" title="Psychotic" src="http://dfsk.files.wordpress.com/2012/07/blog_post_pic1.jpg?w=144&#038;h=144" alt="Psychotic" width="144" height="144" /></a>Going through what was shared on the internet, I found that experts are trying to stress the importance of eliminating the root cause of such incidents, that is, recognizing and treating mental illness instead of people ignoring it and only suggesting solutions like gun control, safety procedures, crisis training etc. I agree with the wise men. However, not having studied that medical field ever, it is tough to understand how the human brain can behave illogically and it is scary to imagine not being able to control our mind &#8211; something that mentally healthy people take for granted. Wouldn&#8217;t it be helpful to learn to recognize mental illness symptoms in a fellow human being and to take action of treatment on behalf of that person? But I also understand how this is easier said than done. It is very difficult to have the confidence to point out to or convince someone that there is a problem and help with a solution long before the psychotic person has taken the final drastic step. Until then, will everyone, including the affected individual keep on suffering and dying?</p>
<p style="text-align:justify;">Such incidents where mentally unstable persons inflict pain on others brings back a memory. It happened a few years ago here in California when I was a graduate student. A late evening class was over and I was waiting for the bus opposite the university. It was dark and a cool wind had sprung up so I moved closer to the bus stop structure to take some shelter against the breeze under its roof. There were a few people waiting nearby. I was talking on the phone and did not completely notice a burly man with what looked like shopping bags moving about, muttering and gesturing to himself.</p>
<p style="text-align:justify;">By instinct we tend to stand away from suspicious-looking people but I failed to do so. He came towards me in a rapid stride and with a quick movement of his thick mustard-colored boots, landed a strong kick on my right shin just below the knee. As I looked up in shock, this is what he said tapping his head, &#8220;Excuse me, I have a pain in my head.&#8221; Then to my relief, he walked away. A guy standing next to me sort of escorted me away and my boyfriend (husband now) who I was talking to on the phone let out a stream of angry cuss words when I hurriedly narrated what had happened. But all of us knew that we couldn&#8217;t do anything about him. First of all, the homeless man was huge but most importantly madmen, as a rule, are not expected to be rational. Who is to say that it is not possible that in the dark recesses of his fractured mind, he had no knowledge of what he had done or that what to us was a violent act towards a fellow innocent being was a totally justified alternate reality to him?</p>
<p style="text-align:justify;">Many times, mindless cruelty stems from being just that &#8211; being &#8216;mind-less&#8217;.</p>
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<title><![CDATA[<strong>Hypnosis "Jedi" style!]]></title>
<link>http://saintleoinkblot.com/2012/06/17/hypnosis-jedi-style/</link>
<pubDate>Sun, 17 Jun 2012 17:28:04 +0000</pubDate>
<dc:creator>Dr. Farris</dc:creator>
<guid>http://saintleoinkblot.com/2012/06/17/hypnosis-jedi-style/</guid>
<description><![CDATA[Star Wars Episode I: The Phantom Menace (Photo credit: Wikipedia) In Star Wars, the Jedi were able t]]></description>
<content:encoded><![CDATA[Star Wars Episode I: The Phantom Menace (Photo credit: Wikipedia) In Star Wars, the Jedi were able t]]></content:encoded>
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<title><![CDATA[The Break]]></title>
<link>http://privatepains.wordpress.com/2012/04/05/the-break/</link>
<pubDate>Thu, 05 Apr 2012 04:02:45 +0000</pubDate>
<dc:creator>Miriam R</dc:creator>
<guid>http://privatepains.wordpress.com/2012/04/05/the-break/</guid>
<description><![CDATA[After about 4 months of Physical Therapy, I stalled on progress. I simply could not (literally) open]]></description>
<content:encoded><![CDATA[<p>After about 4 months of Physical Therapy, I stalled on progress. I simply could not (literally) open up to dilators and fingers of another person. The slightest brush on my inner thigh would cause me to tense up immediately. The 45 minute session tended to consist of her attempting to insert her finger or the dilator, me screaming and begging her to stop, then berating myself for doing so.</p>
<p>I began to feel depressed, that I was not making any progress of any sort. My therapist had suggested verbal Therapy before, but the already prohibitive costs of physical therapy (as well as time limitations) had prevented me from doing so. Therefore, my physical therapist recommended I &#8220;break&#8221; from physical therapy to focus on verbal therapy for a month.</p>
<p>My work with the dilators would continue on my own as I worked through therapy. My (verbal) therapist recognized I had much more difficulty with the finger than the dilator and recommended I start inserting my own finger into my vagina. The first time I did it (with one finger) it was hard, but not extremely difficult. I was so happy to be making progress! From there, things got more and more difficult. I could not progress beyond one finger at a time (even with sufficient lube) unless the two fingers were squished together into one finger of a glove. I got so frustrated with the fact that it felt like It just would not go farther, that I decided to take a look down under (see tomorrows post).</p>
<p>I return to Physical Therapy tomorrow. I am quite frankly terrified. Will my leaving physical therapy for a month mean I am back to square one? Will it be easier? Is the discovery I made freakish and strange? I want to wait until tomorrow to continue my exploration &#8220;down under&#8221; because I want to find out more on the topic. I hope I have made progress after 5 months of treatment. I know this is a condition that is a journey, but I&#8217;d like to see a few steps in the right direction.</p>
<p>Finally, is anyone out there reading this? I have found so much support on fellow people&#8217;s blogs and please comment if you are reading this one and if it is helping you in any way.</p>
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<title><![CDATA[Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: The IAPT experience]]></title>
<link>http://lancashirecarelibraryblog.com/2011/12/12/implementing-nice-guidelines-for-the-psychological-treatment-of-depression-and-anxiety-disorders-the-iapt-experience/</link>
<pubDate>Sun, 11 Dec 2011 23:02:35 +0000</pubDate>
<dc:creator>lancashirecarelibraryblog</dc:creator>
<guid>http://lancashirecarelibraryblog.com/2011/12/12/implementing-nice-guidelines-for-the-psychological-treatment-of-depression-and-anxiety-disorders-the-iapt-experience/</guid>
<description><![CDATA[Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: Th]]></description>
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<p><span style="color:#000080;"><strong>Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: The IAPT experience, </strong></span> <span style="color:#339966;">International Review of Psychiatry, 2011 Aug;23(4):318-27</span></p>
<div><span style="color:#000080;">Clark DM</span></div>
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<p><span style="color:#000080;">University of Oxford , UK</span></p>
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<p><span style="color:#339966;"><strong>Abstract:</strong></span></p>
<p><span style="color:#339966;"> The Improving Access to Psychological Therapies (IAPT) programme is a large-scale initiative that aims to greatly increase the availability of NICE recommended psychological treatment for depression and anxiety disorders within the National Health Service in England. This article describes the background to the programme, the arguments on which it is based, the therapist training scheme, the clinical service model, and a summary of progress to date. At mid-point in a national roll-out of the programme progress is generally in line with expectation, and a large number of people who would not otherwise have had the opportunity to receive evidence-based psychological treatment have accessed, and benefited from, the new IAPT services. Planned future developments and challenges for the programme are briefly described.</span></p>
<p><span style="color:#000080;"><span style="color:#339966;">Lancashire Care staff can request the full-text of this paper, email</span>: <a href="mailto:susan.jennings@lancashirecare.nhs.uk">susan.jennings@lancashirecare.nhs.uk</a></span></p>
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<title><![CDATA[Casey Anthony Undergoing Psychological Treatment]]></title>
<link>http://kissrichmond.com/1744222/casey-anthony-undergoing-psychological-treatment/</link>
<pubDate>Fri, 16 Sep 2011 15:01:48 +0000</pubDate>
<dc:creator>Alexx Dupri</dc:creator>
<guid>http://kissrichmond.com/1744222/casey-anthony-undergoing-psychological-treatment/</guid>
<description><![CDATA[After Casey Anthony was released from prison, her attorney, Jose Baez, said she would seek psycholog]]></description>
<content:encoded><![CDATA[<p><a href="http://ronekissrichmond.files.wordpress.com/2011/09/casey1.jpg"><img src="http://ronekissrichmond.files.wordpress.com/2011/09/casey1.jpg?w=259&#038;h=195" alt="" width="259" height="195" class="alignleft size-full wp-image-1744232" /></a>After Casey Anthony was released from prison, her attorney, Jose Baez, said she would seek psychological treatment.</p>
<p>Now, a source close to Anthony tells PEOPLE exclusively that the Florida woman has been seeing a grief counselor – and will soon start seeing a female psychiatrist.</p>
<p>&#8220;She needs serious help,&#8221; says the source. &#8220;We&#8217;ll see what this counseling will do.&#8221;</p>
<p>Anthony has traveled extensively since her acquittal, but she is now back in Florida while she serves a one-year probation on a check fraud case.</p>
<p>Baez, who did not immediately return calls for comment, previously said that Anthony needed treatment for the trauma of losing her child and her subsequent incarceration.</p>
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<title><![CDATA[Why are medications used to treat mental and behavioral health disorders?]]></title>
<link>http://pomegranatecares.com/2011/06/20/why-are-medications-used-to-treat-mental-and-behavioral-health-disorders/</link>
<pubDate>Mon, 20 Jun 2011 18:05:24 +0000</pubDate>
<dc:creator>Communications</dc:creator>
<guid>http://pomegranatecares.com/2011/06/20/why-are-medications-used-to-treat-mental-and-behavioral-health-disorders/</guid>
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<content:encoded><![CDATA[<p><div id="attachment_578" class="wp-caption alignnone" style="width: 190px"><a href="http://pomegranatecares.files.wordpress.com/2011/06/teenwglassessuperstock1555r-179034-1.jpg"><img src="http://pomegranatecares.files.wordpress.com/2011/06/teenwglassessuperstock1555r-179034-1.jpg" alt="Teenage boy with eyeglasses Exactostock/ Superstock 1555R-179034<br /><p class="wp-caption-text">&#8221; width=&#8221;180&#8243; height=&#8221;180&#8243; class=&#8221;size-full wp-image-578&#8243; /></a> Teenage boy with eyeglasses Exactostock/ Superstock 1555R-179034<br /></p></div>According to The National Institute of Mental Health (NIMH<em>), “Psychiatric medications treat mental disorders. Sometimes called psychotropic or psychotherapeutic medications, they have changed the lives of people with mental disorders for the better. Many people with mental disorders live fulfilling lives with the help of these medications. Without them, people with mental disorders might suffer serious and disabling symptoms.”</em> NIMH explains<em>, “Medications treat the symptoms of mental disorders. They cannot cure the disorder, but they make people feel better so they can function.”</em></p>
<p>Certified Nurse Practitioner and psychiatric specialist Sarah Alley says, <em>“Med management is part of an overall picture. Often, when kids are admitted into residential treatment or for acute hospitalization, there is a long history of events, signs and symptoms, experiences and behaviors that have led to these types of in-patient treatment. There may be environmental reasons, trauma, and/or significant psychiatric symptoms.” </em></p>
<p>According to psychiatrist, Dr. Kasiraja Sathappan, Medical Director,  <em>“It’s important to do a thorough psychiatric evaluation and determine how it all fits together; how the patient has progressed to this point of treatment.  Medications are an important piece in the whole treatment and frequently, medications are a most beneficial way to stabilize a child and allow them to get to a place where they can engage in treatment, be able to process therapeutic intervention, begin to learn and implement coping skills, and to have hope.”</em></p>
<p>To use a helpful analogy, Alley explains,  <em>“For example, a very depressed patient sees the world through the fog of depression and this experience can be like looking out at life through a muddy window without a way to clear the view. Providing them relief with medication can allow them to see more clearly, remove the mud from the “window” so to speak.  It gives them the ability to benefit fully from treatment and see more clearly where they are going and why.”  Alley recently joined Pomegranate from Nationwide Children&#8217;s Hospital.  </em></p>
<p>The NIMH web-site explains, <em>‘Some people get great results from medications and only need them for a short time. For example, a person with depression may feel much better after taking a medication for a few months, and may never need it again. People with disorders like schizophrenia or bipolar disorder, or people who have long-term or severe depression or anxiety may need to take medication for a much longer time.’</em></p>
<p><em>‘For example, anti-psychotic medication used to treat schizophrenia and schizophrenia-related disorders have been available since the mid-1950’s. In the 1990’s, new anti-psychotic medications were developed, called second generation, or ‘atypical’ antipsychotics,’</em> according to NIMH<em>. ‘There are several classes of medication for different conditions: anti-psychotic, anti-depressant, mood stabilizing and anti-convulsant, anti-anxiety, ADHD medications, combination antipsychotic and antidepressant, and other combinations.’</em> You can read more about these types of medications at: <span style="text-decoration:underline;"><a href="http://www.nimh.nih.gov/health/publications/mental-health-medications/complete-index.sht">http://www.nimh.nih.gov/health/publications/mental-health-medications/complete-index.sht</a></span>&#8230;</p>
<p>Some parents question whether medication is necessary, after all<em>, ‘it’s all in the head.’</em> Alley explains that<em>, ‘What’s in the head is a brain. Think of it like a liver, heart, or kidney. Prescribing medication for that organ is no different. The brain is a complex organ with various things that can be out-of-balance or not work as they should at times, including an imbalance of neurotransmitters or over/under activity in certain areas. </em></p>
<p><em>That doesn’t mean something is “wrong” with the person, that they are “weak” or insufficient in some personal way. We don’t say the diabetic doesn’t need insulin when their endocrine system malfunctions because the problem is in the glands, or they are somehow deficient as a person because they cannot control their blood sugars by “willpower”. With good treatment early, including appropriate medication, one can prevent problems in the future, prevent relapse, severity and length of future episodes and preserve brain functioning.’  </em></p>
<p>The NIMH site says<em>, ‘Some people may have a relapse-their symptoms come back or get worse. Usually, relapses happen when people stop taking their medication, or when they only take it sometimes. Some people stop taking the medication because they feel better or they may feel they don’t need it anymore. But no one should stop taking an anti-psychotic medication without talking to his or her doctor. When a doctor says it is okay to stop taking a medication, it should be gradually tapered off, never stopped suddenly.’ </em></p>
<p>NIMH also reports that for children and adolescents, <em>‘Most medications used to treat young people with mental illness are safe and effective. . . In addition to medications, other treatments for young people with mental disorders should be considered. Psychotherapy, family therapy, educational courses, and behavior management techniques can help everyone involved cope with the disorder.”</em></p>
<p>Dr. Sathappan, Medical Director adds<em>, ‘This is why Pomegranate Health Systems uses a multi-disciplinary approach including complete diagnostic and psychiatric evaluation, with the full complement of therapeutic psychological and medical interventions required for a thorough treatment plan. We talk with patients and family members to explain and explore what we’re doing and why, to help each individual achieve the highest possible quality of life in their homes and communities.” </em></p>
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<title><![CDATA[Danielle Staub: "I have addictions and need psychological treatment"]]></title>
<link>http://licensetopimp.wordpress.com/2011/05/24/danielle-staub-i-have-addictions/</link>
<pubDate>Tue, 24 May 2011 09:33:50 +0000</pubDate>
<dc:creator>License to Pimp</dc:creator>
<guid>http://licensetopimp.wordpress.com/2011/05/24/danielle-staub-i-have-addictions/</guid>
<description><![CDATA[05/19/2011 Danielle Staub has decided she needs professional help. The former The Real Housewives of]]></description>
<content:encoded><![CDATA[05/19/2011 Danielle Staub has decided she needs professional help. The former The Real Housewives of]]></content:encoded>
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<title><![CDATA[                  If you feel depressed in winter, you can enjoy the sun]]></title>
<link>http://liangpei.wordpress.com/2011/02/19/if-you-feel-depressed-in-winter-you-can-enjoy-the-sun/</link>
<pubDate>Sat, 19 Feb 2011 01:42:49 +0000</pubDate>
<dc:creator>dream life</dc:creator>
<guid>http://liangpei.wordpress.com/2011/02/19/if-you-feel-depressed-in-winter-you-can-enjoy-the-sun/</guid>
<description><![CDATA[In winter many people will have emotional depression, depressed mood, and this is winter depression]]></description>
<content:encoded><![CDATA[In winter many people will have emotional depression, depressed mood, and this is winter depression]]></content:encoded>
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<title><![CDATA[Schizophrenia and Bipolar Disorder Treatment ]]></title>
<link>http://iwantmeds.wordpress.com/2010/08/25/schizophrenia-bipolar-disorder-treatment/</link>
<pubDate>Wed, 25 Aug 2010 14:42:20 +0000</pubDate>
<dc:creator>rathindey</dc:creator>
<guid>http://iwantmeds.wordpress.com/2010/08/25/schizophrenia-bipolar-disorder-treatment/</guid>
<description><![CDATA[Antipsychotics Zyprexa [Olanzapine] is an drug that is used for treating various psychological disea]]></description>
<content:encoded><![CDATA[<h3><a href="http://zyprexa-antipsychotic.blogspot.com/2010/08/antipsychotics.html">Antipsychotics</a></h3>
<div><a href="http://iwantmeds.files.wordpress.com/2010/08/zyprexa.jpg"><img class="alignright" style="border:0 none;" src="http://iwantmeds.files.wordpress.com/2010/08/zyprexa.jpg?w=122&#038;h=122" border="0" alt="" width="122" height="122" /></a></div>
<p>Zyprexa  [Olanzapine] is an drug that is used for treating various   psychological diseases like schizophrenia and associated symptoms, the   maniac phase of bipolar disease and various other mental roblems.   Zyprexa [Olanzapine] works by opposing the actions of two main chemical   messengers of human brains dopamine and serotonin. Zyprexa [Olanzapine]   is available in the form of capsules which get dissolved by human  saliva  and hence can be taken with our without water.<br />
During the initial phase of treatment the patients using Zyprexa   [Olanzapine] can suffer from low blood pressure, dizziness, increased   heart rate, fainting and other problems. The problems can become worse   if you are dehydrated or after taking blood pressure medication.   Therefore doctors may initially start with small doses of Zyprexa   [Olanzapine] and gradually put you on higher doses after studying your   reaction to the treatment.<br />
Zyprexa [Olanzapine] is not recommended for children below 13 years of   age. Zyprexa [Olanzapine] can treat various symptoms of schizophrenia   including hearing or voices and seeing objects that are not existing,   feeling suspicious, withdrawn or believing in things that are not true.   It can also be used for suppressing symptoms of type I bipolar disease   including severe mood swings, irritation, depression, racing thoughts,   impulsive behavior, fast talking and decreased sleep. Patients may   observe change in their behavior within couple of weeks of use but if   the problem worsens or persists doctors need to be consulted.<br />
Zyprexa [Olanzapine] usage can make you feel sleepy and can also impact   your ability to reach a decision or react quickly. Hence avoid any   activity requiring high alertness after you use Zyprexa [Olanzapine].   Alcohol consumption should also be avoided by patients on Zyprexa   [Olanzapine].<br />
<a href="http://www.iwantmeds.com/medicine-generic/Zyprexa/109.html">http://www.iwantmeds.com/medicine-generic/Zyprexa/109.html</a></p>
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<title><![CDATA[Self Torture: Where it ends?]]></title>
<link>http://answersto.wordpress.com/2010/07/05/self-torture-where-it-ends/</link>
<pubDate>Mon, 05 Jul 2010 04:00:39 +0000</pubDate>
<dc:creator>primavera bebe</dc:creator>
<guid>http://answersto.wordpress.com/2010/07/05/self-torture-where-it-ends/</guid>
<description><![CDATA[What is self-torture? any mental or physical distress inflicted by oneself upon oneself. This can hu]]></description>
<content:encoded><![CDATA[<p><a href="http://answersto.files.wordpress.com/2010/07/spot-emotional-abuse-200x200.jpg"><img class="alignleft size-full wp-image-2375" title="spot-emotional-abuse-200X200" src="http://answersto.files.wordpress.com/2010/07/spot-emotional-abuse-200x200.jpg?w=200&#038;h=200" alt="" width="200" height="200" /></a>What is <span style="color:#0000ff;">self-torture</span>? any mental or physical distress inflicted by oneself upon oneself. This can hurt one-self, giving the feeling of anguish, great distress, psychological suffering and torment. Some hurting themselves intentionally and inconsiderately while others are unaware of this <span style="color:#0000ff;">behavior</span>.</p>
<p>There are numbers of ways self-torture can be assessed, when it comes to this matter you can initially seen it in every relationship particularly with intimate relation like of <span style="color:#0000ff;">spouse, boyfriend, or family</span>. Whenever your partner like the opposite of what you&#8217;ve enjoy, for the sake of <span style="color:#0000ff;">love and relation</span> you&#8217;re going to give way for  him at that very moment in order to avoid <span style="color:#0000ff;">conflicts </span>and <span style="color:#0000ff;">confrontation</span>.</p>
<p>Another way is whenever you&#8217;re bound to attend different <span style="color:#0000ff;">functions, social gatherings, office meetings, convention or dating</span> and many more. You are open to any possibilities that you may encounter self-torture in socially manner. Mostly dealing with what despise you; like in eating the<span style="color:#0000ff;"> food</span> you don&#8217;t like, listening to the<span style="color:#0000ff;"> music </span>you hate, giving smile to your opponent, shaking hands with your rivals, sitting beside your competitor and mingling with your antagonist. This factor contributes in self-torture <span style="color:#0000ff;">emotionally</span>. The reason why we <span style="color:#0000ff;">suffer </span>all this consequences is because we are afraid to disappoint others and shut our mouth not to express what we truly feels and like. Lack of candid frankness but we can&#8217;t blame one person by keeping his mouth shut, probably he got more things to consider and to protect. Therefore he tries to be careful not to open his mouth and speak.</p>
<p>In<span style="color:#0000ff;"> love and relation</span>, self-torture is commonly present specially when you&#8217;re in the point of loving someone who doesn&#8217;t give back love, which we call <span style="color:#0000ff;">unrequited love</span>. Also loving someone who doesn&#8217;t belong to you completely, like someone is owning that person and that person is not yours to keep.</p>
<p>Other torture themselves when they got<span style="color:#0000ff;"> humiliated, embarrassed, rejected</span> they<span style="color:#0000ff;"> inflict physical harm</span> to their selves. Other self-torture themselves <span style="color:#0000ff;">erotically</span> during<span style="color:#0000ff;"> sexual intercourse</span> which they achieved <span style="color:#0000ff;">pain</span> and<span style="color:#0000ff;"> pleasure.</span></p>
<p>Some evident self-torture is performing strenuous exercise, doing arduous task without rest. Staying up all day without sleep, depriving themselves form eating specially their favorite dish.</p>
<p>A person who&#8217;s suffering with self-torture should be subjected to any <span style="color:#0000ff;">psychological treatment</span> immediately. Early signs should not taking for granted for it may lead to more serious problem and it may totally damage one&#8217;s person <span style="color:#0000ff;">own-self </span>later on.<span style="color:#0000ff;"> </span></p>
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<title><![CDATA[Mental Disorders of Old Age]]></title>
<link>http://kraeplinpsychiatry.wordpress.com/2010/06/18/mental-disorders-of-old-age/</link>
<pubDate>Fri, 18 Jun 2010 07:29:27 +0000</pubDate>
<dc:creator>kraeplinpsychiatry</dc:creator>
<guid>http://kraeplinpsychiatry.wordpress.com/2010/06/18/mental-disorders-of-old-age/</guid>
<description><![CDATA[Mental Disorders of Old Age The National Institute of Mental Health&#8217;s Epidemiologic Catchment]]></description>
<content:encoded><![CDATA[<div>Mental Disorders of Old Age</div>
<div>The National Institute of Mental Health&#8217;s Epidemiologic Catchment Area (ECA) program has found that the most common mental disorders of old age are depressive disorders, cognitive disorders, phobias, and alcohol use disorders. Older adults also have a high risk for suicide and drug-induced psychiatric symptoms. Many mental disorders of old age can be prevented, ameliorated, or even reversed. Of special importance are the reversible causes of delirium and dementia; if not diagnosed accurately and treated in a timely fashion, however, these conditions can progress to an irreversible state requiring a patient&#8217;s institutionalization. Table 56-3 lists the general cognitive domains assessed in a neuropsychological evaluation, with the tests used to measure that skill and a description of the specific behaviors measured by each <a name="PG1353"></a></div>
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<p>test. The tests listed in the table constitute a comprehensive test battery generally appropriate for use with a geriatric population. Use of a comprehensive battery is preferable for confident determination of presence and type of dementia or other cognitive disorder in elderly persons; in some circumstances, however, administering a several-hour battery is not possible. Tests marked with an asterisk are the core tests that are most sensitive for detection of a dementia.</p>
<div>
<div>Several psychosocial risk factors also predispose older persons to mental disorders. These risk factors include loss of social roles, loss of autonomy, the deaths of friends and relatives, declining health, increased isolation, financial constraints, and decreased cognitive functioning.</div>
<div>Many drugs can cause psychiatric symptoms in older adults. These symptoms can result from age-related alterations in drug absorption, a prescribed dosage that is too large, not following instructions and taking too large a dose, sensitivity to the medication, and conflicting regimens presented by several physicians. Almost the entire spectrum of mental disorders can be caused by drugs.</div>
<div id="B01273127.0-5661">
<div><strong>Dementing Disorders</strong></div>
<div>Only arthritis is a more common cause of disability among adults age 65 and older than dementia, a generally progressive and irreversible impairment of the intellect, the prevalence of which increases with age. About 5 percent of persons in the United States older than age 65 have severe dementia, and 15 percent have mild dementia. Of persons older than age 80, about 20 percent have severe dementia. Known risk factors for dementia are age, family history, and female sex.</div>
<div>In contrast to mental retardation, the intellectual impairment of dementia develops over timeâ€”that is, previously achieved mental functions are lost gradually. The characteristic changes of dementia involve cognition, memory, language, and visuospatial functions, but behavioral disturbances are common as well and include agitation, restlessness, wandering, rage, violence, shouting, social and sexual disinhibition, impulsiveness, sleep disturbances, and delusions. Delusions and hallucinations occur during the course of the dementias in nearly 75 percent of patients.</div>
<div>Cognition is impaired by many conditions, including brain injuries, cerebral tumors, acquired immune deficiency syndrome (AIDS), alcohol, medications, infections, chronic pulmonary diseases, and inflammatory diseases. Although dementias associated with advanced age typically are caused by primary degenerative central nervous system (CNS) disease and vascular disease, many factors contribute to cognitive impairment; in older persons, mixed causes of dementia are common. Cognitive disorders including dementia and delirium are covered in Chapter 10.</div>
<div>About 10 to 15 percent of all patients who exhibit symptoms of dementia have potentially treatable conditions. The treatable conditions include systemic disorders, such as heart disease, renal disease, and congestive heart failure; endocrine disorders, such as hypothyroidism; vitamin deficiency; medication misuse; and primary mental disorders, most notably depressive disorders.</div>
<div>Depending on the site of the cerebral lesion, dementias are classified as cortical and subcortical. A subcortical dementia occurs in Huntington&#8217;s disease, Parkinson&#8217;s disease, normal pressure hydrocephalus, vascular dementia, and Wilson&#8217;s disease. The subcortical dementias are associated with movement disorders, gait apraxia, psychomotor retardation, apathy, and akinetic mutism, which can be confused with catatonia. Table 56-4 lists some potentially reversible conditions that may resemble dementia. The cortical dementias occur in dementias of the Alzheimer&#8217;s type, Creutzfeldt-Jakob disease (CJD), and Pick&#8217;s disease, which frequently manifest aphasia, agnosia, and apraxia. In clinical practice, the two types of dementias overlap and, in most cases, an accurate diagnosis can be made only by autopsy. Human prion diseases result from coding mutations in the prion protein gene (PRNP) and may be inherited, acquired, or sporadic. They include familial CJD, Gerstmann-StrÃ¤ussler-Scheinker syndrome, and fatal familial insomnia. These are inherited as autosomal-dominant mutations. The acquired diseases include kuru and iatrogenic CJD. Kuru was an epidemic prion disease of the Fore people of Papua, New Guinea, caused by cannibalistic funeral rituals, which peaked in incidence in the 1950s. Iatrogenic disease is rare and is caused, for example, by the use of contaminated dura mater and corneal grafts and treatment with human cadaveric pituitary-derived growth hormone and gonadotropin. Sporadic CJD accounts for 85 percent of the human prion diseases and occurs worldwide, with a uniform distribution and an incidence of about 1 in 1 million per annum, with a mean age at onset of 65 years. It is exceedingly rare in individuals under 30 years of age. (Additional information on dementia and prion disease is contained in Chapter 10, Section 10.3.)</div>
<div>
<div><strong>Depressive Disorders</strong></div>
<div>Depressive symptoms are present in about 15 percent of all older adult community residents and nursing home patients. Age itself is not a risk factor for the development of depression, but being widowed and having a chronic medical illness are associated with vulnerability to depressive disorders. Late-onset depression is characterized by high rates of recurrence.</div>
<div>
<div>The common signs and symptoms of depressive disorders include reduced energy and concentration, sleep problems (especially early morning awakening and multiple awakenings), decreased appetite, weight loss, and somatic complaints. The presenting symptoms may be different in older depressed patients from those seen in younger adults because of an increased emphasis on somatic complaints in older persons. Older persons are particularly vulnerable to major depressive episodes with melancholic features, characterized by depression, hypochondriasis, low self-esteem, feelings of worthlessness, and self-accusatory trends (especially about sex and sinfulness) with paranoid and suicidal ideation. A geriatric depression scale is shown in Table 56-5.</div>
<div>Cognitive impairment in depressed geriatric patients is referred to as the dementia syndrome of depression (pseudodementia), which can be confused easily with true dementia. In true dementia, intellectual performance usually is global, and impairment is consistently poor; in pseudodementia, deficits in attention and concentration are variable. Compared with patients who have true dementia, patients with pseudodementia are less likely to have language impairment and to confabulate; when uncertain, they are more likely to say â€œI don&#8217;t knowâ€; and their memory difficulties are more limited to free recall than to recognition on cued recall tests. Pseudodementia occurs in about 15 percent of depressed older patients, and 25 to 50 percent of patients with dementia are depressed. Depression and bipolar disorder are covered in Section 15.1.</div>
<div id="B01273127.0-5663">
<div><strong>Schizophrenia</strong></div>
<div>Schizophrenia usually begins in late adolescence or young adulthood and persists throughout life. Although first episodes diagnosed after age 65 are rare, a late-onset type beginning after age 45 has been described. Women are more likely to have a late onset of schizophrenia than men. Another difference between early-onset and late-onset schizophrenia is the greater prevalence of paranoid schizophrenia in the late-onset type. About 20 percent of persons with schizophrenia show no active symptoms by age 65; 80 percent show varying degrees of impairment. Psychopathology becomes less marked as patients age.</div>
<div>The residual type of schizophrenia occurs in about 30 percent of persons with schizophrenia. Its signs and symptoms include emotional blunting, social withdrawal, eccentric behavior, and illogical thinking. Delusions and hallucinations are uncommon. Because most persons with residual schizophrenia cannot care for themselves, long-term hospitalization is required.</div>
<div>Older persons with schizophrenic symptoms respond well to antipsychotic drugs. Medication must be administered judiciously, and lower-than-usual dosages often are effective for older adults. Schizophrenia is covered in Chapter 13.</div>
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<div id="B01273127.0-5664">
<div><strong>Delusional Disorder</strong></div>
<div>The age of onset of delusional disorder usually is between ages 40 and 55, but it can occur at any time during the geriatric period. Delusions can take many forms; the most common are persecutoryâ€”patients believe that they are being spied on, followed, poisoned, or harassed in some way. Persons with delusional disorder may become violent toward their supposed persecutors. Some persons lock themselves in their rooms and live reclusive lives. Somatic delusions, in which persons believe they have a fatal illness, also can occur in older persons. In one study of persons older than 65 years of age, pervasive persecutory ideation was present in 4 percent of persons sampled.</div>
<div>Among those who are vulnerable, delusional disorder can occur under physical or psychological stress and can be precipitated by the death of a spouse, loss of a job, retirement, social isolation, adverse financial circumstances, debilitating medical illness or surgery, visual impairment, and deafness. Delusions also can accompany other disordersâ€”such as dementia of the Alzheimer&#8217;s type, alcohol use disorders, schizophrenia, depressive disorders, and bipolar I disorderâ€”which need to be ruled out. Delusional syndromes also can result from prescribed medications or be early signs of a brain tumor. The prognosis is fair to good in most cases; best results are achieved through a combination of psychotherapy and pharmacotherapy.</div>
<div>A late-onset delusional disorder called paraphrenia is characterized by persecutory delusions. It develops over several years and is not associated with dementia. Some workers believe that the disorder is a variant of schizophrenia that first becomes manifest after age 60. Patients with a family history of schizophrenia show an increased rate of paraphrenia. Delusional disorders are covered in Section 14.3.</div>
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<div id="B01273127.0-5665">
<div><strong>Anxiety Disorders</strong></div>
<div>The anxiety disorders include panic disorder, phobias, obsessive-compulsive disorder (OCD), generalized anxiety disorder, acute stress disorder, and posttraumatic stress disorder (PTSD). Anxiety disorders begin in early or middle adulthood, but some appear for the first time after age 60. An initial onset of panic disorder in older persons is rare, but can occur. The ECA study determined that the 1-month prevalence of anxiety disorders in persons age 65 and older is 5.5 percent. By far the most common disorders <a name="PG1355"></a></div>
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<div>P.1355</div>
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<p>are phobias (4 to 8 percent). The rate for panic disorder is 1 percent.</p>
</div>
<div>The signs and symptoms of phobia in older adults are less severe than those that occur in younger persons, but the effects are equally, if not more, debilitating for older patients. Existential theories help explain anxiety when no specifically identifiable stimulus exists for a chronically anxious feeling. Older persons must come to grips with death. The person may deal with the thought of death with a sense of despair and anxiety, rather than with equanimity and Erikson&#8217;s â€œsense of integrity.â€ The fragility of the autonomic nervous system in older persons may account for the development of anxiety after a major stressor. Because of concurrent physical disability, older persons react more severely to PTSD than younger persons.</div>
<div>Obsessions and compulsions may appear for the first time in older adults, although older adults with OCD usually had demonstrated evidence of the disorder (e.g., being orderly, perfectionistic, punctual, and parsimonious) when they were younger. When symptomatic, patients become excessive in their desire for orderliness, rituals, and sameness. They may become generally inflexible and rigid and have compulsions to check things again and again. OCD (in contrast to obsessive-compulsive personality disorder) is characterized by ego-dystonic rituals and obsessions and may begin late in life. Anxiety disorders are covered in Chapter 16.</div>
</div>
<div id="B01273127.0-5666">
<div><strong>Somatoform Disorders</strong></div>
<div>Somatoform disorders, characterized by physical symptoms resembling medical diseases, are relevant to geriatric psychiatry because somatic complaints are common among older adults. More than 80 percent of persons over 65 years of age have at least one chronic diseaseâ€”usually arthritis or cardiovascular problems. After age 75, 20 percent have diabetes and an average of four diagnosable chronic illnesses that require medical attention.</div>
<div>Hypochondriasis is common in persons over 60 years of age, although the peak incidence is in those 40 to 50 years of age. The disorder usually is chronic, and the prognosis guarded. Repeated physical examinations help reassure patients that they do not have a fatal illness, but invasive and high-risk diagnostic procedures should be avoided unless medically indicated.</div>
<div>Telling patients that their symptoms are imaginary is counterproductive and usually engenders resentment. Clinicians should acknowledge that the complaint is real, that the pain is really there and perceived as such by the patient, and that a psychological or pharmacological approach to the problem is indicated.</div>
</div>
<div id="B01273127.0-5667">
<div><strong>Alcohol and Other Substance Use Disorder</strong></div>
<div>Older adults with alcohol dependence usually give a history of excessive drinking that began in young or middle adulthood. They usually are medically ill, primarily with liver disease, and are either divorced, widowed, or are men who never married. Many have arrest records and are numbered among homeless persons. A large number have chronic dementing illness, such as Wernicke&#8217;s encephalopathy and Korsakoff&#8217;s syndrome. Of nursing home patients, 20 percent have alcohol dependence.</div>
<div>Over all, alcohol and other substance use disorders account for 10 percent of all emotional problems in older persons, and dependence on such substances as hypnotics, anxiolytics, and narcotics is more common in old age than is generally recognized. Substance-seeking behavior characterized by crime, manipulativeness, and antisocial behavior is rarer in older than in younger adults. Older patients may abuse anxiolytics to allay chronic anxiety or to ensure sleep. The maintenance of chronically ill cancer patients with narcotics prescribed by a physician produces dependence, but the need to provide pain relief takes precedence over the possibility of narcotic dependence and is entirely justified.</div>
<div>The clinical presentation of older patients with alcohol and other substance use disorders varies and includes confusion, poor personal hygiene, depression, malnutrition, and the effects of exposure and falls. The sudden onset of delirium in older persons hospitalized for medical illness is most often caused by alcohol withdrawal. Alcohol abuse also should be considered in older adults with chronic gastrointestinal problems.</div>
<div>Older persons may misuse over-the-counter substances, including nicotine and caffeine. Over-the-counter analgesics are used by 35 percent of older persons and 30 percent use laxatives. Unexplained gastrointestinal, psychological, and metabolic problems should alert clinicians to over-the-counter substance abuse.</div>
</div>
<div id="B01273127.0-5668">
<div><strong>Sleep Disorders</strong></div>
<div>Advanced age is the single most important factor associated with the increased prevalence of sleep disorders. Sleep-related phenomena reported more frequently by older than by younger adults are sleeping problems, daytime sleepiness, daytime napping, and the use of hypnotic drugs. Clinically, older persons experience higher rates of breathing-related sleep disorder and medication-induced movement disorders than younger adults.</div>
<div>In addition to altered regulatory and physiological systems, the causes of sleep disturbances in older persons include primary sleep disorders, other mental disorders, general medical disorders, and social and environmental factors. Among the primary sleep disorders, dyssomnias are the most frequent, especially primary insomnia, nocturnal myoclonus, restless legs syndrome, and sleep apnea. Of the parasomnias, rapid eye movement (REM) sleep behavior disorder occurs almost exclusively among elderly men. The conditions that commonly interfere with sleep in older adults also include pain, nocturia, dyspnea, and heartburn. The lack of a daily structure and of social or vocational responsibilities contributes to poor sleep.</div>
<div>As a result of the decreased length of their daily sleepâ€“wake cycle, older persons without daily routines, especially patients in nursing homes, may experience an advanced sleep phase, in which they go to sleep early and awaken during the night.</div>
<div>Even modest amounts of alcohol can interfere with the quality of sleep and can cause sleep fragmentation and early morning awakening. Alcohol can also precipitate or aggravate obstructive sleep apnea. Many older persons use alcohol, hypnotics, and other CNS depressants to help them fall asleep, but data show that these persons experience more early morning awakening than trouble falling asleep. When prescribing sedative-hypnotic drugs for older persons, clinicians must monitor the patients for unwanted cognitive, behavioral, and psychomotor effects, including memory impairment (anterograde amnesia), residual sedation, rebound insomnia, daytime withdrawal, and unsteady gait.</div>
<div>Changes in sleep structure among persons over 65 years of age involve both REM sleep and non-rapid eye movement (NREM) sleep. The REM changes include the redistribution of REM sleep throughout the night, more REM episodes, shorter REM episodes, and less total REM sleep. The NREM changes include the decreased amplitude of delta waves, a lower percentage of stages 3 and 4 sleep, and a higher percentage of stages 1 and 2 sleep. In addition, older persons experience increased awakening after sleep onset.</div>
<div>Much of the observed deterioration in the quality of sleep in older persons is caused by the altered timing and consolidation of sleep. For example, with advanced age, persons have a lower amplitude of circadian rhythms, a 12-hour sleep-propensity rhythm, and shorter circadian cycles.</div>
</div>
<p><a name="PG1356"></a></p>
<div>
<div>P.1356</div>
</div>
<div id="B01273127.0-5669">
<div><strong>Suicide Risk</strong></div>
<div>Elderly persons have a higher risk for suicide than any other population. The suicide rate for white men over the age of 65 is five times higher than that of the general population. One third of elderly persons report loneliness as the principal reason for considering suicide. Approximately 10 percent of elderly individuals with suicidal ideation report financial problems, poor medical health, or depression as reasons for suicidal thoughts. Suicide victims differ demographically from individuals who attempt suicide. About 60 percent of those who commit suicide are men; 75 percent of those who attempt suicide are women. Suicide victims, as a rule, use guns or hang themselves, whereas 70 percent of suicide attempters take a drug overdose, and 20 percent cut or slash themselves. Psychological autopsy studies suggest that most elderly persons who commit suicide have had a psychiatric disorder, most commonly depression. Psychiatric disorders of suicide victims, however, often do not receive medical or psychiatric attention. More elderly suicide victims are widowed and fewer are single, separated, or divorced than is true of younger adults. Violent methods of suicide are more common in the elderly, and alcohol use and psychiatric histories appear to be less frequent. The most common precipitants of suicide in older individuals are physical illness and loss, whereas problems with employment, finances, and family relationships are more frequent precipitants in younger adults. Most elderly persons who commit suicide communicate their suicidal thoughts to family or friends before the act of suicide.</div>
<div>Older patients with major medical illnesses or a recent loss should be evaluated for depressive symptomatology and suicidal ideation or plans. Thoughts and fantasies about the meaning of suicide and life after death may reveal information that the patient cannot share directly. There should be no reluctance to question patients about suicide, because no evidence indicates that such questions increase the likelihood of suicidal behavior.</div>
</div>
<div id="B01273127.0-5670">
<div>Other Conditions of Old Age</div>
<div id="B01273127.0-5671">
<div><strong>Vertigo</strong></div>
<div>Feelings of vertigo or dizziness, a common complaint of older adults, cause many older adults to become inactive because they fear falling. The causes of vertigo vary and include anemia, hypotension, cardiac arrhythmia, cerebrovascular disease, basilar artery insufficiency, middle ear disease, acoustic neuroma, and MÃ©niÃ¨re&#8217;s disease. Most cases of vertigo have a strong psychological component, and clinicians should ascertain any secondary gain from the symptom. The overuse of anxiolytics can cause dizziness and daytime somnolence. Treatment with meclizine (Antivert), 25 to 100 mg daily, has been successful in many patients with vertigo.</div>
</div>
<div id="B01273127.0-5672">
<div><strong>Syncope</strong></div>
<div>The sudden loss of consciousness associated with syncope results from a reduction of cerebral blood flow and brain hypoxia. A thorough medical workup is required to rule out the various causes listed in Table 56-6.</div>
</div>
<div id="B01273127.0-5673">
<div><strong>Hearing Loss</strong></div>
<div>About 30 percent of persons over age 65 have significant hearing loss (presbycusis). After age 75, that figure rises to 50 percent. Causes vary. Clinicians should be sensitive to hearing loss in patients who complain they can hear but cannot understand what is being said or who ask that questions be repeated. Most elderly persons with hearing loss can be treated with hearing aids.</div>
<div>
<div id="B01273127.0-5674">
<div><strong>Elder Abuse</strong></div>
<div>An estimated 10 percent of persons above 65 years of age are abused. Elder abuse is defined by the American Medical Association as â€œan act or omission which results in harm or threatened harm to the health or welfare of an elderly person.â€ Mistreatment includes abuse and neglectâ€”physically, psychologically, financially, and materially. Sexual abuse does occur. Acts of omission include withholding food, medicine, clothing, and other necessities.</div>
<div>Family conflicts and other problems often underlie elder abuse. The victims tend to be very old and frail. They often live with their assailants, who may be financially dependent on the victims. Both the victim and the perpetrator tend to deny or minimize the presence of abuse. Interventions include providing legal services, housing, and medical, psychiatric, and social services.</div>
</div>
<div id="B01273127.0-5675">
<div><strong>Spousal Bereavement</strong></div>
<div>Demographic data suggest that 51 percent of women and 14 percent of men over the age of 65 will be widowed at least once. Spousal loss is <a name="PG1357"></a>among the most stressful of all life experiences. As a group, older adults appear to have a more favorable outcome than expected following the death of a spouse. Depressive symptoms peak within the first few months after a death, but decline significantly within a year. A relationship exists between spousal loss and subsequent mortality. Elderly survivors of spouses who committed suicide are especially vulnerable, as are those with psychiatric illness.</div>
</div>
<div>
<div id="B01273127.0-5676">
<div><strong>Psychopharmacological Treatment of Geriatric Disorders</strong></div>
<div>Certain guidelines should be followed regarding the use of all drugs in older adults. A pretreatment medical evaluation is essential, including an electrocardiogram (ECG). It is especially useful to have the patient or a family member bring in all currently used medications, because multiple drug use could be contributing to the symptoms.</div>
<div>Most psychotropic drugs should be given in equally divided doses three or four times over a 24-hour period. Older patients may not be able to tolerate a sudden rise in drug blood level resulting from one large daily dose. Any changes in blood pressure and pulse rate and other side effects should be watched. For patients with insomnia, however, giving the major portion of an antipsychotic or antidepressant at bedtime takes advantage of its sedating and soporific effects. Liquid preparations are useful for older patients who cannot, or will not, swallow tablets. Clinicians should frequently reassess all patients to determine the need for maintenance medication, changes in dosage, and development of adverse effects. If a patient is taking psychotropic drugs at the time of the evaluation, the clinician should discontinue these medications, if possible, and, after a washout period, reevaluate the patient during a drug-free baseline state.</div>
<div>Adults over 65 years of age use the greatest number of medications of any age group; 25 percent of all prescriptions are written for them. Adverse drug reactions caused by medications result in the hospitalization of nearly 250,000 persons in the United States each year. Psychotropic drugs are among the most commonly prescribed, along with cardiovascular and diuretic medications; 40 percent of all hypnotics dispensed in the United States each year are to those older than 75 years of age, and 70 percent of older persons use over-the-counter medications, compared with only 10 percent of young adults. (Chapter 36 presents a comprehensive survey of the psychopharmacological agents.)</div>
<div id="B01273127.0-5677">
<div><strong>Principles</strong></div>
<div>The major goals of the pharmacological treatment of older persons are to improve the quality of life, maintain persons in the community, and delay or avoid their placement in nursing homes. Individualization of dosage is the basic tenet of geriatric psychopharmacology.</div>
<div>Alterations in drug dosages are required because of the physiological changes that occur as persons age. Renal disease is associated with decreased renal clearance of drugs; liver disease results in a decreased ability to metabolize drugs; cardiovascular disease and reduced cardiac output can affect both renal and hepatic drug clearance; and gastrointestinal disease and decreased gastric acid secretion influence drug absorption. As a person ages, the ratio of lean to fat body mass also changes. With normal aging, lean body mass decreases and body fat increases. Changes in the ratio of lean to fat body mass that accompany aging affect the distribution of drugs. Many lipid-soluble psychotropic drugs are distributed more widely in fat than in lean tissue, so a drug&#8217;s action can be unexpectedly prolonged in older persons. Similarly, changes in end-organ or receptor-site sensitivity must be taken into account. In older persons, the increased risk of orthostatic hypotension from psychotropic drugs is related to reduced functioning of blood pressure-regulating mechanisms.</div>
<div>As a general rule, the lowest possible dose should be used to achieve the desired therapeutic response. Clinicians must know the pharmacodynamics, pharmacokinetics, and biotransformation of each drug prescribed and the effects of the interaction of the drug with other drugs that a patient is taking.</div>
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<div id="B01273127.0-5678">
<div><strong>Psychotherapy for Geriatric Patients</strong></div>
<div>The standard psychotherapeutic interventionsâ€”such as insight-oriented psychotherapy, supportive psychotherapy, cognitive therapy, group therapy, and family therapyâ€”should be available to geriatric patients. According to Sigmund Freud, persons older than 50 years are not suited for psychoanalysis because their mental processes lack elasticity. In the view of many who followed Freud, however, psychoanalysis is possible after age 50. Advanced age certainly limits plasticity of the personality, but as Otto Fenichel stated, â€œIt does so in varying degrees and at very different ages so that no general rule can be given.â€ Insight-oriented psychotherapy may help remove a specific symptom, even in older persons. It is of most benefit when patients have possibilities for libidinal and narcissistic gratification, but it is contraindicated if it would bring only the insight that life has been a failure and that the patient has no opportunity to make up for it.</div>
<div>Common age-related issues in therapy involve the need to adapt to recurrent and diverse losses (e.g., the deaths of friends and loved ones), the need to assume new roles (e.g., the adjustment to retirement and the disengagement from previously defined roles), and the need to accept mortality. Psychotherapy helps older persons to deal with these issues and the emotional problems surrounding them and to understand their behavior and the effects of their behavior on others. In addition to improving interpersonal relationships, psychotherapy increases self-esteem and self-confidence, decreases feelings of helplessness and anger, and improves the quality of life. As described by Alvin Goldfarb, geriatric psychotherapy has the general aim of assisting older adults to have minimal complaints, to help them make and keep friends of both sexes, and to have sexual relations when they have interest and capacity.</div>
<div>Psychotherapy helps relieve tensions of biological and cultural origins and helps older persons work and play within the limits of their functional status and as determined by their past training, activities, and self-concept in society. In patients with impaired cognition, psychotherapy can produce remarkable gains in both physical and mental symptoms. In one study conducted in an old-age home, 43 percent of the patients receiving psychotherapy showed less urinary incontinence, improved gait, greater mental alertness, improved memory, and better hearing than before psychotherapy.</div>
<div>Therapists must be more active, supportive, and flexible in conducting therapy with older than with younger adults, and they must be prepared to act decisively at the first sign of an incapacity that requires <a name="PG1358"></a></div>
<div>
<div>the active involvement of another physician, such as an internist, or that requires consulting with, or enlisting the aid of, a family member.</div>
</div>
</div>
<div>Older persons usually seek therapy for a therapist&#8217;s unqualified and unlimited support, reassurance, and approval. Patients often expect a therapist to be all powerful, all knowing, and able to effect a magical cure. Most patients eventually recognize that the therapist is human and that they are engaged in a collaborative effort. In some cases, however, the therapist may have to assume the idealized role, especially when the patient is unable or unwilling to test reality effectively. With the help of the therapist, the patient deals with problems that had been avoided previously. As the therapist offers direct encouragement, reassurance, and advice, the patient&#8217;s self-confidence increases as conflicts are resolved.</div>
<div>Goldfarb has described a brief, supportive therapy technique for institutionalized, cognitively impaired patients. The therapist promotes patients&#8217; foundering self-esteem, sense of control, and safety by permitting them to develop an apparent special relationship with the therapist, who is perceived as a benevolent and powerful figure. The patients believe they have some control over the benevolent physician. This is accomplished in small, subtle ways. For example, the physician elicits the patient&#8217;s preferences for the frequency of sessions, daily timetables, diet, or socializing and then acquiesces to the patient&#8217;s wishes, while maintaining a quiet caution about being unduly manipulative. The technique includes weekly, short (15 minutes) visits and gratifying the patient&#8217;s realistic requests when possible.</div>
<div id="B01273127.0-5679">
<div><strong>Life Review or Reminiscence Therapy</strong></div>
<div>Robert Butler and others have noted the universal tendency of the aging person to reflect on, and reminisce about, the past. Reminiscence is characterized by the progressive return of memories of past experiences, especially those that were meaningful and conflictual. To varying degrees, elderly patients in therapy reminisce about the past, search for meaning in their lives, and strive for some resolution of past interpersonal and intrapsychic conflicts. Life review therapy systematically enhances this reminiscing process and makes it more conscious and deliberate. The therapist may guide the process by encouraging the patient to write or tape a biography with review of special events and turning points. Techniques include reunions with family and good friends and looking through memorabilia, such as scrapbooks or picture albums. This technique has been reported to resolve old problems, increase tolerance of conflict, relieve guilt and fears, and enhance self-esteem, creativity, generosity, and acceptance of the present.</div>
</div>
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<div>
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<div><strong>References</strong></div>
<div id="RU1-56">Ancoli-Israel S, Ayalon L. Diagnosis and treatment of sleep disorders in older adults. Am J Geriatr Psychiatry. 2006;14:95â€“103.</div>
<div id="RU2-56">Conner KR, Conwell Y, Duberstein PR, Eberly S. Aggression in suicide among adults age 50 and over. Am J Geriatr Psychiatry. 2004;12:37â€“42.</div>
<div id="RU3-56">Depp CA, Jeste DV. Definitions and predictors of successful aging: A comprehensive review of larger quantitative studies. Am J Geriatr Psychiatry. 2006;14:6â€“20.</div>
<div id="RU4-56">Jarvik LF, Small GW. Geriatric psychiatry: Introduction and overview. In: Sadock BJ, Sadock VA, eds. Kaplan &#38; Sadock&#8217;s Comprehensive Textbook of Psychiatry. 8th ed. Vol. 2. Baltimore: Lippincott Williams &#38; Wilkins; 2005:3587.</div>
<div id="RU5-56">Jeary K. Sexual abuse and sexual offending against elderly people: A focus on perpetrators and victims. Journal of Forensic Psychiatry and Psychology. 2005;16(2):328â€“343.</div>
<div id="RU6-56">Kales HC, Maixner DF, Mellow AM. Cerebrovascular disease and late-life depression. Am J Geriatr Psychiatry. 2005;13:88â€“98.</div>
<div id="RU7-56">Leentjens AFG. Depression in Parkinson&#8217;s disease: Conceptual issues and clinical challenges. J Geriatr Psychiatry Neurol. 2004;17(3):120â€“126.</div>
<div id="RU8-56">Mast BT, Neufeld S, MacNeill SE, Lichtenberg PA. Longitudinal support for the relationship between vascular risk factors and late-life depressive symptoms. Am J Geriatr Psychiatry. 2004;12:93â€“101.</div>
<div id="RU9-56">Mueller TI, Kohn R, Leventhal N, Leon AC, Solomon D, Coryell W, Endicott J, Alexopoulos GS, Keller MB. The course of depression in elderly patients. Am J Geriatr Psychiatry. 2004;12:22â€“29.</div>
<div id="RU10-56">Reynolds CF III, Dew MA, Pollock BG, Mulsant BH, Frank E, Miller MD, Houck PR, Mazumdar S, Butters MA, Stack JA, Schlernitzauer MA, Whyte EM, Gildengers A, Karp J, Lenze E, Szanto K, Bensasi S, Kupfer DJ. Maintenance treatment of major depression in old age. N Engl J Med. 2006;354:1130â€“1138.</div>
<div id="RU11-56">Sadavoy J, Jarvik LF, Grossberg GT, Meyers BS, eds. Comprehensive Textbook of Geriatric Psychiatry. 3rd ed. New York: Norton; 2004.</div>
<div id="RU12-56">Takeshita J, Ahmed I. Culture and geriatric psychiatry. In: Tseng W-S, Streltzer J, eds. Cultural Competence in Clinical Psychiatry. Washington, DC: American Psychiatric Publishing, Inc.; 2004:147â€“161.</div>
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<title><![CDATA[Cognitive and Behavior Therapies in Panic Disorder]]></title>
<link>http://kraeplinpsychiatry.wordpress.com/2010/06/17/cognitive-and-behavior-therapies-in-panic-disorder/</link>
<pubDate>Thu, 17 Jun 2010 23:13:32 +0000</pubDate>
<dc:creator>kraeplinpsychiatry</dc:creator>
<guid>http://kraeplinpsychiatry.wordpress.com/2010/06/17/cognitive-and-behavior-therapies-in-panic-disorder/</guid>
<description><![CDATA[Cognitive and Behavior Therapies Cognitive and behavior therapies are effective treatments for panic]]></description>
<content:encoded><![CDATA[<div id="B01273127.0-2428">
<div><strong>Cognitive and Behavior Therapies</strong></div>
<div>Cognitive and behavior therapies are effective treatments for panic disorder. Various reports have concluded that cognitive and behavior therapies are superior to pharmacotherapy alone; other reports have concluded the opposite. Several studies and reports have found that the combination of cognitive or behavior therapy with pharmacotherapy is more effective than either approach alone. Several studies that included long-term follow-up of patients who received cognitive or behavior therapy indicate that the therapies are effective in producing long-lasting remission of symptoms.</div>
<div id="B01273127.0-2429">
<div><strong>Cognitive Therapy</strong></div>
<div>The two major foci of cognitive therapy for panic disorder are instruction about a patient&#8217;s false beliefs and information about panic attacks. The instruction about false beliefs centers on the patient&#8217;s tendency to misinterpret mild bodily sensations as indicating impending panic attacks, doom, or death. The information about panic attacks includes explanations that when panic attacks occur, they are time limited and not life threatening.</div>
<div>
<div id="B01273127.0-2430">
<div>Mr. J was a 27-year-old laboratory technician who began having full-blown panic attacks 8 months before seeking help. Although he was unable to identify specific situations that elicited attacks, he was particularly concerned about the possibility of their occurring while he was engaged in laboratory procedures with patients. His attacks typically involved a sudden explosion of autonomic arousal and included palpitations, sweating, dizziness, feelings of unreality, and tingling in his arms and legs. He dreaded the idea that the attacks might recur. In the beginning of his cognitive-behavioral program, he found an educational handout that described the myths of panic attacks (e.g., that they will lead to heart attacks, losing control, or going crazy) particularly reassuring. He began practicing diaphragmatic breathing each evening and, after several weeks, became effective in challenging his negative way of thinking about the consequences of panic attacks. In the latter few weeks of his 12-week program, he practiced exposing himself to physical sensations of panic by doing a variety of interoceptive exercises at home, including hyperventilating for 1 or 2 minutes at a time (designed to help Mr. J acclimate to the physical sensations associated with overbreathing), and spinning in a chair repeatedly (designed to help acclimate him to symptoms of dizziness and feelings of unreality). At the conclusion of the treatment program Mr. J&#8217;s panic attacks had disappeared, and at 6-month follow-up he had maintained his treatment gains by attending â€œbooster sessionsâ€ with his therapist once every 2 months.</div>
</div>
</div>
</div>
<div id="B01273127.0-2431">
<div><strong>Applied Relaxation</strong></div>
<div>The goal of applied relaxation (e.g., Herbert Benson&#8217;s relaxation training) is to instill in patients a sense of control over their levels of anxiety and relaxation. Through the use of standardized techniques for muscle relaxation and the imagining of relaxing situations, patients learn techniques that may help them through a panic attack.</div>
</div>
<div id="B01273127.0-2432">
<div><strong>Respiratory Training</strong></div>
<div>Because the hyperventilation associated with panic attacks is probably related to some symptoms, such as dizziness and faintness, one direct approach to control panic attacks is to train patients to control the urge to hyperventilate. After such training, patients can use the technique to help control hyperventilation during a panic attack.</div>
</div>
<div id="B01273127.0-2433">
<div><strong>In Vivo Exposure</strong></div>
<div>In vivo exposure used to be the primary behavior treatment for panic disorder. The technique involves sequentially greater exposure of a patient to the feared stimulus; over time, the patient becomes desensitized to the experience. Previously, the focus was on external stimuli; recently, the technique has included exposure of the patient to internal feared sensations (e.g., tachypnea and fear of having a panic attack).</div>
</div>
</div>
<div id="B01273127.0-2434">
<div><strong>Other Psychosocial Therapies</strong></div>
<div id="B01273127.0-2435">
<div><strong>Family Therapy</strong></div>
<div>Families of patients with panic disorder and agoraphobia may also have been affected by the family member&#8217;s disorder. Family therapy directed toward education and support is often beneficial.</div>
</div>
<div id="B01273127.0-2436">
<div><strong>Insight-Oriented Psychotherapy</strong></div>
<div>Insight-oriented psychotherapy can be of benefit in the treatment of panic disorder and agoraphobia. Treatment focuses on helping patients understand the hypothesized unconscious meaning of the anxiety, the symbolism of the avoided situation, the need to repress impulses, and the secondary gains of the symptoms. A resolution of early infantile and oedipal conflicts is hypothesized to correlate with the resolution of current stresses.</div>
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<div id="B01273127.0-2437">
<div><strong>Combined Psychotherapy and Pharmacotherapy</strong></div>
<div>Even when pharmacotherapy is effective in eliminating the primary symptoms of panic disorder, psychotherapy may be needed to treat secondary symptoms.</div>
<div><em>Glen O. Gabbard wrote:</em></div>
<div>
<div>Panic-disordered patients frequently require a combination of drug therapy and psychotherapyâ€¦. Even when patients with panic attacks and agoraphobia have their symptoms pharmacologically controlled, they are often reluctant to venture out into the world again and may require psychotherapeutic interventions to help overcome this fearâ€¦. Some patients will adamantly refuse any medication because they believe that it stigmatizes them as being mentally ill, so psychotherapeutic intervention is required to help them understand and eliminate their resistance to pharmacotherapyâ€¦. For a comprehensive and effective treatment plan, these patients require psychotherapeutic approaches in addition to appropriate medications. In all patients with symptoms of panic disorder or agoraphobia, a careful psychodynamic evaluation will help weigh the contributions of biological and dynamic factors.</div>
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<title><![CDATA[Goals and Targeted Behaviors for Social Skills Therapy]]></title>
<link>http://kraeplinpsychiatry.wordpress.com/2010/06/17/goals-and-targeted-behaviors-for-social-skills-therapy/</link>
<pubDate>Thu, 17 Jun 2010 23:06:21 +0000</pubDate>
<dc:creator>kraeplinpsychiatry</dc:creator>
<guid>http://kraeplinpsychiatry.wordpress.com/2010/06/17/goals-and-targeted-behaviors-for-social-skills-therapy/</guid>
<description><![CDATA[Table 13-10 Goals and Targeted Behaviors for Social Skills Therapy Phase Goals Targeted Behaviors St]]></description>
<content:encoded><![CDATA[<table cellspacing="0" cellpadding="0">
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<tr>
<div>Table 13-10 Goals and Targeted Behaviors for Social Skills Therapy</div>
</tr>
</tbody>
</table>
<table border="0" cellspacing="0" cellpadding="0">
<tbody>
<tr>
<th align="left" valign="bottom">Phase</th>
<th align="left" valign="bottom">Goals</th>
<th align="left" valign="bottom">Targeted Behaviors</th>
</tr>
<tr>
<td valign="top">Stabilization and assessment</td>
<td valign="top">Establish therapeutic alliance<br />
Assess social performance and perception skills<br />
Assess behaviors that provoke expressed emotion</td>
<td valign="top">Empathy and rapport<br />
Verbal and nonverbal communication</td>
</tr>
<tr>
<td rowspan="2" valign="top">Social performance within family</td>
<td valign="top">Express positive feelings within family</td>
<td valign="top">Compliments, appreciation, interest in others</td>
</tr>
<tr>
<td valign="top">Teach effective strategies for coping with conflict</td>
<td valign="top">Avoidance response to criticism, stating preferences and refusals</td>
</tr>
<tr>
<td valign="top">Social perception in the family</td>
<td valign="top">Correctly identify content, context, and meaning of messages</td>
<td valign="top">Reading a message<br />
Labeling an idea<br />
Summarizing other&#8217;s intent</td>
</tr>
<tr>
<td rowspan="2" valign="top">Extrafamilial relationships</td>
<td valign="top">Enhance socialization skills</td>
<td valign="top">Conversational skills</td>
</tr>
<tr>
<td valign="top">Enhance prevocational and vocational skills</td>
<td valign="top">Dating<br />
Recreational activities<br />
Job interviewing, work habits</td>
</tr>
<tr>
<td valign="top">Maintenance</td>
<td valign="top">Generalize skills to new situations</td>
<td valign="top"> </td>
</tr>
</tbody>
</table>
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<title><![CDATA[Psychosocial Therapies for Schizophrenia]]></title>
<link>http://kraeplinpsychiatry.wordpress.com/2010/06/17/psychosocial-therapies-for-schizophrenia/</link>
<pubDate>Thu, 17 Jun 2010 22:54:09 +0000</pubDate>
<dc:creator>kraeplinpsychiatry</dc:creator>
<guid>http://kraeplinpsychiatry.wordpress.com/2010/06/17/psychosocial-therapies-for-schizophrenia/</guid>
<description><![CDATA[Psychosocial Therapies Psychosocial therapies include a variety of methods to increase social abilit]]></description>
<content:encoded><![CDATA[<div><strong>Psychosocial Therapies</strong></div>
<div>Psychosocial therapies include a variety of methods to increase social abilities, self-sufficiency, practical skills, and interpersonal communication in schizophrenia patients. The goal is to enable persons who are severely ill to develop social and vocational skills for independent living. Such treatment is carried out at many sites: hospitals, outpatient clinics, mental health centers, day hospitals, and home or social clubs.</div>
<div id="B01273127.0-1965">
<div>Social Skills Training</div>
<div>Social skills training is sometimes referred to as behavioral skills therapy (Table 13-10). Along with pharmacological therapy, this therapy can be directly supportive and useful to the patient. In addition to the psychotic symptoms seen in patients with schizophrenia, other noticeable symptoms involve the way the person relates to others, including poor eye contact, unusual delays in response, odd facial expressions, lack of spontaneity in social situations, and inaccurate perception or lack of perception of emotions in other people. Behavioral skills training addresses these behaviors through the use of videotapes of others and of the patient, role playing in therapy, and homework assignments for the specific skills being practiced. Social skills training has been shown to reduce relapse rates as measured by the need for hospitalization.</div>
</div>
<div id="B01273127.0-1966">
<div><strong>Family-Oriented Therapies</strong></div>
<div>Because patients with schizophrenia are often discharged in an only partially remitted state, a family to which a patient returns can often benefit from a brief but intensive (as often as daily) course of family therapy. The therapy should focus on the immediate situation and should include identifying and avoiding potentially troublesome situations. When problems do emerge with the patient in the family, the aim of the therapy should be to resolve the problem quickly.</div>
<div>In wanting to help, family members often encourage a relative with schizophrenia to resume regular activities too quickly, both from ignorance about the disorder and from denial of its severity. Without being overly discouraging, therapists must help both the family and the patient understand and learn about schizophrenia and must encourage discussion of the psychotic episode and the events leading up to it. Ignoring the psychotic episode, a common occurrence, often increases the shame associated with the event and does not exploit the freshness of the episode to understand it better. Psychotic symptoms often frighten family members, and talking openly with the psychiatrist and with the relative with schizophrenia often eases all parties. Therapists can direct later family therapy toward long-range application of stress-reducing and coping strategies and toward the patient&#8217;s gradual reintegration into everyday life.</div>
<div>Therapists must control the emotional intensity of family sessions with patients with schizophrenia. The excessive expression of emotion during a session can damage a patient&#8217;s recovery process and undermine potentially successful future family therapy. Several studies have shown that family therapy is especially effective in reducing relapses.</div>
<div id="B01273127.0-1967">
<div><strong>National Alliance for the Mentally Ill</strong></div>
<div>The National Alliance for the Mentally Ill (NAMI) and similar organizations offer support groups for family members and friends of patients who are mentally ill and for patients themselves. These organizations offer emotional and practical advice about obtaining care in the sometimes complex health care delivery system and are useful sources to which to refer family members. NAMI has also waged a campaign to destigmatize mental illness and to increase government awareness of the needs and rights of persons who are mentally ill and their families.</div>
</div>
</div>
<div id="B01273127.0-1968">
<div><strong>Case Management</strong></div>
<div>Because a variety of professionals with specialized skills, such as psychiatrists, social workers, and occupational therapists, among others, are involved in a treatment program, it is helpful to have one person aware of all the forces acting on the patient. The case manager ensures that their efforts are coordinated and that the patient keeps appointments and complies with treatment plans; the case manager may make home visits and even accompany the patient to work. The success of the program depends on the educational background, training, and competence of the individual case manager, which varies. Case managers often have too many cases to manage effectively. The ultimate benefits of the program have yet to be demonstrated.</div>
</div>
<div id="B01273127.0-1969">
<div><strong>Assertive Community Treatment</strong></div>
<div>The Assertive Community Treatment (ACT) program was originally developed by researchers in Madison, Wisconsin, in the 1970s, for the delivery of services for persons with chronic mental illness. Patients are assigned to one multidisciplinary team (case manager, psychiatrist, nurse, general physicians, etc.). The team has a fixed caseload of patients and delivers all services when and where needed by the patient, 24 hours a day, 7 days a week. This is mobile and intensive intervention that provides treatment, rehabilitation, and support activities. These include home delivery of medications, monitoring of mental and physical health, in vivo social skills, and frequent contact with family members. There is a high staff-to-patient ratio (1:12). ACT programs can effectively decrease the risk of rehospitalization for persons with schizophrenia, but they are labor-intensive and expensive programs to administer.</div>
</div>
<div id="B01273127.0-1970">
<div><strong>Group Therapy</strong></div>
<div>Group therapy for persons with schizophrenia generally focuses on real-life plans, problems, and relationships. Groups may be behaviorally oriented, psychodynamically or insight oriented, or supportive. Some investigators doubt that dynamic interpretation and insight therapy are valuable for typical patients with schizophrenia. But group therapy is effective in reducing social isolation, increasing the sense of cohesiveness, and improving reality testing for patients with schizophrenia. Groups led in a supportive manner appear to be most helpful for schizophrenia patients.</div>
</div>
<div id="B01273127.0-1971">
<div><strong>Cognitive Behavioral Therapy</strong></div>
<div>Cognitive behavioral therapy has been used in schizophrenia patients to improve cognitive distortions, reduce distractibility, and correct errors in judgment. There are reports of ameliorating delusions and hallucinations in some patients using this method. Patients who might benefit generally have some insight into their illness.</div>
</div>
<div id="B01273127.0-1972">
<div><strong>Individual Psychotherapy</strong></div>
<div>Studies of the effects of individual psychotherapy in the treatment of schizophrenia have provided data that the therapy is helpful and that the effects are additive to those of pharmacological treatment. In psychotherapy with a schizophrenia patient, developing a therapeutic relationship that the patient experiences as safe is critical. The therapist&#8217;s reliability, the emotional distance between the therapist and the patient, and the genuineness of the therapist as interpreted by the patient all affect the therapeutic experience. Psychotherapy for a schizophrenia patient should be thought of in terms of decades, rather than sessions, months, or even years.</div>
<div>
<div>Some clinicians and researchers have emphasized that the ability of a patient with schizophrenia to form a therapeutic alliance with a therapist is predictive of the outcome. Schizophrenia patients who are able to form a good therapeutic alliance are likely to remain in psychotherapy, to remain compliant with their medications, and to have good outcomes at 2-year follow-up evaluations.</div>
<div>The relationship between clinicians and patients differs from that encountered in the treatment of nonpsychotic patients. Establishing a relationship is often difficult. Persons with schizophrenia are desperately lonely, yet defend against closeness and trust; they are likely to become suspicious, anxious, or hostile or to regress when someone attempts to draw close (Fig. 13-13). Therapists should scrupulously respect a patient&#8217;s distance and privacy, and should demonstrate simple directness, patience, sincerity, and sensitivity to social conventions in preference to premature informality and the condescending use of first names. The patient is likely to perceive exaggerated warmth or professions of friendship as attempts at bribery, manipulation, or exploitation.</div>
<div>In the context of a professional relationship, however, flexibility is essential in establishing a working alliance with the patient. A therapist may have meals with the patient, sit on the floor, go for a walk, eat at a restaurant, accept and give gifts, play table tennis, remember the patient&#8217;s birthday, or just sit silently with the patient. The major aim is to convey the idea that the therapist is trustworthy, wants to understand the patient and tries to do so, and has faith in the patient&#8217;s potential as a human, no matter how disturbed, hostile, or bizarre the patient may be at the moment.</div>
<div id="B01273127.0-1973">
<div><strong>Personal Therapy</strong></div>
<div>A flexible type of psychotherapy called personal therapy is a recently developed form of individual treatment for schizophrenia patients. Its objective is to enhance personal and social adjustment and to forestall relapse. It is a select method using social skills and relaxation exercises, psychoeducation, self-reflection, self-awareness, and exploration of individual vulnerability to stress. The therapist provides a setting that stresses acceptance and empathy. Patients receiving personal therapy show improvement in social adjustment (a composite measure that includes work performance, leisure, and interpersonal relationships) and have a lower relapse rate after 3 years than patients not receiving personal therapy.</div>
</div>
<div id="B01273127.0-1974">
<div><strong>Dialectical Behavior Therapy</strong></div>
<div>This form of therapy, which combines cognitive and behavioral theories in both individual and group settings, has proved useful in borderline states and may have benefit in schizophrenia. Emphasis is placed on improving interpersonal skills in the presence of an active and empathic therapist.</div>
</div>
<div id="B01273127.0-1975">
<div><strong>Vocational Therapy</strong></div>
<div>A variety of methods and settings are used to help patients regain old skills or develop new ones. These include sheltered workshops, job clubs, and part-time or transitional employment programs. Enabling patients to become gainfully employed is both a means toward, and a sign of, recovery. Many schizophrenia patients are capable of performing high-quality work despite their illness. Others may exhibit exceptional skill or even brilliance in a limited field as a result of some idiosyncratic aspect of their disorder.</div>
</div>
<div id="B01273127.0-1976">
<div><strong>Art Therapy</strong></div>
<div>Many schizophrenic patients benefit from art therapy, which provides them with an outlet for their constant bombardment of imagery. It helps them communicate with others and share their inner, often frightening world with others. In some circles, the art of the mentally ill is highly collectable; however, whether purchased or not, the production of a work that is appreciated by others can do much to raise self-esteem (see Color Plate 13-14 on page 493.)</div>
</div>
<div id="B01273127.0-1977">
<div><strong>Integrating Psychosocial and Medication Treatments</strong></div>
<div>Antipsychotic medication has been established as the single most effective treatment for schizophrenia, but it is not sufficient for many patients who greatly benefit from the addition of psychosocial therapy. In fact, many studies show that combining both approaches produces the best results.</div>
</div>
</div>
</div>
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<title><![CDATA[Bipolar Disorder Symptoms - How to Find Them]]></title>
<link>http://bipolardisordercauses.wordpress.com/2010/03/03/bipolar-disorder-symptoms-how-to-find-them/</link>
<pubDate>Wed, 03 Mar 2010 18:21:52 +0000</pubDate>
<dc:creator>bipolardisordercauses</dc:creator>
<guid>http://bipolardisordercauses.wordpress.com/2010/03/03/bipolar-disorder-symptoms-how-to-find-them/</guid>
<description><![CDATA[Bipolar disorder symptoms once detected should be addressed immediately. This is because some of the]]></description>
<content:encoded><![CDATA[<p>Bipolar disorder symptoms once detected should be addressed immediately. This is because some of these symptoms are so abnormal and severe that, without proper psychiatric help, they are enough to ruin a person’s career, school life or general social interactions.</p>
<p>Mood episodes of extreme excitement to extreme depression and unusual irritability going far beyond the normal and rational boundaries are extremely common.  A person with this condition might also experience very fast, racing thoughts and highly unstable swings of emotions. Delusions and hallucinations might occur as well.</p>
<p>A patient suffering from bipolar disorder might display the following symptoms:</p>
<ul>
<li>Severe mood changes      with long periods of overly happy moods;</li>
<li>Intense irritability      over something or someone beyond the normal and rational range;</li>
<li>Irrational impulses      like shopping sprees, impulsive sex, and impulsive business investments;</li>
<li>Lack of sleep for      weeks because of racing thoughts;</li>
<li>Significant twisting      of reality;</li>
<li>Suicidal tendencies      that are frequent because of uncontrollable depression;</li>
<li>Unusually high levels      of energy while feeling sad, lonely and hopeless.</li>
</ul>
<p>This disorder negatively affects relationships, families, friendships, schoolwork and jobs, not to mention the person&#8217;s ability to lead a normal life. As the signs and symptoms of this sickness become more prevalent, public awareness is increasing too. It is not necessarily easy to recognize or understand the behaviours or symptoms of bipolar disorder, and it is only a medical professional who can determine if a person suffers from it.</p>
<p><strong>How is the illness diagnosed?</strong><br />
Diagnosis is performed through a series of laboratory, physical and psychological tests. A psychiatrist is usually the best person to determine if a person indeed has this disorder and what treatment plan is necessary. Family members, friends and spouse are often interviewed after running the series of tests to create the whole historical profile of the patient.</p>
<p>Further, this disorder must be differentiated from unipolar depression, in which there is no manic mood swing and instead just depression. Usually two weeks is given as an observational period to observe these symptoms and reactions to treatment.</p>
<p>How then is the condition treated?</p>
<p>Combining psychotherapy and medicinal intake treatments is usually the best solution to treat this disorder since no cure has been discovered yet. Both medication and psychotherapy are part of a long-term treatment plan since this is a lifelong condition.</p>
<p>Not all patients react the same way with a given medicine plan, so what the doctor does is change it often to determine what combination will work best. The doctor uses a daily life chart to monitor the effects the treatment may have on the patient. As the behaviour changes, the doctor may add or reduce some medications to lessen the bipolar disorder symptoms.</p>
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<title><![CDATA[Treatment need and provision in medium secure care]]></title>
<link>http://lancashirecarelibraryblog.com/2010/02/04/treatment-need-and-provision-in-medium-secure-care/</link>
<pubDate>Thu, 04 Feb 2010 10:30:20 +0000</pubDate>
<dc:creator>lancashirecarelibraryblog</dc:creator>
<guid>http://lancashirecarelibraryblog.com/2010/02/04/treatment-need-and-provision-in-medium-secure-care/</guid>
<description><![CDATA[Treatment need and provision in medium secure care, British Journal of Forensic Practice, Jul; 11(2)]]></description>
<content:encoded><![CDATA[<p><strong><span style="color:#000080;">Treatment need and provision in medium secure care,</span></strong> <span style="color:#339966;">British Journal of Forensic Practice, Jul; 11(2): 24-31</span></p>
<p><span style="color:#000080;">Davies J; Oldfield K</span></p>
<p><span style="color:#000080;">Abertawe Bro Morgannwg University NHS Trust, Swansea University, Chiral</span></p>
<p><span style="color:#339966;"><strong>Abstract:</strong></span></p>
<p><span style="color:#339966;">Individuals being treated in medium <strong><em>secure</em></strong> hospitals have typically engaged in some form of offending in other service settings or while in the community. Although psychological treatment for addressing such behaviour in medium <strong><em>secure</em></strong> hospitals is beginning to be developed, at present there is a lack of evidence of &#8216;what works&#8217;. This paper reports a review of the type and level of offending behaviour engaged in by those in a single medium <strong><em>secure</em></strong> service, including the conviction histories for such behaviours and the psychological approaches to risk reduction and offending behaviour taken in medium <strong><em>secure</em></strong> hospitals in England and Wales. The need to develop an evidence base for psychological treatment in medium <strong><em>secure</em></strong> <strong><em>services</em></strong> including at the individual level is clearly indicated.</span></p>
<p><span style="color:#339966;">Lancashire Care staff can request the full-text of this paper, email: <a href="mailto:susan.jennings@lancashirecare.nhs.uk">susan.jennings@lancashirecare.nhs.uk</a></span></p>
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<title><![CDATA[In Defense of Elder Hafen: Brief Response to FMH]]></title>
<link>http://thinkinginamarrowbone.wordpress.com/2009/09/21/in-defense-of-elder-hafen-brief-response-to-fmh/</link>
<pubDate>Mon, 21 Sep 2009 19:47:42 +0000</pubDate>
<dc:creator>Dennis</dc:creator>
<guid>http://thinkinginamarrowbone.wordpress.com/2009/09/21/in-defense-of-elder-hafen-brief-response-to-fmh/</guid>
<description><![CDATA[Elder Hafen recently gave (at an Evergreen conference) what I consider to be a wonderful speech conc]]></description>
<content:encoded><![CDATA[<p>Elder Hafen recently gave (at an Evergreen conference) what I consider to be a wonderful speech concerning same-sex attraction and gay marriage. It is <a href="http://newsroom.lds.org/ldsnewsroom/eng/public-issues/elder-bruce-c-hafen-speaks-on-same-sex-attraction#_edn24" target="_blank">linked on the LDS Newsroom</a>. This speech is probably the most well-balanced and well-informed article on same-sex marriage by an LDS general authority.</p>
<p>Then, to my dismay, I came across <a href="http://www.feministmormonhousewives.org/?p=2657" target="_blank">this post at FMH</a>, in which ECS criticizes Hafen&#8217;s speech, in particular his use of references. But the FMH post itself is misleading and needs to be critiqued.</p>
<p><!--more-->First, ECS critiques that Hafen cites a paraphrase from a <a href="http://online.wsj.com/article/SB124950491516608883.html" target="_blank">Wall Street Journal article</a> about the recent APA resolution on reparative therapy, rather than the resolution itself. Here is the quote in question, followed by ECS&#8217;s reply:</p>
<blockquote>
<blockquote><p>Just last month the American Psychological Association adopted a resolution stating that there is insufficient evidence to prove conclusively whether sexual orientation can be changed.  But in what the Wall Street Journal called “a striking departure” from that Association’s earlier hesitation about encouraging such therapy, the same resolution also stated that “it is ethical—and can be beneficial—for counselors to help some clients reject gay or lesbian attractions,” especially clients with a strong religious identity.</p></blockquote>
<p>It’s a bit strange that Hafen quotes a paraphrase of the resolution written by WSJ reporter instead of quoting the A.P.A. resolution itself.  I read the APA’s report, and I tried to find this quote.  It didn’t appear in the official APA Resolutions or anywhere in the APA report.   Then I noticed that the WSJ article doesn’t say the quoted language is an APA resolution.  The WSJ article doesn’t say anything about a resolution &#8211; yet Hafen claims that the paraphrased language written by a WSJ reporter  (that is not a resolution) is a resolution sanctioned by the A.P.A.  More importantly, the WSJ paraphrase of a non-Resolution does not accurately characterize any A.P.A. Resolutions.</p></blockquote>
<p>My counters:</p>
<p>1. People often quote paraphrases for rhetorical reasons. The in-text citation and footnote are both correct, at any rate, making it clear that this quote comes from the WSJ article.</p>
<p>2. The WSJ article DOES talk about a resolution! In fact, the very quote ECS provides from the article does:</p>
<blockquote><p>But in a striking departure, the American Psychological Association said Wednesday that it is ethical — and can be beneficial — for counselors to help some clients reject gay or lesbian attractions.</p></blockquote>
<p>What is &#8220;said&#8221; here is the resolution! The fact that Hafen knows this, but apparently ECS does not, shows who has done more research on the matter. In fact, ECS&#8217;s comments betray how little she knows about what happened at the APA meeting last month. At any rate, it is false to say that &#8220;The WSJ article doesn&#8217;t say anything about a resolution.&#8221; Ooh, kind of weakens ECS&#8217;s argument, doesn&#8217;t it? Yes.</p>
<p>3. The WSJ paraphrase DOES accurately characterize the APA resolution. It quotes the chair (note, this is the person <em>in charge</em>) of the resolution explaining the need for this kind of middle-ground with religious groups.</p>
<blockquote><p>&#8220;We&#8217;re not trying to encourage people to become &#8216;ex-gay,&#8217;&#8221; said Judith Glassgold, who chaired the APA&#8217;s task force on the issue. &#8220;But we have to acknowledge that, for some people, religious identity is such an important part of their lives, it may transcend everything else.&#8221; . . . &#8220;They&#8217;re faced with a terrible dilemma,&#8221; Dr. Glassgold said. The profession has to offer alternatives, she says, &#8220;so they don&#8217;t pursue these ineffective therapies&#8221; promising change.</p></blockquote>
<p>I don&#8217;t have time to defend this claim like I would like to, but I do think that Hafen&#8217;s quote is consistent with the spirit of the resolution&#8211;and the quote above speaks to that. Interesting that ECS says nothing about any of this.</p>
<p>Second, ECS asserts that Hafen calls homosexuality a disorder. But he does no such thing. He simply criticizes the motivations in declassifying it in the 1970s. Not quite the same thing as calling it a disorder (e.g., maybe it never should have been called a disorder, but nonetheless its being removed as one was more a matter of political motivations than anything–not an irrelevant point even if it one wouldn’t call it a disorder). It is simply inaccurate to say that he called it a disorder because he did no such thing. In the interest of accurate reporting, ECS would be wise to avoid the very things she is criticizing.</p>
<p><a href="http://www.feedburner.com/fb/a/emailFlare?itemTitle=In%20Defense%20of%20Elder%20Hafen%3A%20Brief%20Response%20to%20FMH%20%C2%AB%20Thinking%20in%20a%20Marrow%20Bone&#38;uri=http%3A%2F%2Fthinkinginamarrowbone.wordpress.com%2F2009%2F09%2F21%2Fin-defense-of-elder-hafen-brief-response-to-fmh%2F" target="_blank">Email a friend</a></p>
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<title><![CDATA[Proposed TX Bill seeks to limit jail time for Psychosis sufferers]]></title>
<link>http://mypostpartumvoice.com/2009/03/31/proposed-tx-bill-seeks-to-limit-jail-time-for-psychosis-sufferers/</link>
<pubDate>Wed, 01 Apr 2009 03:23:30 +0000</pubDate>
<dc:creator>Lauren Hale</dc:creator>
<guid>http://mypostpartumvoice.com/2009/03/31/proposed-tx-bill-seeks-to-limit-jail-time-for-psychosis-sufferers/</guid>
<description><![CDATA[Susan Dowd-Stone shares the following at her blog: Representative Jessica Farrar (D-TX) has introduc]]></description>
<content:encoded><![CDATA[<p>Susan Dowd-Stone shares the following at her blog:</p>
<p>Representative Jessica Farrar (D-TX) has introduced a new bill to the Texas Legislature which could limit jail time for mothers who commit infanticide while suffering from postpartum psychosis. While adoption of this historic bill would not replace or affect the appropriate use of the insanity defense for such crimes – a defense which can eliminate jail time while mandating sustained psychological treatment &#8211; it would limit jail time consideration during the penalty phase to two years for mothers deemed to have been under the influence of a pregnancy or lactation related psychosis within 12 months of giving birth at the time of the offense.</p>
<p><a title="Historic Texas Bill" href="http://perinatalpro.com/blog/?p=184" target="_blank">Click here to read the entire article. </a></p>
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<title><![CDATA['Best Practice' for Women in Medium-Secure Psychiatric Facilities]]></title>
<link>http://lancashirecarelibraryblog.com/2008/09/29/best-practice-for-women-in-medium-secure-psychiatric-facilities/</link>
<pubDate>Mon, 29 Sep 2008 00:02:33 +0000</pubDate>
<dc:creator>lancashirecarelibraryblog</dc:creator>
<guid>http://lancashirecarelibraryblog.com/2008/09/29/best-practice-for-women-in-medium-secure-psychiatric-facilities/</guid>
<description><![CDATA[The development of a best practice service for women in a medium-secure psychiatric setting: treatme]]></description>
<content:encoded><![CDATA[<p><strong><a title="treatment components and evaluation," href="http://www3.interscience.wiley.com/journal/121414714/abstract" target="_blank">The development of a best practice service for women in a medium-secure psychiatric setting: treatment components and evaluation,</a> </strong><span style="color:#339966;">Clinical Psychology &#38; Psychotherapy<br />
Volume 15, Issue 5, Date: September/October 2008, Pages: 304-319</span></p>
<p><span style="color:#339966;"><strong>Abstract:</strong> The inadequacy of inpatient facilities for women with severe psychiatric and co-morbid difficulties has been repeatedly documented. The establishment of effective therapeutic programmes for women in medium psychiatric facilities is also in their infancy, and little research has been undertaken. This article describes the development of a best practice psychological treatment programme for women with a dual diagnosis. Emphasis is placed on the need to develop further intensive gender-specific services using an established model for effective therapeutic service development. In addition to a detailed description of the group therapy programme, staff training initiatives, methods for ensuring treatment integrity and a methodology for service evaluation is given.</span></p>
<p><span style="color:#339966;">For the full-text of this article please email:</span> <a href="mailto:susan.jennings@lancashirecare.nhs.uk">susan.jennings@lancashirecare.nhs.uk</a></p>
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<title><![CDATA[The use of pharmacological treatments for people with personality disorder: A systematic review of randomized controlled trials]]></title>
<link>http://lancashirecarelibraryblog.com/2008/08/30/the-use-of-pharmacological-treatments-for-people-with-personality-disorder-a-systematic-review-of-randomized-controlled-trials/</link>
<pubDate>Sat, 30 Aug 2008 19:38:57 +0000</pubDate>
<dc:creator>lancashirecarelibraryblog</dc:creator>
<guid>http://lancashirecarelibraryblog.com/2008/08/30/the-use-of-pharmacological-treatments-for-people-with-personality-disorder-a-systematic-review-of-randomized-controlled-trials/</guid>
<description><![CDATA[The use of pharmacological treatments for people with personality disorder: A systematic review of r]]></description>
<content:encoded><![CDATA[<p><a title="A systematic review of randomized controlled trials" href="http://www3.interscience.wiley.com/journal/120750041/abstract" target="_blank"><strong>The use of pharmacological treatments for people with personality disorder: A systematic review of randomized controlled trials</strong></a><strong>, </strong><span style="color:#339966;">Personality and Mental Health, Volume 2, Issue 3, Date: July 2008, Pages: 119-170<br />
</span></p>
<p><span style="color:#339966;"><strong>Abstract:</strong></span></p>
<p><span style="color:#339966;">This is a companion paper to our earlier review of psychological treatments for people with personality disorder that examined the evidence from randomized controlled trials (RCTs). Here, we report on the evidence of pharmacological treatments from RCTs for people with personality disorder. As in the previous report, this paper incorporates information from an earlier review that examined the evidence to 2002, and extends it to December 2006. As in the previous paper, this review restricts itself to the findings from RCTs, and excludes evidence from other study designs; however, details of these other studies will be posted in the National Personality Disorder Institute Website (</span><a href="http://www.pdinstitute.org.uk"><span style="color:#339966;">http://www.pdinstitute.org.uk</span></a><span style="color:#339966;">).</span></p>
<p><span style="color:#339966;">For the full-text of this article please email</span>: <a href="mailto:susan.jennings@lancashirecare.nhs.uk">susan.jennings@lancashirecare.nhs.uk</a></p>
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