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Symptoms, Causes, and Interventions in Disorders, Essay Example

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Essay

Psychotic Disorders – Symptoms and Causes

The first main type of psychotic disorders is schizophrenia.  Positive symptom schizophrenia may be brief or a recurring disorder.  It is characterized by its active delusions and hallucinations, and is linked to the hyperactive dopamine system (Preston, 2009, p. 40).  Negative symptom schizophrenia does not contain active delusions and hallucinations, and is marked by anhedonia, flat affect, and social withdrawal.  An earlier onset of negative symptom schizophrenia is normally seen.

The second type of psychotic disorders is from psychotic mood disorders.  These psychotic symptoms can be seen in conjunction with poor reality testing.  Depressed and excited states are seen in psychotic mood disorders.

Neurological conditions can also account for psychotic disorders, which makes up the third main group of psychotic disorders.  For instance, head injury can result in certain diseases and produce psychotic behavior.  A number of metabolic and toxic states result in delirium, according to Preston (2009, p. 41).

According to Preston (2009), there are several diseases and disorders that may cause psychosis.  Addison’s disease, delirium, dementias, Huntington’s chorea, multiple sclerosis, pancreatitis, pellagra, porphyria, and temporal lobe epilepsy are among others that can be found in this category (p. 41).  Additionally, the following classes of drugs may cause psychosis: sympathomimetics, anti-inflammatory drugs, anticholinergic drugs, hallucinogenic drugs, and L-dopa (p. 42).

Interventions

Medical treatments are numerous in terms of drugs for psychotic disorders.  Preston (2009) notes that the correct drug is chosen almost exclusively in regards to the listed side effects (p. 43).  These side effects often rest on how well the patient is able to deal with the initial side effects, which is the most common reason for relapse (p. 43).  The five primary side effects are sedation, anticholinergic (ACH) effects, extrapyramidal (EPS) effects, weight gain, and metabolic effects (p. 43).

The first class of EPS side effects is Parkinson-like side effects.  Consisting of those similar to Parkinson’s disease, this class is characterized by those such as flat affect, tremor, and muscular rigidity.  However, these must be contrasted from the primary forms of schizophrenia.  Anticholinergic agents are useful in eliminating Parkinson-like effects.

The second class of EPS side effects is akathisia.  Contrasted from anxiety, akathisia is characterized by inner restlessness.  It is partially alleviated through the use of anticholinergic agents.  Preston (2009) notes that diphenhydramine, propranolol, and minor tranquilizers can be more successful (p. 44).

The third class of EPS side effects is acute dystonias.  These are characterized by muscle spasms and contractions normally along the head and neck.  Intramuscular anticholinergic agents quickly treat these effects.  Otherwise oral anticholinergics can treat the side effect prophylactically.

The fourth and final class of EPS side effects is tardive dyskinesia (TD).  Often irreversible, TD is seen as late in onset for EPS.  According to Preston (2009), it affects one in four after seven years of continuous treatment, or one in twenty-five after one year (p. 44-45).  Chorea in the trunk and extremities, combined with sucking and smacking of the mouth and lips involuntarily characterize TD.  While baclofen, sodium valproate, lecithin, and benzodiazepines can reduce TD symptoms, there is no cure (p. 45).

Among the other classes of side effects relative to antipsychotic medications, there are serious side effects that exist.  Careful monitoring must take place in order to monitor for a number of side effects that can have several implications on the patient’s health.  Heat stroke, neuroleptic malignant syndrome, and other conditions that can jeopardize a patient’s health or lead to death can be seen as a result of the side effects related to antipsychotic medications.

According to Pataracchia (2005), nutritional supplements are an important constituent to the prescribed medication.  From this nutritional adjunct therapy has been seen to maintain and important part of the treatment of schizophrenia, as seen in this article, and in other psychotic disorders.  Optimal dosing for neuroleptics in conjunction with nutritional supplements is best for a patient (Pataracchia, 2005).

Psychotherapeutic intervention can also be effective, although this has not always been the case.  Patients are able to make changes in their behavior, especially in conjunction with antipsychotic drugs.  Cognitive-behavioral therapy and sociocultural therapies represent the two most helpful forms of therapy.

Cognitive-behavioral therapy helps to change the way patients react to hallucinatory experiences.  If the fear, confusion, and other related symptoms are generated from the way in which the patient is unable to view such events, cognitive-behavioral therapy has been demonstrated to help in this manner.  Cognitive-behavioral therapy can help the patient to rational these experiences, which can then produce a clearer picture and eliminate related symptoms from the experiences.

Cognitive-behavioral therapy first presents the patient with the biological causes of hallucinations.  Then the patient is able to understand the triggers and situations in which they appear and are eliminated.  Thus, the patient is able to avoid such situations.

Cognitive-behavioral therapy also teaches the patient how to resist hallucinatory voices.  In conjunction with this, the technique of realizing that the voice is not real is utilized.  In general, cognitive-behavioral therapy helps the patient cope with hallucinatory and related symptoms.  Therapists have also identified ways in which to lessen the effects, such as simulating voices in order to focus not on the hallucinatory voices, in order to cope with these symptoms.

Family therapy can also be helpful, especially in regards to the reduction of relapse rates.  Family therapy is able to lessen the tensions within a family that has a member affected by schizophrenia and related disorders, which helps both the patient in his or her treatment program and within the family.  It teaches the family to be more tolerant of the behaviors and to be supportive, which again is useful for the patient and for family members.

Social or personal therapy can be helpful for the patient.  This type of therapy addresses techniques in order to help the patient with personal and social difficulties within their lives.  Social, problem solving, and decision making skills are stressed in these types of therapy.  It can also focus on various topics, such as finances, health care, and to determine if the patient is taking his or her medications.

On a broader level, the community approach is seen most commonly in regards to schizophrenia, which was affected most in the Community Mental Health Act.  This made communities responsible for health care for those affected with different types of disorders.  Deinstitutionalization allowed schizophrenic patients to receive treatment in the community.

Obsessive-Compulsive Disorder – Symptoms and Causes

Obsessive-compulsive disorder evidently involves both obsessions and compulsions in the disorder.  Obsessions are the thoughts, images, and other objects that seem to invade a person’s consciousness.  Compulsions are behaviors that an individual believes must happen in relationship to his or her anxiety.

Most people are familiar with obsessions and compulsions.  In fact, it is believed to be helpful to have rituals to help in times of stress.  However, a diagnosis of obsessive-compulsive disorder is called for when these actions, take up a lot of time, cause distress, or interfere with daily functions, as seen in DSM-IV-TR and others (Preston, 2009, p. 50).  It is technically an anxiety disorder as these obsessions and compulsions are executed to reduce anxiety.  Additionally, anxiety rises in individuals when these obsessions and compulsions are resisted at times.

There are a number of causes that are theorized to obsessive-compulsive disorder.  The psychodynamic perspective looks at id impulses and ego defense mechanisms.  The behavioral perspective concentrates on explaining compulsions in regards to anxiety, as compulsions are believed to be regarded as coincidental actions, where the improvement is linked to the compulsion as the threat is released.  The cognitive perspective regards these behaviors in affected individuals where the individual believes that he or she is to blame for such thoughts, and the ensuing terrible things that may happen.

Biologically abnormal serotonin activity is linked as a cause of obsessive-compulsive disorder.  This was due to the success of the antidepressant drugs clomipramine and fluoxetine, which were found to reduce obsessive and compulsive symptoms.  Thus, many believe it to be caused by low serotonin levels.  Furthermore, glutamate, GABA, and dopamine are believed to be key in the development of the disorder.

Abnormal functioning in key regions of the brain is believed to be another major biological cause of obsessive-compulsive disorder.  The orbitofrontal cortex and the caudate nuclei are the primary areas in which this is claimed.  In regards to these areas of the brain, these regions of the brain circuit convert sensory information into thoughts and actions.  Researchers believe that either the orbitofrontal cortex or the caudate nuclei are too active, causing troublesome thoughts.  Additionally, the cingulate cortex and the amygdala have been identified in the brain circuit as well.

Interventions

In terms of medication, there are options for the treatment of obsessive-compulsive disorder.  Serotinergic antidepressants include typical medications for the disorder, including clomipramine, fluoxetine, sertraline, paroxetine, and others (Preston, 2009, p. 50).  With regards to chronic medication treatment, improvements are normally seen within the first twelve months of treatment.  After this time a plateau is normally reached.

A common form of psychotherapy can be seen in behavioral therapy for obsessive-compulsive disorder.  This involves what is known as exposure and ritual prevention.  Therapists work with patients to allow them to resist common obsessions and compulsions, where they learn to control such thoughts.

There are also additional forms of psychotherapy that are used.  Psychodynamic therapists work to identify and find techniques to their underlying conflicts and defenses.  Cognitive therapy looks at habituation training to look at obsessive thoughts over and over again.  These techniques help provide clarity and ways in which patients can exercise control.

Borderline Personality Disorder– Symptoms and Causes

Borderline personality disorder is a complex disorder characterized by great instability.  It involves major shifts in mood, an unstable self-image, and impulsivity.  It also has a great effect on the individual’s relationship, making them unstable as well.

Individuals with borderline personality disorder shift in and out of many states.  It is not uncommon for an affected individual to move from very depressive, anxious, and irritable states that can last from a few hours to a few days or more.  Many feel emptiness and are conflicting in terms of their emotions.

Anger is another primary dimension of the disorder.  Sufferers engage in a number of destructive activities, such as self-injurious or self-mutilation behaviors.  For many, the physical discomfort offers relief from emotional suffering.

Identity is also affected in borderline personality disorder.  Friends, goals, aspirations, and even sexual identity can change.  Dissociation can also be seen in the many effects in identity of borderline personality disorder.

Theorists hold a number of causes for borderline personality disorder.  Psychodynamic theorists look at the early relationships, such as one’s parent, to explain the disorder.  Early lack of acceptance and sexual and other types of abuse experienced as a child are commonly seen as causes by theorists.  Additionally, biosocial and sociocultural theories are used to explain the development of borderline personality disorder.

Biological abnormalities are seen to contribute to the development of borderline personality disorder.  Lower brain serotonin activity is seen in regards to sufferers who are particularly impulsive.  The serotonin transport gene 5-HTT is also seen to be linked to the development of the disorder.

Interventions

There are a number of recommended medical treatments for borderline personality disorder, as outlined by Preston (2009).  Serotonic antidepressants are appropriate for anger control problems and compulsivity.  It along with atypical antipsychotics are appropriate for extreme sensitivity to rejection and being alone (p. 51).

Additional subgroups require different types of medication for borderline personality disorder.  Low doses of antipsychotic medications are appropriate for schizotypal tendencies, such as strange thinking and transient psychosis.  Lithium, divalproex, and atypical antipsychotics are appropriate for emotional instability, with respect to treatment options for borderline personality disorder (Preston, 2009, p. 51).

Psychotherapy can be useful in borderline personality disorder.  It is however difficult to balance the feelings of anger and dependency of the patient with that of challenging his or her way of thinking.  This has caused some therapists to refuse treating individuals with the disorder, in light of the difficulties.

Relational psychoanalytic therapy has proved to be more effective than traditional psychoanalytic approaches.  These take on a more supportive and egalitarian focus.  These approaches allow the patient to look at unconscious conflicts and pay attention to their central relationship disturbance.

Dialectical behavior therapy is often regarded as the treatment of choice, in regards to therapy for borderline personality disorder.  This method stems from the cognitive-behavioral treatment model, and uses a number of techniques applied to other disorders.  It also stresses the client-therapist relationship, where the therapist can empathize with borderline clients and examine the patient’s needs.

Attention Deficit Hyperactivity Disorder– Symptoms and Causes

Attention deficit hyperactivity disorder (ADHD) involves difficulties related to attending to tasks.  It can also relate to overactive or impulsive behavior, or display both characteristics.  According to Preston (2009), it affects 5% of children (p. 52).

There are a number of symptoms that feed into one another.  The hyperactivity and difficulty attending to tasks can undermine each other.  Additionally, children can have learning, communication, anxiety, or mood problems as well.

Symptoms of inattention must persist for at least six months to obtain a diagnosis of ADHD.  Failure to listen when spoke to directly and to follow through on instructions are among the direct symptoms.  Losing items, forgetting things in daily activities, and failure to give attention to details also characterize these symptoms of inattention.

Symptoms of hyperactivity and impulsivity must also persist for six months to obtain a diagnosis of ADHD.  Mechanical fidgeting, wandering to and from places and seats, and running and climbing in inappropriate situations characterize such examples.  Excessive talking, blurting out answers before the question is completed, and interrupting others characterizes some verbal symptoms of hyperactivity and impulsivity in ADHD.

It is important to note that these symptoms must be present to a degree that is maladaptive to a child’s development level.  In children, these symptoms must be present before the age of seven.  These symptoms must also be present in at least two settings in which the impairment can be seen.  Finally, it is important that the symptoms represent significant impairment in the child.

The biological factors for ADHD have been identified.  The primary cause is believe to be in the abnormal activity of dopamine, and additionally in the frontal-striatal regions of the brain.  High levels of stress and family dysfunctioning have also been identified.

Interventions

Primarily medical treatment options for ADHD are represented in stimulants (Preston, 2009, p. 52).  There are a number of options under this category.  Amphetamine, dextroamphetamine, dexmethylphenidate, and methylphenidate are four that can become abused for those who may become dependent upon drugs (p. 52).  Antidepressants or pemoline do not incur such risks in regards to abuse potential.

For the most part ADHD will be treated medically, at least for adults (Preston, 2009, p. 53).  According to Preston, stimulants have been demonstrated to be better in controlling ADHD symptoms, although others are helpful (p. 53).  Cardiac screening prior to treating patients with a stimulant is recommended, due to risk of sudden cardiac death or arrhythmias (p. 53).

Behavioral therapy is often used in cases of ADHD.  In this form of therapy, teachers and parents are able to reward children when they are self-aware or attentive.  This enables the children to see the effects of their behavior in the reward that is given.

Behavioral therapy is also useful when combined with stimulant drug therapy.  Behavioral therapy can be more effective when it is combined with drug therapy.  This has the added benefit of lowering the child’s medication, which thus lessens the control of the undesirable effects of the medication.

There are approaches that are appropriate for children who display comorbid psychological disorders.  Medication is the most appropriate approach for children with both ADHD and conduct disorder.  Children with ADHD and anxiety disorders can benefit from medication or behavioral therapy, or both.  A combination of ADHD, conduct disorder, and anxiety symptoms respond well to medication and behavioral therapy.

Aggression – Symptoms and Causes

There are a number of symptoms identified with aggression.  Violence, irritability, and hostility makeup a major part of the symptoms related to aggression.  It can be either episodic or chronic.

Preston (2009) notes a number of psychiatric disorders that can involve symptoms of aggression.  Conduct disorder, depression, explosive disorder, mania, paranoid disorder, schizophrenia, and others have been identified with that of aggression (p. 54).  In these examples and others that fill the spectrum of psychiatric disorders, there are a significant number of conditions that involve aggression.

In children, there are a number of known triggers for aggressive behavior.  Physical fear of others and emotional trauma have been identified.  Difficulties in a child’s family can also trigger aggressive behavior.  Additionally, there are a number of learning, neurological, conduct, or behavior disorders that can trigger aggressive behavior.

The brain has been revealed as a cause of aggression.  The hypothalamus and periaqueductal gray of the midbrain are two areas which are believed to be important in controlling aggression.  It plays a major role in controlling and directing aggressive behavior in mammals.

Aggression also points to the amygdala as critical in this topic.  Competitive drive and aggression has been identified in this area of the brain.  The medial nucleus and the cortical nuclei demonstrated differences in the involvement of such behavior as others that were not determined to be involved in aggression.

Additionally, the prefrontal cortex (PFC) has been identified as having a possible role in aggression.  Violent and antisocial behavior has been linked to reduced activity of the PFC.  Aggression in the PFT has been linked to serotonin specifically.

Testosterone has traditionally been seen to be linked with aggressive behavior.  It is not known to what extent testosterone levels play in aggression.  While higher testosterone levels have been seen to link to aggression, it has not been clearly determined to what extent testosterone plays in aggression.

Serotonin and testosterone are the two most well-known links to aggression.  However, there are other hormones and neurotransmitters that are implicated in aggression as well.  Within the anterior hypothalamus, large amounts of the neurotransmitter vasopressin have been shown to increase aggressive behaviors.  Additionally, other neurotransmitters such as cortisol, norepinephrine, and others are being researched to look at their link to aggressive behaviors in humans.

Interventions

Generally the strategy for treating aggression is to treat the primary disorder.  For instance, if schizophrenia is the primary disorder that may be the cause for the aggressive behavior, antipsychotics for the schizophrenia would be the recommended choice.  According to Preston (2009), a number of alternative medication treatments exist: antipsychotics, anticonvulsants, beta blockers, busipirone, clonidine, lithium, and SSRIs (p. 54).

Preston (2009) notes that there has been no single treatment for aggressive behavior that has a high rate of success (p. 54).  Atypical antipsychotics remains the most commonly prescribed class of medications (p. 54).  In light of these attempts, while such medications demonstrate success in some individuals, high levels of aggression remain a difficult characteristic to treat.

Eating Disorders – Symptoms and Causes

Anorexia nervosa and bulimia make up the two primary forms of eating disorders.  Bulimia is characterized by periodic binge eating, where the individual purges the food afterwards.  In this binge eating, an individual eats much more than what most people would eat in this time period, which is normally around an hour.  A person may exhibit nonpurging-type bulimia nervosa, which is characterized by fasting or excessive exercising to compensate for not purging the food.

Anorexia nervosa is characterized by an intense fear of gaining weight.  One believes that he or she may become fat, and thus fails to maintain the appropriate body weight for one’s age and features.  Anorexia is much more commonly found in women that in men.

The causes of eating disorders are many.  Most researchers use a multidimensional risk perspective to explain eating disorders.  In these key factors that place an individual at risk, more factors are linked to a higher risk of an individual engaging in an eating disorder.  Psychological problems of the ego, cognitive, and mood disturbances are given.  Additionally, sociocultural conditions within society, family, and multicultural dimensions are also given to explain eating disorders.

There are many links made in regards to biological explanations.  Genetics is given as having a major role in the onset of eating disorders.  Serotonin and areas of the hypothalamus are pointed towards in the conversation of eating disorders as well.

Interventions

Anorexia nervosa is generally not responsive to psychotopic medications.  In regards to delusional thinking, atypical antipsychotics are best for dealing with the thoughts around the need to lose weight (Preston, 2009, p. 55).  A psychiatrist can help identify relevant treatments although there are no successful medications that have been demonstrated to assist with anorexia nervosa.

Bulimia is more responsive to medical treatments.  The treatment of bulimia is recommended to take a similar course to that of depression.  Preston (2009) notes that the anticonvulsant topiramate is being regarded well in bulimia and binge eating (p. 55).  Antidepressants may not be well suited for bulimia as they lower the seizure threshold for patients (p. 55).

Psychotherapy is used for the treatment of eating disorders as well.  In fact, there are many perspectives in this regard.  However, to generalize the forms of psychotherapy in regards to eating disorders, strides are made to look at the root of these patterns.  Establishing healthy eating habits are also a goal, often in conjunction with medications.

Alternative treatments also exist for eating disorders.  Such perspectives can of course be made in conjunction with psychotherapy and drug therapies.  Ross (2000) has identified vitamins and miners that can be instrumental in dealing with eating disorders.  According to Ross, thiamin is one such example (2000).  Individuals are recommended to eat foods that are high in this vitamin, such as whole grains, beans, and vegetables.  Additionally, Ross has identified zinc as integral, in foods such as red meat, egg yolk, and sunflower seeds (2000).  This mineral has been identified as important in maintaining appetite, which can be instrumental in weight gain, better body function, and improved outlook (2000).  According to Ross, these two examples, as well as others, can be viewed as factors in the cause of eating disorders (2000).

Post-Traumatic Stress Disorder – Symptoms and Causes

Post-traumatic stress disorder (PTSD) is diagnosed when symptoms last for longer than a month.  PTSD is characterized in the aftermath of a traumatic event.  Events such as death, serious injury, or a threat to the physical integrity of someone, whether it is the individual or others, often characterize the traumatic experience.

PTSD incurs a number of symptoms that are followed after the traumatic event.  Many people re-experience the traumatic event and have recurring thoughts, dreams, and memories of the situation.  Avoidance occurs in relationship to activities that remind the individual of the traumatic event.

Additional emotions and states follow individuals with PTSD.  Reduced responsiveness is seen in individuals, where they lose interest in activities that were previously enjoyed.  Arousal, anxiety, or guilt is also seen as these elements are increased in a person who has PTSD.  These emotions are often felt in regards to the event itself an in coping with situations and life in general.

There are a number of causes for PTSD.  Trauma can develop PTSD, such as combat, disasters, victimization, and other events.  Biological and genetic factors also entail for the onset of PTSD.  Personality, childhood experiences, social support, multicultural factors, and the severity of the trauma are also linked to the cause of PTSD.

Interventions

PTSD can see a number of treatment options.  However, psychotherapy remains the primary choice in treating PTSD.  Certain symptoms may be targeted with the use of psychotropic medications.

Preston (2009) notes a number of special cases in regards to treatment medications for PTSD.  Low doses of an antipsychotic agent over a short course can be helpful for transient psychotic symptoms.  A number of medications can be used for intrusive symptoms, as SSRI antidepressants remain the best option.  Alpha adrenergic agonists and beta blockers can be effective in treating acute PTSD (p. 55-56).

A combination of approaches is normally used, as no single response reduces all of the symptoms.  Drug therapy, behavioral exposure techniques, insight therapy, family therapy, and group therapy represent the most common approaches.  Approaches such as these are combined in response to PTSD.

In terms of therapeutic techniques, eye movement desensitization and reprocessing (EMDR) is widely used.  This technique involves saccadic movement of the eyes while using a number of images from the traumatic event, or images and situations that are avoided.  This method has been determined to be useful to individuals with PTSD.

Group therapy is often helpful for veterans.  This is commonly referred to in the use of rap groups.  Rap groups allow individuals to meet together to share their experiences.  It allows mutual support to be seen and insights, feelings, and support to be shared among individuals.

Psychological debriefing is also seen, often in response to disasters, victimization, or accidents.  These sessions, also referred to as critical incident stress debriefing, allows individuals to talk extensively regarding the trauma about their responses within days of the event.  It is often conducted in a group format in order to help prevent or reduce stress reactions.

References

Pataracchia, Raymond. (2005). Optimal Dosing for Schizophrenia. Journal of Orthomolecular Medicine, Volume 20 (2), 93-99.

Preston, John and James Johnson. (2009). Clinical Psychopharmacology Made Ridiculously Simple. Miami, FL: MedMaster.

Ross, Julia. (2000). Natural Treatment of Anorexia and Bulimia. International Guide to the World of Alternative Mental Health. Retrieved from: http://www.alternativementalhealth.com/articles/anorexia.htm

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