Category Archives: Psychiatry

Hypnotherapy for Bedwetting

How Hypnotherapy compares with other treatments for bedwetting and one boy’s story
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Illustration showing spending difference between men and women during possible recession:-

Andrew Tan, 9, arrived at most early childhood milestones at a young age, and with ease. He walked at 9 months old. He was stringing sentences together and was potty trained when he was 2 years old. But when it came to being dry at night, Andrew had a different story. “We just thought that he’d come to it sooner or later,” says Joanna Tan, Andrew’s mum. “But at 6, he was still wetting the bed at night.”

According to the NHS, bedwetting when asleep, also known as nocturnal enuresis, is very common in children, especially those under 7. About one five-year-old in seven, and one child in 20 children aged 10 wet the bed, and it is more common in boys than girls. It can be caused by medical conditions such as cystitis or diabetes, or by some children’s inability to produce enough of the antidiuretic hormone, ADH, which controls the production of urine at night, or just by the fact that some children develop bladder control later than others. It may also have a psychological cause, because of problems at school or at home, for example.

Andrew overcame his bedwetting by means of hypnotherapy, which involves using hypnosis to treat medical and psychological problems. “He was approaching his seventh birthday and desperately wanted to go to Cub camp and sleepovers,” says Joanna. “He was still wetting the bed, though, and felt embarrassed, ashamed and even angry with himself. I’ve always wanted my son to believe he can accomplish anything he set his mind to, but with his bedwetting, his confidence levels were low. He was a bright chap, with a reading age of 9 or 10 when he was only 7, yet because of his bed-wetting, he felt like a failure. Then I read an article on hypnotherapy, which ended up being Andrew’s route to feeling good about himself again.”

According to the British Society of Clinical Hypnosis, being hypnotised feels like being in a trance state, similar to daydreaming, or like the moment before we fall asleep, in which there’s a deep sense of relaxation. During hypnosis, beneficial corrections may be given directly to the unconscious mind, which is a reservoir of unrecognised potential and knowledge, and the unwitting source of many of our problems.

“We discovered hypnotherapy after trying several conventional treatments from the age of 3, including sedatives,” Joanna says. “When Andrew was nearly 7 we saw the school nurse, who did a bladder test and told us that he had a small bladder. He was given the enuresis alarm, which wakes a child as he begins to wet the bed, but it soon woke everyone else but him!

“After four months with very little success, Andrew was then prescribed Desmopressin, a drug that inhibits the production of urine through the night. This had little effect either. Meanwhile, Andrew continued to be more and more demoralised.”

Waking up with a smile:-

Then Joanna came across Lynda Hudson, a clinical hypnotherapist with 15 years’ experience, who specialises in treating children as well as adults. Having trained at the London College of Clinical Hypnosis, Hudson also has an honours degree in psychology, teaches hypnotherapy to medical students and is currently writing a book on hypnotherapy for children. She is one of the few hypnotherapists in the country who treats them. “About 40-45 per cent of children I see come to me for bedwetting or other anxiety-based problems, which is why I produced a CD called I’m Dry at Night. This aims to change the mindset of a child who wets the bed, telling them that they can take control at the unconscious level. They can also listen to the CD in the safety of their own bedroom before they go to sleep at night,” says Hudson. Although Joanna knew a bit about hypnotherapy, she was a little apprehensive about Andrew being treated person-to-person.

“Using a CD felt different, though. I listened to it myself first, and it seemed so positive. Andrew was keen to give it a go, so he started to listen to it before he went to sleep. By the third night, he slept right through and was dry in the morning. Within a month, he was continuously dry but continued to fall asleep to the CD for the next three months because he found it so relaxing. He started to wake up with a smile on his face and rapidly regained his confidence,” she says.

On the CD, Hudson uses guided imagery. “I have used the idea of locking up the bladder with a large, strong and colourful key and standing sentry outside it. I’ve also included powerful suggestions for signals to be sent from the bladder (via the sentry) to the brain for the child to wake if necessary, or to keep those muscles tightly closed until morning. I can’t promise that this approach will work for every child, but it does for the vast majority,” she says.

It worked well for Andrew. “He’s a thinking child, who wanted it to work, and the fact that hypnotherapy gave him back control of the situation was the catalyst for change,” says Joanna.

Where Andrew was once withdrawn at school and in social situations, he now has high self-esteem, and even put himself up for school council this year. “But the best testament to his new-found confidence is that he agreed to be featured and photographed for this article,” says Joanna. “I warned him that he might be ridiculed for being a bedwetter, but he said, ‘Well, I did it, Mum. I don’t wet the bed any more’.”

Hypnotherapy It clearly worked for Andrew Tan and there is some limited support from clinical trials to suggest that it is an effective treatment. A 2005 review by the Cochrane Collaboration concluded that there is some weak evidence that hypnosis could treat bedwetting, but it was less effective on children between 5 and 7. Effectiveness 2/5

Drugs There are two broad drug-based approaches: a category of antidepressants called tricyclics, and synthetic antidiuretic hormones, normally desmopressin. It’s not clear how the tricyclics work, but the desmopressin reduces the amount of urine produced overnight. There is good evidence that both produce quick results, but a review of 22 clinical trials, published in 2000, found that children tended to relapse when the drugs were stopped. These are available only on prescription and must be taken under medical advice. Effectiveness 3/5

Acupuncture There is some evidence to suggest that acupuncture might help, but again that evidence is weak. The same Cochrane review that examined hypnotherapy concluded that there was similar, weak evidence for acupuncture. A more recent report, published in 2006, describes treating 56 children with 96 per cent effectiveness. However, this was not a clinical trial and, while it might suggest further exploration, it should not be taken as strong evidence. Contact the British Acupuncture Council (020-8735 0400), acupuncture.org.uk, for practitioners in your area; from £35. Effectiveness 2/5

Alarm A bedwetting alarm is one of the commonest treatments used and it seems to work for many children. A 2005 review of all studies carried out between 1980 and 2002 showed that alarms were successful in anything up to 80 per cent of cases, but that up to 50 per cent of children showed some degree of relapse. However, the evidence suggests that an alarm has a greater long-term effect than the common drug treatments. A Cochrane review suggests that as well as an alarm, giving your child additional tasks such as changing his bedsheets and getting him to go to the toilet repeatedly is better than an alarm alone. There are also suggestions that other combinations, such as drugs and alarm, are also more effective than single interventions, but the data is insufficient to draw firm conclusions. The Enuresis Resource and Information Centre can help, from £65. Effectiveness 3.5/5

Click to see:->Stop Bed-Wetting Deep Trance Now Hypnosis Programs

Sources: The Times: June7,’08

Hypnosis

Introduction:
Your mind is incredible. The brain has been compared to a computer in a sort of bio-computer analogy. The analogy has power–but it is an understatement. Science has discovered many of the hard wired connections that appear to give the brain/mind so much control over the body (health, wellness, longevity, youthfulness) and our destinies in terms of success, learning, wealth and prosperity.
There are many estimates by experts regarding the brain/mind. Most agree that at least three relevant observations are true:

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1. Somehow the mind can alter and control even things formerly thought to be a matter of DNA. (Example: multiple personality studies have shown eye color changes as sudden as the personality switch).

2. Only approximately 10% of the brain’s ability is tapped by normal people. The remaining 90% can be likened to an unused muscle–atrophied.

3. There is no law of limitation except that which is self imposed. Most have literally been programmed, like a computer, with what computer people term GIGO (garbage in, garbage out). That is, they have been subjected to repeated messages teaching self doubt, fear, anxiety, etc. This programmed language of limitation has become their life script, their expectation, and therefore most of their reality.

The mind is the ultimate frontier. Your potential is probably yet unrealized. Our business exists to facilitate you in realizing your personal best. That’s why we say, “InnerTalk®, when believing in yourself matters!”

Definition:
Hypnosis (from the Greek hypnos, “sleep”) is “a trance-like state that resembles sleep but is induced by a person whose suggestions are readily accepted by the subject.”

The technique is used for medical purposes to relieve anxiety or otherwise improve or alter behavior. It is also used in popular stage acts in which subjects are persuaded to perform bizarre feats.

Other variations include mass-hypnosis, in which crowds are simultaneously influenced, and autosuggestion in which a subject persuades themself.

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How can Hypnosis Help?

Hypnosis is simply a state of complete relaxation, somewhere between being fully awake and being asleep. In fact, all of us pass through brief periods of hypnosis every day: once when falling asleep and once again when waking up. When we are in hypnosis, we are able to get in touch with our inner resources and our subconscious minds.

Most of us these days have heard of the ‘conscious’ and ‘subconscious’ parts of our minds. These are like the ‘thinking’ and ‘unthinking’ parts of our consciousness. When we are puzzling things out, learning, using logic and being scientific about things we are using our conscious minds. The subconscious deals with automatic actions, such as habits and instinctive reactions.

Can Anyone be Hypnotized?
There are large individual differences in response to hypnosis. Hypnosis has little to do with the hypnotist‘s technique, and very much to do with the individual’s capacity, or talent, for experiencing hypnosis. Most people are at least moderately hypnotizable. However, while relatively few people absolutely cannot be hypnotized, by the same token, relatively few people fall within the highest level of responsiveness (so-called hypnotic virtuosos).

There is some controversy over whether hypnotizability can be modified. Some clinical practitioners believe that virtually everyone can be hypnotized, if only the hypnotist takes the right approach. However, there is little evidence favoring this point of view. Similarly, some researchers believe that developing positive attitudes, motivations, and expectancies concerning hypnosis can enhance hypnotizability. However, there is also evidence that such interventions may only affect behavioral compliance with suggestions, not the subjective experiences that lie at the core of hypnosis. As with any other skilled performance, hypnosis is probably a matter of both aptitude and attitude: negative attitudes, motivations, and expectancies can interfere with performance, but positive ones are not by themselves sufficient to create hypnotic

How is Hypnotizability Measured?

Hypnotizability is measured by standardized psychological tests such as the Stanford Hypnotic Susceptibility Scale or the Harvard Group Scale of Hypnotic Susceptibility (click on to the figure to see an enlarged view). These instruments are work-samples that are similar to other performance tests. Hypnotizability, so measured, yields a roughly normal (i.e., bell-shaped) distribution of scores.

What Happens During Hypnosis?
A typical hypnosis session begins with an induction procedure in which the person is asked to focus his or her eyes on a fixation point, relax, and concentrate on the voice of the hypnotist. Although suggestions for relaxation are generally part of the hypnotic induction procedure, people can respond positively to hypnotic suggestions while engaged in vigorous physical activity. The hypnotist then gives suggestions for further relaxation, focused attention, and eye closure. After the person’s eyes are closed, further suggestions for various imaginative experiences are given. For example, individuals might be asked to extend their arms and imagine a heavy object pushing their hands and arms down or to hear a voice asking questions over a loudspeaker. Or, the hypnotist might suggest that when they open their eyes, they would not be able to see some object that has been placed in front of them. Posthypnotic suggestions may also be given for responses to occur after hypnosis has been terminated, including posthypnotic amnesia, the inability to remember events and experiences that took place during hypnosis. Response to each of these suggestions is scored in terms of objective behavioral criteria – did the arm drop a specified distance over a period of time, did the person answer questions realistically, did the person deny seeing the object, etc.?
Does the Ability to be Hypnotized Vary with Age?
Cross-sectional studies of different age groups show a developmental curve, with very young children relatively unresponsive to hypnosis. Hypnotizability reaches a peak at about the onset of adolescence but then scores generally drop off among middle-aged and elderly individuals. Longitudinal studies indicate that hypnotizability assessed in college students remains about as stable as IQ over a period of 25 years.

Can one Hypnotize oneselfself?

The role of individual differences makes it clear that, in an important sense, all hypnosis is self-hypnosis. The hypnotist does not hypnotize the individual. Rather, the hypnotist serves as a sort of coach or tutor whose job is to help the person become hypnotized. While it takes considerable training and expertise to use hypnosis appropriately in clinical practice, it takes very little skill to be a hypnotist. Beyond the hypnotist’s ability to develop rapport with the person, the most important factor determining hypnotic response is the hypnotizability of the individual.Click to see :->Self hypnosis for personal development

Is the Ability to be Hypnotized Related to Personality?

Hypnotizability is not substantially related to other individual differences in ability or personality, such as intelligence or adjustment. Interestingly, it does not appear to be related to individual differences in conformity, persuasibility, or response to other forms of social influence. However, research has found that hypnotizability is related to an individual’s disposition to have hypnosis-like experiences outside of formal hypnotic settings. Similarly, an extensive interview study by Josephine Hilgard showed that hypnotizable individuals tend to display a high level of imaginative involvement in domains such as reading and drama.

What Happens to the Brain during Hypnosis?
Researchers have been interested in biological correlates of hypnotizability as well as in those that can be measured by paper-and-pencil tests. Although hypnosis is commonly induced with suggestions for relaxation and even sleep, brain activity in hypnosis more closely resembles that of a person who is awake. The discovery of hemispheric specialization, with the left hemisphere geared to analytic and the right hemisphere to nonanalytic tasks, led to the speculation that hypnotic response is somehow influenced by right-hemisphere activity. Studies employing both behavioral and electrophysiological mechanisms have been interpreted as indicating increased activation of the right hemisphere of the brain among highly hypnotizable individuals, but positive results have proved difficult to replicate and interpretation of these findings remains controversial.

Hypnosis is influenced by verbal suggestions, which must be interpreted by the individual in the course of responding. Therefore, the role of the left hemisphere of the brain should not be minimized. One proposal is that hypnotizable individuals show greater flexibility in using the left and right hemispheres in a task-appropriate manner, especially when they are actually hypnotized. Because involuntariness is so central to the experience of hypnosis, it has also been suggested that the frontal lobes (which organize intentional action) may play a special role. A better understanding of the neural substrates of hypnosis awaits studies of neurological patients with focalized brain lesions, as well as brain-imaging studies (e.g., PET, fMRI) of normal individuals.


Health Applications of Hypnosis:-

Can Hypnosis Improve the Quality of Life for Individuals with Chronic Illnesses? Hypnosis has been used as a psychological treatment for a variety of illnesses with apparent success. While it is unlikely that hypnotic suggestions are capable of curing physical disease, they can be used to enhance relaxation and alleviate pain and other physical discomforts, and therefore they may make a positive contribution to the overall quality of care and of life. For example, several controlled studies have shown that hypnotic suggestions administered to patients who suffer from asthma can reduce both bronchodilator use and attacks of “wheezing”, as well as increase peak expiratory flow rates. Hypnosis has also been used effectively in the treatment of irritable bowel syndrome, hyperemesis gravidarum (persistent nausea and vomiting) in pregnant women, and anticipatory nausea experienced by cancer patients who receive chemotherapy. Hypnotic suggestions have been observed to stimulate and inhibit allergic responses, and may also speed the healing of burns and wounds, but these issues require further carefully controlled study.

Even though the use of hypnosis may be associated with positive therapeutic outcomes, it is not clear that hypnosis itself is responsible for the effects observed. The active ingredient in some treatments labeled “hypnosis” might be mere relaxation, or a kind of placebo effect attributable to the use of a hypnotic ritual. It is well known, for example, that the “relaxation response” meditation technique introduced by Benson can alter blood pressure, heart rate, oxygen consumption, and the levels of certain neurotransmitters. The relaxation response is not the same as hypnosis, but hypnotic techniques may achieve some of their effects by virtue of the high levels of relaxation commonly associated with them. In the case of asthma, however, hypnosis seems to have a specific effect over and above relaxation.

The professional and popular literature contains occasional reports of clinical improvements and even cures of cancer in patients who have been treated with hypnosis or related techniques, such a relaxation and imagery. However, these apparent successes are typically poorly documented, and in the final analysis it is difficult to distinguish such “miracle cures” from spontaneous remissions which sometimes occur in these conditions. The most appropriate use of hypnosis in cancer treatment is as a complement to traditional medical treatments, such as chemotherapy, with the goal of enhancing the patient’s quality of life while treatment is in progress.

Can Hypnosis be used in Pain Reduction?
Hypnosis has been employed in the clinic for both medical and psychotherapeutic purposes. By far the most successful and best documented of these has been hypnotic analgesia for the relief of pain. Clinical studies indicate that hypnosis can effectively relieve pain in patients suffering pain from burns, cancer and leukemia (e.g., bone marrow aspirations), childbirth, and dental procedures. In such circumstances, as many as half of an unselected patient population can obtain significant, if not total, pain relief from hypnosis. Hypnosis may be especially useful in cases of chronic pain, where chemical analgesics such as morphine pose risks of tolerance and addiction. Hypnosis has also been used, somewhat heroically perhaps, as the sole analgesic agent in abdominal, breast, cardiac, and genitourinary surgery, and in orthopedic situations, although it seems unlikely that more than about 10% of patients can tolerate major medical procedures with hypnosis alone.

A comparative study of experimental pain found that, among hypnotizable people, hypnotic analgesia was superior to morphine, diazepam, aspirin, acupuncture, and biofeedback (Click on to the figure at the right to see an enlarged view). Hypnotic analgesia relieves both sensory pain and suffering. It is not a matter of simple relaxation or self-distraction. It does not appear to be mediated by endorphins or other endogenous opiates. There is a placebo component to all active analgesic agents, and hypnosis is no exception; however, hypnotizable people receive benefits from hypnotic suggestion that outweigh those of plausible placebos.

Does Hypnosis Increase Physical Performance?

From the beginning of the modern era, a great deal of research effort has been devoted to claims that hypnotic suggestions enable individuals to transcend their normal voluntary capacities — to be stronger, see better, learn faster, and remember more. However, research has largely failed to find evidence that hypnosis can enhance human performance. Many early studies, which seemed to yield positive results for hypnosis, possessed serious methodological flaws such as the failure to collect adequate baseline information. In general, it appears that hypnotic suggestions for increased muscular strength, endurance, sensory acuity, or learning do not exceed what can be accomplished by motivated individuals outside hypnosis.

Can Hypnosis Improve Recall?

A special case of performance enhancement has to do with hypnotic suggestions for improvements in memory — what is known as hypnotic hypermnesia. Hypermnesia suggestions are sometimes employed in forensic situations, with forgetful witnesses and victims, or in therapeutic situations, to help patients remember traumatic personal experiences or the events of early childhood. While field studies have sometimes claimed that hypnosis can powerfully enhance memory, these anecdotal reports have not been duplicated under laboratory conditions.

A 1994 report by the Committee on Techniques for the Enhancement of Human Performance, a unit of the U.S. National Research Council, concluded that gains in recall produced by hypnotic suggestion were rarely dramatic, and were matched by gains observed even when individuals are not hypnotized. In fact, there is some evidence that hypnotic suggestion can interfere with normal hypermnesic processes. To make things worse, any increases obtained in valid recollection are met or exceeded by increases in false recollections. Hypnotized individuals (especially those who are highly hypnotizable) may be especially vulnerable to distortions in memory produced by leading questions and other subtle, suggestive influences.

Hypnosis is sometimes used therapeutically to recover forgotten incidents, as for example in cases of child sexual abuse. Although the literature contains a number of dramatic reports of the successful use of this technique, most of these reports are anecdotal in nature and fail to obtain independent corroboration of the memories that emerge. Given what we know about the unreliability of hypnotic hypermnesia, and the risk of increased responsiveness to leading questions and other sources of bias and distortion, such clinical practices are not recommended. Similar considerations obtain in forensic situations. In fact, many legal jurisdictions severely limit the introduction of memories recovered through hypnosis, out of a concern that such evidence might be tainted. The Federal Bureau of Investigation has published a set of guidelines for those who wish to use hypnosis forensically, and similar precautions should be employed in the clinic.

Similar conclusions apply to hypnotic age regression, in which individuals receive suggestions that they are returning to a previous period in their lives (this is also a technique that is used clinically to foster the retrieval of forgotten memories of child abuse). Although age-regressed individuals may experience themselves as children, and may behave in a childlike manner, there is no evidence that they actually lose adult modes of mental functioning, or return to childlike modes of mental functioning. Nor do age-regressed individuals retrieve forgotten memories of childhood.
Does Hypnosis have an Effect on Psychosomatic Disorders?
Hypnotic suggestion can have psychosomatic effects, a matter that should be of some interest to psychophysiologists and psychoneuroimmunologists. A famous case study convincingly documented the positive effects of hypnotic suggestion on an intractable case of congenital ichthyosiform erythroderma, a particularly aggressive skin disorder. Carefully controlled studies have shown that hypnotic suggestions can have a specific effect on the remission of warts. However, the same effects can be achieved by suggestions administered nonhypnotically. The mechanisms by which these “psychosomatic” effects are produced are theoretically interesting, and possibly clinically significant, but it is not yet clear that they have anything to do with hypnosis.

Can Hypnosis be used in Psychotherapy?
Hypnosis has been used in psychotherapy—both in psychodynamic or cognitive-behavioral oriented therapy. In the former case, hypnosis is used to promote relaxation, enhance imagery, and generally loosen the flow of free associations (some psychodynamic theorists consider hypnosis to be a form of adaptive regression or regression in the service of the ego). However, there is little evidence from controlled outcome studies that hypnoanalysis or hypnotherapy are more effective than nonhypnotic forms of the same treatment. By contrast, a 1995 meta-analysis by Kirsch and colleagues showed a significant advantage when hypnosis is used to complement cognitive-behavioral therapy for a number of problems, including anxiety and hypertension. In an era of evidence-based mental health care, it will be increasingly important for practitioners who use hypnosis to document, quantitatively, the clinical benefits of doing so.

Can Hypnosis help with Weight Control?
In the Kirsch study (mentioned above in the Psychotherapy section), the prospects for hypnosis appeared to be especially favorable in the treatment of obesity, where individuals in the hypnosis group continued to lose weight even after formal treatment had ended. In one study, for example, women who received personally tailored hypnotic suggestions for specific food aversions, in the context of a traditional self-monitoring and goal-setting treatment, lost approximately twice as much weight as a comparison group. This comparison group received the behavioral treatment alone (no hypnotic suggestion). However, the actual weight lost by the hypnosis group was only about 14 lb. on average. Given that the patients were approximately 50% overweight at the outset, it is not clear that the treatment actually improved their clinical status. Studies that document the clinical efficacy of hypnosis should pay careful attention to the terms in which outcome is assessed. While hypnosis may seem to offer an advantage over some other treatments, it is not clear that the statistical significance or experimental results translates into meaningful clinical significance or real results for individuals.

Can Hypnosis Help People Stop Smoking?
There have been many attempts to use hypnosis for habit control, however, hypnosis has no coercive power. That is, one cannot be hypnotized against his or her will, and even deeply hypnotized individuals cannot be made, by virtue of hypnotic suggestions, to do things that run against their own or others’ interests. You cannot cajole a smoker to the local hypnotist and expect him or her to stop smoking. However, where the patient is appropriately motivated, as in the obesity study described earlier, hypnosis may offer a boost to treatment.

One popular hypnotic treatment for smoking involves a single session in which patients are taught to repeat a simple persuasive message during self-hypnosis. In one large-scale study of this technique, about 50% of patients stopped smoking immediately after treatment; at follow-up one and two years later, however, this figure had dropped to about 25%. Although this study did not include a nonhypnotic control group, this is about the same success rate as achieved with other cognitive-behavioral interventions. However, these other treatments are typically more intensive, so that the single-session hypnotic treatment may have some advantage in terms of efficiency. Interestingly, long-term abstinence was not related to traditional measures of hypnotizability, suggesting that the success of the treatment may have had more to do with the persuasive message than with hypnosis per se.

Caveats for Health Practitioners in the Use Hypnosis with Patients An important but unresolved issue is the role played by individual differences in the clinical effectiveness of hypnosis. As in the laboratory, so in the clinic: a genuine effect of hypnosis should be correlated with hypnotizability.

It is possible that many clinical benefits of hypnosis are mediated by placebo-like motivational and expectational processes — that is, with the “ceremony” surrounding hypnosis, rather than hypnosis per se. An analogy is to hypnotic analgesia, which appears to have a placebo component available to insusceptible and hypnotizable individuals alike, and a dissociative component available only to those who are highly hypnotizable. Unfortunately, clinical practitioners are often reluctant to assess hypnotizability in their patients and clients, out of a concern that low scores might reduce motivation for treatment. This danger is probably exaggerated. On the contrary, assessment of hypnotizability by clinicians contemplating the therapeutic use of hypnosis would seem to be no different, in principle, than assessing allergic responses before prescribing an antibiotic. In both cases, the legitimate goal is to determine what treatment is appropriate for what patient.

It should be noted that clinicians sometimes use hypnosis in non-hypnotic ways — practices which tend to support the hypothesis that whatever effects they achieve through hypnosis are related to its placebo component. There is nothing particularly “hypnotic”, for example, about having a patient in a smoking-cessation treatment rehearse therapeutic injunctions not to smoke and other coping strategies while hypnotized. It is likely that more successful use of hypnosis as an adjunct to the cognitive-behavioral treatment of smoking, overweight, and similar habit disorders would be to use hypnotic suggestions in order to control the patient’s awareness of cravings for nicotine, sweets, and the like. Given the ability of hypnotic suggestions to control conscious perception and memory, such strategies might well have therapeutic advantage — but only, of course, for those patients who are hypnotizable enough to respond positively to such suggestions.

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Resources:

http://www.innertalk.com/index_read_more.html

http://www.institute-shot.com/hypnosis_and_health.htm

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Delusion

Definition:
A delusion is commonly defined as a fixed false belief and is used in everyday language to describe a belief that is either false, fanciful or derived from deception. In psychiatry, the definition is necessarily more precise and implies that the belief is pathological (the result of an illness or illness process). As a pathology it is distinct from a belief based on false or incomplete information or certain effects of perception which would more properly be termed an apperception or illusion.

Delusions typically occur in the context of neurological or mental illness, although they are not tied to any particular disease and have been found to occur in the context of many pathological states (both physical and mental). However, they are of particular diagnostic importance in psychotic disorders and particularly in schizophrenia and bipolar disorder.

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Psychiatric definition
Although non-specific concepts of madness have been around for several thousand years, the psychiatrist and philosopher Karl Jaspers was the first to define the three main criteria for a belief to be considered delusional in his book General Psychopathology. These criteria are:

*certainty (held with absolute conviction)

*incorrigibility (not changeable by compelling counterargument or proof to the contrary)

*impossibility or falsity of content (implausible, bizarre or patently untrue)

These criteria still continue in modern psychiatric diagnosis. In the most recent Diagnostic and Statistical Manual of Mental Disorders, a delusion is defined as:

A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everybody else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the person’s culture or subculture (e.g., it is not an article of religious faith).

Symptoms:
The criteria that define delusional disorder are furnished in the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision, or DSM-IV-TR, published by the American Psychiatric Association. The criteria for delusional disorder are as follows:

*non-bizarre delusions which have been present for at least one month

*absence of obviously odd or bizarre behavior

*absence of hallucinations, or hallucinations that only occur infrequently in comparison to other psychotic disorders

*no memory loss, medical illness or drug or alcohol-related effects are associated with the development of delusions

Diagnostic issues:
The modern definition and Jaspers’ original criteria have been criticised, as counter-examples can be shown for every defining feature.

Studies on psychiatric patients have shown that delusions can be seen to vary in intensity and conviction over time which suggests that certainty and incorrigibility are not necessary components of a delusional belief.

Delusions do not necessarily have to be false or ‘incorrect inferences about external reality’. Some religious or spiritual beliefs by their nature may not be falsifiable, and hence cannot be described as false or incorrect, no matter whether the person holding these beliefs was diagnosed as delusional or not.

In other situations the delusion may turn out to be true belief. For example, delusional jealousy, where a person believes that their partner is being unfaithful (and may even follow them into the bathroom believing them to be seeing their lover even during the briefest of partings) may result in the faithful partner being driven to infidelity by the constant and unreasonable strain put on them by their delusional spouse. In this case the delusion does not cease to be a delusion because the content later turns out to be true.

In other cases, the delusion may be assumed to be false by a doctor or psychiatrist assessing the belief, because it seems to be unlikely, bizarre or held with excessive conviction. Psychiatrists rarely have the time or resources to check the validity of a person’s claims leading to some true beliefs to be erroneously classified as delusional.This is known as the Martha Mitchell effect, after the wife of the attorney general who alleged that illegal activity was taking place in the White House. At the time her claims were thought to be signs of mental illness, and only after the Watergate scandal broke was she proved right (and hence sane).

Similar factors have led to criticisms of Jaspers’ definition of true delusions as being ultimately ‘un-understandable’. Critics (such as R. D. Laing) have argued that this leads to the diagnosis of delusions being based on the subjective understanding of a particular psychiatrist, who may not have access to all the information which might make a belief otherwise interpretable.

Another difficulty with the diagnosis of delusions is that almost all of these features can be found in “normal” beliefs. Many religious beliefs hold exactly the same features, yet are not universally considered delusional. Similarly, Thomas Kuhn argued in The Structure of Scientific Revolutions that scientists can hold strong beliefs in scientific theories despite considerable apparent discrepancies with experimental evidence.

These factors have led the psychiatrist Anthony David to note that “there is no acceptable (rather than accepted) definition of a delusion.” In practice psychiatrists tend to diagnose a belief as delusional if it is either patently bizarre, causing significant distress, or excessively pre-occupies the patient, especially if the person is subsequently unswayed in belief by counter-evidence or reasonable arguments.

Click for Delusions - Description, Types

Diagnosis:

Client interviews focused on obtaining information about the sufferer’s life situation and past history aid in identification of delusional disorder. With the client’s permission, the clinician obtains details from earlier medical records, and engages in thorough discussion with the client’s immediate family—helpful measures in determining whether delusions are present. The clinician may use a semi-structured interview called a mental status examination to assess the patient’s concentration, memory, understanding the individual’s situation and logical thinking. The mental status examination is intended to reveal peculiar thought processes in the patient. The Peters Delusion Inventory (PDI) is a psychological test that focuses on identifying and understanding delusional thinking; but its use is more common in research than in clinical practice.

Even using the DSM-IV-TRcriteria listed above, classification of delusional disorder is relatively subjective. The criteria “non-bizarre” and “resistant to change” and “not culturally accepted” are all subject to very individual interpretations. They create variability in how professionals diagnose the illness. The utility of diagnosing the syndrome rather than focusing on successful treatment of delusion in any form of illness is debated in the medical community. Some researchers further contend that delusional disorder, currently classified as a psychotic disorder, is actually a variation of depression and might respond better to antidepressants or therapy more similar to that utilized for depression. Also, the meaning and implications of “culturally accepted” can create problems. The cultural relativity of “delusions,”—most evident where the beliefs shown are typical of the person’s subculture or religion yet would be viewed as strange or delusional by the dominant culture—can force complex choices to be made in diagnosis and treatment. An example could be that of a Haitian immigrant to the United States who believed in voodoo. If that person became aggressive toward neighbors issuing curses or hexes, believing that death is imminent at the hands of those neighbors, a question arises. The belief is typical of the individual’s subculture, so the issue is whether it should be diagnosed or treated. If it were to be treated, whether the remedy should come through Western medicine, or be conducted through voodoo shamanistic treatment is the problem to be solved.

Treatments:
Delusional disorder treatment often involves atypical(also callednovelornewer-generation) antipsychotic medications, which can be effective in some patients. Risperidone(Risperdal), quetiapine(Seroquel), and olanzapine(Zyprexa) are all examples of atypical or novel antipsychotic medications. If agitationoccurs, a number of different antipsychotics can be used to conclude the outbreak of acute agitation. Agitation, a state of frantic activity experienced concurrently with anger or exaggerated fearfulness, increases the risk that the client will endanger self or others. To decrease anxiety and slow behavior in emergency situations where agitation is a factor, an injection of haloperidol(Haldol) is often given usually in combination with other medications (often lorazepam, also known as Ativan). Agitation in delusional disorder is a typical response to severe or harsh confrontation when dealing with the existence of the delusions. It can also be a result of blocking the individual from performing inappropriate actions the client views as urgent in light of the delusional reality. A novel antipsychotic is generally given orally on a daily basis for ongoing treatment meant for long-term effect on the symptoms. Response to antipsychotics in delusional disorder seems to follow the “rule of thirds,” in which about one-third of patients respond somewhat positively, one-third show little change, and one-third worsen or are unable to comply.

Cognitive therapy has shown promise as an emerging treatment for delusions. The cognitive therapist tries to capitalize on any doubt the individual has about the delusions; then attempts to develop a joint effort with the sufferer to generate alternative explanations, assisting the client in checking the evidence. This examination proceeds in favor of the various explanations. Much of the work is done by use of empathy, asking hypothetical questions in a form of therapeutic Socratic dialogue—a process that follows a basic question and answer format, figuring out what is known and unknown before reaching a logical conclusion. Combining pharmacotherapy with cognitive therapy integrates both treating the possible underlying biological problems and decreasing the symptoms with psychotherapy.

Prognosis:
Evidence collected to date indicates about 10% of cases will show some improvement of delusional symptoms though irrational beliefs may remain; 33–50% may show complete remission; and, in 30–40% of cases there will be persistent non-improving symptoms. The prognosis for clients with delusional disorder is largely related to the level of conviction regarding the delusions and the openness the person has for allowing information that contradicts the delusion.

Prevention:
Little work has been done thus far regarding prevention of the disorder. Effective means of prevention have not been identified.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
Resources:

http://en.wikipedia.org/wiki/Delusions

http://www.minddisorders.com/Br-Del/Delusional-disorder.html

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