Transcript A social approach: psychosocial treatment

L.O. To describe and evaluate 2
treatments for schizophrenia
Originally called Humanistic
Therapy
Throughout the 20 th century, many psychotherapists felt that psychological
therapy was focussing to much on structures, like personality; losing
sight of how the sufferers felt.
Consequently, a number of Humanistic therapies developed: Client-Centred
Therapy and Gestalt Therapy
Key features of humanistic therapies include:1.
They were holistic therapies- considering the patient as a whole, and
not just their particular psychopathological symptoms
2.
Therapy should help enable patients to make their own decisions and
solve their problems, rather than imposing structured treatments or
ways of thinking on to them
3.
Focus on the therapist-client relationship should be based on genuine
care and empathy, rather than the limited, constrained type which
professional specialists maintain.
4.
Emotional awareness in patients need to be developed, before patients
can face and resolve their life problems, as it helps alleviate
psychological distress.
What would you want?
• You’ve been released!
• What sort of support would you want and why?
• You must work in pairs and write a detailed
account of what you could expect in a community
based program. You can do this in the form of a
spider diagram on A3 paper.
Characteristics of Assertive
Community Therapy (ACT)
• Focus on who needs help most.
• Sheltered accommodation with 24-hour care.
• Work and employment opportunities in sheltered social firms and
co-operative business.
• The idea is to help with independence, rehab and recovery, and
to avoid re-hospitalisation and homelessness.
• Treatment is based around the patient in their real life setting –
visiting them to help, rather than just offering therapies, with
enough varied staff to offer this support.
• Multi-discipline approach – working with psychiatrists, nurses,
social workers and other patients with whom the treatment has
worked, so a team can focus on one individual.
• There is a big commitment to spend as much time as necessary
with the patient in order to rehabilitate and support them,
offering this holistic treatment.
Evaluation of ACT
Outcome research has shown that community care has the potential to
enhance quality of life and perhaps reduce symptoms for patients with
schizophrenia.
• Trauer et al. (2001) assessed effectiveness of American sheltered
accommodation; 125 patients moved from a psychiatric ward to
community units, sheltered accommodation for up to 20 patients.
Patients were assessed a month before and a month after leaving
hospital and one year later for symptoms, personal functioning,
quality of life and for where they wanted to live. There was little
change for severity of symptoms; however, quality of life for the
patients was significantly better. They preferred this sort of living.
• Leff (1997) showed much lower levels of symptoms (especially
negative) than hospitalised patients.
• In Britain, Margret Thatcher’s government saved £2,000 million by
closing psychiatric hospitals between 1985 and 1991 alone; however
this money, at the time, wasn’t reinvested in community care
(shepherd, 1998).
Can you apply your knowledge?
You have learned about either family therapy or care in the community (Social Approach) as ways
of treating mental disorders.
Describe one of these treatments/therapies. (4 marks)
Care in the community:
• Care/Treatment is provided while the patient lives in the community, either at home or in
sheltered accommodation/eq;
• They can call on Community Psychiatric Nurses for support/eq;
• Care in the community uses drop-in centres, half way houses, and home medication/eq; (list – 1
mark, minimum of three)
• There will be drop-in centres that provide a 24/7 service/eq;
• Medication will be self administered for many, though those needing extra support can receive
it/eq;
• Hospitalisation will only be used as a last resort if the person feels they cannot cope/ eq;
• Support is provided so clients are able to deal with the environmental factors thought to
trigger/exacerbate their mental illness/eq;
Evaluate the treatment/therapy you have described in (a).
Care in the community
• Potentially improves the quality of life for recipients as they are able to maintain a normal lifestyle(e.g. Trauer et al
2001)/eq;
• Symptoms /problems of institutionalisation tend to be reduced as a result of living in the community (e.g. Leff 1997)/eq;
• Most patients find living in the community preferable to being in hospital/ eq; (1 mark) although others may find the
situation challenging/overwhelming/eq; (2 mark)
• Chronic underfunding can lead to poor/inadequate provision such as emergency help lines being restricted/ eq;
• This tends to be locality specific so affluent/urban areas may be fine but poor/rural areas not/ eq;
• A reluctance to provide and fund adequate hospital beds means some who need admission do not get admitted when
necessary/eq;
• Poor levels of supervision may mean medication is not taken, leading to dangers for the patient and/or the
community/eq;
• Coping with a mentally ill person may put strain on families leading to further problems/ eq;
• If a client’s assessment/discharge from hospital has been rushed they may find living in the community very difficult
because they are not prepared for it/eq;
Astrid, a community psychiatric nurse (CPN), has contacted the emergency
team at the mental health unit as a client has had a serious relapse. Once the
client has been admitted the duty psychiatrist decides to use a biological
treatment/therapy to treat the client.
Describe one treatment/therapy from the Biological Approach that the duty
psychiatrist may use to treat a mental disorder. Evaluate this
treatment/therapy using research evidence.
Drugs
Description
• Drug treatments use psychoactive drugs that change the
balance of neurotransmitters in the brain • e.g.
antipsychotics reduce the availability of dopamine as high
levels of dopamine are implicated in schizophrenia
• Psychiatrists will adjust the quantity of a drug so it is
tailored to the level needed for that patient
• Psychoactive drugs for treating mental disorders are
available on prescription and patients will be monitored to
ensure they are responding to the drugs
• There are usually several different drugs for treating the
same disorder and it may be necessary to try several different
ones until the drug that suits a particular patient best is found
Evaluation
• Drug treatments have side effects, some of which are unpleasant leading to poor
compliance
• Drugs act relatively quickly allowing stabilisation of the patient’s condition during
the acute phase of illness
• However they are not instantaneous, indeed take longer to act than should be the
case if neurotransmitter imbalance is the primary cause of the disorder
• Drug treatment is often referred to as a chemical straightjacket/chemical cosh as
the side effects can often be debilitating
• Drug treatment allows the patient to return to and function effectively in the
community
• Avery & Winokur (1976) found that depressed patients treated with ECT were
significantly more likely to survive over a period of several years than those either
not treated at all or only with antidepressant drugs
• Nulman et al (1997) showed no deleterious effects on cognitive or language
functions in children whose mothers had undergone drug treatment for depression
during pregnancy