Tuesday, November 15, 2011

Intellectually Disability

  The DSM-1V2 defines mental retardation as follows:

  1. Significantly subaverage intellectual functioning-ie, an IQ of approximately 70 or below.
  2. Deficits or impairments in adaptive functioning.
  3. Onset before age 18 years.
Levels of Severity
  Mental retardation is subdivided into levels of severity based on IQ and associated features (Table 1).

  Individuals with mental retardation represent 1% to 3% of the general population. Mental retardation is approximately 1.5 times more common in boys than in girls.
  Until recently, a significant proportion of individuals with mental retardation were cared for in residential facilities such as state-run training schools. Currently, however, the vast majority of the developmentally disabled live in the community and use community resources for treatment.

  Mental retardation is highly heterogeneous as to cause. More than 250 biologic causes are known, most of which can be grouped under the general categories of chromosomal abnormalities, other genetic factors, prenatal and perinatal factors (eg, anoxia), acquired childhood disorders, environmental factors (eg, lead),3and sociocultural factors.
  Knowing the cause in a particular case can sometimes provide important clues for understanding an individual's presentation; however, only approximately 25% of cases of mental retardation have a known biologic cause; in the remaining 75% of cases, the cause is unknown or is traceable to nonbiologic (eg, psychosocial) factors.

  It has been estimated that 40% to 70% of individuals with mental retardation have diagnosable psychiatric disorders.4 This subgroup of individuals, however, are not the only ones who come in contact with psychiatrists. Like anyone else, a developmentally disabled person may present with emotional, behavioral, interpersonal, or adjustment problems that do not constitute major psychiatric disorders but that may benefit nonetheless from psychiatric input. Psychiatrists should remember that in clinical settings they do not have the opportunity to see people with mental retardation living and working in the community in a normal, non-problematic manner. As a result, they often do not have a baseline with which to compare current functioning.
  Psychiatrists called on to evaluate and treat developmentally disabled individuals in either an emergency or inpatient setting need to be aware of special considerations that set this population apart. These considerations occur mainly in two areas: (1) working as part of a team with the patient's regular caregivers; and (2) characteristics of mental retardation that may confound the usual procedures for psychiatric diagnostic assessment and treatment planning.

Table 1
Levels of Severity of Mental Retardation
Levels       IQ       Precentage of Mentally Retarded Population
50-55 to 70
35-40 to 50-55
20-25 to 35-40
Relationships With Other Caregivers
  Psychiatric care of individuals with mental retardation is most effectively rendered when the psychiatrist uses an interdisciplinary team model.5 The psychiatrist must take into account not only the acute problem but also the patient's relationship to long-term caregivers. These professionals tend to be deeply involved in the life of the patient, who they care a great deal about and see as their "client." They will likely contribute critically important diagnostic information and play a crucial role in implementing the treatment plan.
  At the same time, referring caregivers sometimes distrust doctors and medications.4'6 This aversion may lead them to delay getting a consultation until they are "at the end of their rope" and feel as if they can no longer cope with the patient, whose condition may have worsened in the interim. They may simultaneously harbor unrealistic expectations, such as that the psychiatrist will be a magical rescuer. This ambivalence can have disruptive consequences. A successful treatment outcome may depend in part on how well the psychiatrist can bridge the gap between different conceptual models (medical versus habilitative), clinical languages, and organizational styles.

Special Diagnostic Issues
  Mental retardation may obscure the standard diagnostic indicators of psychiatric disorders. For one thing, especially for the psychiatrist unaccustomed to the normal manifestations of mental retardation, those manifestations may overshadow symptoms attributable to psychiatric illness.7 Moreover, impairments in cognitive and verbal skills make it difficult for many developmentally disabled individuals to articulate abstract or global concepts such as a depressed mood. Most DSM-IV diagnoses require that the patient describe his or her internal state. Asking a person with an IQ below 40 about hallucinations, delusions, or guilt is seldom productive. On the other hand, the person's disorganized behavior may have diagnostic significance.8
  These are the challenges that people with mental retardation often pose for psychiatric diagnosis. Sovner 9 identified four aspects of mental retardation that may influence diagnosis:

  1. Intellectual distortion - emotional symptoms are difficult to elicit because of deficits in abstract thinking and in receptive and expressive language skills.
  2. Psychosocial masking - limited social experiences can influence the content of psychiatric symptoms (eg, mania presenting as a belief that one can drive a car).
  3. Cognitive disintegration - decreased ability to tolerate stress, leading to anxiety-induced decompensation (sometimes misinterpreted as psychosis).
  4. Baseline exaggeration - increase in severity or frequency of chronic maladaptive behavior after onset of psychiatric illness.

 To allow for these possible distortions, Sovner9 proposed that the standard diagnoses for mania and depression be modified, when applied to the developmentally disabled, to focus on biologic signs and symptoms and behavioral equivalents to subjective states. 

Friday, September 2, 2011

Wednesday, March 2, 2011

How to make Criticism

All too often people choose not to object to what they consider mistreatment, when objecting would greatly improve their lives.  Instead, they remain silent, fearing that making a legitimate complaint will reveal a weakness of which the other person will take advantage. Others mistakenly feel that anyone who complains is automatically a troublemaker or a shrew.  Still more fell that they are worthwhile to other people only so long as they act compliantly. Nearly all of these think that they have tried to voice their objections and weren’t listed to.
In an intimate relationship, when one person suffers as a result of the other’s behavior, often the inflictor of pain doesn’t realize what he’s doing.  Most of us don’t want to inflict pain, yet we are all capable of harming the people we love.  If a friend or colleague belittles you, it is your responsibility to tell him and give him the opportunity to show good faith.  But to make an objection in a way that is fair, forceful and accurate take practice.  The following principles, evolved over years of working with students and married couples have helped to maintain constructive communication in many relationships.
Presenting Cases
Complain directly to the person you think is harming you.
Try not to object to your colleague’s behavior in front of someone else. To most people, being criticized seems like being personally attacked. Your indifference to your colleague’s comfort, displayed by your willingness to criticize him in front of others, will be taken at least as seriously as the content of what you say.  In fairness to him and yourself, wait until you are alone.
Don’t compare the person’s behavior with that of others
No one wants to be described as inferior. Comparisons predispose others not to listen, even when the complaint is justified. Anyhow, such comparisons always miss the main point.  
Make your complaints as soon as you can
Speaking up, like any other task, becomes more difficult when you postpone it.  Waiting allows your anger to build, and increases the likelihood of making irrelevant comments.
Don’t repeat a point once you’ve made it and the other person has carefully considered it.
The reward for patiently listening out to be exoneration from having to hear the same crime discussed again.
Object only to actions that the other person can change.
You may ask a person not to shout; but if you ask a person not to be angry with you, you are probably expecting too much.
Try to make only one complaint at a time.
If you make more, you will demoralize the other person and perhaps obscure your major point.
Don’t preface your complaint
“Listen. There is something I’ve wanted to tell you for a long time. It may hurt you, but…”
What could be worse? Instead of inoculating your listener against the pain, you are stabbing him to death. By prefaces, you convince both him and yourself that your complaint is to be monstrous, that probably he won’t be capable of  receiving it in the same friendly spirit in which you are making it.
After making your complaint in good faith, don’t apologize for it
Apology will only renew your own conflict about whether you had the right to say what you did. It is asking the other person to brace you against the stress of disagreeing with him and imposes an unnecessary burden on him.
Avoid sarcasm 
Among sarcasm’s invariably motivations are contempt and fear. Your contempt will predispose the other person not to heed you, and you make a choice not to confront him directly, you intensify the fear of him. Being sarcastic is cowardly, no matter how clever the turn of phrase.
Don’t talk about other people’s motivations when making an objection.
Hardly a man is now alive who doesn’t sense the difference between “Please don’t interrupt me” and “You never want me to finish what I am saying.”  You give the listener reason to disregard your essential complaint if he concludes that your speculation about his motive is wrong. Don’t confuse consequence and intention.
Avoid words like “always” and “never.”
 Exaggerations intended for emphasis rob you of accuracy and the psychological advantages that go with it.
If you never compliment the other person, don’t expect him to remain open to your criticisms
Complaints ring loud and long when they’re the only sounds that are made. If you want make occasional objections, you have the obligation to compliment the person at other times.  I also recommend the practice of thanking people for listening to your criticisms.  
                                                              - Madhusoodan. S

successful teachers qualities

The most successful teachers share some common characteristics. Here are the top six keys to being a successful teacher. Every teacher can benefit from focusing on these important qualities. Success in teaching, as in most areas of life, depends almost entirely on your attitude and your approach.
1. Sense of Humor A sense of humor can help you become a successful teacher. Your sense of humor can relieve tense classroom situations before they become disruptions. A sense of humor will also make class more enjoyable for your students and possibly make students look forward to attending and paying attention. Most importantly, a sense of humor will allow you to see the joy in life and make you a happier person as you progress through this sometimes stressful career.
2. A Positive Attitutude A positive attitude is a great asset in life. You will be thrown many curve balls in life and especially in the teaching profession. A positive attitude will help you cope with these in the best way.
3. High Expectations An effective teacher must have high expectations. You should strive to raise the bar for your students. If you expect less effort you will receive less effort. You should work on an attitude that says that you know students can achieve to your level of expectations, thereby giving them a sense of confidence too. This is not to say that you should create unrealistic expectations. However, your expectations will be one of the key factors in helping students learn and achieve.
 4. Consistency In order to create a positive learning environment your students should know what to expect from you each day. You need to be consistent. This will create a safe learning environment for the students and they will be more likely to succeed. It is amazing that students can adapt to teachers throughout the day that range from strict to easy. However, they will dislike an environment in which the rules are constantly changing.
5. Fairness Many people confuse fairness and consistency. A consistent teacher is the same person from day to day. A fair teacher treats students equally in the same situation.
6. Flexibility One of the tenets of teaching should be that everything is in a constant state of change. Interruptions and disruptions are the norm and very few days are 'typical'. Therefore, a flexible attitude is important not only for your stress level but also for your students who expect you to be in charge and take control of any situation. 

Thursday, February 17, 2011

History of Psychology

Functionalism, an early school of psychology, focuses on the acts and functions of the mind rather than its internal contents. Its most prominent American advocates are William James and John Dewey, whose 1896 article "The Reflex Arc Concept in Psychology" promotes functionalism.
The founder of psychoanalysis, Sigmund Freud, introduces the term in a scholarly paper. Freud's psychoanalytic approach asserts that people are motivated by powerful, unconscious drives and conflicts. He develops an influential therapy based on this assertion, using free association and dream analysis.
Edward B. Titchener, a leading proponent of structuralism, publishes his Outline of Psychology. Structuralism is the view that all mental experience can be understood as a combination of simple elements or events. This approach focuses on the contents of the mind, contrasting with functionalism.
First psychology clinic
After heading a laboratory at University of Pennsylvania, Lightner Witmer opens world's first psychological clinic to patients, shifting his focus from experimental work to practical application of his findings.
Interpretation of Dreams
Sigmund Freud introduces his theory of psychoanalysis in The Interpretation of Dreams, the first of 24 books he would write exploring such topics as the unconscious, techniques of free association, and sexuality as a driving force in human psychology.
Manual of Experimental Psychology
With publication of the Manual of Experimental Psychology, Edward Bradford Titchener introduces structuralism to the United States. Structuralism, an approach which seeks to identify the basic elements of consciousness, fades after Titchener's death in 1927.
First woman president of the APA 
Mary Calkins is elected president of the APA. Calkins, a professor and researcher at Wellesley College, studied with William James at Harvard University, but Harvard denied her a Ph.D. because of her gender.
IQ tests developed
Using standardized tests, Alfred Binet and Theodore Simon develop a scale of general intelligence on the basis of mental age. Later researchers refine this work into the concept of intelligence quotient; IQ, mental age over physical age. From their beginning, such tests' accuracy and fairness are challenged.
Psychoanalysts visit Clark University
Sigmund Freud and Carl Jung visit the United States for a Psychoanalysis Symposium at Clark University organized by G. Stanley Hall. At the symposium, Freud gives his only speech in the United States.
John B. Watson publishes "Psychology as Behavior," launching behaviorism. In contrast to psychoanalysis, behaviorism focuses on observable and measurable behavior.
First African American doctorate in psychology
Francis Cecil Sumner earns a Ph.D. in psychology under G. Stanley Hall at Clark University. Sumner later serves as chair of the Howard University psychology department.

The Child's Conception of the World
Swiss psychologist Jean Piaget publishes The Child's Conception of the World, prompting the study of cognition in the developing child.
Rorschach test created
Swiss psychiatrist Hermann Rorschach devises a personality test based on patients' interpretations of inkblots.
Menninger Clinic founded
Charles Frederick Menninger and his sons Karl Augustus and William Clair found The Menninger Clinic in Topeka, Kansas. They take a compassionate approach to the treatment of mental illness, emphasizing both psychological and psychiatric disciplines.
Menninger Clinic founded
First Nobel Prize for psychological research
Electroencephalogram invented
Psychiatrist Hans Berger invents the electroencephalogram and tests it on his son. The device graphs the electrical activity of the brain by means of electrodes attached to the head.
Nazi persecution of psychologists
After the Nazi party gains control of the government in Germany, scholars and researchers in psychology and psychiatry are persecuted. Many, including Freud, whose books are banned and burned in public rallies, move to Britain or the United States.
Alcoholics Anonymous
Alcoholics Anonymous (AA) is founded by Bob Smith of Akron, Ohio. AA's group meetings format and 12-step program become the model for many other mutual-support therapeutic groups.

Gestalt psychology
Kurt Koffka, a founder of the movement, publishes Principles of Gestalt Psychology in 1935. Gestalt (German for "whole" or "essence") psychology asserts that psychological phenomena must be viewed not as individual elements but as a coherent whole.
First lobotomy in the United States
Walter Freeman performs first frontal lobotomy in the United States at George Washington University in Washington, D.C. By 1951, more than 18,000 such operations have been performed. The procedure, intended to relieve severe and debilitating psychosis, is controversial.
The Neurotic Personality of Our Time
Psychologist Karen Horney publishes The Neurotic Personality of Our Time. Horney goes on to challenge many of Freud's theories, as have many later psychologists and scholars. Specifically, she questions Freud's theories on the Oedipal Complex and castration anxiety.
The Behavior of Organisms
B.F. Skinner publishes The Behavior of Organisms, introducing the concept of operant conditioning. The work draws widespread attention to behaviorism and inspires laboratory research on conditioning.

Electroconvulsive therapy begun
Italian psychiatrist and neuropathologist Ugo Cerletti and his associates treat human patients with electrical shocks to alleviate schizophrenia and psychosis. ECT, while controversial, is proven effective in some cases and is still in use in 2001.
The Psychoanalytic Treatment of Children
Anna Freud publishes The Psychoanalytic Treatment of Children, introducing basic concepts in the theory and practice of child psychoanalysis.

National Mental Health Act Passed
U.S. President Harry Truman signs the National Mental Health Act, providing generous funding for psychiatric education and research for the first time in U.S. history. This act leads to the creation in 1949 of the National Institute of Mental Health (NIMH).
First drug to treat depression 
Studies are published reporting that the drug imipramine may be able to lessen depression. Eight years later, the FDA approves its use in the United States under the name Tofranil.
Thorazine tested
The anti-psychotic drug chlorpromazine (known as Thorazine) is tested on a patient in a Paris military hospital. Approved for use in the United States in 1954, it becomes widely prescribed.
APA Ethical Standards
The American Psychological Association publishes the first edition of Ethical Standards of Psychologists. The document undergoes continuous review and is now known as APA's Ethical Principles of Psychologists and Code of Conduct.
Epilepsy and the Functional Anatomy...
In Epilepsy and the Functional Anatomy of the Human Brain, neurosurgeon Wilder G. Penfield publishes results from his study of the neurology of epilepsy. His mapping of the brain's cortex sets a precedent for the brain-imaging techniques that become critical to biopsychology and cognitive neuroscience.
The Nature of Prejudice
Social Psychologist Gordon Allport publishes The Nature of Prejudice, which draws on various approaches in psychology to examine prejudice through different lenses. It is widely read by the general public and influential in establishing psychology's usefulness in understanding social issues.

In his studies of epilepsy, neuroscientist Wilder G. Penfield begins to uncover the relationship between chemical activity in the brain and psychological phenomena. His findings set the stage for widespread research on the biological role in psychological phenomena.
The development of psychoactive drugs in the 1950s and their approval by the FDA initiates a new form of treatment for mental illness. Among the first such drugs is Doriden, also known as Rorer, an anti-anxiety medication approved in 1954.
Humanistic Psychology
In the wake of psychoanalysis and behaviorism, humanistic psychology emerges as the "third force" in psychology. Led by Carl Rogers and Abraham Maslow, who publishes Motivation and Personality in 1954, this approach centers on the conscious mind, free will, human dignity, and the capacity for self-actualization.
Cognitive psychology 
Inspired by work in mathematics and other disciplines, psychologists begin to focus on cognitive states and processes. George A. Miller's 1956 article "The Magical Number Seven, Plus or Minus Two" on information processing is an early application of the cognitive approach.
Syntactic Structures
Noam Chomsky publishes Syntactic Structures, marking a major advancement in the study of linguistics. The book helps spawn the field of psycholinguistics, the psychology of language.
FDA approves Librium
The FDA approves the use of chlordiazepoxide (known as Librium) for treatment of non-psychotic anxiety in 1960. A similar drug, diazepam (Valium), is approved in 1963.
Community Mental Health Centers Act passed
U.S. President John F. Kennedy calls for and later signs the Community Mental Health Centers Act, which mandates the construction of community facilities instead of large, regional mental hospitals. Congress ends support for the program in 1981, reducing overall funds and folding them into a mental health block-grant program.
First National Medal of Science to psychologist
Neal E. Miller receives the National Medal of Science, the highest scientific honor given in the United States, for his studies of motivation and learning. He is the first psychologist to be awarded this honor.
FDA approves Lithium
The FDA approves lithium carbonate to treat patients with bipolar mood disorders. It is marketed under the trade names Eskalith, Lithonate, and Lithane.
Homosexuality removed from DSM 
After intense debate, the American Psychiatric Association removes homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM). The widely used reference manual is revised to state that sexual orientation "does not necessarily constitute a psychiatric disorder."
PET scanner tested
A new brain scanning technique, Positron Emission Tomography (PET), is tested. By tracing chemical markers, PET maps brain function in more detail than earlier techniques.
Evolutionary psychology
Richard Dawkins publishes The Selfish Gene, which begins to popularize the idea of evolutionary psychology. This approach applies principles from evolutionary biology to the structure and function of the human brain. It offers new ways of looking at social phenomena such as aggression and sexual behavior.

The Selfish Gene
Richard Dawkins publishes The Selfish Gene, a work which shifts focus from the individual animal as the unit of evolution to individual genes themselves. The text popularizes the field of evolutionary psychology, in which knowledge and principles from evolutionary biology are applied in research on human brain structure.
Standardized IQ tests found discriminatory
The U.S. District Court finds the use of standardized IQ tests in California public schools illegal. The decision in the case, Larry P. v. Wilson Riles, upholds the plaintiff's position that the tests discriminate against African American students.
AIDS and HIV first diagnosed
The epidemic of acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection presents mental health professionals with challenges ranging from at-risk patients' anxiety and depression to AIDS-related dementia.
Insanity Defense Reform Act passed
U.S. Congress revises federal law on the insanity defense, partly in response to the acquittal of John Hinckley, Jr. of charges of attempted assassination after he had shot President Ronald Reagan. The act places burden of proof for the insanity defense on the defendant.
Homeless Assistance Act passed
The Stewart B. McKinney Homeless Assistance Act provides the first federal funds allocated specifically for the homeless population. The act includes provisions for mental health services, and responds, in part, to psychological studies on homelessness and mental disorders.

Prozac, Paxil, and Zoloft made available
The FDA approves the new anti-depressant medication fluoxetine, (Prozac). The drug, and other similar medications, acts on neurotransmitters, specifically, serotonin. It is widely prescribed and attracts attention and debate.
Cultural psychology
In Acts of Meaning, Four Lectures on Mind and Culture, Jerome Bruner helps formulate cultural psychology, an approach drawing on philosophy, linguistics, and anthropology. Refined and expanded by Hazel Markus and other researchers, cultural psychology focuses on the influences and relationship among mind, cultural community and behavior.
Sequencing of the Human Genome
Sixteen public research institutions around the world complete a "working draft" mapping of the human genetic code, providing a research basis for a new understanding of human development and disease. A similar, privately funded, project is currently underway.

The latest revision of the Diagnostic Statistical Manual of Mental Disorders (DSM) is published in a version for personal digital assistants (PDAs). The manual, first published in 1954, outlines prevalence, diagnosis, and treatment of mental disorders. Only 132 pages on first printing, in 2000 it was 980 pages.