Integration of hypnotic and systematic desensitization techniques in the treatment of phobias: a case report.
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This case history presents a treatment procedure for a nine-year-old girl who masturbated in the classroom. A fading procedure within a behavioral management contract was implemented which proved to be effective. One-, three-, six-, and nine-month follow-ups did not show any evidence of relapse or symptoms substitution.
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The Lesch--Nyhan syndrome is a heritable disorder of the metabolism of uric acid in which behavioral manifestations are prominent and among the most provocative. The mutated or variant gene that determines this disorder is carried on the X chromosome. The disease is expressed exclusively in males. The molecular expression of the abnormal gene is in the completely defective activity of the enzyme hypoxanthine guanine phosphoribosyl transferase. As a result these patients overproduce uric acid and may develop early in life many of the clinical findings we associate with gout. They have in addition a variety of neurological abnormalities including mental retardation, spastic cerebral palsy, and involuntary, choreoathetoid movements. Involved patients have unusual, compulsive, aggressive behavior. Its most prominent but by no means exclusive feature is self-mutilation. The central feature in the management of this behavior is physical restraint. A number of practical procedures have been learned which facilitate the care and feeding of these patients. Promising new findings suggest that behavioral modification using extinction techniques and pharmacologic methods utilizing agents designed to increase the effective cerebral content of serotonin may each have a place in the management of behavior in this syndrome.
A girl of borderline intelligence developed repeated syncopal attacks that were compulsively self-induced, apparently by forced expiration against a closed glottis (Valsalva's maneuver). In addition, she had typical absence seizures triggered by her apneic attacks, which could also be induced by hyperventilation. The absence seizures were suppressed by treatment with valproate sodium, which had no effect on the self-induced apneas. These were considerably improved with fenfluramine hydrochloride treatment, which was also associated with marked improvement of her previously abnormal behavior.
Reported the results of a factor analytic study of the Personal Development Study (PDS). The PDS was administered for research purposes to four diagnostic groups, which included 89 institutionalized alcoholics, 336 unmarried mothers, 159 college students, and 388 chronic schizophrenics. A principal component factor analysis with Varimax rotation performed on the combined populations (N = 972) yielded five main factors labeled as projection, optimism-responsibility, reaction and symptom formation, repressive-compulsive, and intropunitiveness-guilt. Analysis of base rates of responding to the individual items revealed that the four populations ranged along a continuum, with the normals at one extreme and the institutionalized schizophrenics at the other extreme of greater pathological responding.
A therapy is described in which clients vividly imagine the cognitions that usually trigger their stuttering, and then contingently experience a painful shock. With the cessation of shock, alternate desirable cognitions are imagined that are designed to facilitate fluent speech. A case study illustrating the treatment is presented. Stuttering is compared with addictive behaviors such as smoking, and it is concluded that cognitive commonalities exist among seemingly disparate behaviors. The cognitive conditioning framework provides an integrative model that can be usefully applied in a variety of situations.
Hypnosis as an intrapsychological and interpersonal experience is used as an integrative and amplifying procedure in relation to biofeedback mechanism and behavior therapy. The hypnotic capacity for linking cognitive to affective reactions within a feedback loop of sensory and motor imagery is presented as a dynamic approach to behavior modification during psychotherapy.
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We used positron emission tomography to investigate local cerebral metabolic rates for glucose (LCMRG1c) in patients with obsessive-compulsive disorder before and after treatment with either fluoxetine hydrochloride or behavior therapy. After treatment, LCMRG1c in the head of the right caudate nucleus, divided by that in the ipsilateral hemisphere (Cd/hem), was decreased significantly compared with pretreatment values in responders to both drug and behavior therapy. These decreases in responders were also significantly greater than right Cd/hem changes in nonresponders and normal controls, in both of whom values did not change from baseline. Percentage change in obsessive-compulsive disorder symptom ratings correlated significantly with the percent of right Cd/hem change with drug therapy and there was a trend to significance for this same correlation with behavior therapy. By lumping all responders to either treatment, right orbital cortex/hem was significantly correlated with ipsilateral Cd/hem and thalamus/hem before treatment but not after, and the differences before and after treatment were significant. A similar pattern was noted in the left hemisphere. A brain circuit involving these brain regions may mediate obsessive-compulsive disorder symptoms.
In the past decade, various investigators have attempted to find new pharmacological agents for the treatment of obsessive disorders. Of these, the drug which has attracted attention and has been most promising is clomipramine. This paper attempts to review the usefulness of clomipramine in the treatment of obsessive disorder. Accidentally, it was discovered that clomipramine was effective in alleviating obsessive symptoms in depressed patients by a Spanish psychiatrist, Lopez-Ibor. Initial studies carried out mainly on patients with major depression reported that obsessive symptomatology benefited with clomipramine therapy. A number of uncontrolled and controlled studies confirmed the efficacy of this drug in obsessive neurosis. The drug improves the obsessive symptoms. Discontinuation of the drug is followed by a relapse. The efficacy, dosage, duration and side effects of treatment with clomipramine are discussed in this paper.
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