Managements Flashcards
What is the aim of psychotherapy?
Support patients in changing the way they interact with and perceive the world, to come to terms with past stressors and to cope more effectively with current and future stressors.
What is the aim of CBT?
Initially to help individuals identify and challenge their automatic negative thoughts and then to modify any abnormal underlying core beliefs.
How is CBT delivered?
Can be delivered in many ways; individually/ groups/ self help via books or computer
What are the indications for CBT?
Mild- mod depressive illness Eating disorders Anxiety disorders Substance misuse Schizophrenia Can also be used for chronic health conditions- fibromyalgia, chronic pain, chronic fatigue syndrome.
What thought processes do CBT target?
Selective abstraction All or nothing thinking Magnification/minimisation Catastrophic thinking Overgeneralisation Arbitrary interference (coming to conclusion in the absence of any evidence to support it)
What are behavioural therapies based on?
Behavioural therapies are based on the learning theory and particularly operant conditioning. Operant conditioning states that behaviour is reinforced if it has positive consequences for the individual and it prevents any negative consequences.
What are examples of behaviour therapies?
Relaxation training- useful in stress related and anxiety disorders
Systemic desensitisation- used for phobic anxiety disorders, gradually exposed to a hierarchy of anxiety producing situations.
Flooding- involves patients being rapidly exposed to the phobic object without attempt to reduce anxiety beforehand
Exposure and response prevention- exposed To the situation which causes anxiety and prevented from performing the actions.
Behavioural activation - used for depressive illness, rationale is that patients avoid doing certain things as they feel they will not enjoy it, activatIon involves gradually increasing amount of activity and making realistic and achievable plans.
What is the rationale behind using behaviour therapies?
Based upon the idea that childhood experiences, past unresolved conflicts and previous relationships significantly influence an individuals current situation.
What is the aim of behavioural therapies?
The unconscious is explored using free association (client says whatever comes to mind) and the therapist will then interpret the statements. Conflicts and defence mechanisms will be explored and the client will develop insight into their maladaptive behaviour.
How is psychoanalysis carried out?
It is an intense therapy with normally between one and five 50 minute sessions per week, for a number of years, the duration is much longer than in CBT.
What is psycho education?
The delivery of information to people in order to help them understand and cope with their mental illness
. Name and nature of illness
. Likely cause of illness
. What health services can do to help them
. What they can do to help themselves
What is the rationale behind counselling?
Behaviour and emotional life are shaped by previous experience, current environment and relationships that individuals have.
What is counselling?
Form of relieving distress and is undertaken by means of active dialogue between the counsellor and the client. Can range from sympathetic listening to active advice on problem solving.
What Is interpersonal therapy used for? How does it work?
It is used to treat depression and eating disorders
The focus is on an interpersonal problem (disagreement between 2 or more people)
The therapy focuses on difficulties that arise in relationships and the impact this has on the individual
What is EMDR?
EMDR is a psychotherapy treatment which aims to help patients access and process traumatic memories with the goal of emotionally resolving them
It is an effective treatment for PTSD
It involves client recalling emotionally traumatic material while focusing on an external stimuli (asking patients to look one way or another or follow their finger).
What is used for individuals with borderline personality disorder?
DBT- dialectical behavioural therapy
Adopts components of CBT and also provides group skills training to provide the individual with alternative coping strategies rather than self harm when faced with emotional instability.
What is cognitive analytic therapy?
Combines cognitive theories and psychoanalytic approaches into an integrated therapy.
Can be used in eating and personality disorders.
How do antidepressants work?
Work on the monoamine hypothesis
By enhancing the activity of noradrenaline and serotonin
Why are SSRIs often first line for depression?
They are better tolerated, work more quickly and have a lower risk of inducing mania compared to other SSRIs.
What is the MOA of SSRIs?
They work by inhibiting the reuptake of serotonin from the synaptic cleft into the pre synaptic neurones and therefore SSRIs increase the concentration of serotonin in the synaptic cleft.
Fluvoxamine is an example of an SSRI, why is this not regularly prescribed?
Cytochrome P450 enzyme inhibitor and therefore commonly interacts with other medications, potentiating their effects.
What are the side effects of SSRIs?
Nausea Dyspepsia Bloating Diarrhoea and constipation Sweating Tremor Rashes Extrapyramidal side effects (uncommon) Sexual dysfunction Somnolence
What is the best SSRI to use in cardiac disease?
Sertraline
What are the cautions of using SSRIs?
History of mania, epilepsy, cardiac disease, acute angle closure glaucoma, diabetes mellitus, GI bleeding, young adults as it can possible increase suicidal risk, SUICIDAL IDeATION
Contra indication: mania
When can SSRIs not be used/ contraindicated?
Mania
Other than sertraline, what are the examples of SSRIs?
Fluoxetine
Citalopram
Escitalopram
Paroxetine
How do TCAs work?
Inhibit the reuptake of adrenaline and serotonin in the synaptic cleft. They also have affinity for cholinergic receptors and dopamine receptors which contributes to side effects.
What is serotonin syndrome?
A rare but life threatening complication of increased serotonin activity, it is usually rapid but can occur within minutes of taking SSRIs.
What are the clinical features of serotonin syndrome?
Cognitive= headaches, agitation, hypomania, confusion, hallucinations and coma
Autonomic effects= shivering, sweating, hyperthermia, Hypertension and tachycardia
Somatic effects= myoclonus (muscle twitching), hyper reflexia, tremor
How would you manage serotonin syndrome?
Stopping the offending drug and supportive measures
What is the MOA of TCAs?
They work by inhibiting the reuptake of serotonin and adrenaline in the synaptic cleft. They also have affinity for cholinergic and dopamine receptors.
What are the side effects?
Anticholinergic side effects: dry mouth, constipation, urinary retention, blurred vision, confusion
Cardiovascular: arrhythmias, postural hypotension, tachycardias, syncope, sweating
Metabolic: increased appetite and weight gain
Endocrine: galactorrhoea, gynaecomastia, testicular enlargement
Neurological: convulsions and movement disorders
How do monoamine oxidase inhibitors work?
Inactivate monoamine oxidase enzymes that oxidise the monoamine neurotransmitters dopamine, noradrenaline, serotonin and tyramine.
