Chapter 35 - Treatment and rehabilitation of neuropsychiatric disorders Flashcards
How can you define neuropsychiatry?
“…is best
conceptualized as ‘an aspect of psychiatry that seeks to advance the
understanding of clinical problems through increased knowledge of brain
function and structure’” p. 717
What categories does neuropsychiatry tend to see?
◆ those whose psychiatric disorders result from clearly identifiable brain
dysfunction;
◆ patients with psychiatric problems with neurological comorbidity;
◆ patients who present with neurological symptoms in the absence of
underlying neurological disease (Lishman 1992).
Which of the three beforementionend groups:
◆ those whose psychiatric disorders result from clearly identifiable brain
dysfunction;
◆ patients with psychiatric problems with neurological comorbidity;
◆ patients who present with neurological symptoms in the absence of
underlying neurological disease.
Are most likely to be targeted for psychological interventions?
Group 3: patients who present with neurological symptoms in the absence of
underlying neurological disease
What might be necessary before commencing a neuropsychiatric intervention?
Even more assessments - After the necessary investigations for a diagnosis are met, you might need further assessments in order to document the nature of the thought pattern that
may be problematic,the patient’s psychophysiological disturbance, or the frequency or pattern of
occurrence of the behaviour that is to be changed.
Explain the A-B-C model
The antecedents–behaviour–consequences.
the A–B–C model, which assesses the antecedents and setting
events of the behaviour, the behaviour itself, and the consequences of
the behaviour.
Yo fully understand the A-B-C see p. 718
Name some areas of interest in neuropsychiatry regarding the patients’ behavior and background.
- interrelationship between problem behaviours.
- Motivational analysis of the patient’s motivation for treatment.
- developmental factors
- predisposing,
precipitating, and perpetuating factors - the nature of the behaviour and the pattern of its
occurrence (analogue conditions) - the use of
behavioural experiments, where the validity of patients’ automatic
thoughts can be challenged,
Name some of the important aspects for an intervention to be succesful. (What needs to be present for any intervention to ever have an effect?
Awareness and insight. - Schizophrenics and bipolar often lack insight of their own conditions, and it is argued that just having awareness of ones’ illness might be an intervention in it self.
Motivation to change is needed.
A good therapeutic relationship.
What is the six-stage model of change?
the six-stage model of change is an useful guide to therapy, both from the point of developing awareness of problems, and increasing motivation to change.
What are the six stages of the six-stage model of change?
◆ the pre-contemplation stage where others are aware that there is a
problems but the patient has not yet considered the possibility of
changing;
◆ the contemplation stage where the patient is aware of the need to
change but may feel ambivalence over this;
◆ the determination stage where the patient decides to take action;
◆ the action stage where the patient undertakes activities to achieve
change;
◆ the maintenance stage where additional skills are learned to prevent
relapse;
◆ the relapse stage where the patient learns to cope with relapse. (p. 721)
Which precautions might be necessary if the patient have cognitive impairments?
◆ The clinician may need to make therapy sessions more highly
structured;
◆ The sessions may need to occur with greater frequency.
◆ The sessions might need to deal with more specific behaviours,
possibly in a more concrete way.
◆ It may be necessary to adapt therapy techniques and materials to
overcome a person’s memory or reading impairments.
Does cognitive-based therapy (CBT) work on psychosis? Schizo and bipolar?
9 months of CBT, directed at
medication-resistant symptoms of psychosis, led to a reduction in the
distress caused by delusions and in the frequency of hallucinations,
with the improvement persisting at an 18-month follow-up.
Can you name a few disorders that might benefit from Cognitive based therapy?
EVERY SINGLE ONE OF THEM APPARENTLY.
People with general social aggression, people with psychosis, people with depression, people with stroke, even people with Parkinson’s disease seem have some betterment through CBT - p. 723-725.
It just has to be designed to the specific target group.
Who might not benefit from CBT?
stroke patients with intercurrent illness and further stroke might not
benefit from treatment;
◆ patients with impaired memory and reasoning abilities might be less
able to understand the concepts underpinning the treatment and
therefore might have difficulty applying them independently.
Probably other impairments as well..
Name some approaches of treating somatoform disorders (e.g.
somatization disorder, conversion disorder, hypochondriasis), factitious
disorders, and dissociative disorders.
there is increasing evidence that cognitive behavioural
approaches may be of considerable value in treating a number of such
disorders. (p. 727)
Other therapeutic approaches for somatization disorder have included
behaviour therapy, exploratory psychotherapy, and group psychotherapy (p. 727)
Name some issues to consider when implementing treatment of somatoform disorders.
◆ Patients should come for psychological treatment having been told
clearly what illness(es) they do and do not have, and the symptoms
and disability that will and will not be attributable to any such
illnesses.
◆ They should come for treatment already knowing that they are to see
someone who will be treating their disorder from a psychological
perspective, not from a medical one
◆ This should be preceded by a clear account given to the patient to
indicate that all necessary investigations have been undertaken. p. 728
