Transcript Integration of Drugs and Psychological Therapies in Treating Mental

Integration of Drugs and
Psychological Therapies in
Treating Mental and Behavior
Disorders
Chapter 19
Role of Medication
• Treat acute symptoms associated with a
mental disorder by ameliorating debilitating
symptoms
• Prophylactic function – altering brain
chemistry to prevent the onset of a symptom
complex
• Allows introduction of behavioral or
psychological interventions -- cotherapy
Effectiveness of Drugs and
Therapy
• In the treatment of panic disorder,
agoraphobia, simple phobias, and to a lesser
extent, social phobias, behavioral and
cognitive-behavioral therapies have
traditionally been thought to have more
consistent and longer-lasting effects than
medications
Effectiveness of Drugs and
Therapy
• Psychotherapy, specifically panic-focused
cognitive-behavioral therapy, and
medications (SSRIs, TCAs,
benzodiazepines, and MAO inhibitors) are
equally effective in the acute treatment for
panic disorder.
Effectiveness of Drugs and
Therapy
• Combining cognitive-behavioral therapy
and medication in the treatment of panic
disorder has not yet been convincingly
shown to be superior to cognitivebehavioral therapy alone, but additional
studies may lead to modification of this
statement.
Effectiveness of Drugs and
Therapy
• Medications and behavioral techniques are
equally effective in the treatment of
obsessive-compulsive disorder,
posttraumatic stress disorder, and
generalized anxiety disorder.
Effectiveness of Drugs and
Therapy
• In the treatment of major depressive
disorder, antidepressant medications and
cognitive-behavioral therapy are equally
effective and display additional efficacy
when used in combination.
Effectiveness of Drugs and
Therapy
• Individuals who respond to cognitivebehavioral therapy for the treatment of
depression “tend to be less severely
impaired than those who do not respond.”
Effectiveness of Drugs and
Therapy
• At the very least, cognitive-behavioral
therapy added to pharmacological
management of depression “reduces relapse
rates for acute major depression and
persistent severe residual symptoms.”
Effectiveness of Drugs and
Therapy
• In the treatment of eating disorders such as
bulimia nervosa, “cognitive-behavioral
therapy is the psychological treatment of
choice . . . and . . . medication with
fluoxetine (an SSRI) adds modestly to the
benefit of psychological treatment.
Effectiveness of Drugs and
Therapy
• The positive effects of cognitive-behavioral
therapy in treating depression in adults are
also seen in adolescents, and treatment
gains in adolescents are maintained over
time.
Effectiveness of Drugs and
Therapy
• In patients with cigarette dependence and
comorbid history of depression, cognitivebehavioral therapy was more effective than
an antidepressant (nortriptyline). However
nortriptyline allayed the negative affect that
occurs in the days following smoking
cessation. Long term most return to
smoking anyway.
Effectiveness of Drugs and
Therapy
• In bipolar disorder and schizophrenia, drug
therapy is essential as primary therapy and
psychological therapies are introduced
following control of symptomatology.
Effectiveness of Drugs and
Therapy
• New generation of antipsychotic drugs
which can effectively ameliorate both the
positive and the negative symptomatology
of schizophrenia, permitting the
introduction of psychosocial interventions
that can assist with the integration of the
patient into society and improve functioning
level.
Effectiveness of Drugs and
Therapy
• Psychosocial interventions with
schizophrenics can provide long term
changes that persist long after drug therapy
is discontinued.
Effectiveness of Drugs and
Therapy
• Prescription of a psychotherapeutic
medication is only the first step in treatment
of schizophrenia. Following control of
symptoms, introduction of psychological
interventions optimizes therapy.
Treatment Team
• One team member is usually a clinician with prescription
privileges (physician or psychiatric or mental health nurse
practitioner).
• Other clinicians on team have responsibility for
psychotherapeutic interventions.
• Other members include: nurses, pharmacists, counselors,
vocational rehabilitation counselors, physical or
occupational therapists, dieticians, spiritual counselors,
family members, and psychiatric, occupational, or
recreational assistants.
Treatment Team
• Nonprescribing members of the team should
be familiar with the pharmacology, uses,
limitations, and side effects of the drugs
being used by their clients.
• They should know about alternative
medications that might provide different
spectrum of side effects.
Treatment Team
• Nonprescribing clinicians must be able to professionally converse with
the prescribing physician, monitor drug therapy, and institute
psychological therapies appropriate to the condition under treatment.
• All should monitor for both positive and negative effects and be
sensitive to the meaning medications have to their clients
• Never forget that effective psychotherapy depends on the ability of
patients to comply with treatment requirements
• All members of the team have responsibility for assessment as this
relates to diagnosis, treatment planning, and outcome assessment.
Herbal Medicines Used in the
Treatment of Psychological
Disorders
Chapter 20
Herbal Medicine
• Some believe that since they are ancient
they are effective (some are some are not).
• Some believe that because they are natural
they are safe (opium, marijuana, cocaine,
caffeine, nicotine, etc. are herbals – are
they all safe?)
• Some herbals can be abused
Herbals and the Law
• 1920’s government stepped in and severely restricted sale and non
prescription use of many drugs – cocaine taken out of Coca Cola,
bromides taken off market, etc.
• 1994 Dietary Supplement Health Education Act – any product labeled
a supplement could be sold as long as didn’t claim to cure a disease.
• Can’t say “alleviates depression;” rather it “promotes emotional
balance.”
• Can’t say “alleviates the signs and symptoms of Alzheimer’s disease;
rather it enhances “mental sharpness.”
• No scientific evidence of effectiveness is required
Herbals and Uses
St John’s Wort
Depression – effective for mild or moderate depression, fewer side effects than
prescription antidepressants
Ginkgo
cognitive disorders/ promote mental sharpness Studies show very small but
statistically significant effect. Effect not large enough to be clinically
significant
Kava
Intoxicant with effects similar to alcohol/ induce relaxation/ antianxiety
Ephedrine (Ma-huang)
Pharmacologically closely resembles amphetamines but duration of effect
much shorter. Used as appetite suppressant (Metabolife) and as
psychostimulant. Can cause problems with blood pressure and cardiac
arrhythmias. Deaths are not infrequent
Valerian
Mild sedative and anxiolytic Action similar to benzodiazapines. It works but
not as effective as prescription drugs
German chamomile
Insomnia and anxiety
Evening primrose,
hops, lemon balm
Effectiveness unknown or no scientific evidence of effectiveness
Conclusions
• With the exception of St. John’s wort for depression and
ginkgo for dementia, there is insufficient evidence to
recommend the use of herbal medicines in the treatment of
psychiatric illness
• None of the herbals is clearly superior to the prescription
alternatives
• More research needed
• Experiences and healing traditions of other cultures make
an important contribution to modern medicine and should
not be ignored.