Hypnosis

I
INTRODUCTION
Hypnosis, altered state of consciousness and heightened responsiveness to suggestion; it may be induced in normal persons by a variety of methods and has been used occasionally in medical and psychiatric treatment. Most frequently hypnosis is brought about through the actions of an operator, the hypnotist, who engages the attention of a subject and assigns certain tasks to him or her while uttering monotonous, repetitive verbal commands; such tasks may include muscle relaxation, eye fixation, and arm levitation. Hypnosis also may be self-induced, by trained relaxation, concentration on one's own breathing, or by a variety of monotonous practices and rituals that are found in many mystical, philosophical, and religious systems.
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CHARACTERISTICS
Hypnosis results in the gradual assumption by the subject of a state of consciousness in which attention is withdrawn from the outside world and is concentrated on mental, sensory, and physiological experiences. When a hypnotist induces a trance, a close relationship or rapport develops between operator and subject. The responses of subjects in the trance state, and the phenomena or behavior they manifest objectively, are the product of their motivational set; that is, behavior reflects what is being sought from the experience.
Most people can be easily hypnotized, but the depth of the trance varies widely. A profound trance is characterized by a forgetting of trance events and by an ability to respond automatically to posthypnotic suggestions that are not too anxiety-provoking. The depth of trance achievable is a relatively fixed characteristic, dependent on the emotional condition of the subject and on the skill of the hypnotist. Only 20 percent of subjects are capable of entering somnambulistic states through the usual methods of induction. Medically, this percentage is not significant, since therapeutic effects occur even in a light trance.
Hypnosis can produce a deeper contact with one's emotional life, resulting in some lifting of repressions and exposure of buried fears and conflicts. This effect potentially lends itself to medical and educational use, but it also lends itself to misinterpretation. Thus, the revival through hypnosis of early, forgotten memories may be fused with fantasies. Research into hypnotically induced memories in recent years has in fact stressed their uncertain reliability. For this reason a number of state court systems in the U.S. have placed increasing constraints on the use of evidence hypnotically obtained from witnesses, although most states still permit its introduction in court.
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MEDICAL USES
Hypnosis has been used to treat a variety of physiological and behavioral problems. It can alleviate back pain and pain resulting from burns and cancer. It has been used by some obstetricians as the sole analgesia for normal childbirth. Hypnosis is sometimes also employed to treat physical problems with a possible psychological component, such as Raynaud's syndrome (a circulatory disease) and fecal incontinence in children. Researchers have demonstrated that the benefit of hypnosis is greater than the effect of a placebo and probably results from changing the focus of attention. Few physicians, however, include hypnosis as part of their practice.Some behavioral difficulties, such as cigarette smoking, overeating, and insomnia, are also amenable to resolution through hypnosis. Nonetheless, most psychiatrists think that fundamental psychiatric illness is better treated with the patient in a normal state of conscio

Anxiety

I
INTRODUCTION
Anxiety, emotional state in which people feel uneasy, apprehensive, or fearful. People usually experience anxiety about events they cannot control or predict, or about events that seem threatening or dangerous. For example, students taking an important test may feel anxious because they cannot predict the test questions or feel certain of a good grade. People often use the words fear and anxiety to describe the same thing. Fear also describes a reaction to immediate danger characterized by a strong desire to escape the situation.
The physical symptoms of anxiety reflect a chronic “readiness” to deal with some future threat. These symptoms may include fidgeting, muscle tension, sleeping problems, and headaches. Higher levels of anxiety may produce such symptoms as rapid heartbeat, sweating, increased blood pressure, nausea, and dizziness.
All people experience anxiety to some degree. Most people feel anxious when faced with a new situation, such as a first date, or when trying to do something well, such as give a public speech. A mild to moderate amount of anxiety in these situations is normal and even beneficial. Anxiety can motivate people to prepare for an upcoming event and can help keep them focused on the task at hand.
However, too little anxiety or too much anxiety can cause problems. Individuals who feel no anxiety when faced with an important situation may lack alertness and focus. On the other hand, individuals who experience an abnormally high amount of anxiety often feel overwhelmed, immobilized, and unable to accomplish the task at hand. People with too much anxiety often suffer from one of the anxiety disorders, a group of mental illnesses. In fact, more people experience anxiety disorders than any other type of mental illness. A survey of people aged 15 to 54 in the United States found that about 17 percent of this population suffers from an anxiety disorder during any given year.
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ANXIETY DISORDERS
The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, a handbook for mental health professionals, describes a variety of anxiety disorders. These include generalized anxiety disorder, phobias, panic disorder, obsessive-compulsive disorder, and post-traumatic stress disorder.
A
Generalized Anxiety Disorder
People with generalized anxiety disorder feel anxious most of the time. They worry excessively about routine events or circumstances in their lives. Their worries often relate to finances, family, personal health, and relationships with others. Although they recognize their anxiety as irrational or out of proportion to actual events, they feel unable to control their worrying. For example, they may worry uncontrollably and intensely about money despite evidence that their financial situation is stable. Children with this disorder typically worry about their performance at school or about catastrophic events, such as tornadoes, earthquakes, and nuclear war.
People with generalized anxiety disorder often find that their worries interfere with their ability to function at work or concentrate on tasks. Physical symptoms, such as disturbed sleep, irritability, muscle aches, and tension, may accompany the anxiety. To receive a diagnosis of this disorder, individuals must have experienced its symptoms for at least six months.
Generalized anxiety disorder affects about 3 percent of people in the general population in any given year. From 55 to 66 percent of people with this disorder are female.
B
Phobias
A phobia is an excessive, enduring fear of clearly defined objects or situations that interferes with a person’s normal functioning. Although they know their fear is irrational, people with phobias always try to avoid the source of their fear. Common phobias include fear of heights (acrophobia), fear of enclosed places (claustrophobia), fear of insects, snakes, or other animals, and fear of air travel. Social phobias involve a fear of performing, of critical evaluation, or of being embarrassed in front of other people.
C
Panic Disorder
Panic is an intense, overpowering surge of fear. People with panic disorder experience panic attacks—periods of quickly escalating, intense fear and discomfort accompanied by such physical symptoms as rapid heartbeat, trembling, shortness of breath, dizziness, and nausea. Because people with this disorder cannot predict when these attacks will strike, they develop anxiety about having additional panic attacks and may limit their activities outside the home.
D
Obsessive-Compulsive Disorder
In obsessive-compulsive disorder, people persistently experience certain intrusive thoughts or images (obsessions) or feel compelled to perform certain behaviors (compulsions). Obsessions may include unwanted thoughts about inadvertently poisoning others or injuring a pedestrian while driving. Common compulsions include repetitive hand washing or such mental acts as repeated counting. People with this disorder often perform compulsions to reduce the anxiety produced by their obsessions. The obsessions and compulsions significantly interfere with their ability to function and may consume a great deal of time.
E
Post-Traumatic Stress Disorder
Post-traumatic stress disorder sometimes occurs after people experience traumatic or catastrophic events, such as physical or sexual assaults, natural disasters, accidents, and wars. People with this disorder relive the traumatic event through recurrent dreams or intrusive memories called flashbacks. They avoid things or places associated with the trauma and may feel emotionally detached or estranged from others. Other symptoms may include difficulty sleeping, irritability, and trouble concentrating.
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CAUSES
Most anxiety disorders do not have an obvious cause. They result from a combination of biological, psychological, and social factors.
A
Genetics and Neurobiology
Studies suggest that anxiety disorders run in families. That is, children and close relatives of people with disorders are more likely than most to develop anxiety disorders. Some people may inherit genes that make them particularly vulnerable to anxiety. These genes do not necessarily cause people to be anxious, but the genes may increase the risk of anxiety disorders when certain psychological and social factors are also present.
Anxiety also appears to be related to certain brain functions. Chemicals in the brain called neurotransmitters enable neurons, or brain cells, to communicate with each other. One neurotransmitter, gamma-amino butyric acid (GABA), appears to play a role in regulating one’s level of anxiety. Lower levels of GABA are associated with higher levels of anxiety. Some studies suggest that the neurotransmitters norepinephrine and serotonin play a role in panic disorder.
B
Psychological Factors
Psychologists have proposed a variety of models to explain anxiety. Austrian psychoanalyst Sigmund Freud suggested that anxiety results from internal, unconscious conflicts. He believed that a person’s mind represses wishes and fantasies about which the person feels uncomfortable. This repression, Freud believed, results in anxiety disorders, which he called neuroses.
More recently, behavioral researchers have challenged Freud’s model of anxiety. They believe one’s anxiety level relates to how much a person believes events can be predicted or controlled. Children who have little control over events, perhaps because of overprotective parents, may have little confidence in their ability to handle problems as adults. This lack of confidence can lead to increased anxiety.
Behavioral theorists also believe that children may learn anxiety from a role model, such as a parent. By observing their parent’s anxious response to difficult situations, the child may learn a similar anxious response. A child may also learn anxiety as a conditioned response. For example, an infant often startled by a loud noise while playing with a toy may become anxious just at the sight of the toy. Some experts suggest that people with a high level of anxiety misinterpret normal events as threatening. For instance, they may believe their rapid heartbeat indicates they are experiencing a panic attack when in reality it may be the result of exercise.
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Social Factors
While some people may be biologically and psychologically predisposed to feel anxious, most anxiety is triggered by social factors. Many people feel anxious in response to stress, such as a divorce, starting a new job, or moving. Also, how a person expresses anxiety appears to be shaped by social factors. For example, many cultures accept the expression of anxiety and emotion in women, but expect more reserved emotional displays from men.
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TREATMENT
Mental health professionals use a variety of methods to help people overcome anxiety disorders. These include psychoactive drugs and psychotherapy, particularly behavior therapy. Other techniques, such as exercise, hypnosis, meditation, and biofeedback, may also prove helpful.
A
Medications
Psychiatrists often prescribe benzodiazepines, a group of tranquilizing drugs, to reduce anxiety in people with high levels of anxiety. Benzodiazepines help to reduce anxiety by stimulating the GABA neurotransmitter system. Common benzodiazepines include alprazolam (Xanax), clonazepam (Klonopin), and diazepam (Valium). Two classes of antidepressant drugs—tricyclics and selective serotonin reuptake inhibitors (SSRIs)—also have proven effective in treating certain anxiety disorders.
Benzodiazepines can work quickly with few unpleasant side effects, but they can also be addictive. In addition, benzodiazepines can slow down or impair motor behavior or thinking and must be used with caution, particularly in elderly persons. SSRIs take longer to work than the benzodiazepines but are not addictive. Some people experience anxiety symptoms again when they stop taking the medications.
B
Psychotherapy
Therapists who attribute the cause of anxiety to unconscious, internal conflicts may use psychoanalysis to help people understand and resolve their conflicts. Other types of psychotherapy, such as cognitive-behavioral therapy, have proven effective in treating anxiety disorders. In cognitive-behavioral therapy, the therapist often educates the person about the nature of his or her particular anxiety disorder. Then, the therapist may help the person challenge irrational thoughts that lead to anxiety. For example, to treat a person with a snake phobia, a therapist might gradually expose the person to snakes, beginning with pictures of snakes and progressing to rubber snakes and real snakes. The patient can use relaxation techniques acquired in therapy to overcome the fear of snakes.
Research has shown psychotherapy to be as effective or more effective than medications in treating many anxiety disorders. Psychotherapy may also provide more lasting benefits than medications when patients discontinue treatment.

Bipolar Disorder

I
INTRODUCTION
Bipolar Disorder, mental illness in which a person’s mood alternates between extreme mania and depression. Bipolar disorder is also called manic-depressive illness. When manic, people with bipolar disorder feel intensely elated, self-important, energetic, and irritable. When depressed, they experience painful sadness, negative thinking, and indifference to things that used to bring them happiness.
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PREVALENCE
Bipolar disorder is much less common than depression. In North America and Europe, about 1 percent of people experience bipolar disorder during their lives. Rates of bipolar disorder are similar throughout the world. In comparison, at least 8 percent of people experience serious depression during their lives. Bipolar disorder affects men and women about equally and is somewhat more common in higher socioeconomic classes. At least 15 percent of people with bipolar disorder commit suicide. This rate roughly equals the rate for people with major depression, the most severe form of depression.
Some research suggests that highly creative people—such as artists, composers, writers, and poets—show unusually high rates of bipolar disorder, and that periods of mania fuel their creativity. Famous artists and writers who probably suffered from bipolar disorder include poets Lord Byron and Anne Sexton, novelists Virginia Woolf and Ernest Hemingway, composers Peter Ilyich Tchaikovsky and Sergey Rachmaninoff, and painters Amedeo Modigliani and Jackson Pollock. Critics of this research note that many creative people do not suffer from bipolar disorder, and that most people with bipolar disorder are not especially creative.
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SYMPTOMS
Bipolar disorder usually begins in a person’s late teens or 20s. Men usually experience mania as the first mood episode, whereas women typically experience depression first. Episodes of mania and depression usually last from several weeks to several months. On average, people with untreated bipolar disorder experience four episodes of mania or depression over any ten-year period. Many people with bipolar disorder function normally between episodes. In “rapid-cycling” bipolar disorder, however, which represents 5 to 15 percent of all cases, a person experiences four or more mood episodes within a year and may have little or no normal functioning in between episodes. In rare cases, swings between mania and depression occur over a period of days.
In another type of bipolar disorder, a person experiences major depression and hypomanic episodes, or episodes of milder mania. In a related disorder called cyclothymic disorder, a person’s mood alternates between mild depression and mild mania. Some people with cyclothymic disorder later develop full-blown bipolar disorder. Bipolar disorder may also follow a seasonal pattern, with a person typically experiencing depression in the fall and winter and mania in the spring or summer
People in the depressive phase of bipolar disorder feel intensely sad or profoundly indifferent to work, activities, and people that once brought them pleasure. They think slowly, concentrate poorly, feel tired, and experience changes—usually an increase—in their appetite and sleep. They often feel a sense of worthlessness or helplessness. In addition, they may feel pessimistic or hopeless about the future and may think about or attempt suicide. In some cases of severe depression, people may experience psychotic symptoms, such as delusions (false beliefs) or hallucinations (false sensory perceptions).
In the manic phase of bipolar disorder, people feel intensely and inappropriately happy, self-important, and irritable. In this highly energized state they sleep less, have racing thoughts, and talk in rapid-fire speech that goes off in many directions. They have inflated self-esteem and confidence and may even have delusions of grandeur. Mania may make people impatient and abrasive, and when frustrated, physically abusive. They often behave in socially inappropriate ways, think irrationally, and show impaired judgment. For example, they may take airplane trips all over the country, make indecent sexual advances, and formulate grandiose plans involving indiscriminate investments of money. The self-destructive behavior of mania includes excessive gambling, buying outrageously expensive gifts, abusing alcohol or other drugs, and provoking confrontations with obnoxious or combative behavior.
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CAUSES
The genes that a person inherits seem to have a strong influence on whether the person will develop bipolar disorder. Studies of twins provide evidence for this genetic influence. Among genetically identical twins where one twin has bipolar disorder, the other twin has the disorder in more than 70 percent of cases. But among pairs of fraternal twins, who have about half their genes in common, both twins have bipolar disorder in less than 15 percent of cases in which one twin has the disorder. The degree of genetic similarity seems to account for the difference between identical and fraternal twins. Further evidence for a genetic influence comes from studies of adopted children with bipolar disorder. These studies show that biological relatives of the children have a higher incidence of bipolar disorder than do people in the general population. Thus, bipolar disorder seems to run in families for genetic reasons.
Personal or work-related stress can trigger a manic episode, but this usually occurs in people with a genetic vulnerability. Other factors—such as prenatal development, childhood experiences, and social conditions—seem to have relatively little influence in causing bipolar disorder. One study examined the children of identical twins in which only one member of each pair of twins had bipolar disorder. The study found that regardless of whether the parent had bipolar disorder or not, all of the children had the same high 10-percent rate of bipolar disorder. This observation clearly suggests that risk for bipolar illness comes from genetic influence, not from exposure to a parent’s bipolar illness or from family problems caused by that illness.
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TREATMENT
Different therapies may shorten, delay, or even prevent the extreme moods caused by bipolar disorder. Lithium carbonate, a natural mineral salt, can help control both mania and depression in bipolar disorder. The drug generally takes two to three weeks to become effective. People with bipolar disorder may take lithium during periods of relatively normal mood to delay or prevent subsequent episodes of mania or depression. Common side effects of lithium include nausea, increased thirst and urination, vertigo, loss of appetite, and muscle weakness. In addition, long-term use can impair functioning of the kidneys. For this reason, doctors do not prescribe lithium to bipolar patients with kidney disease. Many people find the side effects so unpleasant that they stop taking the medication, which often results in relapse.
From 20 to 40 percent of people do not respond to lithium therapy. For these people, two anticonvulsant drugs may help dampen severe manic episodes: carbamazepine (Tegretol) and valproate (Depakene). The use of traditional antidepressants to treat bipolar disorder carries risks of triggering a manic episode or a rapid-cycling pattern.

Conduct Disorder

Children with conduct disorder repeatedly violate the personal or property rights of others and the basic expectations of society. A diagnosis of conduct disorder is likely when symptoms continue for 6 months or longer. Conduct disorder is known as a "disruptive behavior disorder" because of its impact on children and their families, neighbors, and schools.Another disruptive behavior disorder, called oppositional defiant disorder, may be a precursor of conduct disorder. A child is diagnosed with oppositional defiant disorder when he or she shows signs of being hostile and defiant for at least 6 months. Oppositional defiant disorder may start as early as the preschool years, while conduct disorder generally appears when children are older. Oppositional defiant disorder and conduct disorder are not co-occurring conditions.What are the signs of conduct disorder?
Symptoms of conduct disorder include:
· Aggressive behavior that harms or threatens other people or animals;
· Destructive behavior that damages or destroys property;
· Lying or theft;
· Truancy or other serious violations of rules;
· Early tobacco, alcohol, and substance use and abuse; and
· Precocious sexual activity.
Children with conduct disorder or oppositional defiant disorder also may experience:
· Higher rates of depression, suicidal thoughts, suicide attempts, and suicide;
· Academic difficulties;
· Poor relationships with peers or adults;
· Sexually transmitted diseases;
· Difficulty staying in adoptive, foster, or group homes; and
· Higher rates of injuries, school expulsions, and problems with the law.
How common is conduct disorder?
Conduct disorder affects 1 to 4 percent of 9- to 17-year-olds, depending on exactly how the disorder is defined (U.S. Department of Health and Human Services, 1999). The disorder appears to be more common in boys than in girls and more common in cities than in rural areas.



Who is at risk for conduct disorder?
Research shows that some cases of conduct disorder begin in early childhood, often by the preschool years. In fact, some infants who are especially "fussy" appear to be at risk for developing conduct disorder. Other factors that may make a child more likely to develop conduct disorder include:
· Early maternal rejection;
· Separation from parents, without an adequate alternative caregiver;
· Early institutionalization;
· Family neglect;
· Abuse or violence;
· Parental mental illness;
· Parental marital discord;
· Large family size;
· Crowding; and
· Poverty.
What help is available for families?
Although conduct disorder is one of the most difficult behavior disorders to treat, young people often benefit from a range of services that include:
· Training for parents on how to handle child or adolescent behavior.
· Family therapy.
· Training in problem solving skills for children or adolescents.
· Community-based services that focus on the young person within the context of family and community influences.
What can parents do?
Some child and adolescent behaviors are hard to change after they have become ingrained. Therefore, the earlier the conduct disorder is identified and treated, the better the chance for success. Most children or adolescents with conduct disorder are probably reacting to events and situations in their lives. Some recent studies have focused on promising ways to prevent conduct disorder among at-risk children and adolescents. In addition, more research is needed to determine if biology is a factor in conduct disorder.Parents or other caregivers who notice signs of conduct disorder or oppositional defiant disorder in a child or adolescent should:
· Pay careful attention to the signs, try to understand the underlying reasons, and then try to improve the situation.
· If necessary, talk with a mental health or social services professional, such as a teacher, counselor, psychiatrist, or psychologist specializing in childhood and adolescent disorders.

Attention-Deficit Hyperactivity Disorder

I
INTRODUCTION
Attention-Deficit Hyperactivity Disorder or Hyperactivity (ADHD), disorder beginning in childhood, characterized by a persistent inability to sit still, focus attention on specific tasks, and control impulses. Children with ADHD show these behaviors more frequently and severely than other children of the same age. A person with ADHD may have difficulty with school, work, friendships, or family life. ADHD has also been referred to as attention-deficit disorder, hyperkinesis, minimal brain dysfunction, and minimal brain damage.
Attention-deficit hyperactivity disorder is one of the most common mental disorders of childhood, affecting 3 to 5 percent of school-age children. The disorder occurs at least four times more often in boys than in girls. Although the symptoms sometimes disappear with age, ADHD can persist into adolescence and adulthood. Some estimates show that up to 2 percent of adults have ADHD.
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DIAGNOSIS
Diagnosing ADHD is difficult because most children are inattentive, hyperactive, and impulsive at least some of the time. In diagnosing ADHD, experts use guidelines listed in the Diagnostic and Statistical Manual of Mental Disorders. These guidelines require that a child show behaviors typical of ADHD before the age of seven. The behaviors must last for at least six months, and must occur more frequently than in other children of the same age. The behaviors also must occur in at least two settings, such as classroom and home, rather than just at a single setting.
Controversy exists over the diagnosis of ADHD. Physicians in the United States diagnose the disorder more often than doctors elsewhere in the world. Critics regard this discrepancy as evidence that physicians and psychologists too often apply psychiatric labels to children who are naturally more active or simply nuisances to teachers and parents.
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CHARACTERISTICS
Children and adults with ADHD consistently show various degrees of inattention, hyperactivity, and impulsiveness. Inattention means that people with ADHD have difficulty keeping their minds on one thing. They may get bored with homework or other tasks after a few minutes, make careless mistakes, have trouble listening, and seem to daydream. However, children with ADHD sometimes can concentrate on and complete new or unusually interesting tasks. Hyperactivity involves almost constant motion, as if driven by a motor. Children may squirm and fidget at their desks in school, get up often to roam around the room, constantly touch things, disturb other people, tap pencils, and talk constantly. ADHD also makes children unusually impulsive, so that they act before thinking. They may run into the street without looking, blurt out inappropriate comments in class, interrupt conversations, and be unusually clumsy or accident-prone.
Children with ADHD often have severe learning problems because of their difficulties in paying attention, following instructions, and completing tasks. In addition, their disruptive, demanding behavior makes them unpopular with peers. Children with ADHD often receive constant criticism and correction from teachers and parents, who believe the behavior is intentional. The combination of negative feedback, poor academic achievement, and social problems may contribute to low self-esteem and other emotional problems.
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CAUSES
Scientists do not know what causes ADHD. However, they have discredited many theories that once were widely accepted. One theory contended that ADHD resulted from minor head injuries or undetectable brain damage due to infections or complications during birth. Experts called ADHD “minimal brain damage” and “minimal brain dysfunction” when this theory was popular in the early 1970s. Another theory linked ADHD with consumption of refined sugar and food additives. Scientists questioned this theory when studies showed that few children with ADHD benefited from diets restricting sugar and food colorings. Most experts also reject the idea that poor parenting or a dysfunctional home environment causes ADHD.
Most scientists regard ADHD as a biological disorder caused by abnormalities in the brain. Studies have shown that areas of the brain that control attention span and limit impulsive behavior are less active in people with ADHD. In addition, ADHD seems to run in families, suggesting that genetic factors may play an important role. One study showed that about one-third of fathers who had ADHD in childhood have children with ADHD.
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TREATMENT
Although there is no cure for ADHD, a variety of treatments may help children with this disorder. These include medication, counseling, social skills training, and other methods.
A
Medication
Drugs are the most common treatment for ADHD and can help reduce symptoms of the disorder. Physicians usually prescribe one of three drugs: methylphenidate (Ritalin), dextroamphetamine (Dexedrine or DextroStat), and pemoline (Cylert). These drugs are normally stimulants, yet they ease hyperactivity and other symptoms in 90 percent of children with ADHD. The drugs work by altering levels of neurotransmitters, brain chemicals that transmit nerve signals. A newer stimulant used to treat ADHD, Adderall, combines dextroamphetamine and amphetamine.
Medical experts regard stimulants as safe. The most common side effects include stomachaches, loss of appetite, nervousness, and insomnia. Drug therapy may slow a child’s rate of growth temporarily, but growth usually returns to normal during adolescence. Low doses of stimulants do not cause a “high” sensation, sedate the child, or cause addiction. Experts often recommend that children take medication only during school, with medication breaks on weekends and holidays to reduce unwanted side effects. Doctors may prescribe other types of drugs if stimulants do not prove effective.
Critics argue that physicians medicate too many children who do not have ADHD. They point out that allergies, depression, anxiety, conflicts with teachers or parents, and other problems can make normal children seem hyperactive, impulsive, and distracted.
B
Other Therapies
Most children with ADHD need more than medication. Drugs only relieve symptoms of ADHD, which usually return when medication is discontinued. Although drugs help a child to concentrate and complete schoolwork, they cannot increase a child’s knowledge, teach academic skills, or directly alter underlying learning disorders or other problems. Experts cite the need for more information on whether medication improves a child’s chances for a successful career.
Children may benefit from several different kinds of therapy. Psychological counseling, for instance, can help them recognize and deal with negative feelings that result from their symptoms. Social skills training can help them recognize how their behavior affects other people and help them develop more appropriate behavior. Children with ADHD also may benefit from special academic tutors who show them how to break school assignments down into small parts that can be completed one at a time.
Because children with ADHD often cause family turmoil, parents and other family members may benefit from therapy or support groups in which other parents share their experiences. Parental skills training can teach parents to manage a child’s behavior with praise and other rewards, and with penalties such as “time-outs” in which a child must sit alone to calm down.
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ADHD IN ADULTS
Many children with ADHD continue to have problems as adolescents and adults. Adults with ADHD may be unusually impatient and restless and may become bored before finishing a task. They may constantly arrive late for appointments, lose things, change jobs often, fail to organize their time or set priorities, and have difficulty maintaining friendships and other relationships. Studies suggest they are more likely than others to develop other mental illnesses such as anxiety and depression, as well as substance-abuse problems such as alcoholism and drug dependence.

Impulse control disorders

Definition
Impulse control disorders are characterized by an inability to resist the impulse to perform an action that is harmful to one's self or others. This is a relatively new class of personality disorders, and the most common of these are intermittent explosive disorder, kleptomania, pyromania, compulsive gambling disorder, and trichotillomania.
Description
All of these impulse control disorders involve the loss or lack of control in certain specific situations. The hallmark of these disorders is the individual's inability to stop impulses that may cause harm to themselves or others. Affected individuals often feel anxiety or tension in considering these behaviors. This anxiety or tension is relieved or diminished once the action is performed.
Intermittent explosive disorder is more common among men, and involves aggressive outbursts that lead to assaults on others or destruction of property. These outburst are unprovoked or seem to be out of proportion to the event that precedes them.
Kleptomania is more common among women, and involves the theft of objects that are seemingly worthless. The act of stealing relieves tension and is seen by the individual to be rewarding. The actual stealing is not preplanned, and the concept of punishment for the crime does not occur to these individuals, although they are aware that what they are doing is wrong.
Pyromania is more common among men, and involves setting fires in order to feel pleasure and relieve tension.
Pathological gambling occurs in roughly 1-3% of the population, and involves excessive gambling despite heavy monetary losses. These losses actually act as a motivating factor in continuing gambling in order to recoup some of what was lost.
Trichotillomania involves pulling hair from one's own scalp, face, or body, and is more common in women. It often begins in childhood, and is often associated with major depression or attention-deficit/hyperactivity disorder.
Causes and symptoms
The exact causes of impulse control disorders are not fully understood as of 2004. Individuals who have had serious head injuries, however, can be at a higher risk for developing impulse control disorders, as are those with epilepsy.
Some cases of impulse control disorders appear to be side effects of general medical conditions. As of 2004, several groups of researchers have noted that some older adults with Parkinson's disease become compulsive gamblers as the disease progresses. It is thought that this gambling behavior is a side effect of dopaminergic drugs, as it does not respond to standard treatments for compulsive gambling but only to changes in the patient's medication.
Another medical condition that is associated with impulse control disorders is carcinoid syndrome. In one group of 20 consecutive patients with the syndrome, 75% met DSM-IV diagnostic criteria for one or another impulse control disorder. The researchers attribute the connection to the high levels of serotonin (a neurotransmitter) produced by carcinoid tumors.
Diagnosis
A diagnosis of any of these impulse control disorders can be made only after other medical and psychiatric disorders that may cause the same symptoms have been ruled out.
Some doctors may administer questionnaires or similar psychiatric screeners as part of the differential diagnosis. Two instruments that have been devised in the early 2000s to specifically target impulsive behavior are the Gambling Urge Scale (GUS) and the Lifetime History of Impulsive Behaviors (LHIB) Interview.
Intermittent explosive disorder involves severe acts of assault or destruction of property. The aggression seen during these acts is vastly out of proportion to events that may seem to have precipitated the acts.
Kleptomania involves stealing objects that are unnecessary and of little monetary value. The act of stealing is not an expression of anger or vengeance. Again, there is an increased tension before the act is committed, and this is resolved or relieved once the object is stolen.
Pyromania is classified by the deliberate setting of fires more than once. The individual will exhibit a fascination and attraction to fire and any objects associated with it. Before the fire is set, there is tension, with a resolving relief once the fire is set. Acts of true pyromania are not done for monetary gain, to express anger, to conceal criminal behavior, or in response to hallucination.
Pathological gambling is a disorder to gamble despite continuing losses and monetary insufficiency. This disorder typically begins in youth, and affected individuals are often competitive, easily bored, restless, and generous.
For a diagnosis of pathological gambling, five or more of the following symptoms must be present:
a preoccupation with gambling
a need to gamble with more money to achieve the thrill of winning
repeated attempts to control or stop gambling
irritability or restlessness due to repeated attempts of control
gambling as an escape from stress
lying to cover up gambling
conducting illegal activities, such as embezzling or fraud, to finance gambling
losing a job or personal relationship due to gambling
borrowing money to fund gambling
Trichotillomania is the continuous pulling out of one's own hair. Again, there is an increased sense of tension before pulling the hair, which is relieved once it is pulled out. Recurrent pulling out of one's hair resulting in noticeable hair loss. Affected individuals can undergo significant distress and impaired social, occupational, and functional behavior.
Treatment
A combination of psychological counseling and medication are the preferred treatments for the impulse control disorders. For kleptomania, pyromania, and trichotillomania, behavior modification is usually the treatment of choice. Children with trichotillomania are often helped by antidepressant medication. For pathological gambling, treatment usually involves an adaptation of the model set forth by Alcoholics Anonymous. Individuals are counseled with the goal of eventual response to appropriate social limits. In the case of intermittent explosive disorder, anger management and medication may be used in extreme cases of aggression.
Prognosis
These disorders can usually be controlled with medication, although it may need to be continued long-term to help prevent further aggressive outbursts. Long-term counseling is usually necessary as well. Support groups and meetings may also help these individuals.
The prognosis for intermittent explosive disorder, kleptomania, and pyromania is fair. Little is known about the prognosis for trichotillomania, and studies have shown that the condition can disappear for long periods (months to years) without any psychological counseling. For pathological gambling, the prognosis varies greatly from person to person. While total cure for this condition is unlikely, much like alcoholism, long periods of abstinence or continuous abstinence are possible.
Prevention
There are no known preventive treatments or measures for impulse control disorders.
Key Terms
Carcinoid syndrome
The pattern of symptoms (often including asthma and diarrhea) associated with carcinoid tumors of the digestive tract or lungs.
Compulsive gambling disorder
An impulse control disorder in which an individual cannot resist gambling despite repeated losses.
Intermittent explosive disorder
A personality disorder in which an individual is prone to intermittent explosive episodes of aggression during which he or she causes bodily harm or destroys property.
Kleptomania
An impulse control disorder in which one steals objects that are of little or no value.
Pyromania
An impulse control disorder in which one sets fires.
Trichotillomania
An impulse or compulsion to pull out one's own hair.

Behavior Modification

I
INTRODUCTION
Behavior Modification, psychological methods for treating maladjustment and for changing observable behavior patterns. In the behavior modification process, the procedures used are monitored so that changes can be made when necessary. Physical and mental coercion, brain surgery, brainwashing, drug use, and psychotherapy are often considered methods of behavior modification because they try to, and frequently do, change behavior. None of them, however, is behavior modification as the term is used in present-day psychology.
II
HISTORICAL DEVELOPMENT
The foundation for behavior modification was laid at the beginning of the 20th century in the experimental laboratory of the Russian physiologist Ivan P. Pavlov. A dog was being trained to salivate when a circle was projected on a screen and not to salivate when an ellipse was shown. The shape of the ellipse was gradually modified to resemble the circle. When only a slight difference between the circle and the ellipse could be perceived, the dog became agitated and no longer displayed the conditioned response it had acquired. This type of disturbance was called an “experimentally induced neurosis.”
A second landmark event for behavior modification took place when Pavlov's conditioning principles were extended to humans. In 1920 the American psychologists John B. Watson and Rosalie Rayner reported an experimental study in which an 11-month-old baby who had previously played with a white laboratory rat was conditioned to be fearful of the rat by associating a loud noise with the animal, a process known as pairing. The psychologist Mary Cover Jones later performed experiments designed to reduce already established fears in children. She found two methods particularly effective: (1) associating a feared object with a different stimulus capable of arousing a positive reaction, and (2) placing the child who feared a certain object with other children who did not.
Behavior modification techniques were used in the 1940s and '50s by psychologists in South Africa, England, and the United States. Joseph P. Wolpe, a South African physician, questioned the effectiveness of psychotherapy for treating disturbed young adults, especially those with disabling fear reactions. To deal with anxiety disturbances, Wolpe devised treatment procedures based on Pavlov's classical-conditioning model. At about the same time, a group of psychologists in London, headed by Hans J. Eysenck and M. B. Shapiro, launched a new program of research on the development of treatment techniques, basing their investigations on the learning theory of the American psychologists Clark L. Hull and Kenneth W. Spence.
In the U.S. two kinds of investigations helped to establish the field of behavior modification. One was a further extension of the classical-conditioning principles to clinical problems such as bed-wetting and alcoholism. The other was the application of the operant-conditioning principles developed by B. F. Skinner to the education and training of handicapped children in schools and institutions and to the treatment of adults in psychiatric hospitals.
By the early 1960s, behavior modification had become a clearly identifiable applied psychology movement with two components: behavior therapy and applied behavior analysis.
III
BEHAVIOR MODIFICATION TECHNIQUES
Some of the treatment techniques used in behavior therapy became prominent enough to acquire specific names. Among them are systematic desensitization, aversion therapy, and biofeedback.
Systematic desensitization, the most widely used technique, attempts to treat disturbances having identifiable sources, such as a paralyzing fear of closed spaces. This method usually involves training the individual to relax in the presence of fear-producing stimuli. The therapist assumes that the anxiety reaction will be replaced gradually with the new relaxation response; this is called reciprocal inhibition.
Aversion therapy is used to break disabling bad habits. An aversive stimulus, such as an electric shock, is given together with the “bad habit,” such as an alcoholic drink. Repeated pairings result in changing the values of such stimuli from positive attraction to repulsion.
Biofeedback is most often used in treating disturbed behavior that has a physical basis. It provides an individual with information about an ongoing physiological process such as blood pressure or heartbeat rate. By the use of a mechanical device, indications of moment-to-moment variations in bodily functioning can be observed and monitored by the individual. The therapist may provide some reward for desirable changes, such as a decrease in blood pressure.
Applied behavior analysis is used to develop educational and treatment techniques that can be tailored to each individual's requirements while still following a constant format, whether the patients are retarded or disturbed children in a school or residential setting, or adults in a psychiatric hospital or rehabilitation center. Five essential steps characterize this approach: (1) deciding what the individual can do to ameliorate the problem; (2) devising a program to weaken undesirable behavior and strengthen desirable substitute behavior; (3) carrying out the treatment program according to behavioral principles; (4) keeping careful and objective records; and (5) altering the program if progress can thereby be improved.

How Dyslexics Write

Dyslexia

I
INTRODUCTION
Dyslexia, the inability to learn to read fluently. No single definition of dyslexia is accepted by all reading specialists. In the United States, federal law governing special education classifies dyslexia as a “specific learning disability” or as a “specific reading disability.” The World Health Organization labels dyslexia a “specific reading disorder,” and other sources label it a “specific language disorder.” However, a central feature of all definitions is an unexpected and substantial difficulty in learning to read. The lack of a commonly accepted definition of dyslexia has caused some educators, physicians, and researchers to avoid using the term altogether.
Because there is no clear and widely held definition of the problem, estimates of the number of persons with dyslexia vary widely. Most researchers have suggested that dyslexia is rare, occurring in 1 to 2 percent of the world’s population. However, others contend that 10 to 20 percent of the population have dyslexia or display dyslexic characteristics. Those arguing for the higher incidence levels also suggest that dyslexia can appear in differing levels of intensity, affecting the reading achievement of some individuals more than others. Dyslexia is usually identified during childhood, but it continues to affect individuals throughout their lives.
II
CHARACTERISTICS
Before about 1970 most explanations of dyslexia held that the root of the problem lay in visual difficulties. For example, many experts believed that dyslexic children saw letters backward or in reverse order. Since then, however, much research has shown that children with dyslexia are no more prone to reverse letters while reading and writing than are other children.
Most dyslexia research now focuses on problems distinguishing the various sounds, or phonemes, that make up speech. Available evidence suggests that dyslexics have substantial difficulty decoding the phonological system of words—that is, they have problems breaking words into their various constituent sounds. For example, dyslexics may have difficulty breaking the spoken word hit into the three phonemes that correspond to the letters h, i, and t. Because they cannot segment hit into these three sounds, dyslexics often do not associate those sounds with the corresponding letters that would enable them to read the word. About 20 percent of all children experience some difficulty in distinguishing the individual sounds of spoken words. However, most of those children benefit from specialized instruction to treat reading problems early. Only 1 to 2 percent of children exhibit continuing reading difficulties after they receive such instruction.
III
INCIDENCE
Evidence suggests that dyslexia is more common in some families than others. Because of this, some researchers claim that there may be a genetic basis for dyslexia, but this has not been conclusively proved. Most studies have also reported that dyslexia affects significantly more boys than girls. However, a recent large-scale study reported that although schools identified more boys with reading problems than girls, test results showed severe reading difficulties in roughly equivalent numbers of both sexes.
IV
DIAGNOSIS
Common methods of diagnosing dyslexia vary widely, although most experts rule out other common sources of learning difficulty—such as lack of intelligence, absence from school, hearing or vision problems, and behavior disorders—before making a diagnosis of dyslexia. Many researchers have called for a shift in methods to identify dyslexia. Some argue that a diagnosis of dyslexia should be made only in children who continue to struggle with reading, even after having received high-quality, intensive tutorial instruction. This diagnostic method consists of two steps. First, experts assess the intensity and appropriateness of the instruction the child has received. If they find no evidence of an appropriate, intensive educational intervention to correct reading problems, then a diagnosis of dyslexia is premature. Second, experts assess the child’s ability to distinguish phonemes. Once again, a diagnosis of dyslexia would be premature if examiners identified difficulties in this area but found that the child had received no intervention to develop phonological processing skills.
Experts diagnose dyslexia only when reliable evidence shows that a child’s reading difficulties do not seem correctable through intensive, appropriate instruction. A child may not respond well in group instructional settings and may fall behind classmates in both reading acquisition and phonological processing skills. But these deficits alone would not warrant a diagnosis of dyslexia. Such a diagnosis is appropriate only if the deficits remain after the child receives intensive tutorial instruction to correct them.
V
LIVING WITH DYSLEXIA
Many children experience some difficulties learning to read, write, and spell. With access to appropriate teaching, however, most of these children can and do become good readers. Effective instruction for dyslexics provides significant opportunity to read books of appropriate difficulty, meaningful writing activity, and guidance in developing useful strategies for decoding words and in establishing self-monitoring skills. However, few students with reading difficulties receive such instruction. Intensive tutorials often require one-to-one instruction, which most schools find too expensive to provide. A small number of private schools in the United States have well-researched and successful instructional programs for children with reading difficulties, but these serve relatively few students.
Even after receiving high-quality instruction, a small percentage of children fail to develop fluent reading abilities. Although these children are identified by most experts as dyslexic, even they can learn to read. Their reading often remains slower than their peers and the effort required for reading remains substantially greater. Nonetheless, many dyslexics not only graduate from high school and college but go on to excel in a wide variety of occupations.

Dyslexics get stuck at the starting gate because they can’t make the connection between the symbol and the sound.

D...........Disability to learn

Y...........Hundred years on {Understanding dyslexia}

S...........Spelling Disorder {Phonetics}

L..........Low school performance

E……… Early language impairment

X……….Genes on “x” chromosomes

I………..IQ above normal

A……….Attention deficit disorder

Phobia

Phobia, intense and persistent fear of a specific object, situation, or activity. Because of this intense and persistent fear, the phobic person often leads a constricted life. The anxiety is typically out of proportion to the real situation, and the victim is fully aware that the fear is irrational.
Phobic anxiety is distinguishable from other forms of anxiety only in that it occurs specifically in relation to a certain object or situation. This anxiety is characterized by physiological symptoms such as a rapid, pounding heartbeat, stomach disorders, nausea, diarrhea, frequent urination, choking feelings, flushing of the face, perspiration, tremulousness, and faintness. Some phobic people are able to confront their fears. More commonly, however, they avoid the situation or object that causes the fear—an avoidance that impairs the sufferer's freedom.
Psychiatrists recognize three major types of phobias. Simple phobias are fears of specific objects or situations such as animals, closed spaces, and heights. The second type, agoraphobia, is fear of open, public places and situations (such as public vehicles and crowded shopping centers) from which escape is difficult; agoraphobics tend increasingly to avoid more situations until eventually they become housebound. Social phobias, the third type, are fears of appearing stupid or shameful in social situations. The simple phobias, especially the fear of animals, may begin in childhood and persist into adulthood. Agoraphobia characteristically begins in late adolescence or early adulthood, and social phobia is also associated with adolescence.
Although agoraphobia is more often seen in treatment than the other types of phobia, it is not believed to be as common as simple phobia. Taken together, the phobias are believed to afflict 5 to 10 persons in 100. Agoraphobia and simple phobia are more commonly diagnosed in women than in men; the distribution for social phobia is not known. Agoraphobias, social phobias, and animal phobias tend to run in families.
Behavioral techniques have proved successful in treating phobias, especially simple and social phobias. One technique, systematic desensitization, involves gradually confronting the phobic person with situations or objects that are increasingly close to the feared ones. Exposure therapy, another behavioral method, has recently been shown more effective. In this technique, phobics are repeatedly exposed to the feared situation or object so that they can see that no harm befalls them; the fear gradually fades. Antianxiety drugs have also been used as palliatives. Antidepressant drugs have also proved successful in treating some phobias.

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder, mental illness in which a person experiences recurrent, intrusive thoughts (obsessions) and feels compelled to perform certain behaviors (compulsions) again and again. Most people have experienced bizarre or inappropriate thoughts and have engaged in repetitive behaviors at times. However, people with obsessive-compulsive disorder find that their disturbing thoughts and behaviors consume large amounts of time, cause them anxiety and distress, and interfere with their ability to function at work and in social activities. Most people with this disorder recognize that their obsessions and compulsions are irrational but cannot suppress them.
Obsessive-compulsive disorder usually begins in adolescence or early adulthood. It affects from 1.5 to 2 percent of people in the United States. The disorder affects slightly more women than men.
II
SYMPTOMS
Obsessions can include a variety of thoughts, images, and impulses. Common obsessions include fears of contamination from germs, doubts about whether doors are locked or appliances are turned off, nonsensical impulses such as shouting in public, sexual thoughts that are disturbing to the individual, and thoughts of accidentally and unknowingly harming someone. People with obsessions may avoid shaking hands with other people because they fear contamination, or they may avoid driving because they fear they will injure someone in a traffic accident.
People usually perform compulsions to relieve the anxiety produced by their obsessions, although not all people with obsessions perform compulsions. The most common compulsions involve cleaning rituals and checking rituals. For example, people with obsessions about germs may wash their hands dozens of times each day until their skin becomes raw. People with obsessions about neatness and symmetry may constantly rearrange or straighten objects on their desk. People with checking compulsions must repeatedly check to make sure they locked doors and windows or turned off water faucets. Other compulsions include counting objects, hoarding vast amounts of useless materials, and repeating words or prayers internally.
Obsessive-compulsive disorder can have disabling effects on people’s lives. People with severe cases of this disorder may need hospitalization to help treat the compulsions. In less extreme instances, individuals with compulsions often must allow a great deal of extra time to complete seemingly routine tasks, such as preparing to leave the house in the morning. Individuals may avoid going to certain places or engaging in certain activities because they feel embarrassed about their behavior.
In addition, family members of someone with this disorder may feel angry at the person because the compulsive behaviors intrude on their time together or interfere with the family’s functioning. For instance, some individuals hoard things, such as newspapers or magazines, because they believe they may someday need certain pieces of information. The piles of newspapers may cover the living areas and make other family members feel embarrassed to have guests in the home.
III
CAUSES
Like many mental illnesses, obsessive-compulsive disorder appears to result from a combination of biological and psychological influences. Some people may have a biological predisposition to experience anxiety. Research also suggests that abnormal levels of the neurotransmitter serotonin may play a role in obsessive-compulsive disorder. Brain scans of people with obsessive-compulsive disorder have revealed abnormalities in the activity level of the orbital cortex, cingulate cortex, and caudate nucleus, a brain circuit that helps control movements of the limbs.
The disorder may develop when these biological influences combine with a psychological vulnerability to anxiety. Some people may develop a psychological vulnerability to anxiety in childhood. They may come to believe that the world is a potentially dangerous place over which one has little control. People seem to develop obsessive-compulsive disorder specifically when they learn that some thoughts are dangerous or unacceptable and, while attempting to suppress these thoughts, develop anxiety about the recurrence of the thoughts and about the perceived dangerousness and intrusiveness of the thoughts.
IV
TREATMENT
Treatment for obsessive-compulsive disorder includes psychotherapy, psychoactive drugs, or both. Mental health professionals consider exposure and response prevention, a type of cognitive-behavioral therapy, to be the most effective form of psychotherapy for this disorder. In this technique, the therapist exposes the patient to feared thoughts or situations and prevents the patient from acting on his or her compulsion. For example, a therapist might have patients with cleaning compulsions touch something dirty and then prevent them from washing their hands. This technique helps 60 to 70 percent of people with obsessive-compulsive disorder.
Medications to treat obsessive-compulsive disorder include selective serotonin reuptake inhibitors, such as fluoxetine (Prozac) and fluvoxamine (Luvox). A tricyclic antidepressant, clomipramine (Anafranil), also helps relieve symptoms of the disorder. About 80 percent of people with the disorder show some improvement with a combined treatment of medication and behavioral therapy. However, many patients relapse when they stop taking the medication.