L4 Somatic & Psychotherapy

What is the purpose of mental health treatment modality ? (ie. Somatic therapy & psychotherapy)

• To help the clients (who failed) to have a better control over behaviour and appraisal of reality

What are the important aspects of mental health to maintain satisfactory daily function of a person ? (ie. the focus for health profession to attain optimal functioning for the client) (7)

1. Mood + Affects → Happiness

2. Control over behavior

3. Appraisal of reality

4. Effectiveness in work

5. A healthy self-concept

6. Presence of satisfying relationships

7. Effective coping strategies.

What are the history of biological treatments of mental disorders ? (+ which one now still use)

1. (Physiotherapy) Hydrotherapy & massage

2. Psychosurgery (Lobotomy)

3. Insulin shock therapy: large those of insulin to decrease glucose levels —> insulin coma

---

Still use nowadays:

• Electroconvulsive therapy (ECT) = brain stimulation therapy

• Vagus nerve stimulation (VNS)

• Transcranial magnetic stimulation (TMS)

• Deep brain stimulation (DBS)

Which of the following is/are non-invasive ?

Correct: TMS

What is the indication of using transcranial magnetic stimulation (TMS) ?

• Major depression,

• Auditory hallucinations

Describe the mechanisim of TMS

• Changing magnetic field into the brain (non-invasive)

• Low-frequency —> reduce brain activity

• High-frequency —> increase brain activity

What is the indication of vagus nerve stimulation ?

• For treatment-resistant depression mainly

What is the mechanism of vagus nerve stimulation ?

• Implanted device stimulating vagus nerve

Suggest an advantage of using vagus nerve stimulation.

• Safe and fewer adverse effects than medications

What is the indication of deep brain stimulation ?

• Tremor, Parkinson’s

• Dystonia 肌張力障礙

• Epilepsy

• OCD (obsessive-compulsive disorder) 強迫症

What is the mechanism of deep brain stimulation ?

• Tiny electrodes are implanted into abnormal areas in the brain (invasive)

• Emitting pulses of electrical activity to block abnormal brain activity

What is the indication of electroconvulsive therapy (ECT)

1. Depression — severe

2. Depressive phrase of bipolar disorder

3. High risk of suicide

What is the consideration of choosing electroconvulsive therapy (ECT)

1. Severity of a psychiatric problem

2. Risks of other treatments outweigh

   the risks of ECT

3. ECT → effective previously

4. Other treatment – intolerance,

   resistance, adverse effect etc

Describe the procedure (mechanism) of electroconvulsive therapy (ECT) (5)

• Use mild electrical current into the brain

• Induce grand mal seizure

• Change the abnormal biochemical condition: neurotransmitters / neuroendocrine

• More effective for mood disorders

• Unilateral and bilateral placement of the electrodes

What is the S/E of electroconvulsive therapy (ECT)

• Cognitive

  • Disorientation, confusion, memory disturbance (reversible)
    ** Unclear, no strong supporting evidence of ECT vs brain damage

• Cardiovascular

  • Transient cardiovascular changes

• Systemic

  • headache, nausea, muscle soreness

List the preperation for ECT (10)

1. Consent

2. Physical assessment -rule out cardiovascular problem, pulmonary problem

3. Fasting at least 6-8 hours

4. Baseline vital signs

5. Empty bladder prior the ECT

6. Protect patient from injury – electricity / tongue, give a mouthguard to protect the teeth

7. ECG monitoring

8. Sedative, particularly for anxiety patient

9. Prevent aspiration – suction available

   - use of atropine (also avoid bradycardia)

10. Other pre-op preparation

List the the nursing care (pre-procedure) for electroconvulsive therapy (ECT)

1. Pre-procedure orientation

2. Lower anxiety

3. Support patient and family

4. Effective team communication

5. Co-ordinate the patients journey and attendance at the clinic

6. Monitoring psychological and physical status

7. Documentation

List the the nursing care (Intra-procedure) for electroconvulsive therapy (ECT)

1. Support

2. Effective communication with the team and anesthesiologist

3. Prepare the patient

4. Observation

   1. Seizure, cardiac function, airway, potential S/E, seizure pattern safety

5. Documentation

List the the nursing care (post-procedure) for electroconvulsive therapy (ECT)

1. Ensure the patient recovers appropriately

2. Observe

• cardiovascular and pulmonary function

• emotional status （family and patient）

• injury and safety

3. Support

4. Hygiene care （PRN）

5. Documentation

6. Prepare for discharge

7. Effective communication - team / patient / family

What is light therapy ?

• A type of somatic therapy

• Exposing a patient to artificial therapeutic lighting

• 5-20 times brighter than indoor lighting

What is the indication of light therapy ?

• Non-psychotic winter depression or seasonal affective disorder (SAD)

What is Psychotherapy ?

Psychotherapy is a collaborative treatment based on the relationship between an individual and a psychologist, work together to identify and change the thought and behavior patterns that are keeping you from feeling your best.

• Collaborative

• Client-centered

List the types of psychotherapy

1. Psychoeducation

2. Relaxation Exercise

3. Abdominal Breathing

4. Progressive Muscle Relaxation

5. Mindfulness Therapy

6. Family Therapy

7. Group Therapy

8. cognitive Behavioral Therapy (CBT)

what is the purpose of psychoeducation ?

Can apply to all mental illness, individual / group

• To lower the anxiety to the illness (patient and/or family)

• Relapse prevention —> through equip the patient in disease management

What will be included in psychoeducation ? (7)

Nature of illness：

• Cause of the illness

• Signs and symptoms

• Disease process and prognosis

• Knowledge of medication

  • Knowledge of the consequence adhere / non-comply with treatment regime

• Knowledge of early signs and symptom of relapse

• Available resource and therapy choice （group therapy, support groups etc）

• Healthy living style: daily living activities （Sleep, appetite, personal hygiene), stress management, coping skills, problem solving skills, social connection and community support

What are the 6 scientific relaxation techniques (exercise) to de-stress mind and body in ?

1. Exercise

2. Deep breathing

3. Mindfulness meditation

4. Progressive relaxation

5. Guided imagery

6. Biofeedback (e.g. Heart variability, EMG, EEG, breathing)

What is guided imagery ?

A relaxation exercise

• Assist patents with visualising a calming environment

• Visualisation of tranquil settings —> distraction from intrusive thoughts

List the steps of guided imagery

1. Sit or lie down comfortably and minimal distraction

2. Visualize a relaxing environment

• by recalling one from memory or

• create one trough imagination

  • e.g. a day at the beach

3. Sustain the visualization as long as needed

• Focusing on feelings of calm associated with being in relaxing environment

List the steps of abdominal breathing

1. Sit or lie comfortably, with lose garments

2. Put one hand on the chest and one on the abdomen

3. Slowly inhale through the nose, to slow down the intake of breath

4. As you inhale, feel the stomach expand with your hand

5. Slowly inhale through pursed lips to regulate the release of air.

6. Focus on shifting the breath

   • to feel the rise and fall of the abdomen

   • it should be more than the chest

7. Rest and repeat

8. 5-10 minutes, 3-4 times / day

What is progressive muscle relaxation ? (4)

• For people with tension， +/- with anxiety symptoms

• Through tensing and releasing each muscles

• From head to toe or toe to head progressively, then reverse.

• The mind - focus on the feelings when the muscles are in the relaxation phase

List steps of progressive muscle relaxation

1. Sit and lie down comfortably

2. Tense the muscle part.

3. Hold for 5 seconds

4. Release for 10 seconds

5. Repeat to the other muscle part.

List the key components of mindfulness (4)

• Attention

• Present moment

• Non-judgmentally

• Acceptance

What are the benefits of mindfulness therapy ? (6)

• A clear mind

• recognize mood

• positive affects

• recovery from negative experience

• improve immune system

• effective in pain, stress, anxiety, depressive relapse

What are the key concepts of family therapy ? (3)

• Family structure

• Family system

• Boundaries

List the types of family therapy (3)

• Extended family system

• Structural family therapy

• Strategic family therapy

What are the key techniques of family therapy ? (3)

• Family mapping

• Enactments 制定

• Reframing

Nuclear family VS extended family ?

A nuclear family is a traditional family structure consisting of two parents and their dependent children living together in the same household.

Extended families, which include additional relatives like grandparents or aunts and uncles

What is the role of a family therapist ?

Assist client

• As a role of a director / promoter

• A supervisor, helps in de-triangulate the problems

• Sometimes power based

What is the purpose of group therapy ?

By providing a new & safe learning environment,

• Encourage express feelings

• Encourage socializing and avoid social isolation

• Improve skills of expression and interpersonal interaction

What is the mode of cognitive behavioral therapy ? (3)

• Individual / couple / groups

• Short term,

• structured
  

What is the role of cognitive behavioral therapist ? (5)

• As a role of trainer / educator / consultant

• Not insight oriented

• Identify dysfunctional thought patterns→behavior

• Gain coping skills

• Break maladaptive and self-defeating pattern

What are the 3 major components in cognitive behavioral therapy ?

• Cognitive

• Affect / feelings

• Behavior

—> they are interconnected (the triangle)

In cognitive behavioral therapy (CBT), what are the 2 technique / strategy to create cognitive distortions (irrational thoughts), and what are they ?

• Behavioural strategies

  • Reinforcement for positive change.

  • Social skill training

  • Assertiveness training

  • Teach alternative ways to deal with frustration

• Cognitive strategies

  • helps the client recognize and correct inaccurate internal mental schemata 圖式