psychiatric therapies and medications Flashcards
What is psychoanalysis?
individual meets their therapist a few times a week. Can appear to be unstructured and random. It is more dependent than some of the other therapies on the patient-therapist relationship.
The therapist is aiming to help the individual explore and understand their unconscious motivation
• Psyhoanalysis and psychodynamic = interchangeable.
Define repression
pushing away of unacceptable ideas or thoughts.
define denial
denying external reality of unwanted information
define displacement
uncomfortable emotions or thoughts are moved from a bad object to a more acceptable one.
define projection
unacceptable ideas and thoughts are transferred on to another person.
define regression
moving to a lower level of complexity when under stress.
define reaction formation
taking the opposite attitude to oppressed wis
define rationalisation
explanation of things in a logical or ethical way
define sublimation
creative activities which are motivated and driven from sexual instincts and drives
define identification
attributes of others are taken on to oneself
What is the goal of psychodynamic therapies?
- Psychodynamic therapy tends to focus on unconscious processes as they are manifested in a person’s present behaviour.
- The goals are to raise the patient’s self-awareness and understanding of how events in the past may be influencing current behaviour.
- In this way the patient is able to explore past unresolved conflict (which is what leads to the current behaviour that is causing them problems or symptoms). Such as dysfunctional relationships and unresolved feelings.
- In doing so the current problems can be better understood and enable more effective change.
How long do psychodynamic therpies last?
from around 12 sessions through to 40 sessions.
• Brief psychotherapy is felt to be most appropriately suited to highly motivated individuals of above average intelligence who are psychologically minded.
What is the main function of CBT?
negative thoughts maintain the negative behaviour and a vicious cycle is established.
The main function of CBT is to break this cycle by getting individuals to recognise how their thoughts and feelings impact on each other.
What happens in CBT?
common to use dysfunctional thought records to challenge these views.
Individuals are asked to rate their emotions, what they were thinking about at the time and the thoughts that were running through their mind (i.e. negative automatic thoughts).
challenge these automatic thoughts with alternative more positive views and then rate the outcome according to how far the individual now believes the original thoughts.
By continually doing this it has been shown that individuals are able to challenge their thoughts and feel brighter as a result.
What behavioural approach is coupled with CBT?
• Behavioural techniques encourage an individual to reengage with activities, often referred to in therapeutic terms as ‘behavioural reactivation’.
What is CBT used to treat?
depression, anxiety, stress related disorders and somatoform disorders.
• It has been used in the treatment of schizophrenia in an attempt to help individuals deal with hallucinations and delusions.
• Research suggests that CBT can help patients deal with chronic pain and life altering diagnoses such as HIV infection and cancer.
When is trauma focused CBT used?
• Trauma focused CBT is a specific treatment used for the management of PTSD.
This involves an individual focusing on the trauma.
It is believed that individuals are helped by the repeated exposure to what happened, which allows the mind to habituate to the experience.
What is Eye movement desensitisation and reprocessing and how does it work?
- This treatment involves an individual with PTSD focusing on the worst picture of the trauma, coupling that with a thought (e.g. I am out of control, their feelings at the time, and the part of the body where the feeling is felt)
- While holding these four separate things together, bilateral stimulation (e.g. through asking the patient to follow the fingers of the therapist from side to side or alternating hand tapping), the individual is asked to allow their mind to go where it wants to (e.g. a form of free association).
- It is not known how eye movement desenitisation and reprocessing works.
- Supposedly it processes the memories
What is relaxation training?
- This is a useful form of therapy for people with stress or anxiety disorders.
- Here patients are asked to use techniques such as progressive muscle relaxation, where the individual moves through different muscle groups tensing and relaxing them, or guided imagery when at times of stress or anxiety the individuals learns to take themselves off into a situation they find relaxing, such as walking in a meadow or alongside a stream on a warm summer’s day.
What is systematic desensitisation ans when is it used??
treatment of phobic anxiety disorders, systematic densentisation is often used.
In this an individual is gradually expose to more stress inducing situations on a hierarchy they have developed in conjunction with the therapist regarding their phobia
- The aim of graded desensitisation programme is to gradually move through the steps, asking individuals to rate their level of anxiety at each step.
- As the levels of anxiety reduce, the individual is asked to move up to the next level of the hierarchy.
- This has been shown to be a very effective treatment of phobic disorders if individuals are able to fully engage with it.
What is Exposure with response prevention and when is it used?
particularly used for OCD, the patient is asked to think of a hierarchy of situations that may fuel a particular ritual and expose themselves in a controlled way without engaging in the ritualistic behaviour.
It is anticipated that if the patient can hold off engaging in the ritual for upwards of an hour, the anxiety and drive to do it will eventually habitate and die out.
What is interpersonal therapy and what is it used to treat?
developed to treat individuals with depression but is now also used for the treatment of other conditions such as anorexia nervosa.
- This theory argues that life events occurring after the formulative years influence psychopathology.
- The focus is on an interpersonal problem using techniques from different psychotherapies.
deals with four interpersonal problem areas: grief, role dispute, role transition and interpersonal deficits.
- Problems in a patient’s life are split into one of these four areas and strategies are developed to help the patient to cope with difficulties or to think about them in a different way.
- As with CBT, homework is often used to enable the patient to experiment and try out these strategies in their day to day lives.
What are the advantages of group therapies?
It allows:
• Universality = shared experiences among clients.
• Altruism = members are able to help each other.
• Instillation of hope = members are able to learn from each other.
• Cohesiveness = belonging, acceptance and validation to the counselling process.
• Corrective recapitulation of primary family experience = members will often unconsciously identify other members of the group as similar to their immediate family.
• Self understanding/interpersonal learning = members may achieve a higher level of self awareness through interactions and observations of others.
• Catharsis = the experience of relief from emotional distress by expressing emotions.
What does counselling set out to do?
• Individuals already have the ability to work through their problems and a counsellor’s role is to facilitate this process by providing conditions of warmth, empathy and unconditional positive regard.
What are the different types of counselling?
Problem solving counselling - purely focuses on identifying and formulating problems, setting clear and achievable goals, generating alternatives for coping and then allowing an individual to problem solve as necessary - recommended for mild forms of depression and anxiety.
Other forms use techniques developed separately as therapies (e.g. cognitive behavioural counselling and interpersonally counselling).
Psychodynamic counselling - uses psychodynamic theory. e.g. grief or bereavement counselling, which is widely used to help individuals with the loss of a loved one to help them work through the different stages of grief (denial, anger, bargaining, depression and acceptance).
What is family therapy and when/why is it used?
- Families are an environmental factor that can influence the presentation and maintenance of mental health problems.
- A child mental health assessment should include a brief assessment of family functioning which will identify any need for more detailed exploration.
- It is one of the most effective therapies available.
- It is the first line treatment for several disorders of childhood, including eating disorders, anxiety, bereavement, conduct problems, substance misuse, chronic illness and psychosomatic disorders.
- The approach is focused on collaboration and seeing family therapy intervention as a way of helping families find their own solutions.
- In practice it remains about helping families find better ways of being or functioning.
Give three examples if SSRIs
Sertraline, Citalopram, paroxetine
What are SSRIs used for?
NICE says meds for mod to severe (but might consider in mild to mod if not wanting to engage in other treatments)
How long do SSRIs take to work?
Can be started at therapeutic dose (no need for titration)
Need 2-4 weeks to see benefit
Absent/minimal response after 3-4 weeks consider switching (try different SSRI or move to 2nd line)
What are the common side effects with SSRIs?
Better tolerated than TCAs and safe in overdose
Hyponatraemia (can occur with all a/d but these are worst – think in people with poor renal function/summer)
GI bleeds (esp in 65 and over)
Nausea and vomiting (warn pt about this, stops in first couple of weeks though)
Can get increased agitation and anxiety in first couple of weeks so also warn)
Suicidality
Indigestion/diarrhoea/constipation
Loss of libido/erectile dysfunction
Dizziness/dry mouth/blurred vision/sweatiness/headaches
Discontinuation symptoms with paroxetine
What is a serious potential complication with SSRIs?
Serotonin syndrome (risk if using 2 different agents at same time (this could be during switching due to long half lives) If prescribed alongside another a/d (such as TCA/MAOI/St Johns wort/Ecstasy. (restless, fever, tremor, myoclonus, confusion, fits, arrhythmias)
What are the classical features of serotonin syndrome?
1) Changes to mental state eg. feeling confused, agitated or restless
2) Physical symptoms eg. sweating, diarrhoea, fever, sensitive reflexes, tachycardia, twitching, clumsy, shivering
3) Feeling or being sick or at worst seizures
What do you get in Antidepressant discontinuation syndrome and how do you avoid it?
- Feeling dizzy
- Not sleeping
- Stomach cramps
- Flu-like symptoms
- Having vivid dreams or a headache, feeling light headed, sick or tired
To avoid discontinuation, try and reduce over course of 4 wks and warns pts
Give examples of TCAs
Imipramine, clomipramine, amitriptyline, nortriptyline
Lofepramine
How do TCAs work?
Block NAd and 5HT
Can’t start straight away at therapeutic dose, have to start low and titrate to a therapeutic dose to reduce SEs
What side effects do you get with TCAs?
anticholinergic = constipation/urinary retention/dry mouth/blurred vision
Amitriptyline and lofepramine can be sedative
Toxicity in overdose
Give examples of SNRIs
Venlafaxine, Duloxetine
when are SNRIs used?
This or Mirtazapine are 2nd line after SSRIs
