Peppered with mnemonics, ward tips, exam tips, and integrated mini-cases, the fourth edition of this best-selling book focuses on helping you hone in on, and remember, the most important concepts for the clerkship and the exam. Matthew S. E-Book Description.

First Aid for the Psychiatry Clerkship 4th Edition PDF Free Download The 1-selling psychiatry clerkship book provides just what you need to deliver a strong performance on the psychiatry clerkship and earn honors on the shelf exam. E-Book Details. Table of Contents. Chapter 1. How to Succeed in the Psychiatry Clerkship Chapter 2.

Examination and Diagnosis Chapter 3. Psychotic Disorders Chapter 4. They always occur secondary to an under- Treating a delirious patient lying medical condition. See chapter on Dissociative Disorders for discussion is often a FEUD: of amnestic syndromes caused by psychiatric disorders. Though the elderly are susceptible to the same Axis I disorders as younger adults, certain diagnoses are more prevalent in this population, such as cognitive disorders and major depression. Also, illnesses often have differ- ent clinical presentations in the elderly and may require unique treatments.

Approach to the Geriatric Patient Geriatric patients should undergo the same psychiatric assessment as younger adults, including the mental status exam. In patients who suffer from cogni- tive disorders, family members or caretakers may need to be interviewed to obtain collateral information.

A careful history of current medications should be taken, as drugs often produce adverse behavioral, cognitive, and psychiatric symptoms in the elderly, and elderly individuals may be taking multiple med- ications at the same time. A person of any age who is dealing with loss or death experiences these same stages. Symptoms of major depression in the elderly often include problems with memory and cognitive functioning; because this clinical picture may be mis- taken for dementia, it is termed pseudodementia.

Patients may appear demented; however, their symptoms are only secondary to their underlying depression. It can be difficult to differ- entiate the two. Always investigate a possible diagnosis of major depression when when they do not know an an elderly person presents with nonspecific complaints such as these.

It is important to be able to distinguish normal grief reactions from pathological ones depression. Elderly people often re- port difficulty sleeping, daytime drowsiness, and daytime napping. The causes of sleep disturbances may include general medical conditions, environment, and medications, as well as normal changes associated with aging.

These episodes are redistributed throughout the sleep cycle and are shorter than normal. Total amount of REM sleep re- mains about the same as with younger adults. Therefore, other approaches should be tried first, including alcohol cessation, increased structure of daily routine, elimination of daytime naps, and treatment of underlying medical conditions that may be exacerbat- ing sleep problems.

If sedative-hypnotics must be prescribed, medications such as hydroxyzine Vistaril or zolpidem Ambien are safer than the more sedating benzodiazepines. Patients who are restrained suffer both physically and psychologically.

Always try alterna- tives such as closer monitoring or tilted chairs. Medications Many older people are on multiple medications. They suffer from more side effects because of decreased lean body mass and impaired liver and kidney function. When confronted with a new symptom in an elderly patient on multiple medications, always try to remove a medication before adding one.

Approximately half the patients stay on per- manently, and half are discharged after only a few months. Old-Age Homes Institutions in which the elderly can live for the rest of their lives, with no at- tempt to rehabilitate.

Learning disorders affect academic achievement or daily activities and cannot be ex- plained by sensory deficits, poor teaching, or cultural factors. They are often due to deficits in cognitive processing abnormal attention, memory, visual perception, etc. His social norms and rules, with at least three acts within the following categories mother reveals that he often during the past year: pokes the cat they have at 1. Aggression toward people and animals home with sharp objects.

Destruction of property Think: Conduct disorder. Deceitfulness 4. In- Unlike conduct disorder, dividual psychotherapy that focuses on behavior modification and problem- ODD does not involve solving skills is often useful. Adjunctive pharmacotherapy may be helpful, violation of the basic rights including antipsychotics or lithium for aggression and selective serotonin re- of others. Arguments with adults does not comply in any 3.

His behavior 4. Deliberately annoying people is appropriate toward his 5. Easily annoyed 6. Anger and resentment classmates. Spiteful Oppositional defiant 8. Blaming others for mistakes or misbehaviors disorder ODD. Treatment should involve individual psychotherapy that focuses on behavior modification and problem-solving skills as well as parenting skills training.

Onset before age 7 ADHD. Parental counseling education and parenting skills training 4. Group therapy—to help patient improve social skills, self-esteem, etc. Impairment is noticeable at an early age of life and involves multiple areas of development. Think: Autism. It almost always begins before age 3. Restricted or stereotyped behaviors, interests, or activities inflexi- ble routines, repetitive movements, preoccupations, etc.

Social skills training and behavioral modification techniques may be useful. Normal prenatal and perinatal development 2. Normal psychomotor development during the first 5 months after birth in girls; early development 3. Normal head circumference at birth, but decreasing rate of head appears normal, but growth between the ages of 5 and 48 months diminished head 4.

Loss of previously learned purposeful hand skills between ages 5 and 30 circumference and months, followed by development of stereotyped hand movements stereotyped hand such as hand wringing, hand washing, etc.

Early loss of social interaction, usually followed by subsequent im- ensue. Cognitive provement development never 6. Problems with gait or trunk movements progresses beyond that of 7. Severely impaired language and psychomotor development the first year of life. Seizures 9. Normal development in the first 2 years of life 2. Tics are involuntary movements or vocalizations. Vocal tics may first appear many years after the motor tics. The most common motor tics involve the face and head, such as blinking of the eyes.

Enuresis is the invol- untary voiding of urine bedwetting. Rule out medical conditions urethritis, diabetes, seizures. Primary—child never established urinary continence. The great majority of cases Secondary—manifestation occurs after a period of urinary continence, of enuresis spontaneously remit by age 7.

Encopresis Bowel control is normally achieved by the age of 4. Bowel incontinence can result in rejection by peers and impairment of social development. One must rule out conditions such as metabolic abnormalities such as hypothyroidism , lower gastrointestinal problems anal fissure, inflammatory bowel disease , and dietary factors. It is characterized by not speaking in certain situations such as in school. Onset is usually around age 5 or 6, and it may be preceded by a stress- ful life event.

Treatment involves supportive psychotherapy, behavior therapy, and family therapy. Children with this disorder may refuse to go in Children to school or to sleep alone. They may complain of physical symptoms in order to avoid having to go to school. When forced to separate, they become ex- tremely distressed and may worry excessively about losing their parents for- ever.

Onset is usually around age 7 and may be preceded by a stressful life event. Parents are often afflicted with anxiety disorders and may express excessive concern about their children. Treatment involves fam- ily therapy, supportive psychotherapy, and low-dose antidepressants. Child Abuse Child abuse includes physical abuse, emotional abuse, sexual abuse, and ne- glect.

Doctors are legally required to report all cases of suspected child abuse to appropriate social service agencies. In cases of suspected abuse, children may be admitted to the hospital without parental consent in order to protect them. They also have an increased risk of subsequently abusing their own children. Amnesia and feelings The phenomenon of of detachment often arise suddenly and may be temporary in duration.

Instead, their onset is related to a stressful life event or personal problem. Many patients with dissociative disorders have a history of trauma or abuse during childhood. However, the diagnosis of dissociative amnesia re- quires that amnesia be the only dissociative symptom present. Patients with this disorder are usually aware that they are having difficulty remembering but are not very troubled by it.

This is opposite to and cannot be explained by another disorder, medical condition, or sub- the type of memory loss stance use. Think: Dissociative Many patients abruptly return to normal after minutes or days. Recurrences amnesia. Hypnosis or administration of sodium amobarbital or lorazepam during the interview may be useful to help patients talk more freely. Subsequent psychotherapy is then recommended. Patients often assume an entirely new identity and occupation after arriving Dissociative Fugue— in the new location.

They are unaware of their amnesia and new identity, and Fugitives take off and form they never recall the period of the fugue. After the episode, the patient will assume his or her old identity without ever re- membering the time of the fugue. Patients with dissociative identity disorder have A year-old sanitation two or more distinct personalities that alternately control their behaviors and worker currently lives in thoughts.

Patients are often unable to recall personal information. While one Baltimore for the past 2 personality is dominant, that personality is usually but not always unaware years. He moved from of events that occurred during prior personality states.

Up to one third of pa- Symptoms of multiple tients attempt suicide. She denies his accusations and has no Depersonalization disorder is characterized by persistent or recurrent feelings memory of the event.

Patients feel separated from their bodies and mental processes, as if they disorder multiple are outside observers.

They are aware of their symptoms and often fear they personality disorder. Depersonalization is often accompanied by anxiety or panic. Diagnosis requires that episodes be persistent or recurrent, as transient symp- toms of depersonalization are common in normal people during times of stress. They truly believe that their symptoms are due to medical problems and are not consciously feigning symptoms.

Primary gain: Expression of unacceptable feelings as physical symptoms in order to avoid facing them Secondary gain: Use of symptoms to benefit the patient increased atten- tion from others, decreased responsibilities, avoidance of the law, etc.

With the exception of hypochondriasis, somatoform disorders are more com- mon in women. One half of patients have comorbid mental disorders, espe- cially anxiety disorders and major depression. They have a long-standing history of numer- ous visits to doctors. Symptoms may periodically improve and symptoms involving several then worsen under stress.

She is a psychiatrist. Secondary gain should be minimized. Medications should be resistant to psychiatric used with caution and only with a clear indication; they are usually ineffec- referral.

Think: tive, and patients tend to be erratic in their use. Relaxation therapy, hypnosis, Somatization disorder. Onset is always preceded or exacer- bated by a psychological stressor, although the patient may not connect the Conversion disorder: two. Patients are often surprisingly calm and unconcerned la belle indifference Patients convert when describing their symptoms, which may include blindness or paralysis.

She seems disorders calm and indifferent. Symptoms resolve within 1 month. Symptoms may spontaneously resolve after hypnosis or sodium amobarbital interview if the psychological trigger can be uncovered during the interview. Most patients spontaneously recover. Patients either fear having a disease or are convinced that one the medical clinic with is present. They misinterpret normal bodily symptoms as indicative of disease. He terpretation of normal body symptoms.

Episodic—symptoms may wax and wane periodically. Exacerbations occur Think: Hypochondriasis. Patients are usually resis- tant to psychotherapy.

Group therapy or insight-oriented psychotherapy may be helpful if patient is willing. Though their physical imperfections are either minimal or completely imagined, patients view them as severe and visits a plastic surgeon grotesque. The pain often co-exists with a medical condition but is not directly caused by it. Patients often have a history of multiple visits to doctors.

SSRIs, transient nerve stimulation, biofeedback, hypnosis, and psychotherapy may be beneficial. Primary gain is a bacteremia. The patient prominent feature of this disorder see definition p. These patients may take insulin, con- When the patient is sume blood thinners, or mix feces in their urine in order to produce symp- confronted with the toms of medical disease. In addition, they will often demand specific hypothesis that he has medications.

They are very skilled at feigning symptoms necessitating been injecting himself with hospitalization. Inpatient hospitaliza- tion resulting from abuse provided a safe, comforting environment, thus link- ing the sick role with a positive experience.

Patients who are confronted while in the hospital usually leave. Common external motivations include avoid- back pain, knee pain, and ing the police, receiving room and board, obtaining narcotics, and receiving blurry vision since a minor monetary compensation.

Somatoform Disorders car accident 8 weeks ago. After the to a known medical condition. They are generally uncooperative and refuse to accept a settlement, his symptoms good prognosis even after extensive medical evaluation. However, their symp- disappear. Think: Malingering. Factitious disorders: Patients pretend they are ill with no obvious external reward.

Malingering most common : Patients pretend they are ill with obvious external incentive. Patients may or may not try to suppress their impulses and may not feel remorse or guilt after they have acted out. Anxiety or tension is often experienced prior to the impulse, and relief or satisfaction results after the behavior is completed.

Impulse control disorders are not caused by another mental condition, general medical problem, or substance use. Patients may have history of child abuse, head Low levels of serotonin trauma, or seizures. Treatment involves use of selective serotonin reuptake inhibitors SSRIs , an- ticonvulsants, lithium, and propanolol.

Individual psychotherapy is difficult and ineffective. There is some anecdotal evidence for naltrexone use. Preoccupation with gambling 2. Need to gamble with increasing amount of money to achieve pleasure 3. Repeated and unsuccessful attempts to cut down on gambling 4.

Restlessness or irritability when attempting to stop gambling 5. Gambling done to escape problems or relieve dysphoria 6. Returning to reclaim losses after gambling 7.

Lying to therapist or family members to hide level of gambling 8. Committing illegal acts to finance gambling 9. Jeopardizing relationships or job because of gambling After 3 months of abstinence from gambling, insight-oriented psychotherapy may be attempted. It is also important to treat comorbid mood disorders, anxiety disorders, and substance abuse problems.

Patients with anorexia or bulimia have a disturbed body image and use extensive measures to avoid gaining weight vomiting, laxatives, excessive exercise, etc. Binge eating may occur in all of the eating disorders. Treatment involves behavioral therapy, family therapy, and supervised weight- gain programs. Some antidepressants may be useful as adjunctive treatment to promote weight gain, such as paroxetine or mirtazapine. Others promote weight loss, so it is important to check side effect profiles before prescribing.

Patients are embarrassed by their bingeing and are overly symptoms are more ego- concerned with body weight. However, unlike patients with anorexia, they dystonic distressing ; usually maintain a normal weight and may be overweight. Think: Treatment may include individual psychotherapy, cognitive—behavioral ther- Bulimia nervosa. Over one half of all people in the United States are obese.

Genetic factors, overeating, and lack of activity may all contribute to the development of obesity. Excess weight is associated with adverse effects on health, including increased risk of diabetes, hypertension, cardiac disease, and osteoarthritis. Patients with this disorder suffer emotional Eating Disorders distress over their binge eating, but they do not try to control their weight by purging or restricting calories, as do anorexics or bulimics.

Eating very rapidly 2. Eating until uncomfortably full 3. Eating large amounts when not hungry 4. Eating alone due to embarrassment over eating habits 5. Comorbid mood disorders or anxiety disor- ders should be treated as necessary.

Up to one third of people in the United States will experience a sleep disorder at some point in their lives.

Primary sleep disorders may be further subdivided into: 1. Dyssomnias—disturbances in the amount, quality, or timing of sleep 2.

Amount of REM sleep decreases with age. Slow-wave sleep is made up first. Disturbance occurs three or more times per week for day it is ingested. Think: Primary room for sleep and sex only. During her lunch of patients ; associated with emotion, particularly laughter hour, she goes to the 2.

Short REM latency lounge and takes a nap, 3. He gets 9 hours DIAGNOSIS of restless sleep every night Sleep disruption and excessive daytime sleepiness EDS caused by abnormal and denies any substance sleep ventilation from either obstructive or central sleep apnea abuse or significant medical illnesses. Think: Narcolepsy. OSA: Nasal continuous positive airway pressure nCPAP , weight loss, Fatigue is being too tired to nasal surgery, or uvulopalatoplasty complete activities.

Subtypes include jet lag type, shift work type, Obstructive sleep apnea— and delayed sleep or advanced sleep phase type. Think: Obstructive sleep apnea. Episodes usually occur during terror disorder or the first third of the night during stage 3 or 4 sleep non-REM. Patients are sleepwalking disorder, not awake and do not remember the episodes. Other motor activity may occur, such as getting dressed, talking, or screaming.

Behavior usually terminates with pa- tient returning to bed, but patient may awaken with confusion for several minutes. Episodes occur during the first third of the night during stages 3 and 4 sleep and are never remembered. Desire: The interest in sexual activity 2. Excitement: Begins with either fantasy or physical contact. It is charac- terized in men by erections and in women by vaginal lubrication, cli- toral erection, labial swelling, and elevation of the uterus in the pelvis tenting.

Both men and women experience nipple erection and in- creased pulse and blood pressure. Plateau: Characterized in men by increased size of the testicles, tight- ening of the scrotal sac, and secretion of a few drops of seminal fluid. Women experience contraction of the outer one third of the vagina and enlargement of the upper one third of the vagina. Facial flushing and increases in pulse, blood pressure, and respiration occur in both men and women. Orgasm: Men ejaculate and women have contractions of the uterus and lower one third of the vagina.

Resolution: Muscles relax and cardiovascular state returns to baseline. Men have a refractory period during which they cannot be brought to orgasm; women have little or no refractory period. However, men usually require more direct stimulation of genitals and more time to achieve orgasm.

The intensity of ejaculation usually decreases, and the length of refractory period increases. After menopause, women experience vaginal dryness and thinning due to de- creased levels of estrogen. These conditions can be treated with hormone re- placement therapy or vaginal creams.

General medical conditions: Examples include history of atherosclero- sis causing erectile dysfunction from vascular occlusion , diabetes causing erectile dysfunction from vascular changes and peripheral neuropathy , and pelvic adhesions causing dyspareunia in women.

Substance abuse: Alcohol and marijuana enhance sexual desire by sup- Dopamine enhances libido; pressing inhibitions. However, long-term alcohol use decreases sexual serotonin inhibits libido. Cocaine and amphetamines enhance libido by stimulating dopamine receptors. Narcotics inhibit libido. Presence of a sexual disorder see below. The most common sexual disorders in women are sexual desire disorder and orgasmic disorder. The most common disorders in men are secondary erectile disorder and premature ejaculation.

May be primary never had one or secondary acquired after previous ability to main- Male erectile disorder is tain erections. Both male and female orgasmic disorders may be either primary never achieved orgasm or secondary acquired. Causes may include relationship problems, guilt, stress, and so on.

Couples meet with a male and female thera- pist together in four-way sessions to identify and discuss their sexual problems. Therapists suggest sexual exercises for the couple to attempt at home; activi- ties initially focus on heightening sensory awareness and progressively incor- porate increased levels of sexual contact.

Treatment is short term. Behavior Therapy Behavior therapy approaches sexual dysfunction as a learned maladaptive be- havior. Eventually, patients are able to respond appropriately to the stimuli. Other forms of behavioral therapy include muscle relaxation techniques, assertiveness training, and prescribed sexual exercises to try at home.

When the man has been excited to near ejaculation, he or his sexual partner is instructed to squeeze the glans of his penis in order to prevent ejaculation.

Gradually, he gains awareness about his sexual sensations and learns to achieve greater ejaculatory control. This technique functions in the same manner as the squeeze technique. Dyspareunia: Gradual desensitization to achieve intercourse, starting with muscle relaxation techniques, progressing to erotic massage, and finally achieving sexual intercourse Vaginismus: Women may obtain some relief by dilating their vaginas regu- larly with their fingers or a dilator.

Paraphilic fan- tasies alone are not considered disorders unless they are intense, recurrent, and interfere with daily life; occasional fantasies are considered normal com- ponents of sexuality even if unusual. Only a small percentage of people suffer from paraphilias. Most paraphilias oc- cur only in men, but sadism, masochism, and pedophilia may also occur in women. The most common paraphilias are pedophilia, voyeurism, and exhibi- tionism.

Good prognostic factors are self-referral for treatment, sense of guilt associated with the behavior, and history of otherwise normal sexual activity in addition to the paraphilia. Patients gain insight into the stimuli that cause them to act as they do.

People with this disorder have the subjective feeling that they were born the wrong sex. Gender Gender identity disorder is more common in men than women. The etiology of homosexuality is unknown, but genetic or pre- natal factors may play a role. Since the time of Freud, many other psychoanalytic theories have been developed. Preconscious—contains memories that are easy to bring into awareness 3.

Conscious—involves current thoughts and secondary process thinking logical, mature, and can delay gratification Structural Theories 1. Problems with reality testing occur in psychotic individuals. They are unconscious processes that are normal and healthy when used in moderation. However, excessive use of cer- tain defense mechanisms may be seen in some psychiatric disorders.

Defense mechanisms are often classified hierarchically. Mature defense mecha- nisms are healthy and adaptive, and they are seen in normal adults. Neurotic defenses are encountered in obsessive—compulsive patients, hysterical patients, and adults under stress. They are the most primi- tive defense mechanisms. Mature Defenses 1. Altruism—performing acts that benefit others in order to vicariously experience pleasure 2.

Humor—expressing feelings through comedy without causing discom- fort to self or others 3. Sublimation— satisfying socially objectionable impulses in an accept- able manner thus channeling them rather than preventing them Clini- cal example: Person with unconscious urges to physically control others becomes a prison guard.

Suppression—purposely ignoring an unacceptable impulse or emotion Psychotherapies in order to diminish discomfort and accomplish a task Clinical exam- ple: Nurse who feels nauseated by an infected wound puts aside feelings of disgust to clean wound and provide necessary patient care. Neurotic Defenses 1.

Controlling—regulating situations and events of external environ- ment to relieve anxiety 2. Displacement—shifting emotions from an undesirable situation to one that is personally tolerable Clinical example: Student who is angry at his mother talks back to his teacher the next day and refuses to obey her instructions.

Intellectualization—avoiding negative feelings by excessive use of in- tellectual functions and by focusing on irrelevant details or inanimate objects Clinical example: Physician dying from colon cancer describes the pathophysiology of his disease in detail to his year-old son.

Isolation of affect—unconsciously limiting the experience of feelings or emotions associated with a stressful life event in order to avoid anxi- ety Clinical example: Woman describes the recent death of her beloved husband without emotion.

Rationalization—creating explanations of an event in order to justify outcomes or behaviors and to make them acceptable. Reaction formation—doing the opposite of an unacceptable impulse Clinical example: Man who is in love with his coworker insults her.

Repression—preventing a thought or feeling from entering conscious- ness Repression is unconscious, whereas suppression is a conscious act. Immature Defenses 1. Regression—performing behaviors from an earlier stage of develop- ment in order to avoid tension associated with current phase of devel- opment Clinical example: Woman brings her childhood teddy bear to the hospital when she has to spend the night.

Projection—attributing objectionable thoughts or emotions to others Clinical example: Husband who is attracted to other women believes his wife is having an affair. Other Defense Mechanisms 1. Undoing—attempting to reverse a situation by adopting a new behav- Impress your attending and ior Clinical example: Man who has had a brief fantasy of killing his point it out.

Psychoanalysis is therefore insight oriented. Patients best suited for psychoanalysis have the following characteristics: Under age 40, not psychotic, intelligent, and stable in relationships and daily living. Patients attend sessions four to five times a week for multiple years.

Important Concepts and Techniques Used in Psychoanalysis Free association: the patient is asked to say whatever comes into his or her mind during therapy sessions. The purpose is to bring forth thoughts and feelings from the unconscious so that the therapist may interpret them. Dream interpretation: Dreams are seen to represent conflict between urges and fears. Interpretation of dreams by the psychoanalyst is used to help achieve therapeutic goals.

Therapeutic alliance: This is the bond between the therapist and the pa- tient, who work together toward a therapeutic goal. Ex- ample: Patient who has repressed feelings of abandonment by her father be- comes angry when her therapist is 5 minutes late for an appointment. The therapist must remain aware of countertransference issues, as they may interfere with his or her objectivity.

Psychoanalysis-Related Therapies Examples of psychoanalysis-related therapies include: 1. Interpersonal therapy: Focuses on development of social skills to help treat certain psychiatric disorders. Treatment is short weekly sessions for 3 to 6 months. Idea is to improve interpersonal relations. Supportive psychotherapy: Purpose is to help patient feel safe during a diffi- cult time.

Treatment is not insight oriented but instead focuses on empa- thy, understanding, and education. Supportive therapy is commonly used as adjunctive treatment in even the most severe mental disorders. Dependency is encouraged. It can be used to extin- guish maladaptive behaviors such as phobias, sexual dysfunction, compul- sions, etc. Learning Theory Behavioral therapy is based on learning theory, which states that behaviors can be learned by conditioning and can similarly be unlearned by deconditioning.

Operant conditioning: Behaviors can be learned when followed by positive or negative reinforcement. Behavioral Therapy Techniques Deconditioning Systemic desensitization: The patient performs relaxation techniques while being exposed to increasing doses of an anxiety-provoking stimulus. Gradually, he or she learns to associate the stimulus with a state of relax- ation. Commonly used to treat phobic disorders.

Flooding and implosion: Through habituation, the patient is confronted with a real flooding or imagined implosion anxiety-provoking stimulus and not allowed to withdraw from it until he or she feels calm and in con- trol.

Relaxation exercises are used to help the patient tolerate the stimu- lus. Example: A patient who has a fear of flying is made to fly in an airplane [flooding] or imagine flying [implosion].

Aversion therapy: A negative stimulus such as an electric shock is re- peatedly paired with a specific behavior to create an unpleasant response. Commonly used to treat addictions or paraphilias.

Example: An alcoholic patient is prescribed Antabuse, which makes him ill every time he drinks alcohol. Token economy: Rewards are given after specific behaviors to positively Psychotherapies reinforce them. Commonly used to encourage showering, shaving, and other positive behaviors in disorganized or mentally retarded individuals. Biofeedback: Physiological data such as heart rate or blood pressure mea- surements are given to patients as they try to mentally control physiolog- ical states.

Commonly used to treat migraines, hypertension, chronic pain, asthma, and incontinence. Example: A patient is given her heart rate and blood pressure measurements during a migraine while being in- structed to mentally control visceral changes that affect her pain.

The patient is taught to identify mal- adaptive thoughts and replace them with positive ones. Most commonly used to treat depressive and anxiety disorders. May also be used for paranoid per- sonality disorder, obsessive—compulsive disorder, somatoform disorders, and eating disorders.

Cognitive therapy can be more effective than medication. I must not be smart since I received average grades this semester. Faulty assumptions lead to: Negative thoughts: I am stupid. I will never amount to anything worth- while.

Nobody likes a worthless person. Any of the psychotherapeutic techniques may be employed, including psychoanalytical, behavioral, cognitive, educa- tional, and so on. Certain groups are leaderless including step groups like Alcoholics Anony- mous and do not have a therapist present to facilitate the group.

These groups meet to discuss problems, share feelings, and provide support to each other. Group therapy is especially useful in the treatment of substance abuse, adjust- ment disorders, and personality disorders. He or she may be viewed differently and treated differently after the development of psy- chopathology, and new tensions and conflicts within the family may arise.

Psychopathology may arise partly or entirely from dysfunction within the family unit. These conditions are most effectively treated with the entire family present. The therapist may assist in correcting these problems as well.

Usually, the therapist sees the couple together conjoint therapy , but they may be seen separately concurrent therapy. In addition, each person may have a separate therapist and be seen individually collaborative therapy.

In the treatment of sexual problems, two therapists may each see the couple together four-way therapy. Relative contraindica- tions include lack of motivation by one or both spouses and severe illness in one of the spouses, such as psychosis.

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