Workshop 6 - Non-pharmacological treatment of CNS conditions

Question 1

Explain when a psychological / behavioural approach is indicated?

Answer 1

The main features of psychological therapies:
- Using suggestions
- Restoring morale
- Providing a rationale for the patiesnts condition
- Providing information

Mainly for phobic disorders, anxiety and depression - not just for changing behaviours but also for dealing with emotions. Helpful for dealing with bereavment issues, relationship problems, social or personality issues.

Question 2

Describe the various types and features of psychological therapies that are available on the NHS?

Answer 2

Type of therapy affected by numbers taking part and degree of complexity (high and low intensity)

Individual - particular problems of the patient
Couples - relationship problems contribute the psychiatric disorder
Family - difficulties of the child/ adolscent
Groups - several patients require similar treatment eg exposure for agarophobis or when contributions of other members may be helpful - alcohol abuse

1. Low intensity: Counselling - least complex, giving advice / help for
   adjustment to a stresstul situation / to life events, iliness, loss. bereavement.
   Concerned with emotions and knowledge.
   * Marital or relationship problems
   Interpersonal problems- alternative ways of coping with
   ‘difficulty.
   * Psychodynamic counselling- influence of past experience on
   develoomentorcurrent benaviour
   * ‘Problem solving’ counselling- Particularly helpful for low
   mood or subclinical denrescior
   Severity of problem-Mild to moderate
   Chronicity of problem-Recent onset (<1 year) except for
   Interpersonal problems
   Patient factors- Preference for brief treatment.
2. Cognitive Behavioural Therapy (CBT), also known as
   ‘dynamic psychotherapies’.
   All psychiatric disorders have cognitive and behavioural components
   [Cognition- the mental process by which knowledge is acquired. These include perception, reasoning, acts of creativity, problem solving and intuition/.
   These features have to change if the patient is to recover.
   * CBT is an active problem solving approach that helps patients develop skills and enables them ultimately to become their own therapist.

CBT focuses on the present and current problems and ways in which the patients thinking and acting perpetuates the problems. ie focus on factors which are maintaining the disorder at the time of treatment.
* CBT focuses on 2 types of disturbed thinking: intrusive thoughts (automatic thoughts) and dysfunctional beliefs and attitudes (dysfunctional assumptions).
CBT-Mainly used to treat anxiety, obsessions & compulsions, depression or eating disorders.

3. Behavioural Techniques
   * Exposure. Used to reduce avoidance behaviour (phobic conditions). Starts with gradual and progress (desensitization) or intensive at the start (flooding)
   * Conditioning /Aversion therapy e.g bedwetting/enuresis.
   Bedwetting in under 19s. NICE guidelines [CG111] Oct 2010
   * Relaxation training. Useful for sub-threshold states of anxiety and stress related disorders e.g insomnia or mild hypertension

Question 3

Which mental health conditions are these therapies largely used to treat?

Answer 3

1. Anxiety / Generalised Anxiety Disorder (GAD)- chronic anxiety condition characterized by excessive and uncontrollable worry and associated somatic symptoms.
   * Unlike other anxiety disorders, GAD involves diffuse anxiety in the absence of a specific feared object, class of stimuli, or situation. Individuals suffering from GAD instead fear and avoid an array of subtle internal and external stimuli. - chronic arousal of the autonomic nervous system.
   * Patient presents with insomnia, muscle tension, Gl issues, IBS.
2. Eating disorders - excessive concern about shape and weight and low self esteem NOT the same as restricted eating due to Autism or other developmental disorders

Question 4

What is the role of diet and physical exercise in management of mental health disorders?

Answer 4

Nutrient Intake: A balanced diet provides essential nutrients, including vitamins, minerals, and omega-3 fatty acids, which are crucial for brain health. Nutritional deficiencies can lead to cognitive impairments and mood disturbances. Mediteranean diet

• Releases serotonin and endorphins - Raises self-esteem
• Increased social interaction
• Reduces stress
• Help with sleep
• More blood pumped to the brain
• Increases the size of the hippocampus (memory)
• Increaes connections between the nerve cells in the brain - improves memory and helps protect brain against injury and disease.

Question 5

What role does the pharmacist have if someone is NOT receiving pharmacological treatment for a mental health condition?

Answer 5

Education and Counseling: They can explain the benefits of psychotherapy, lifestyle modifications, and self-care strategies.

Medication Management: They can provide guidance on avoiding substances that may worsen mental health symptoms.

Monitoring and Side Effects: Pharmacists can monitor for such side effects and suggest adjustments to medication regimens if necessary.

Question 6

What are psychological therapies?

Answer 6

Treating thoughts and behaviours in a holistic fashion without pharmacological interventions

Tend to be delivered by psychologists (use psychological methods/ techniques to actively treat), pshycotherapist (deliver talking therapies which identify and treat the problem) and counsellor (help and support for situational emotions/ problems