Hypomania and Mania:  What is the Difference?

Hypomania, mania, and depression are all symptoms of bipolar disorder.  A bipolar disorder does not necessarily entail extreme emotional swings from mania to depression.  There is a moderate emotional and mental state in between termed hypomania.

What is Hypomania?

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Hypomania is felt as a much lesser degree of mania.  It is a state in which a person has all the symptoms of mania but with less the severity and the impairment that mania usually creates.  A hypomanic person is on a “high” which puts him in a condition in which he feels more self-assured, energetic, expansively generous, sensual, and the like.  On the flip side, hypomania can also bring on irritability, distracted thinking, racing thoughts, anger, and a dissociative feeling from the world.

Although the positive side of hypomania sounds like a good thing (and indeed it does feel great), it nevertheless will inevitably dip into depression or escalate into mania if a hypomanic person’s bipolar disorder remains undiagnosed.

Just as mania and depression are mental states that may last for some time, hypomania can last anywhere from weeks to years.  Since the hypomanic condition does not really impair a person’s ability to function, hypomania may not be easily recognized enough to require a serious diagnosis or check.

Hypomania is more common in people with Bipolar II disorder.  Bipolar II differs from Bipolar I in the severity of the upswing moods.  Bipolar II patients do not experience extreme “elation” or “euphoria” typifying mania which often debilitates normal functioning, usually to a dangerous degree as to require hospitalization.  Instead, they experience the dampened version of mania in which recognizable symptoms are present but do not pose as much impairments to judgement as mania does with dangerous behaviour that is highly destructive to one’s self and others.

What is Mania?

manic episode

Mania is the state in which symptoms such as recklessness, irritability and aggression, super-inflated self-esteem and self-importance, and heightened senses are manifested in such extreme degree that resulting behaviour poses a significant threat to the bipolar patient’s safety and that of others.  A manic patient’s symptoms debilitate him and usually impair normal functioning and reasoning so much so that sometimes, hospitalization may be required.  A person who has impulsively thrown all his life’s savings on a sports car he can ill afford may be having a manic episode.

Symptoms of Hypomania and Mania

Both hypomanic and manic periods exhibit more or less these same symptoms:

  • Very energetic
  • Increased self confidence
  • Increased aggression and irritability
  • Feelings of intense happiness or “high”
  • Increased sense of entitlement or self-importance
  • Reduced concentration or focus; high distractibility
  • Decreased inhibitions
  • Increased sexual urges
  • Thoughts and ideas coming in fast
  • Increased sociability and social congress
  • Indulgence in daring behaviour, sometimes bordering on recklessness
  • Sharper sense of smell, taste, sight, and other senses

The Difference

While hypomania and mania share the same symptoms, the major difference between them is degree of severity.  Where mania takes these symptoms to a feverish pitch, hypomania simply coasts with these so that hypomanics actually feel great and are even grateful for this state as a relief from depression.  To illustrate, where a woman in a manic state may damagingly splurge on 20 handbags, a hypomanic one may still exhibit some reasonable financial judgement by buying only five handbags at her shopping spree.

If hypomania just weren’t part of a disorder, a majority of us would actually enjoy being in this state of mind.  With more energy and an increased feeling of purpose, hypomania can put us on a creative and productive high.  It may come with a certain degree of crankiness and feelings of disconnectedness; yet for people with bipolar disorder, hypomania is a much better condition to be in than having to ride depression and mania.

Hypomania however can morph into a full blown manic period or crash into a depression; so treatment must be sought to help to stave off the other undesirable mental states.

Treatment

The trouble with getting treatment for people in a hypomanic period is that they feel too good to believe they are sick enough to need help.  Professional help, however, is vital to stabilize the extremities of mental states of people with bipolar disorder.

There are several approaches to treating hypomania and mania.  Talking therapies such as Cognitive Behavioural Therapy (CBT), psychotherapy, and Mindful-Based Cognitive Therapy (MCBT) form one approach. Medications to help prevent a hypomanic’s from sliding into mania or depression is another.   Such drugs which should be prescribed by a psychiatrist, not just a GP, are antipsychotics, common of which are:

  • risperidone (Risperdal).
  • olanzapine (Zyprexa)
  • quetiapine (Seroquel)

Bear in mind that medications, prescribed or otherwise, usually carry side effects about which one must always discuss with their psychiatrist.

Electroconvulsive Therapy (ECT)

 

What is Electroconvulsive Therapy?

Electroconvulsive Therapy or ECT is a form of medical therapy for people with severe mental illness who do not respond to counselling, medication, or other forms of treatment.  The therapy involves sending carefully controlled electric impulses to the brain to stimulate a brief epileptic fit with the goal of relieving extreme depression, mania, or catatonia.  The electric stimuli seem to provoke changes in brain chemistry which help alleviate the patient’s mental symptoms.

When ECT is administered, the patient is given a muscle relaxant and put to sleep with anaesthesia.  Electrodes are placed on the head after which a finely channelled electric current is sent to stimulate the brain.  These impulses trigger slight seizure-like movements in the sleeping patient.  The session is painless and lasts only several minutes after which the patient awakes with no memory of the treatment or the events leading up to it.  He may also wake up disoriented but this will last only for a while.

Improvements in patients are noticed usually after the first three sessions and major improvements are palpable after six.  These improvements could manifest as better sleeping patterns, less lethargy, or better appetites.

Is Electroconvulsive Therapy Dangerous?

ECT today is a generally safe method as it involves no pain or bad shocks.  There is a side effect though which involves memory impairment lasting about several weeks after the treatment.  Although memory is usually resolved in the short-term, there are rare cases in which patients do lose personal and skill memories and have difficulty processing new information.

In cases of extreme depression, the benefits however may outweigh the risks of a memory disadvantage especially in patients whose need for some symptom alleviation are urgent.  For instance, a mother with severe postnatal depression may require the symptom alleviation ECT may provide, when other therapies have failed to, in order to for her to adequately nurture her infant.

ECT has gotten a bad reputation because of the errors done during its early developmental phase.  ECT’s stigma stemmed from misuse of equipment, inadequate information and staff training, and improper treatment administration.  These errors had proved to be injurious to some patients who were administered with high electric charges without anaesthesia causing memory loss, fractured bones, and other serious injuries.  Electroconvulsive therapy has evolved to today’s relatively safe administration of finely controlled charges, anaesthesia, and strict supervision.

electroconvulsive-therapy-adverse effects

Who are Candidates for ECT?

Patients who merit a prescription for electroconvulsive therapy may be:

  • suicidal because of severe depressive symptoms.  About 80% of these cases report a mood improvement with ECT.
  • unresponsive to drugs or talking therapies
  • in a severe manic episode lasting for a long period of time
  • catatonic
  • those that have a history of responding well to ECT therapy in the past
  • aggressive or extremely agitated because of dementia
  • pregnant and cannot take medications
  • intolerant of the side effects of drugs
  • mothers with severe postnatal depression.  As electroconvulsive therapy works more quickly than counselling or medication, it helps cut down the time that the mother spends away from infant nurture.
  • nutritionally compromised because patient refuses food or sustenance owing to extreme depression
  • severely psychotic or schizophrenic

Is ECT Effective?

There is a huge body of evidence now that ECT is an invaluable treatment tool for those with acute depression and psychosis.  Although electroconvulsive therapy can go a long way in treating patients, this must be followed up with talking therapies and medication to avert recurrence of extreme symptoms.

Types of Electroconvulsive Therapies

There are two types of ECT administration which is differentiated by the location of electrode placement:

  • Right Unilateral Treatment

Right unilateral treatment involves the placement of one electrode at the crown of the head and the other, at the right temple.  The placement produces milder stimuli and therefore has lower risks of side effects concerning memory.  The patient response rate, however, is also slower compared to bilateral ECT, the other type of treatment.  If patients do not respond to right unilateral treatment, they may be switched to the stronger bilateral one.

  • Bilateral Treatment

Bilateral treatment is a full-on type that requires electrodes to be placed on both the left and right temples of the patient’s head.  In this case, the electric stimuli are much stronger, but still controlled, and therefore more effective in resistant patients.  Bilateral ECT however carries more risk of some memory loss.

Bilateral ECT

The patient and doctor should work out which treatment type is best.  This usually involves taking into consideration the patient’s medical and psychiatric history, severity of symptoms, and personal concerns as well.

 

 

Major Mental Disorders (MMD)

The acronym MMD stands for Major Mental Disorder of which there are five broad categories:  anxiety disorder, mood disorder, psychotic disorder, dementia, and eating disorder.  These mental illnesses are not a result of one cause but rather an interplay of a variety of factors which include environment, genetics, and lifestyle.

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Anxiety Disorders

An anxiety disorder is positive in a diagnosis if the patient has any of these three symptoms:

  • illogical or inappropriate fearful and anxious response to objects, events, people, and situations
  • inability to control these fear responses
  • having no control over anxious feelings so much so that it disrupts normal functioning

Anxiety disorders are specifically manifested by these mental sub-illnesses:

  • Generalized Anxiety Disorder (GAD) — GAD is characterized by excessive or chronic worrying about one or many areas of life such as family, income, career, friends, and school, among other things.  The fears may often be unfounded and skew off tangent; if there is some basis, the amount of worrying is excessively way out of proportion to the real situation.  A person afflicted with GAD may find himself unable to go about his life normally because of excessive dread.
  • Panic Disorder — characterized by feelings of terror and fear which may or may not occur suddenly.  These are repeated panic attacks accompanied by physical symptoms such as rapid heartbeat, chest pain, sweat, tremors, and disorientation.
  • Phobias — intense fear, often irrational, of something that actually does not pose any immediate or even potential danger.  Ex.  fear of enclosed spaces (claustrophobia); fear of crowds (agoraphobia);  fear of darkness (achluophobia)
  • Post-Traumatic Stress Disorder (PTSD)  — often characterized by emotional numbness and recurring vivid memories of traumatic incidents.

 

Psychotic Disorders

Psychotic disorders are known as a set of mental illnesses that involve a distortion of reality.  To someone plagued with psychosis, delusions (assignations of unreal meaning to normal and innocent events) and hallucinations (experiences of non-existent things that are not connected to any genuine sources such as hearing voices) are perceived to be as real as normal people see things to be.

Mental maladies under psychotic disorders are:

  • Schizophrenia — a serious mental disorder that is marked by distorted thought patterns, hallucinations, delusions, and paranoia, all of which lead the individual toward strange, irrational behaviours.  Schizophrenics may hear voices not attached to any source or may believe in delusions such as being a real princess or warrior.
  • Schizo-affective Disorder — a variant of schizophrenia mixed with mood disorders such as mania or depression.

Mood Disorders

Mood disorders are also known as affective disorders.  Persistent feelings of sadness or abnormal elation over a certain period of time may qualify under this mental malady.  Extreme emotional fluctuations also characterize this category under which these illnesses belong:

  • Bipolar Disorder — a disorder identified by extreme changes in mood from mania (“high” mood state) to depression (“low” mood state).     major mental disorder
  • Clinical Depression — surpasses the normal feelings of sadness and puts one in a chronic state of pessimism, hopelessness, emptiness, worthlessness, anxiousness, and other severely low mood situations.  Patients cannot just bounce back from their low moods, unlike unafflicted individuals who have the abilities to cope with abysmal feelings.  Clinical depression has been known to be the cause of some suicide cases.
  • Dysthymic Disorder — an illness marked with constant low-grade depression for more than two years.  Symptoms include low energy, feelings of hopelessness and low self-esteem, sleep and appetite problems, poor focus, and indecisiveness.

The danger to these depressive mood disorders is that the risk for suicide among sufferers is high.

Dementias

Dementia refers to a slew of mental health problems symptomised by rapidly declining memory and other cognitive functions.  Dementia is diagnosed when the one or more of the following are impaired:

  • Memory
  • Ability to concentrate or pay attention
  • Visual perception
  • Language and communication abilities
  • Judgement and reasoning

The cause to all these impairments are brain cell damages which hinder these cells from communicating adequately with each other.  Alzheimer’s disease makes up a large percentage of dementia cases, followed closely by vascular dementia and dementia due to medical problems such as Parkinson’s and Huntington’s disease.  Toxic substances such as drugs, alcohol, mercury, lead, etc. can contribute to the development of dementia as well.

Eating Disorders

Eating disorders involve extreme thoughts, attitudes, and behaviour towards food and weight.  These disorders manifest as either of these issues:

  • Anorexia Nervosa  — a condition that is indicated by an overwhelming and all-consuming dread of being fat.  Anorexics have a distorted body image and obsessive thoughts about food, calories, and weight on which they impose severe restrictions.  For sufferers, one can never be too thin.  Anorexia is dangerous because the condition can cause death from suicide, cardiac arrest, starvation, and other medical complications.
  • Bulimia Nervosa —  an eating disorder in which the sufferer chronically binge eats and then frantically purges the calories consumed as an attempt to lose weight or not gain the pounds from overeating.  Bulimics, like anorexics, have an obsession with food; only they overeat with the thought that they can purge their “sins” later.  A person with bulimia can consume between 3,000 – 5,000 calories in a short hour.  In the next, he often guiltily purges what he has consumed by inducing vomiting, applying enemas, exercising voluminously, or going on crash diets.  The constant binge-and-purge cycle wreaks havoc on the metabolic system, forcing bulimics to gain weight over time.
  • Binge Eating Disorder — chronic overeating without any purging involved.  The cycle moves around binge eating, feeling guilty and ashamed for gluttony,  then emotional eating again to assuage the guilt.  Binge eaters are usually obese and may suffer from hypertension, cardiovascular disease, depression, and anxiety.

 

These major mental illnesses are treatable but need the help of professional mental health practitioners.  The stigma associated with mental maladies however is the main cause of why  people avoid treatment or fail to recognize that they need treatment.  More information and education about mental illnesses should be provided so that early stages may be recognized and tended to correctly.

Antipsychotic Medication

Antipsychotic medications are prescribed drugs used to treat people with some form psychosis.  Psychosis is an umbrella of mental disorders that are characterized by radically impaired emotions and thought patterns, so convoluted that the afflicted person actually loses touch with reality.  These mental disorders include bipolar disorder, borderline personality disorder (BPD), schizophrenia, and paranoia, all of which include the psychotic marks of delusions and hallucinations in their roster of symptoms.

ANTIPSYCHOTIC-DRUGS

How Do Antipsychotic Drugs Work?

Antipsychotic drugs target the neurotransmitters in the brain which are dopamine, noradrenaline, serotonin, and acetylcholine.  These brain chemicals have the main hand in regulating moods, emotions, and behaviour.  Of all these neurotransmitters, dopamine is the most important target.

By changing the effect these neurotransmitters currently have on an individual’s brain, antipsychotic drugs can suppress, reduce, or even prevent the onslaught of:

  • hallucinations (ex. hearing voices)
  • delusions (perceiving things, situations, and events not based on reality.  Ex.  A delusional person may firmly believe that the restaurant waitresses are laughing at him because they know his spouse has been cheating with someone else…even if they do not know him.)
  • Extreme mood swings
  • Thought disorders

What antipsychotics cannot do is cure a patient of his mental disorder.  These drugs can only act on the symptoms not on the entire illness.

Types and Side Effects

Antipsychotic medication was introduced in the 1950s and has to a large extent been successful in alleviating hallucinatory and delusional symptoms in psychotic patients so much so that these individuals have been able to lead a relatively normal life.  Although a boon to the mental health field at that time, early antipsychotics (termed typical) possessed its fair share of mild to severe side effects which manifested as:

  • muscle stiffness
  • tremors and spasms
  • restlessness
  • increased skin sensitivity to sunlight
  • low blood pressure
  • liver poisoning; so with some typical medications, liver tests may be mandatory
  • Parkinson’s disease-like symptoms
  • gastrointestinal disturbance
  • weight loss
  • skin rashes, ranging from mild to serious cases which may develop into Stevens-Johnson syndrome, a life-threatening illness  (rare side effect)
  • spontaneous ejaculation
  • tinnitus (ringing in the ears)
  • vertigo
  • drooling
  • excessive thirst

These typical drugs are still prescribed today because there are patients who tolerate these better than the newer atypical drugs.

Atypical antipsychotic drugs are considered the newbies in its category although the first, clozapine (Clorazil) was formulated over twenty years ago in 1990.  Atypicals have fewer side effects thanantipsychotic meds the older typical antipsychotics and are thus more often prescribed as a first-line treatment.

Most of the atypical drugs were developed for the treatment of schizophrenia and mania.  These are contraindicated for people with cardiovascular problems or with a history of epilepsy or Parkinson’s disease.  Many of these drugs such as risperidone and olanzapine should not be prescribed to older people as they increase the risk for stroke.  Atypical drugs may also compromise cognitive skills such as driving or operating heavy machinery.

The most noteworthy side effect of atypical antipsychotics is weight gain, increased appetite, and other metabolic issues.  Other side effects are:

  • dizziness
  • extreme sleepiness
  • low blood pressure when standing
  • fainting
  • rapid heartbeat (tachychardia); slow heartbeat, irregular heartbeat
  • tardive dyskinesia — uncontrollable movements of the lips, tongue, face, trunk, and limbs.  Usually a side effect of long-term drug use.
  • Parkinsonism
  • insomnia
  • anxiety; restlessness; agitation
  • raised prolactin levels provoking milk production
  • sexual problems
  • seizures
  • indigestion
  • headache
  • lethargy; lack of energy; tiredness
  • drooling
  • impulsive behaviour like gambling (attributable to Aripiprazole)
  • unusual taste sensations
  • numb lips and mouth
  • still muscles
  • raised levels of enzymes in liver
  • loss of menstrual periods
  • blurred vision

Side effects vary from individual to individual.  Other symptoms not on the common list may manifest as well; so, medical monitoring is crucial.

Withdrawing Intake of Antipsychotic Drugs

It is highly inadvisable to suddenly stop taking the prescribed drugs once already under antipsychotic medication.  Doctor’s approval is highly recommended as one has to follow a medical plan for a gradual and slow withdrawal from the drug over a period of several weeks or months.  While there are people who can stop taking their prescriptions without issues, the majority usually experience a recurrence of psychotic symptoms when suddenly going off their medications.

Furthermore, withdrawing from the drug is not a simple matter of gradual decrease of intake.  Situational factors such as timing of circumstances and availability of support from family and friends are crucial to making this huge leap.  Withdrawal can begin when there are no life-changing events or stressful things going on such as moving house, getting a new job, travelling to a new place, etc.  But as people can never be pigeon-holed, there are some patients that do withdrawals well when preoccupied with new things going on in their life.  No matter what type of patient one is, it is important to know that the manner of withdrawing from antipsychotic drugs is crucial because the aim is to avoid relapses.

Paranoia

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Understanding Paranoia

Paranoia is a state of mind in which the individual thinks other people are out to do him harm, physically, socially, or otherwise.  It encompasses an irrational dread of some present or impending disaster or bad thing for which other people are responsible.  Paranoid thoughts are often unfounded but the paranoid person believes all these as realities.

Being on one’s toes or being rightfully distrustful of other people do not make one a true paranoid; but, when this same individual starts weaving complex scenarios justifying their suspicions and experiencing intense suffering and fear from their thoughts to the exclusion of rationality, then he may be diagnosed as paranoid, possibly with schizophrenia.

Psychotic or schizophrenic people often have these persecutory delusions so that they live in fear of being harmed, controlled, plotted against, vilified, and socially disparaged.  These individuals often feel they are of particular importance and that is why they feel singled out for persecution.  Severe cases of paranoia may include hearing of voices, all malicious or threatening.

Causes of Paranoia

By itself, paranoia is not classified as a mental illness as schizophrenia and bipolar disorders are.  Instead, it is an indicator that something is wrong and that there is some underlying mental health issue or even a neurological disease such as Parkinson’s and Huntington’s disease.

Paranoia may also be caused by street drugs such as barbiturates, LSD, marijuana, and cocaine.  Impaired cognitive functions and chronic fatigue from chronic sleep deprivation may generate paranoia as well.

Traumatic life experiences such as a spouse’s betrayal or sudden loss of a job can cause a person to have extreme thoughts of persecution.  Uncontrollable environmental disasters such as bombings and high crime may understandably trigger paranoid delusions, some justified but most not.

Recent research has also discovered that individuals who have problems understanding other people’s perspectives and have low empathetic abilities tend to make negative assumptions of other people’s behaviour.  While these characteristics by themselves do not automatically make one paranoid, stressful life events may push such an individual toward feeling more threatened and consequently, paranoid.

paranoid-person-quotes-2

 

Treatments for Paranoia

One unfortunate side effect of paranoia is that the individual may not think of himself as needing any kind of help.  In fact, a genuinely paranoid person may think that their patterns of thoughts have developed from rational deductions and inferences of their personal observations.  While their beliefs are far from reality, paranoid people may scoff at treatments unless they suspect that they could partly be wrong.  Herein lies the difficulty in persuading a paranoid person to accept psychological or psychiatric intervention.

Treatments for paranoia may include:

  • Talking Treatments

Talking treatments refer to therapies that encourage patients to talk about their thoughts and emotions with a mental health professional.  Talking to trained therapists help paranoid persons come to terms with their fears and to perceive them as they are.  Doing so also help individuals take more control over their thoughts, allowing them to make positive thought and behavioural changes.  Talking treatments may involve the following therapy types:

  • Medication

Antipsychotic drugs such as clozapine, risperidone, and olanzapine may be prescribed for severe paranoia.  Know that paranoid people may be highly suspicious of drugs, even prescribed ones, as they may have delusions of their own doctor conspiring against them.

  • Hospitalization / Day Care Centres

In cases when a severely paranoid person becomes violent or is threat to himself and others, the person may be admitted to the hospital whether he goes voluntarily or not.  Once, he has been stabilized, he may be discharged and entitled to a treatment plan.

Care centres also exist as aftercare hostels where patients have the opportunity to live under a supportive environment.  Under such an arrangement, acute paranoia sufferers may be given the chance to develop the skills needed for getting back in society and reacquiring some independence.

 

What Psychosis is All About

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What is Psychosis?

Psychosis is a mental health problem which makes a person interpret or perceive the things around him differently. The thinking and emotions of the affected person are so impaired that he’s already lost in contact with reality. People suffering from psychosis are referred to as psychotic.

Symptoms and Causes

There are two main symptoms of Psychosis:

  1. Hallucinations – when a person sees, hears or feels things that are not really there. Examples: Hearing voices, feeling insects on skin, seeing imaginary visions or images.
  2. Delusions – when a person has false thoughts or believes in things that are obviously untrue. Examples: Believing that he’s related to a famous person, believing his cat is plotting to kill him.

Another symptom of psychosis is the flight of ideas or when a person’s thoughts move too quickly from one idea to the next. It’s also called the ‘word salad’ or ‘thought disorder’. A person experiencing this might lose control of his words and link words together not because of their meaning but simply because they sound alike.

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Here are some of its common causes:

-Alcohol

-Stroke

-Stress

-Epilepsy

-Illegal drugs

-Brain cysts or tumors

-Dementia

-HIV

-Traumatic Experiences

-Infections affecting the brain

-Prescription drugs (steroids, stimulants)

-Brain diseases (Parkinson’s, Huntington’s)

-Psychological Disorders (Schizophrenia, Bipolar and Personality Disorders)

psychotic

Types of Psychosis

There are 3 main types of Psychosis:

  1. Brief Reactive Psychosis – Temporary reaction to extreme personal stress like death of a loved one. A person suffering from this will eventually recover in a few days.
  2. Drug- or Alcohol-Related Psychosis – A person can experience this type of psychosis in two ways – short-term and long-term. Short-term psychosis is when a certain drug or alcohol resulted in a psychotic episode – but it usually goes away when the effect of the drug or alcohol wears off. Long-term psychosis happens when a person addicted to a drug or alcohol suddenly stops taking or drinking it.
  3. Organic Psychosis – This type of Psychosis is caused by a brain illness like Parkinson’s disease.

 psychotic-depression-1

Treatment and Recovery

Treating psychosis often involves a combination of treatments. Here are the three most commonly used methods to treat psychosis:

  1. Rapid Tranquilization – There are times when a person having a psychotic episode becomes so agitated that he might hurt himself or other people around him. During these cases, a doctor will administer a fast-acting shot to calm and relax the patient right away.
  2. Drugs and Medication – There are medications called ‘antipsychotics’ which reduce hallucinations and delusions. They also help a patient think more clearly.
  3. Cognitive Behavioral Therapy – This means that a patient will have regular meetings with a mental health counselor. Its goal is to change the mindset and behavior of the patient.