Clinical Psychology-Introduction__and_Overview zz
INTRODUCTION TOCLINICAL PSYCHOLOGY
Lecture one
? ?For copyright issues, please do not
? ?e this for purposes other than a
? ?ading material, many thx, Jung Aims
• Overview of main psychological disorders
(Mental Health Problems)
• Understanding of causes from a
psychological perspective
• Introduction to psychological therapies
3
Commonly asked questions
[*] Why did you get into it?
(accusing)
[*] can you read MY mind?
(defensive, and
egocentric)
[*] It MUST be miserable?
(judgmental)
[*] Is it different to psychiatry?
(engaging?)
[*] …..any other?
Clinical Psychology
[*] Deals with disorders in which there are a mix of
emotional, cognitive and behavioural issues
[*] Aims to provide an understanding of:
– Causes of MHP
– the features and symptoms
– The prevalence of MHP
– Treatment approaches
4
Clinical Psychology
[*] Services provided in:
– Adult Mental Health
– Child & Adolescent
– Learning Disability
– Older Adults
– Neuropsychology
– Forensic
– Physical Health
Scale of mental health problems (MHP)
[*] WHO survey of 25,000 people in 14 countries:
[*] 25% had a MHP, e.g.
– 10% had depression
– 8% an anxiety disorder
– 3% had harmful use of alcohol
5
Scale of MHP (2)
[*] In the UK
– 20% of all adults at any one time have some mental
health problem (MHP)
– 55% of all adults will, at some point, be clinically
depressed
– 3-6% of all adults will have important symptoms of
anxiety
– 1% lifetime risk of schizophrenia
– 2-3% of population have a major drug dependence
– 1% of adolescent women have significant Anorexia
Scale of MHP (3)
[*] 40% of all consultations with GP's are to do with a MHP
[*] 5% of all deaths (under75 years) are due to suicide – 5,000
annually in UK
[*] Suicide a major cause of death in group 15 to 25 age
[*] symptoms such as poor sleep, fatigue and worry affect half
the population at any one time and does not necessarily
lead toa MHP ("…wishing you good mental health")
6
Clinical Psychology:
Interventions
– What kind of treatment works for what kinds of
problems for what kinds of people, when, why and how
– Does depression last a lifetime or can it be treated by a
"talking therapy", a drug, or both?
– does family therapy rather than individual counselling
help someone be recover from symptoms of bulimia?
– Could early parenting style affect adolescent offending
behaviour? could this be changed by parental counselling?
– the answersmight be complex, but there is evidence that
interventions work
Referral letter
[*] "CB is a very pleasant young man. He suffered a
severe head injury on **/97. He also suffered
orthopaedic injuries to his legs. His recovery has
been remarkable. He is now fully mobile. His IQ
is unaffected. However, his memory for current
events and past life appears limited. He has taken
to staying at home, barely socialises, and seems to
need to check locks, cookers etc. before leaving
the house…I believe some psychological
intervention of some form may be helpful…"
– Consultant Neurologist Dr Redwood
全贴上算了 sigh 不知道有人看没有。。
7
Case illustration: CB Assessment
[*] Pre-injury :Systems analyst
[*] Traumatic Brain Injury in a road accident (RTA) aged 23
[*] Coma 4 weeks
[*] Cognitive function (thinking, reasoning etc.) fine
[*] Dense retrograde amnesia
– I.e. limited memory for
[*] People, even relatives
[*] events from childhood through to the accident
[*] own likes or dislikes (but for Man.Utd)
[*] Poor anterograde memory (everyday events since the accident)
CD: Self-report of symptoms
[*] did not "trust" himself to remember activities
[*] limited daily routine ("game boy thumb")
[*] occasional visits to a local shop but will check and re-check the house
before going
– Cooker "off", back door & front door "locked" (up to 20 times)
– tolerated20 minute visit to a pub oncea week to socialise
– embarrassed"don't know if I lent John something, might ask Steve for it
back…"
– "checked himself" for personal possessions "constantly"
[*] Poor sleep, appetite down, pessimistic, suicidal thoughts
[*] Family very worried as CB getting ++ withdrawn &
depressed
slide 8 a
CB: emotional issues "underlying"
obsessive behaviour
[*] Attention & Memory:
– checking to "keep order" that he did what he thought he had
? compensatory behaviour for cognitive deficits
[*] Loss of self- control/ fear
? checking a means of re-asserting sense of control
[*] Issues re: self-image
– said he "looked a mess" after his accident. Friends had said that he
was good looking now, but he was "stuck" in a poor self image
? routines/checking "saves" from having to be with others
9
CB: Interventions
[*] Individual and Group therapy(neuro and CBT)
[*] Palm-top organiser for long term & prospective (future) memory
– E.g. to meet friends at pub
[*] Voice organiser for working memory
– E.g. "Dave said to meet at gym tomorrow"
[*] breathing/tense-relaxexercises for general anxiety
[*] Attention training & CBT for managing worries
[*] hierarchical goals for graded exposure to:
– social activities
– community mobility
– physical activities
CB: working through a hierarchy
[*]1 Making a call to a friend
[*] friendsonly"puttingup" with
me
[*] won't rememberwhattalked
about
2 Meetingfriends in a pub
[*] leaving house
[*] Unable to keep track of
belongings/conversation
3 Going to a club with friends
[*] too many people/pushing
[*] losing friends and not getting
self home
[*] General Strategies:
Check evidence (negative "voice")
list chat items (check f-fax)
pad for notes
who-what-when-where
breathing exercises
listen to door "click"
visualise belongings at home
find quiet area
check breathing
visualise belongings at home
picture where things are
make "leaving" arrangements
slides 10 slides 11 a
CB: Outcome
"I've had my life back…I spent all the time since the
accident at home watching TV..afraid that if I do
something I'd look foolish… every weekend,
friends…using
management] strategies... that was confusing for a
while but over time you get used to the new habits,
and what technique to use where and when, and you
get to trust ..and get confident.. you've
got to watch for that vicious cycle of withdrawal.."
12
Main issues
[*] Assessment & Diagnosis is very important
– could be combination of anxiety disorder and/or
depression and/or effects of neurological injury
(medical aspects)
[*] Must be able to "see the person" not the diagnostic
label
[*] Treatment needs to be:
– Evidence based
– monitored for effectiveness
Structure of Course
[*] Lectures
[*] Historical background
– Socio-cultural context of
mental health issues
[*] Mental Health Disorders
– Mood disorders
[*] Depression (I /II)
[*] anxiety
– Main forms (I)
– PTSD (II)
– Psychosis
– Specialist services, e.g.
[*] eating disorders
[*] drug & alcohol
[*] Practicals
– Weeks 3 & 7
[*] Tutorials
– Weeks 4 & 8
页:
[1]
2