PSYCHO-SOCIAL THERAPIES

~Psychotherapy is a method of treatment of emotional and personality problems. The basic principles of psychotherapy are based on the therapist-patient relationship. In this the therapist respects the patient and treats him as a human being.

~Therapies designed to help patients with mental illness, including drug addicts, to provide the interpersonal and intrapersonal skills necessary for living, using a combination of individual psychotherapy and group therapies, are called psychotherapy. Psychotherapy helps the patient develop a sense of self-identity.

~This is a method for treating problems of emotional types in which a trained person modifies and removes symptoms.

~ Psychotherapy is the process of observing personal and family patterns to gain a greater understanding of thoughts, feelings, social experiences, and relationships as well as oneself.

INDIVIDUAL PSYCHOTHERAPY

~This psychotherapy is conducted on a one to one basis. A therapist treats one client at a time.

~ The method of bringing change in a person by exploring their feeling, attitude, thinking and behavior is called Individual Psychotherapy.

INDICATION

~Stress Related Disorders

~Alcoholism

~Sexual disorders

AIMS OF INDIVIDUAL PSYCHOTHERAPY

~Therapists help clients understand their feelings.

~Modifying maladaptive behavior.

~Improving IPR and establishing a therapeutic relationship.

~ Making personal changes and providing constant emotional support.

~Helping clients gain insight into problems.

NURSE’S ROLE

~Co-ordinating with other team members.

~Let the patient make his own decisions.

~Explain the treatment to the patient.

A trusting relationship should be developed.

~Nurses encourage clients to be involved in therapy.

BEHAVIOR THERAPY

~This therapy is applied for psychological treatment based on experimental psychology and aims to change symptoms and behavior.

It is a systematic application of scientific principles of learning and a form of psychotherapy, which aims to change maladaptive behavior into adaptive behavior.

INDICATIONS

• Panic
• Phobia
• Obsessive compulsion neurosis

•Generalized compulsion neurosis

• Post-traumatic stress
• Bipolar disorder
• Major depression

•Schizophrenia

• Ticks
• maladaptive behavior
• Obesity

•Anorexia nervosa

• Head one
• Hypertension
• Chronic pain
• Asthma

•Insomnia

TYPES

Systematic desensitization:

~ The main purpose of this method is to remove fear and anxiety. In this, the patient is given muscle relaxation training. In this the situation is imagined.

~ If the patient has anxiety or fear, then the problems are made to face gradually from less intensity to more intensity.

• Aversion therapy:

~ This is the method of behavior therapy, in which the patient is made to feel a painful or unpleasant experience towards the undesirable or maladaptive behavior and a situation is created in which he himself develops aversion towards that maladaptive behaviour.

~Examples: In chemical aversion, a patient is administered a medicine that causes nosia or vomiting when the person drinks alcohol. This is repeated until the person begins to associate alcohol consumption with the feeling of illness, and so on. The patient does not want to drink alcohol. The patient goes away from alcohol.

•CBT (Cognitive Behavioral Therapy):

~ In this, the emotional problems that arise in the person due to faulty thoughts are solved. In this, the therapist plays a guiding role and corrects the faulty thought and perception of the patient. This helps in bringing a change in the patient’s thoughts, feelings and behavior towards himself.

Flooding:

~This is also called Implosive Therapy. This method is opposite to systematic desensitization in which the person is made to face the matter/object directly with maximum intensity and thus the person’s fear towards that matter/object will be gradually removed.

Example: If a person is afraid of insects, the therapist will suddenly put a real or rubber insect in front of him during the conversation. For some time the person will be very scared but gradually he will start playing with the rubber insect.

PSYCHOANALYTIC PSYCHOTHERAPY

~Psychoanalysis therapy was developed by Sigmund Freud. It focuses on the person’s Id, Ego and SuperEgo. The patient is encouraged to communicate freely. And the information of early psycho-sexual development of a person is obtained.

Different methods are used such as Free Association, Fantasy, Dream Analysis etc.

~ This therapy is effective in anxiety and neurotic reactions and is helpfull in bringing about modification in the personality of a person. The interaction duration in psychoanalysis is 40-45 minutes and this therapy has to be given 4-5 days in a week and 4-5 years.

SUPPORTIVE PSYCHOTHERAPY

~ Supportive psychotherapy is a dynamic psychotherapy of the patient performed by trained therapists in accordance with psychoanalytic understanding and psychodynamic principles. The goal of this therapy is to improve ego function.

COMPONENT

Reassurance

~In this the patient is explained that his condition will improve and his fear will be removed.

•Manipulation

~ In this, the patient’s living condition is changed and their mental well being is improved. It is also called environmental modification.

•Mental Ventilation

~The patient’s emotions and feelings are allowed to speak freely.The patient is allowed to say his feelings and emotions until no emotional disturbance is created.

•Reeducation

~Therapist-patient relationship and group therapy are used to deal with the patient’s problems and relationships.

GROUP THERAPY (Group Therapy) :-

~ Group therapy is the treatment of psychological problems. In this, one or more Psychotherapists and two or more patients engage in this therapy on an emotional and cognitive level. Through this, the person gets personal insight, improvement in interpersonal relationship and improves his destructive behavior.

~ When individual therapy fails or drugs therapy does not help and the patient needs socialization, this group therapy is helpfull.

TYPES

•Psycho-analytical group therapy

•Psycho-drama group therapy

•Re-educational group therapy

•Group Dynamic Group Therapy

•Existential group therapy

GROUP SIZE AND MEMBERS

~Group therapy consists of 10-15 members.

~Duration of group therapy is 45-60 minutes.

OBJECTIVES

Self-discipline develops and socialization improves.

~Understands own mental illness and improves communication.

~proper behavior develops and self concept develops.

~To find out own problems and solutions.

CONTRAINDICATION

~ Delusion

~Antisocial Behavior

~Actively suicidal patient

~Severely depressed patient

PRINCIPLES

~Share problems, support each other.

~interact with each other.

~ Expresses and communicates one’s feelings.

~Behavior can change, can learn something new.

~Socialization improves.

NURSE’S ROLE

~Nurses encourage clients to be involved in group therapy.

~Creating a therapeutic environment that promotes trust and makes members feel completely safe and comfortable.

~Promoting effective communication and identifying patterns of interaction.

~Get the family to identify problems that demand change.

~Encourage all members to share their feelings.

FAMILY THERAPY

~In family therapy, the therapist helps the patient to explain his abnormal behavior year and to improve communication with each other. The purpose of family therapy is not only to improve the relationship but to modify the behavior of one or more members using each other’s relationship and family importance.

~Family therapy is an intervention needed to change the family. A family is a unit that is essential for good interaction among each other.

AIMS/GOALS

~To reduce dysfunctional behavior of family members.

~To reduce conflict (fights) in family relations.

~To improve family communication skills.

~ Increase awareness and sensitivity to other family members to meet their needs.

~Strengthening the family’s capacity to cope with major life stressors and traumatic events.

~ To improve the integration of the family system in the social system.

TYPES

~Individual Family Therapy

~Conjoined Family Therapy

~Couple therapy

~Multiple Family Group Therapy

~Network Therapy

INDICATION OF FAMILY THERAPY

~Family Relationship Problems

~Individual therapy failure

~ Psychosis

~Schizophrenia

~anxiety disorders

~bipolar disorders

~Communication Problems

~substance abuse

NURSES ROLE

~ To assess the types of family as functional or dysfunctional.

~Nurses encourage clients to be involved in family therapy.

~Creating a therapeutic environment that promotes trust and makes members feel completely safe and comfortable.

~Promoting effective communication and identifying patterns of interaction.

~Get the family to identify problems that demand change.

~Encourage all members to share their feelings.

OCCUPATIONAL THERAPY

~Occupational therapy (OT) can be described as the art and science of challenging a person’s efforts in specially selected activities designed to restore and enhance their performance.

~Occupational therapy is the use of goal oriented and purposeful activities in the assessment and treatment of individuals with psychological, physical, or developmental disabilities.

~Occupational therapists work with individuals, families, groups and communities.

GOALS

~Recovery Promotion

~ Preventing hospitalization.

Creating a good habit of work and leisure.

~Helping the client to increase self-confidence.

INDICATIONS

~Depression

~Chronic schizophrenia

~Anxiety disorder

~manic disorder

~Paranoid schizophrenia

~Catatonic schizophrenia

~Antisocial personality

~dementia

~Substance Abuse

~Childhood Disorders

CLASSIFICATION

~Diversional : Organized games

~Remedial games: Physiotherapy for particular muscle groups, (basket making, candle making, weaving, tailoring, gardening etc.)

PRINCIPLES

~Select activities based on the strength and ability of the client’s interest IQ level.

~Using the client’s available resources.

~ Select short-term activities to build self-confidence.

Provide good reinforcement even for small achievement.

~Plan activities that provide new experiences to the client to meet daily activities.

NURSES ROLE

~Coordinates with other therapeutic team members in diagnosing strengths, abilities, and talents, client’s IQ level interest and selecting activities for specific clients.

~Educates the client to develop specific new skills.

~Get the family to identify problems that demand change.

~Promotes socialization and shows positive interest in clients.

MILIEU THERAPY

~Milieu is a French word with Mi meaning middle and Lieu meaning environment. Thus milieu means environment.

~In psychiatry, therapy involving the environment or milieu is called milieu therapy.

Therapeutic milieu means that the patient should provide a healthy environment which helps in the recovery of the patient, most of the mental illness is caused by unhealthy environment, thus a healthy therapeutic environment increases the social productivity of the patient.

~Milieu therapy includes a safe physical environment, all members of the treatment team, and other clients.

The purpose of the therapeutic milieu is to promote the recovery of the client admitted to the hospital and to prevent complications.

GOALS

~ Changing maladaptive behavior into adaptive behavior.

~Promoting early recovery.

~Reducing length of hospital admission.

~To resocialize the client.

~To promote self-confidence.

COMPONENTS

•Maintaining Safe Environment

~ Dispose of all needles safely and out of client contact.

~Smoking should not be allowed and the use of matches and lighters should be prohibited or supervised.

~Keep sharp object away from patient.

~Identify potential objects e.g. Mop handles, hammers.

~Do not keep medication unlocked.

•The Trust Relationship

~ Trust is the foundation of the therapeutic relationship, developing trust is the key to the therapeutic environment.

•Building Self Esteem

~ Setting and maintaining limits.

~Accepts the client as a person.

~Being decisive at all times.

~Initially provide the client with tasks, responsibilities and activities.

~Ask the client to make his own decision according to his condition.

•Limit Setting

~State the expectation or limit clearly, directly and simply and as clearly as possible.

The consequences to the client of crossing the limit should also be clearly stated at the beginning.

ECT (ELECTRO-CONVULSIVE THERAPY)

~ECT is a type of somatic treatment, ECT was first introduced by Cerletti and Bini in 1938. ECT is also called electro-shock therapy or shock therapy.

In ~ECT, electric current is applied by placing electrodes in the temporal region of the patient under anesthesia, due to which convulsions are produced in the patient, which helps the brain chemicals of the patient to change and is helpful in improving mood and thinking.

~Voltage : 70 to 120 Volts

~Duration : 0.7 to 1.5 second

~Frequency : 3 times in 1 week or as per indication.

~Total Numbers : 6 to 10 or as per indication.

TECHNIQUE OF ETC

Direct Method:

~ In this method ECT is given without anesthesia and muscle relaxants. Currently this method is not used. It is more effective than modified ECT but has more side effects.

Direct Method:

~ In this method ECT is given without anesthesia and muscle relaxants. Currently this method is not used. It is more effective than modified ECT but has more side effects.

Modified/Indirect Method:

~In this method ECT is given under anesthesia and muscle relaxants drugs. It is less effective but the side effect is also less. This method is commonly used.

ELECTRODES PLACEMENTS

~Electrode is placed in two ways unilateral and bilateral.

•1. Unilateral

In this, the electrode is placed in the temporal region on one side of the patient. If the person is left handed then right temporal region

And if it is right handed, the electrode is placed in the left temporal region.

•2. Bilateral

In this, the electrode is placed in the temporal region on both sides of the patient and an imaginary line is drawn from the outer canthus of the patient’s eye to the targus of the ear. Then electrodes are placed on both sides 1 inch above its midpoint.

MODE OF ACTION

Mode Of Action of ~ECT is not Clear. Administration of ECT causes acute amnesic changes in behavior.

~According to the biological mechanism, giving ECT causes Neurochemical, Neuroendocrine and Neurophysiological Changes.

• Neurochemical :

~Catecholamine is a group of hormones that includes dopamine, epinephrine and norepinephrine. They are produced by adrenal glands and CNS cells. As emotional stress increases, production increases.

• Neurophysiological :

~ECT convulsion causes cerebral hypometabolic state.

• Neuroendocrine :

Changes in polypeptides in the hypothalamus affect movement.

PURPOSE OF ETC

~For quick recovery of the patient

~ When drugs are not available

~ When drugs are not effective

INDICATION OF ETC

• Major depression
• Post partum depression

•Psychotic depression

•Bipolar depression

•Suicidal tendencies

•Melancholia

•Schizophrenia

• Mania

•Severe catatonia

•Paranoid delusions

•Severe psychosis

CONTRAINDICATION OF ECT

~Raised ICP (Intra Cranial Pressure)

~In tumors and hemato

~subarachnoid hemorrhage

~Cerebro vascular hemorrhage

~MI (Myocardial Infarction)

~ Congestive Heart Failure (CHF)

~Bleeding disorders

~aneurysm

~Thrombophlebitis

~ Pneumonia

COMPLICATION OR ADVERSE EFFECT

~Memory Impairment

~ Short term memory loss

~Anxeity

~ Confusion

~nozia

~ Drowsiness

~Headache

~ Tongue bite

~Cardiac arrest

~Fatigue

~ Fractures and dislocations

~Apnea

NURSING CARE OF PATIENT UNDER ECT

•Nursing Care Before Giving ECT

~Physical examination and investigations like ECG, Hb Urine albumine /sugar, and X-ray etc.

~ Explain this procedure to the patient’s close relatives and take written consent. As far as possible, do not tell the patient that ECT is to be given.

~Metallic articles like watch, bangles, ring etc. Ornaments should be removed.

~Keep patient NBM (Nil by mouth) before giving ECT. Keep the patient NBM for 6-8 hours before giving ECT.

Removing the artificial denture so that respiratory blockage can be prevented.

~Remove hair oil, lipstick, mack-up, nail polish etc. so that cyanosis status can be known.

Ask to empty bladder and bowel before giving ECT.

~ Tie allergy/ID bands to the patient and do not include fatty food or meat or fried food in the patient’s food.

~ Instruct the patient to maintain his personal hygiene and assess the patient’s anxiety level.

~Ask the patient to remove tight clothes, give hospital clothes.

~Providing support to the patient and removing their fear.

~Giving the patient muscle relaxants medicine as per prescription to reduce the patient’s anxiety.

•Nursing Care During ECT

~ Helping to take the patient from the stretcher or wheel chair to the ECT table.

~Giving the patient a comfortable dorsal position and keeping a small pillow in the patient’s lumber region.

~ Giving short acting anesthetic drugs or muscle relaxants drugs as per prescription.

~Giving support to shoulder and arm and restraining thigh so that fracture does not occur.

~ To record blood pressure, pulse and check oxygen level in patient’s vital sign.

Keeping a mouth gag and tongue depressor between the teeth so that the tongue does not bite.

Clean the area where the electrode is to be placed with an alcohol swab or gel.

~Hyperextension of the patient’s head with chin support so that jaw fracture can be prevented.

Helping to place the electrode and supporting all major joints.

~Monitor voltage, frequency and duration.

Monitor Siezure activity using the ~Cuf method.

~Siezure Administer 100% Oxygen during activity.

~ If the patient recovers from anesthesia, he should be transferred to the recovery room.

Nursing Care After ECT

~Giving the patient side lying position so that aspiration of secretion does not occur.

~ To monitor patient’s vital sign and provide side rails so that injury does not occur.

Give continuous oxygenation to the patient until spontaneous respiration starts.

~Assessing confusion and restlessness.

~Giving medication as per prescription and checking side effect.

~Documenting and mentioning important events.

INSULIN SHOCK THERAPY

~Insulin shock therapy was a popular treatment method in the 1940s-1950s as a form of psychiatric treatment. Schizophrenic patients were given large amounts of insulin to induce hypoglycemic coma. This causes convulsion in the body. This method was supposed to suppress brain activity and reduce mental states. However, due to the long-term effects of the treatment, US psychiatric facilities eventually abolished it.

~It was introduced in 1933 and was widely used in the 1940s and 1950s.

~ Insulin shock therapy also called insulin coma therapy is the first biological treatment for schizophrenia.

PROCEDURE

~ This therapy was a labor-intensive treatment that required trained staff and a special unit.

~There were no standard guidelines for insulin coma therapy (ICT) treatment.

~Usually, the patient is slowly given 100-150 units of insulin six days a week for two months.

~After receiving ICT, nurses should spend time giving the patient special treatment such as walking, picking flowers, or playing games.

~450 units of insulin was used intermittently and the study was documented for up to two years.