Therapeutic Modalities in Psychiatry

Therapeutic Modalities in Psychiatry

Treatment Modalities

  • Broadly divided into:

    • Somatic (Physical) Therapies

    • Psychological Therapies

    • Milieu Therapy

    • Therapeutic Community

    • Activity Therapy

Somatic (Physical) Therapies

1. Psychopharmacology

  • Psychotropic (Psychoactive) Drugs: Used in the treatment of psychiatric disorders.

2. Electroconvulsive Therapy (ECT)

  • Induces a grand mal seizure using electrical current
    to the brain.

  • Voltage: 70-120 volts; Duration: 0.7-1.5 seconds.

3. Psychosurgery

  • Surgical intervention to modify behavior or mood disturbances.

General Guidelines for Medication Administration

  • Administer medications only with a written order.

  • Chart all medications on the patient's case record sheet.

  • Confirm patient’s identity before administering medications.

  • Monitor patients closely during and after medication administration.

Classification of Psychotropic Drugs

  1. Antipsychotics

  2. Antidepressants

  3. Mood Stabilizers

  4. Anxiolytics and Hypnosedatives

  5. Antiepileptic Drugs

  6. Antiparkinsonian Drugs

  7. Miscellaneous Drugs (e.g., stimulants, vitamins)

Antipsychotics

  • Used for: Treatment of psychotic symptoms, known as Neuroleptics.

  • Classification:

    • First-generation (Low Potency): Chlorpromazine, Prochlorperazine, Thioridazine.

    • First-generation (High Potency): Fluphenazine, Haloperidol.

    • Second-generation: Aripiprazole, Clozapine, Olanzapine, etc.

Indications for Antipsychotics

  • Organic Psychiatric Disorders: Delirium, Dementia.

  • Drug-induced Psychosis: Schizophrenia, Mania, Major Depression with Psychotic Symptoms.

  • Childhood Disorders: ADHD, Autism, Conduct Disorder.

Adverse Effects of Antipsychotic Drugs

  1. Extrapyramidal Symptoms (EPS):

    • Neuroleptic-induced Parkinsonism

    • Acute Dystonia

    • Akathisia

    • Tardive Dyskinesia

    • Neuroleptic Malignant Syndrome (NMS)

Antidepressants

  • Classification:

    • Monoamine Oxidase Inhibitors (MAOIs): Phenelzine, Tranylcypromine.

    • Tricyclic Antidepressants (TCAs): Imipramine, Amitriptyline, etc.

    • Selective Serotonin Reuptake Inhibitors (SSRIs): Fluoxetine, Paroxetine.

    • Atypical Antidepressants: Venlafaxine, Mirtazapine.

Mechanisms and Indications

  • Indicated for: Depression, anxiety disorders, panic attacks, OCD.

  • Mechanism of Action: Generally increase levels of neurotransmitters (NA, 5-HT).

Side Effects of Antidepressants

  • Autonomic (dry mouth, constipation), CNS effects (sedation), cardiac side effects.

Mood Stabilizers

Lithium

  • Used for: Bipolar disorder, Schizoaffective disorder.

  • Mechanism: Decreases catecholamine activity at the synapse.

  • Side Effects: Neurological (tremors), renal (polydipsia), cardiovascular.

Other Mood Stabilizers

  • Carbamazepine, Sodium Valproate.

  • Used for managing bipolar disorder and seizures.

Anxiolytics and Hypnosedatives

Examples Include:

  • Benzodiazepines: Diazepam, Lorazepam.

  • Azapirones: Buspirone.

Indications

  • Anxiety disorders, insomnia, panic disorder, etc.

Psychological Therapies

1. Psychoanalytic Therapy

  • Developed by Freud, focuses on resolving unconscious conflicts.

2. Behavior Therapy

  • Focuses on modifying maladaptive behaviors using conditioning techniques.

Techniques:

  • Systematic Desensitization

  • Flooding

  • Aversion Therapy

3. Cognitive Therapy

  • Modifies negative thought patterns to improve mood.

4. Group Therapy

  • Support system where peers share experiences and facilitate healing.

5. Family and Marital Therapy

  • Focuses on improving relationships and communication within families.

Role of the Nurse

Responsibilities Include:

  • Monitoring patients receiving antipsychotics for side effects.

  • Educating patients on medication adherence and potential food interactions (with MAOIs).

  • Preparing and supporting patients undergoing ECT, including pre- and post-procedure care.