Mental Disorders: Deinstitutionalization, Diagnosis, and Treatment
Deinstitutionalization and its Impact
Deinstitutionalization, a policy initiated in the 1960s, aimed to discharge patients from mental hospitals and reintegrate them into the community. However, this policy has resulted in many individuals with severe psychological disturbances becoming homeless or incarcerated. The primary concern with deinstitutionalization is the lack of adequate community resources in many areas to support these discharged patients. Essential needs like food and shelter may be scarce.
A crucial question arises: Does deinstitutionalization truly improve the lives of individuals with psychological disturbances, or is it a step backward? It can potentially worsen an already precarious situation. When the least restrictive environment becomes a cardboard box instead of a federally funded institution, it becomes a significant problem. For instance, discharging an individual experiencing hallucinations with minimal support or structure is unwise. Reintegrating into society after prolonged institutionalization is challenging, and such individuals might pose a risk to others due to their delusions.
Four Aspects of Abnormality and Generalized Anxiety Disorder
1. Deviant Behavior
Individuals with generalized anxiety disorder may exhibit deviant behavior guided by irrational beliefs, leading to inappropriate actions.
2. Distressing Behavior
People with generalized anxiety disorder often experience significant distress or impairment, particularly in impoverished environments.
3. Dysfunctional Behavior
Generalized anxiety disorder is characterized by dysfunctional and maladaptive thinking patterns about oneself.
4. Dangerous Behavior
(Content related to dangerous behavior in generalized anxiety disorder was not provided in the original text.)
Treatment Approaches for Depression
Cognitive-Behavioral Therapy
Cognitive-behavioral therapists integrate cognitive and behavioral techniques to alleviate depression. For example, Beck’s four phases of therapy focus on transforming negative thoughts into more productive ones. This is considered the most effective approach.
Psychodynamic Therapy
Psychodynamic therapists aim to help depressed individuals become aware of and process their real or imagined losses and excessive dependence on others. An example is using free association to bring underlying conflicts to the surface.
Humanistic/Existential Therapy
(Content related to humanistic/existential therapy for depression was not provided in the original text.)
Biological Approaches
Most biological approaches involve antidepressant medications. Other methods, such as electroconvulsive therapy (ECT), involve attaching electrodes to the patient’s head and sending electrical currents through the brain.
DSM-V Criteria for Autism Spectrum Disorder and Impact on Asperger’s Diagnosis
The DSM-V introduced a new category called “Neurodevelopmental Disorders.” This category includes Autism Spectrum Disorder, which combines previously separate diagnoses like Autistic Disorder, Asperger’s Disorder, and Childhood Disintegrative Disorder. This merging led to the elimination of Asperger’s Disorder as a distinct diagnosis. Individuals previously diagnosed with Asperger’s would now receive a diagnosis of Autism Spectrum Disorder, while others might be assigned to a different category, such as the newly proposed Social Communication Disorder.
Treatment of Conduct Disorder and ADHD
Therapists often utilize family intervention to treat conduct disorders, focusing on teaching parents to interact positively with the child. In contrast, ADHD is primarily treated with medication. The majority of children diagnosed with ADHD receive medication. Occasionally, effective behavioral programs are implemented to reward attentiveness.
Mental Disorders as a Risk Factor for Violence and Challenges in Prediction
Individuals with severe mental disorders are at a somewhat higher risk of violence compared to those without such disorders. Approximately 25 percent of patients in mental hospitals assault others during their stay, while 15 percent have committed assault before admission. While certain severe mental disorders can contribute to dangerous behavior, it’s crucial to avoid generalizing this to all individuals with mental disorders. Human behavior is inherently complex and difficult to predict. Accurately predicting which individuals will engage in violent acts is particularly challenging. Research suggests that psychiatrists tend to overestimate the likelihood of violence, although their short-term predictions may be more accurate. Researchers are developing new assessment techniques using statistical approaches to improve the prediction of violent behavior.
Personality Disorders at a Cocktail Party
Odd Personality Disorders
Paranoid Personality Disorder
Individuals with paranoid personality disorder might wonder why they were invited to the party in the first place.
Treatment focuses on understanding the patient’s anger and addressing their underlying desire for fulfilling relationships.
Schizoid Personality Disorder
Individuals with schizoid personality disorder likely wouldn’t attend the party.
Treatment involves helping them experience more positive emotions and participate in group therapy.
Schizotypal Personality Disorder
Individuals with schizotypal personality disorder might talk about unusual topics, such as the magic that brought them to the party.
Treatment aims to help them “reconnect” with the world.
Dramatic Personality Disorders
Antisocial Personality Disorder
Individuals with antisocial personality disorder might not interact with anyone at the party.
Treatment focuses on encouraging them to consider the needs of others.
Borderline Personality Disorder
Individuals with borderline personality disorder might initially talk to everyone and then gossip about them later.
Treatment often involves psychoanalytic therapy with a supportive approach from the therapist.
Histrionic Personality Disorder
Individuals with histrionic personality disorder might start dancing on tables shortly after the party begins.
Treatment aims to help them recognize their excessive dependency and develop self-reliance.
Narcissistic Personality Disorder
Individuals with narcissistic personality disorder might spend the party talking about themselves.
Treatment focuses on helping them acknowledge and address their insecurities and defenses.
Anxious Personality Disorders
Avoidant Personality Disorder
Individuals with avoidant personality disorder might attend the party but avoid talking to anyone.
Treatment emphasizes building trust with the client.
Dependent Personality Disorder
Individuals with dependent personality disorder might attach themselves to someone with antisocial personality disorder, which can be a detrimental combination.
Treatment involves helping them take responsibility for themselves.
Obsessive-Compulsive Personality Disorder
Individuals with obsessive-compulsive personality disorder might walk around offering coasters to everyone and ensuring the trash is disposed of properly.
Treatment focuses on helping them understand their underlying feelings and modifying their dichotomous (all-or-nothing) thinking and perfectionism.