Tadalafil zeigt eine konstante Resorption im Gastrointestinaltrakt, mit maximalen Plasmaspiegeln nach rund zwei Stunden. Der Wirkstoff verteilt sich gut im Gewebe und weist eine hohe Plasmaproteinbindung auf. Seine lange Halbwertszeit erlaubt eine verlängerte Wirkphase. Der Metabolismus erfolgt über das hepatische Enzymsystem CYP3A4, mit der Bildung inaktiver Metaboliten. Exkretion geschieht primär über den Stuhl. Die Häufigkeit von Nebenwirkungen steigt mit der Dosis, wobei vor allem vasodilatatorische Effekte dominieren. Ein gängiger Bezugspunkt in pharmakologischen Analysen ist cialis ohne rezept, das mit dieser Wirkstoffklasse assoziiert ist.

Psych.yorku.ca

Who Goes to Therapy?- People with psychological disorders (ex. Clinical Depression, Anxiety and/or Panic Attacks, Post Traumatic StressDisorder)- People with everyday problems (ex. Academic stress, Marital conflicts, A sense of emptiness) 3 Approaches to Therapy:1) Insight therapies: “Talk therapy” to enhance self-knowledge & insight. Includes supportive therapy, which isbasic emotional support focused on current life difficulties2) Behaviour therapies: Change maladaptive behavior using learning principles3) Biomedical interventions: Physiological interventions - Freud 1856-1939 “father of psychoanalysis”- bring unconscious conflicts and motives into awareness- Conflicts  anxiety and negative emotions- Psychological disorders: unresolved conflicts (childhood  adulthood)- Unconscious defense mechanisms: used to cope with the anxiety- BUT, defense mechanisms can be ineffective or too rigid Self-defeating behaviours, problems in relationships, psychological disorders - Psychoanalysts : “Psychological detectives”, “Psychological archeologists”- Techniques a) free associationb) dream analysisc) interpretations Major elements of Psychoanalysis: Resistance Transference/CountertransferenceORIGINALLY: Psychoanalysis: long-term, intensive, several sessions a weekNOW: Psychodynamic Psychotherapy: short-term, one session a week, different forms - Carl Rogers 1940s- Stems from a humanistic approach- Only the client can know and feel what is right- Goal: To facilitate a self-propelled and self-generated growth process in the client- The therapist, therefore, does not: - Interpret the meaning of the client’s experience - Rogers’ Necessary & Sufficient Conditions for Change a) Genuineness: Therapist must not be fakeb) Unconditional Positive Regard: Therapist must show acceptance, warmth and caringc) Empathy: Therapist must understand the world from the client’s point view - Communication during a therapy session: Reflections, Clarifications - emphasizes recognizing & changing negative thoughts and maladaptive beliefs- Increased vulnerability to depression - Blame setbacks on personal inadequacies- Focus selectively on negative events- Make unduly pessimistic projections about the future- Draw negative conclusions about personal worth - Main Goal: To change thinking “errors”- Clients are taught to detect their self-defeating automatic thoughts- Then they do a reality test with these thoughts (hypothesis testing)- Usually short-term goal-directed treatment- Therapist is directive- Often “homework” is given Evaluating Insight Therapies- Research reveals interesting results: - spontaneous remission- insight therapies do work- similar results found with different methods - therapeutic relationship- emotional support & empathy- cultivating hope and sense of future- self-understanding and coping- working through - Not insight therapy – not concerned with the source of problems- Focus on changing maladaptive behaviours in very specific contexts- Assume that behaviour results from learning- Use learning principles to direct change TYPES OF BEHAVIOUR THERAPIES1) Systematic Desensitization Use counter-conditioning to eliminate phobias – build an anxiety hierarchy– client is trained in muscle relaxation on command– work through anxiety hierarchy and imagine each stimulus **NOW the stimuli are paired with a relaxed response2) Aversion Therapy: - treat addictions and negative behaviours- e.g., alcohol is paired with drug causing nausea to create an aversion to alcohol 3) Social Skills Training:- modelling- behavioural rehearsal- shaping Evaluating Behaviour Therapies- Research on behaviour therapies: only effective for specific types of problems- Versus: insight therapies: can be used for many different types of problems or disorders - Physiological interventions- Biological malfunctions  psychological disorders Biomedical Therapy #1: Psychopharmacotherapy - Treatment of mental disorders with medication- 3 main categories of drugs: 1. Antianxiety Drugs- to relieve tension, anxiety & nervousness- benzodiazepines, tranquilizers- ex. Valium, Xanax- very commonly prescribed- common side effects: drowsy, lightheaded, dry mouth, depressed (Table 15.1)- also patients can experience withdrawal- potential for abuse and overdose has been exaggerated- newer drug: Buspar 2. Antipsychotic Drugs- mainly used to treat schizophrenia - effective for 70% of patients to some degree - common side effects: drowsy, constipation, cotton mouth, Parkinson’s-type symptoms, tardive dyskinesia - newer drug class: atypical antipsychotics 3. Antidepressant Drugs- to elevate mood and relieve depression- classes: tricyclics, MAO inhibitors, selective serotonin reuptake inhibitors- SSRIs most popular nowadays- they slow the reuptake at serotonin synapses- ex. Prozac, Paxil, Zoloft- side effects: weight gain, sleep problems, sexual dysfunctionLithium & Mood Stabilizers- lithium mainly used to treat bipolar disorder- it stops and prevents manic & depressive episodes- high concentrations of lithium are toxic, so it must be monitored very carefully- mood stabilizers were developed as alternatives to lithium- the most popular mood stabilizer is valproic acid, also effective for bipolar disorder and with less adverseeffects Criticisms:- superficial, short lived effects- relapse often occurs when drugs are discontinued- overmedication/overprescription- damage of side effects*Controversial issue: the pharmaceutical companies and the drug industry Biomedical Therapy #2: Electroconvulsive Therapy (ECT) - light anesthesia- electrodes attached to the skull over temporal lobes of the brain- electrical current applied for about 1 sec- triggers a convulsive seizure (~30 sec)- usually the patient wakes up after 1-2 hours with some confusion and nausea which clear up in a couple of hours- usually 6-12 treatments are givenThere are many misconceptions about ECT, a lot of stigma.
- Used most in the 1940s-1950s due to a lack of effective drug therapies- Common short-term side effect: memory loss- With the discovery of the effects of various drugs, the use of ECT declined- Nowadays it is starting to be used more once again- It is still controversial Blending Approaches to Treatment- Eclecticism: Theoretical integration, Technical eclecticism- Most psychologists nowadays describe their approach as eclectic Empirically Supported Treatments:- Do studies show treatment is superior to placebo or no treatment?Criticisms:- Real world vs “artificial” research setting- Insurance companies- What about eclecticism? Mental Health Institutions- 1840s: Dorothea Dix- Provide care and proper treatment- BUT: overcrowded, isolated, underfunded- 1950s: revolving door problem- 1960s: Community Mental Health Movement -local community based care- less inpatient hospitalization- prevention of psychological disorders Deinstitutionalization: effective drug therapies emerged- TODAY: inpatient care - local general hospitals– specialized mental hospitals– briefer period of time– more personalized care Continuing Problems in Mental Health Care:In Canada (vs. United States)- homelessness (psychiatric survivors)- lack of government funding for community care and local hospitals (** Ontario)- over-reliance on drug therapy for mild disorders- third-party insurance companies Therapeutic Services – WHERE?- Schools and Universities- Social Services- Community Mental Health Centres- Local Hospitals- Private Practice Therapeutic Services – WHO?- Psychologists- Psychological Associates- Psychiatrists- Social Workers- Psychotherapists- Family Doctors Considerations when looking for a therapist- Theoretical orientation- Gender- Sensitivity to minority issues (i.e., sexual orientation, ethno-cultural)- Area of specialization- A good therapeutic relationship York’s Counselling & Development Centre:- Free as a York student www.yorku.ca/cdc/, 416-736-5297 Other Resources:- Gerstein Centre (24-hour crisis line)

Source: http://www.psych.yorku.ca/smurtha/intro_psych_a/Treatment.pdf