Non-pharmacological treatment

Question 1

What is ECT?

Answer 1

The use of an electrical stimulus to generate a convulsion for therapeutic purposes.

Usually

• 6-12 treatments
• 2-3 per week.

Question 2

What are the indications of ECT?

Answer 2

1. MDD
   w. melanocholia, psychotic features, suicide risk.
2. First line if
   - high risk of suicide
   - inadequate oral intake
   - intolerance of medication
   - contraindication of medications.
   - treatment resistant.

For:

• acute mania
• schizophrenia
• catatonia
• neuroleptic malignant syndrome (adverse reaction to neuroleptic or antipsychotic drugs)
• parkinsons disease
• patients’ treatment preference.

Question 3

What are the contraindications of ECT?

Answer 3

1. raised intracranial pressure

Relative contraindications (weighed against risk of not receiving ECT)

CVSR:

• vascular aneurysms
• hypertension
• recent MI
• recent stroke
• cardiovascular conduction defects.
• pacemakers

Neuro:

• brain tumors
• skull defects
• retinal detachment.

Question 4

What are the legal issues surrounding ECT?

Answer 4

If patient unable to give consent - only can be administered under involuntary care, in accordance with the Mental Health Review Tribunal. Primary carer must be informed.

Question 5

What are the SE/adverse effects of ECT treatment?

Answer 5

Immed post op

• h/a
• myalgia
• nausea
• general disorientation

ST effects

• anterograde and retrograde memory

Question 6

What is the benefit vs harm involved in ECT?

Answer 6

ECT - see SE

Non ECT

• MDD untreated = high morbidity
• suicide
• MI.

Question 7

What is involved in a ECT screen?

Answer 7

1. Thorough history and examination
   - respiratory
   - cardiovascular
   - dentition
   - skull: defects/plates.
2. Anaesthetic consultation
3. Baseline cognitive exam, depression scales etc.
4. Blood tests
   - FBC
   - Serum biochemistry, including potassium levels.
5. Imaging
   - ECG
   - Chest Xray
   - others as indicated.

Question 8

What is CBT, what is it’s underlying principle, and what are the main indications for this type of therapy?

Answer 8

Underlying principle:

Cognitive - thoughts are a result of core beliefs

1- anteceding event

2- thoughts, based on core beliefs.

3- feelings + actions.

Treatment - exercises and awareness to change core beliefs, and to remove emotions from thoughts.

Cognitive element - recognition of core beliefs, mindfulness.

Behavioural element - graduated exposure + response prevention.

Indications:

• anxiety
• depression.
• self esteem issues.
• addiction.
• bipolar disorder + schizophrenia. (adjunct: increase functioning, decrease substance abuse)

Question 9

What is acceptance and commitment therapy and what are the main indications for this form of therapy?

Answer 9

Give skills to accept what is out of the pt’s personal control, emotional control.

Primary method - mindfulness.

Indications

• anxiety
• adjustment issues.
• depression
• addiction.

Question 10

What is Dialectical Behaviour Therapy and what are the main indications for using this form of therapy?

Answer 10

x

Question 11

What is the definition of psychotherapy?

What factors lead to more successful psychotherapy?

Answer 11

Talking therapy between the patient (a person in distress) and a trained observor. It helps the patient to think, feel, act and therefore cope in a more adaptive way.

FACTORS

1. Neurosis >>>>>> Psychosis.
   - anxiety
   - depression
   - OCD
   - BPD
2. Age: younger = better.
3. Intelligence: IQ 90-150 (too high, too low = bad)
4. Education (need to be able to understand the therapist, have insight)
5. Access.
6. Motivation and commitment. Ie, CBT = high homework.

Question 12

What issues can arise in psychotherapy?

Answer 12

1. Transferance: the feelings that the patient picks up from the therapist.
2. Counter transferance: the feelings that the therapist picks up from the patient.
3. Boundary overlaps
   - code of conduct
   - power imbalance
   - cannot have any sort of pre existing relationship (or develop one with the therapist/pt).

Question 13

What is interpersonal therapy? What are the main indications for this form of therapy?

Answer 13

Basis: the symptoms are due to 4 different possibilities

1. grief
2. role conflict
3. interpersonal sensitivity
4. role change.

Psychotherapy targets there areas to increase functioning.

Indications

• depression
• adjustment problems.
• bipolar disorder + schizophrenia. (adjunct: increase functioning, decrease substance abuse)