Indigenous Perspectives Slides PDF

Final Notes From the slides that are considered important Indigenous Perspectives Slides Over 50 distinct Nations The perspective incorporates four dimensions of wellness : Physical, emotional, mental, spiritual and extends beyond the individual to include...

Final Notes From the slides that are considered important Indigenous Perspectives Slides Over 50 distinct Nations The perspective incorporates four dimensions of wellness : Physical, emotional, mental, spiritual and extends beyond the individual to include family. Community, and relationships with the land Indigenous Knowledge - dismisssed for hundreds of years - O er a dramatic contrast to western approaches to treat mental health problems - Allows for the appreciation and integration of other approaches considered e ective - Emphasis on nding balance, whether internal balance, balance with nature, or communal balance Indigenous Paradigm Vs the Western Paradigm Indigenous: Relationship with the earth: the earth is viewed as a mother gure and a teacher who put be loved Purpose of the human mind: the human mind is considered a tool to create harmony and balance among all beings Role of emotions: emotions are seen as valuable sources of wisdom and guidance Understanding of spirit: spirit is considered the essence of all life and transcends the limitations of organized religion True Knowledge: arise from a connection with spirit and serves the greater good by fostering balance and harmony Purpose of Life: Life is seen as a journey of cleansing, growth, and transformation Western Relationship with the earth: the earth is often treated as a resource or commodity Purpose of the human mind: the mind is valued for its capacity to innovate and achieve individual potential Role of emotions: emotions are seen as something to control or suppress if they don’t align with societal expectations Understanding of spirit: spirit is usually tied to religion, which is often separated from daily life and seen as a personal choice True knowledge: knowledge is measure empirically, valued only when proven through science or logical reasoning, earned by those with recognize credentials ff fi fi ff  Purpose of life: life is often understood as a pursuit of success Resume: Indigenous: centers on interconnectedness, balance and spirituality, while the Western Paradigm prioritizes individualism, rationality, and material progress Impact of colonialisms Colonial perspectives: -indigenous people were deemed primitive, their lands seen as empty (terra nullius) - colonization required colonizers to adopt a colonizing sense of self Trauma and dissociation: - colonialism caused cultural dissociation ex: residential schools separated children from traditions - Trauma is intergenerational, transmitted through psychological and epigenetic processes Healing from Colonial Violence Acknowledgement and Letting Go: - recognizing colonization’s harm and beginning with forgiveness - Ceremonial methods like washing away grief are used Reconnecting and reconstructing: - ancestral healing methods ex: NECHI programs for alcoholism - Rea rming indigenous values and spirituality in daily relationships Community relationships: - emphasizing relationships of love, respect, and confrontation of oppression Diné (Navajo) Healing Chantway system: - 2 parts: diagnostic and chantway (speci c healing rituals) - Ceremonies involve ancestral stories, herbs, chanting, and rituals over several days - Healing aims to recreate balance and return the patient to their origin Western perspectives: - recognizes symbolic healing ex: sand paintings, mythic imagery) (Sandner 1979) - Indigenous ceremonies integrate group psychotherapy and art therapy Western Models of Understanding Indigenous Healing Cognitive and Narrative Approaches - Diné healing alters patient’s story using cultural symbols Biopsychosocial Framework - altered states during rituals promote integrations between mind and body Community Role - social bonding during ceremonies enhances healing and immune response ffi fi  Recommendations for psychotherapists: Advocacy and Cultural Awareness - Understand Canada’s history of colonization and its impact on indigenous peoples - Respect indigenous knowledge and practices Client-centered approach - let clients communicate their priorities and de ne their healing path - Include family and community in wellness discussions Strengths-based methods - focus on resilience and existing strengths of the client Classi cation and diagnostic Manuals Introduction and Quotes on Classi cation Important points: - Classi cation is a practical tool for managing and understanding complex realities - Categories in psychiatry are essential for tradition but do not exclude dimensional analysis Notes: the purpose of diagnostic classi cation is to aid clinicians and researchers - Both ICD and DSM provide structured frameworks to diagnose and understand mental disorders Key concepts and de nitions Diagnosis: assigning symptoms to a speci c classi cation Clinical assessment: Gathering relevant information for diagnosis Reliability and validity are crucial for diagnostic systems Prevalence and incidence de ne the scope and new cases or disorders Notes: reliable systems minimize subjectivity; DSM and ICD strive for this through rigorous de nitions Validity issues arise from overlapping symptoms or vague criteria Major Diagnostic Manuals ICD-11: covers all medical and psychological disorders, used globally DSM-5-TR: often preferred for research and clinical practices, emphasizing mental disorders Notes: ICD is WHO- developed and legally binding in member countries for coding health information DSM-5 is more detailed for researchers, providing speci c criteria for disorders fi fi fi fi fi fi fi fi fi fi fi  Classi cation of Mental Disorders ICD-11: categorizes mental disorders into speci c types ex:mood disorders, neurodevelopemental disorders DSM/ICD uses: standard language for clinicians and researchers Coding systems for insurance, education, and legal contexts Notes: these manuals facilitate interdisciplinary communication but face critiques about user- friendliness Emil Kraepelin (1856-1926) - Created the rst classi cation system for mental illnesses - Introduced the concepts of syndromes with distinct symptoms and caused - Kraepelin’s work forms the foundation of current diagnostic frameworks - HIghlighted physical causes of mental illnesses like schizophrenia Development of ICD and DSM 1939: WHO introduced mental disorders into mortality statistics 1952: APA released the rst DSM - DSM evolved from psychodynamic roots (DSM-1 and 2) to a research-based system Notes: DSM-III introduced operational criteria and a multiaxial approach Recent editions emphasize evidence-based revisions De nitions of Mental Disorder DSM-IV: De ned disorders based on distress, disability, or risks to life DSM-5: Focuses on signi cant disturbances in cognition, emotion, or behavior re ecting dysfunction Notes: DSM-5 excludes socially deviant behavior unless linked to dysfunction De nitions evolve to align with societal and scienti c advancements GAD diagnostic Guidelines Comparison - ICD-II: symptoms persist for several months - Emphasis on physiological symptoms like gastrointestinal distress DSM-5-TR - symptoms persist for 6 months - Requires at least 3 of six associated symptoms ex: fatigue, irritability Notes: Both systems emphasize distress and impairment but di er in symptom thresholds and duration requirements fi fi fi fi fi fi fi fi fi fi ff fl  Major Changes from DSM-IV-TR to DSM 5 Autism spectrum Disorder (ASD): Combines Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder Obsessive-Compulsive and related disorders: OCD reclassi ed, now group with disorders like hoarding and trichotillomania Trauma and stressor related disorders: PTSD moved to its own category alongside Acute Stress disorder and others Substance-Related and Addictive Disorders: - Includes non-substance addictions like gambling - Introduced gradation: mild, moderate, severe Schizophrenia Subtypes: removed (paranoid, disorganized, etc) to emphasize uni ed criteria Notes: these changes re ect evolving understanding of the underlying mechanisms and clinical presentations Reclassi cations aims to improve diagnostic speci city and treatment targeting DSM-5 Categories Disorders categorized into 20 groups based on symptom similarity and shared vulnerabilities ex: genetic Examples include: Neurodevelopmental disorders ex: ADHD, Autism Anxiety Disorders separated from OCD and PTSD Impulse Control disorders grouped with related behaviors Notes: emphasis on grouping by shared traits (biological, emotional, or cognitive) - Introduction of dimensional thinking alongside traditional categories Understanding Mental Disorders 3 Perspectives: 1. Real things: disorders are objectives realities that can be understood scienti cally 2. Heuristic Constructs: disorders serve as practical tools for classi cation, not ultimate truths 3. Social Constructs: disorders re ect cultural and societal biases Notes: - Critics argue that diagnosis is in uenced by societal trends and pressures ex: media, pharmaceutical interests) - Awareness of these perspectives helps contextualize controversies in mental health diagnosis fi fl fl fl fi fi fi fi fi  Criticisms of DSM and ICD Validity and reliability: Diagnostic categories are constructs, not objective entities Cultural Biases: Some diagnoses re ect societal norms, not universal truths Overdiagnosis: increased prevalence of disorders like autism, ADHD, and PTSD may result from expanded criteria Pharmaceutical In uence: lowered thresholds can promote unnecessary medication use Notes: valid concerns about medicalizing normal behaviors and stigmatizing individuals - Highlights the need for a cautious and evidence-based approach to diagnosis Trends and Future Directions - Movement toward dimensional diagnosis instead of strict categories - Developmental of alternative diagnostic systems like RDoC, focusing on biological markers - Other frameworks, ex: Psychodynamic Diagnostic Manual (PDM) provide alternative views Notes: dimensional systems promise to capture the continuum of mental health better RDoC emphasizes measurable biological underpinnings, potentially bridging the gap between psychiatry and neurosciences Discrete vs Dimensional Classi cation - DSM: Uses categorical (yes/no) approaches, which may oversimplify - Dimensional approaches: propose scales ex: 1-10 to capture symptom severity and variation Notes: - dimensional classi cation may align better with real-world presentations but complicated clinical communication - The debate highlights the tension between simplicity for utility and complexity for accuracy Adding New diagnoses - no de nitive scienti c methods exists for validating new diagnoses - Decisions should weigh evidence, clinical utility, and potential harms ex: overmedicalization Notes: Ongoing controversy re ects the limitations and subjectivity inherent in diagnostic systems Raise awareness about balancing innovation with responsibility in mental health care fi fl fi fi fl fi fl Anxiety Disorders Anxiety Disorders Overview - Anxiety is pervasive and common, a ecting millions globally Symptoms span several dimensions: Cognitive: Racing, thoughts, worry Emotional: Feeling unsafe or agitated Physiological: Heart rate, breathing Changs Existential: Concerns about life’s meaning or death Ecological: Anxiety about environmental issues Notes: Anxiety disorders are rooted in a mix of cognitive appraisal and physiological vulnerabilities Highlighted brain areas include the amygdala (fear response) and PFC (regulation of emotions) Neurobiology of Anxiety Brain areas: - Amygdala: key in fear response and emotional memory - PFC/ACC: Modulates primitive emotional responses Neurochemical factors: - Cortisol ( via HPA axis) and adrenaline (via sympathetic activation) drive stress responses - Norepinephrine (NE): involved in emotional memory and anxiety - GABA: inhibitory neurotransmitter, reduced anxiety disorders Notes: - dysregulation between the amygdala and PFC may lead to heightened fear and reduced coping - Treatments like GABA agonists (benzodiazepines) aim to restore this balance Anxiety Disorder prevalence and comorbidity - Anxiety is more prevalent in women and young adults - High comorbidity with depression, substance use disorders and PTSD - Shared biological and psychological underpinnings with depressive disorders Notes: The tripartite model distinguishes anxiety and depression by physiological hyperarousal (anxiety) vs anhedonia (Depression) ff  Phobias Overview - de ned as disproportionate fear leading to avoidance and distress Speci c phobias: - subcategories includes animals, situations, natural environments, and blood/injection - Lifetime prevalence: nearly 10% untreated - Common types: fear of animals, heights, closed spaces, and blood Notes: - phobias can be culturally in uenced ex: Taijin Kyofusho in Japan) - Speci c phobias are distinct from broader categories like agoraphobia and SAD Ethiology of Phobias Behavioral Perspective: - Classical conditioning: fear arises when a neutral stimulus is paired with a frightening event - Operant conditioning: Avoidance behaviors reduce fear and reinforce phobia Evolutionary perspective: - Fear of certain stimuli ex: snakes may be evolutionarily advantageous Cognitive perspective: - In SAD, negative beliefs about social performance perpetuate fear Notes: - Prepared learning suggests we are biologically predisposed to fear certain objects - Cognitive distortions in SAD involve overestimating social risks and undervaluing performance Role of Social media in anxiety - Emerging disorders linked to technology, ex: FOMO, nomophobia Social media promotes: constant social comparison, reduced real-life interactions and sleep, anxiety linked to online approval/rejection Notes: - social media ampli es existing vulnerabilities in anxious individuals - Increasing awareness of its psychological impacts is crucial Therapies for Phobias Behavioral Approaches: - systematic desensitization: gradual exposure to feared stimuli - Flooding: Direct, intensive exposure - Modeling: observing others interact with phobic stimuli Cognitive Approaches - target dysfunctional beliefs in SAD - teach social skills and adjust self-perceptions fi fi fi fi fl Biological Approaches - Benzodiazepines and SSRIs reduce symptoms but may lead to dependency Psychoanalytic Approaches - Focus on uncovering and addressing unconscious con icts Notes: - behavioral therapies are most e ective but require patient willingness - Cognitive and biological approaches are complementary for long-term management Exposure Hierarchy example - Gradual exposure builds tolerance example: starting with asking for directions (low fear) or progressing to public speaking or social hosting (high fear) Notes: - structure hierarchies help patients confront fears progressively - Monitoring fear ratings ensures adaptive progression Anxiety Part 2 Panic attack and Panic Disorder - panic attacks are sudden episodes of intense fear with physical symptoms like labored breathing, heart palpitations and chest pain Panic disorder: - recurrent, unexpected attacks and worry about future attacks - Lifetime prevalence: 2-3% (men) and 5-6% (women) - Associated with low socioeconomic status and beings typically in adolescence Notes: - Panic attacks can occur without an apparent trigger (uncured) or with a speci c one (cued) - High comorbidity with depression, substance use, and physical conditions ex: asthma Etiology of Panic Disorder Biological Factors - linked to physical conditions like mitral valve prolapse and inner ear disease - Genetic predisposition supported by family and twin studies - Implicated neurotransmitters include norepinephrine (NE) and GABA) Cognitive Theories: - Misinterpretation of bodily sensations leads to a vicious cycle of anxiety and panic Notes: - studies suggest an overactive locus coeruleus (NE- producing region) in panic disorder - Perceived lack of control increases susceptibility to panic attacks ff fl fi  Treatments for Panic Disorder - Medications: SSRIs (preferred), tricyclics, MAOIs and benzodiazepines - Psychotherapy: Cognitive-behavioral therapy (CBT): corrects misinterpretations and gradually exposes triggers - Mindfulness-based therapies show promise Notes: - combining CBT and medication is most e ective for long-term outcomes - Psychoeducation helps patients understand and manage their symptoms Generalized Anxiety Disorder (GAD) - Persistent, uncontrollable worry about everyday issues - Symptoms include muscle tension, fatigue, restlessness and di culty concentrating - Diagnosis requires symptoms lasting at least 6months Notes: - lifetime prevalence: 1-3% (men), 3-5% (women) - Onset typically in adolescence, in uenced by stressful life events - Comorbid with mood disorders and other anxiety disorders Etiology of GAD Sociocultural Perspective - linked to societal stressors like poverty, disasters, and low SES - Greater prevalence in higher- income countries despite societal stress link Cognitive perspective: - maladaptive assumptions and intolerance of uncertainty drive worry - Mete-worry and avoidance theory explain GAD as a coping mechanisms for high arousal Notes: - therapists use CBT to address intolerance of uncertainty and focus on breaking the cycle of worry - Context, such as the COVID-19 pandemic, can drastically increase prevalence Treatments for GAD Biological treatments: - Benzodiazepines, SSRIs, and second-generation anxiolytics like bus-irone - Alternative options included beta-blockers and anticonvulsants Psychological Approaches: - CBT: targets maladaptive thought patterns and reduces uncertainty intolerance - Humanistic approaches focus on unconditional positive regard Notes: - medications manage symptoms but have dependency risks (benzodiazepines) or delayed e ects (SSRIs) - Psychotherapy emphasizes long-term coping mechanisms over symptom suppression ff fl ff ffi Schizophrenia Schizophrenia Overview - Complex disorder a ecting attention, perception, emotion, motivation, and thought processing - Symptoms categorized as: Positive: Hallucinations, delusions Negative: Blunted a ect, social withdrawal Disorganized: Speech, thought, behavior - high suicide rates (10-15%): approximately 50% attempt suicide Note: - Chronic and heterogeneous in presentation; outcomes vary signi cantly - Early theorists like Kraepelin and Bleuler laid the groundwork for modern understanding Historical Perspectives - Kraepelin (1898): identi ed dementia praecox with early onset and deteriorating course - Bleuler (1908): Coined schizophrenia focusing on the breaking of associative threads and excluding inevitable deterioration Notes: - the shift from Kraeplein’s biological model to Bleuler’s psychological focus highlights evolving theories of etiology and progression Diagnosing Schizophrenia with DSM-5 - at least 2 Criterion A symptoms required, with one being delusions, hallucinations, or disorganized speech - Subtypes (paranoid, disorganized, etc) from DSM-IV - Schizophrenia presents as diverse « clinical pictures » leading some to consider it a spectrum of related disorders Note: - the DSM-5 update re ects recognition of overlapping symptoms and variability in patient presentation Prevalence, Onset, and Course - Lifetime prevalence 1% (varies between 0.2-2%) - Onset typically in late adolescence or early adulthood - More severe negative symptoms in men; more a ective symptoms in women Notes: - gender and cultural di erences in uences symptom presentation and treatment outcomes ff ff fl ff fi fl ff fi  Symptoms of Schizophrenia Positive Symptoms: Hallucinations: auditor most common Delusions: themes include persecution, grandeur and control Disorganized speech and behavior Negative symptoms: - abolition, alogia, at a ect, anhedonia, and sociality Cognitive symptoms: - de cits in attention, memory, and executive functioning Notes: - positive symptoms are more acute and treatable, while negative and cognitive symptoms persist and are more disabling Di erential Diagnoses Mood and substance related disorders: psychotic features tied to mood episodes or substance use Schizophreniform and brief psychotic disorders: di er by duration less than 6months for schizo, less 1 month for brief psychotic disorder Schizoa ective disorder: combination of schizophrenia and mood symptoms Delusional disorder: persistent, non-bizarre delusions without other psychotic symptoms Notes; - accurate diagnosis depends on duration, symptom consistency, and the presence of mood episodes Cultural and socioeconomic factors - Prevalence consistent across cultures but in uenced by urbanization and SES - Better prognosis in non-Western countries, potentially due to social support and reduced stigma Notes: cultural context shapes the expression and management of schizophrenia Outcomes and Comorbidity - rules of thirds of prognosis: 1/3 improve, 1/3 stabilize, 1/3 deteriorate - High comorbidity with substance abuse, mood disorders, and personality disorders Note: schizophrenia patients are more often victims than perpetrators of violence ff fi ff fl ff fl ff  Treatments and Care - E ective treatment requires a bio psychosocial approach - Living arrangement: homeless or incarcerated - With family, or supervised housing Notes: - outcomes improve with supportive environments and comprehensive care Schizophrenia part 2 - Schizophrenia has genetic predispositions, with higher risk in close relatives - Environmental factors may also contribute to concordance rates Biochemical Factors 1. Dopamine (DA): - early theories linked schizophrenia to increased dopamine activity - Typical antipsychotics block D2 receptors, reducing positive symptoms but causing Parkinson-like side e ects - Dopamine imbalance hypothesis: Excess DA in the mesolimbic pathway causes positive symptoms, while reduced DA in the mesocortical pathway causes negative symptoms 2. Serotonin (5-HT) - Atypical antipsychotics block serotonin ex: 5-HT2A receptors - Serotonin modulates dopamine pathways, a ecting symptoms 3. Glutamate (GLU): - low glutamate levels are associated with schizophrenia - PCP and ketamine, which block NMDA receipts, mimic schizophrenia symptoms - Interaction between glutamate and dopamine in uences symptom development Antipsychotic drugs 1. First-generation Antipsychotics (FGAs) - block D2 receptors but have high side e ects, including extrapyramidal symptoms (EPS) 2. Second-Generation Antipsychotics (SGAs) - Block both D2 and 5-HT2A receptors - Lower EPS risk but higher risk of metabolic side e ects ex: weight gain, hyperglycemia 3. Third-generation Antipsychotics (TGAs) - Dopamine system stabilizers like aripiprazole act as partial D2 agonists, balancing dopamine activity in di erent pathways Neuroanatomical Abnormalities - enlarged ventricles and reduced prefrontal and temporal lobe structures - Neural network dysfunctions ex: fronts-temporal disconnection, corticolimbic dysfunction ff ff ff ff ff fl ff Developmental and environmental factors 1. Congenital Factors: - prenatal exposure to infections ex:in uenza increase risk 2. Psychosocial stress: - low socioeconomic status and social exclusion are linked to higher schizophrenia prevalence - High family expressed emotion correlates with relapse Cognitive and psychological theories - Biological factors may initiate symptoms, but faulty interpretations worsen them ex: hallucinations leading to feelings of persecution - Cognitive behavioral therapy focuses on engagement, normalization, and developing alternative explanations for symptoms Emerging Treatments 1. Avatar therapy: - innovative approach involving interactions with computer-generated representations of hallucinations 2. Open dialogue Model (R.D Laing): - controversial idea viewing schizophrenia as a self-healing process. This approach lacks widespread clinical support Treatment Guidelines 1. Selection and adherence to antipsychotic medication 2. Management of comorbid disorders ex: substance use, depression 3. Psychosocial treatments, including family interventions, social skills training, CBT, and assertive community treatment fl