Transcript Dr Darton Presentation

Treatment and recovery in
mental health
NICE guidelines and service user
perspectives
Katherine Darton
outline
• Standard diagnosis and treatment in psychiatry
• Schizophrenia as an example
- symptoms
- treatments
- alternative ways of understanding
- alternative approaches to treatment
• CAMs – possible place?
Diagnosis
• based on ICD-10 (WHO) and
DSM-IV (APA) criteria
• mood disorders – depression
anxiety
• psychotic disorders
• crucial for access to treatment
NICE guidelines
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Depression – mild to moderate; severe
Anxiety – + panic disorder, OCD & BDD
Self-harm
Eating disorders
PTSD
Bipolar disorder
Schizophrenia
Personality disorders – antisocial; ‘dangerous and severe’;
borderline
• Plus guidelines on specific treatments
Schizophrenia - symptoms
Positive symptoms
• Hallucinations – voices, things seen, etc.
• Delusions – being controlled by outside
force; paranoia; thought insertion; thoughts
being heard; magic powers
• Lack of insight
• Increased salience (dopamine)
Schizophrenia - symptoms
Negative symptoms
• Self neglect
• Lack of emotional response
• Absence of thoughts
• Apathy
Schizophrenia - treatments
• Medication – ‘antipsychotics’
• Talking treatments – CBT
• Arts therapies – art, drama, music, dance
Medication
• Antipsychotics – neuroleptic; ataraxic
[ataraxy – detachment; indifference – distinct
from sedation]
• Block dopamine – and other neurotransmitters
Dopamine
Brain neurotransmitter
• Salience – the importance attached to things
associated with psychosis
• Voluntary movement
• Prolactin
• Effects on other neurotransmitters
synapse
• Photomicrograph of synapse
Synapse - diagram
Antipsychotics – adverse effects
• Parkinsonism
• Other movement disorders - tics, spasms,
tardive dyskinesia, loss of fine control
• Akathisia
• Prolactin – breast development; lactation
sexual side effects
• Heart effects – disturbances of heart rhythm
Antipsychotics – adverse effects
• Metabolic syndrome – weight gain, increased
blood fats, diabetes
• Blood disorders
• Antimuscarinic effects
• Constipation
• Life-limiting
• ‘not worth the candle’?
Antipsychotics – and talking
• Reduce salience – hence some psychotic
symptoms
• Do not change beliefs or past experiences
• need CBT or other talking therapy to unlearn
things wrongly attributed and come to terms
with damaging events (Human Givens therapy)
• Arts therapies – may help deal with bad
memories; park difficult ideas.
Schizophrenia – controversies
• ‘a scientific delusion’ – subjective diagnosis
• An unhelpful label – stigmatising; implies
deterioration
• No evidence for discrete condition
• 4% of population hear voices – only a minority
are bothered by them
Alternative approaches
• Formulation vs diagnosis (sense-making)
• Other cultures
• Hearing Voices Network – a new approach to
symptoms (the voices have a message – need
to translate it)
• Narrative approaches (tree of life)
• Group therapy – helps people know themselves
Recovery
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Process rather than outcome
Person rather than symptoms/diagnosis
Hope
The end of ‘untreatability’ (unheilbarkeit)
Self-determination
Allow people to tell their story
Come off medication
(‘hi-jacked by professionals’)
Medication withdrawal
• Psychoactive substances
• Consequences of long-term medication –
receptor changes
• Abrupt withdrawal
• Slow withdrawal –
dose reduction
switch to drug with longer half-life
Alternative therapies
• Help with adverse effects
• Help with withdrawal
• help with symptoms?
Acceptance as treatment
• Need for evidence of efficacy - scientific
studies in peer-reviewed journals
Personalisation – an opportunity?
Resources
Books
• Gail Hornstein – Agnes’s jacket
• Marius Romme and Sandra Escher – Accepting voices
• Jim Read – Psychiatric drugs: key issues and service user
perspectives
• South Somerset Mind – Art of recovery
Websites
• www.mind.org.uk
• www.hearing-voices.org
• www.mentalhealth.org.uk
• www.nice.org.uk