Transcript long version

Module Eleven
THERAPEUTICAL
INTERVENTIONS
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Lesson 1: Scientific approach
Lesson 2: Biological therapies
Lesson 3: Psychotherapy
(3 training hours)
(2 training hours)
(3 training hours)
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TOTAL TIME: 8 TRAINING HOURS OF 45
MINUTES
Lesson 1
SCIENTIFIC APPROACH
TIME :
135 minutes (3 training hours of 45 minutes)
Step 1: introduction (10΄)
Scientific approach is useful to the
coordination of several persons’ offer who
contribute to the care of a person.
This approach permits the examination of all
characteristics of a person’s life and does
not examine only one.
Step 1 (continued)
Slide 11.1.1: Members of the scientific
therapeutical team
 Personnel of immediate care (Nurses, Caretakers)
 Psychiatrists
 Psychologists
 Social Workers
 Health visitors
 Work therapists
 Physiotherapists
 General doctors or Pathologists
 Others
Step 2: Exercise (20΄)
Pen and paper
What can be the specific role of:
 Personnel of immediate care?
 Psychiatrist?;
 Psychologist?;
 Social Worker?
 Health Visitor?
Step 3: Slide projection and
Discussion (15΄)
Slide 11.1.2: Role of immediate care personnel
 Know the person better than anyone else
 Evaluate the desires/ dislikes / opinions/ reactions
of the patient.
 Help the person develop a pleasant everyday life.
 Help the person prepare for difficulties or
changes of his/her life.
 Collect information, observe changes and help to
the progress of cases or intervention programs.
Step 3 (continued)
Slide 11.1.3: Psychiatrist's role
 Evaluate, diagnose, face and manage a mental
disorder.
 Work as a member of a scientific group for the
management of a difficult behaviour.
 Help the person develop an appropriate behaviour
and eliminate the difficult behaviour.
 Psychiatrist’s responsibility is to prescribe
medication and to observe its use, helped by the
information of the scientific group.
Step 3 (continued)
Slide 11.1.4: Psychologist’s role
 Try to understand the function and the causes of
the difficult behaviour and develop ways that can
help the persons learn more appropriate
behaviours.
 Facilitate the group understand the person’s
behaviour collecting objective elements for the
behaviour and his / her environment using
psychometric tests.
 Furthermore, the psychiatrist collaborates with
the scientific group in order to develop
appropriate strategies of intervention and also
observe any other change.
Step 3 (continued)
Slide 11.1.5: Social Worker’s role
 Try to understand the importance of social factors
in the person’s life to the maintenance of the
psychiatric problems.
 Facilitate the group understand the social side of
these problems collecting information regarding
the family, the residence, the profession and the
social relationships of the person.
 Collaborate with the group in developing the
necessary interventions and finding social support
groups.
Step 3 (continued)
Slide 11.1.6: Health visitor’s role
 Understand the mental disorder and evaluate its
possible progress.
 Organize in collaboration with the therapeutical
group the necessary therapeutical interventions
for treating the continuous needs of the person
and preventing the possible subsides.
 Be a flexible connection between the person with
psychiatric problems and the psychiatric group or
other service that observes the person.
Step 4: Group Discussion (15΄)
Which do you think are the functions of a
scientific therapeutical group ?
Step 5: Slide projection (15΄)
Slide 11.1.7: Functions of scientific group
 Diagnose the mental disorder.
 Develop an objective evaluation of the person.
 Try to understand the behaviours’ function.
 Understand the context of this behaviour.
 Evaluate the environment.
 Develop a supposition.
 Decide for the interventions.
 If there is no progress, to develop a second
supposition and a different intervention.
 Develop strategies that will eliminate the danger
of reappearance of the symptoms and behaviours.
Step 6: Group discussion (15΄)
Which particular intervention techniques
used by members of the scientific group
for persons with psychiatric problems do
you know?
Step 7: Slide projection(5΄)
Slide 11.1.8: Basic elements in every therapeutical
intervention
1. Describe the problem (s).
2. Make sure that the evaluation and the diagnose
include a detailed history, physical and
psychiatric examination, information for the
skills and needs of the person.
3. Determine possible alternative therapeutical
interventions.
4. Choose one, apply it, and observe its result.
5. Take a long time to evaluate the application.
6. Observe other factors, like the behaviour of the
personnel, important events.
7. If the result is not satisfactory, alter your
intervention or choose another, but use always a
enough time.
Step 8: Exercise study of a
clinical case (15΄)
Leaflet 11.1.1: study of clinical case:
therapeutical intervention
Pen and paper
What are the actions you would proceed to
solve the problem?
What kind of information would you collect
for better understanding Anna’s
behaviour?
Step 9: Discussion (15΄)
Leaflet 11.1.2: example of intervention
Step 10: Questions and
comments (5΄)
Step 11: Lesson’s evaluation
(5΄)
Lesson 2
BIOLOGICAL THERAPIES
TIME :
90 minutes (2 training hours of 45 minutes)
Step 1: Introduction (10΄)
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Biological therapies of mental disorders are mainly
empirical.
Practically many have been proved effective and consist
the priority therapy for particular disorders.
Biological therapies used nowadays is pharmacotherapy
and electrospasmic therapy.
In the past other methods were used as well which are
now abandoned (insulin comma and psycho surgery).
Biological therapies aim to correct mental functions using
chemical or physical means.
Step 2: Discussion (10΄)
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Have you ever heart about placebo’s
action?
What do you think that happens if instead
of the normal drug, the patient take a
similar to shape, which does not include
the medical substance?
Step 3: Slide projection
(10΄)
Slide 11.2.1: Placebo’s action
Amelioration of symptoms caused by :
 the patients expectations for amelioration (mainly
in younger patients with low intelligence,
distress, extroverts and of female gender).
 The prestige and the behaviour of the therapist.
 Placebo’s shape (size of the pill, form, color, etc).
 The situation for which the therapy is prescribed
(mainly to acute symptoms, like headaches,
nausea, etc).
Step 4: Theory presentation
(15΄)
As it appears from placebo’s action as well, in the
practice of pharmacotherapy many factors are
involved and not only the action of the medical
substance itself. Such factors are:
 Medication choice
 Prescription
 Way of taking
 Psychological perception of the medication
 Environments’ influence
Step 4 (continued)
Regarding medication used in psychiatry, even if
society is negative, it is a fact that:
 The appearance of antipsychotic medication
during the second half of 20th century had as a
result to make unnecessary the long stay of
psychotic persons in psychiatric clinics and
ameliorate their life in general.
 Antidepressant medication has very satisfactory
results for most of Depression’s types.
 Modern medication of all categories appear
constantly and is more effective and with less
side effects.
 Certainly this medications cannot cure mental
disorders, but eliminate the symptoms and
ameliorate decisively the quality of patients’ life.
Step 5: Exercise (15΄)
Leaflet 11.2.1: Appropriate pharmacotherapy
Complete next to every mental disorder or
problem the number that corresponds to
the categories of medication used for the
therapy of this disorder.
Step 6: Slide projection(10΄)
Slide 11.2.2: Principal medication categories used
in psychiatry and symptoms of each one
 Antipsychotics: Schizophrenia, Mania, Other
Disorders
 Antiparkinson medication: acute detuning ecto pyramid syndromes
 Antidepressants: Depression, Obsessive
Compulsive Disorder, Panic Disorder, chronic
pain, Hypochondriasis
 Mood stabilizers: Mania control, as protection for
Bipolar Disorder, Schizoemotional Disorder,
Aggressive behaviour
 Anxiolytics: Anxiety, Insomnia, Withdrawal
symptoms
Step 7: Theory presentation
(10΄)
Electrospasmic therapy
 It is presented to public in the most
negative way, as violent and inhuman.
 It still exists (but it is limited because of
medication’s efficiency) as a method with
particular symptoms and important results.
Step 7 (continued)
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The principal symptoms consist in:
Depression that does not subside in
medication
suicidal” depression,
Depression accompanied by denial of food
or liquids,
Catatonic syndromes
Acute Schizophrenia.
Step 7 (continued)
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It is done with the application of electric stimulus through
electrodes placed on one or both sides of encephalic
hemispheres and generalize an epileptic seizure.
The patient should provide his /her consent after being
informed.
Before therapy the patient undergoes general anesthesia
and muscle relaxation.
Typically, ECT is given three times a week for a total of 6
to 12 sessions.
The most common side effect is short memory loss, which
recovers within few months (usually 6-9).
Step 8: Questions and
comments (5΄)
Step 9: Lesson’s evaluation (5΄)
Lesson 3
PSYCHOTHERAPY
TIME :
135 minutes (3 training hours of 45 minutes)
Step 1: Brainstorming (10΄)
What is psychotherapy and what do you
know about it?
Step 2: Slide projection (5΄)
Slide 11.3.1:Definition of psychotherapy
Psychotherapy is the development of a trust
relationship, which permits free
communication and leads to understanding,
completion and acceptance of self.
Step 3: Theory presentation (20΄)
There are many types of psychotherapy, but these have the
following common characteristics:
 Include a emotionally intense relationship with a person
or a team.
 Are based on a theory that explains the problem and
suggests methods of treatment.
 Give information for the origin of the problem, its
progress and give possible alternatives offering hope for
release.
 They comprise indirect ways of enforcing person’s Self
esteem.
 Give the opportunity to the person to experience success.
 Enforce emotional excitation.
 Are conducted in an environment determined as protected
space of therapy.
Step 3 (continued)
Psychotherapy can be done in several levels:
 Unofficially between friends, relatives or support
groups.
 As a general approach from professionals in
mental health. This aims to : offer support in a
period of crisis, support persons who are not able
to change or ameliorate their state, guide and give
advice, focus in particular difficulties or problems
in order to find solutions.
 Officially from professionals of mental health
with special training to a particular category. The
aim in this case is to achieve more radical
changes in personality and behaviour of the
person so that he /she becomes able to manage
his/ her difficulties.
Step 4: Slide projection (10΄)
Slide 11.3.2: Main psychotherapy types
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Dynamic psychotherapy
psychoanalysis
existential psychotherapy
short psychotherapy
Group Psychotherapy
Family psychotherapy
Behavior therapy
Cognitive therapy
Step 5: Theory presentation
(45΄)
Existential therapy
 Based on existential theory.
 The aim is to change the personality and the
behaviour of the person.
 For achieving this goal there are used
psychological methods such as self –
determination, interpretation and juxtaposition.
 It is appropriate for people who want to
understand their problem through psychological
terms, have the ability to face tension that comes
from inner dilemmas and are able to establish and
maintain a psychotherapeutic relationship.
Step 5 (continued)
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Classic psychoanalysis is mainly focused in the
conflicts of early childhood, is long, costly and is
applied rarely nowadays.
Psychoanalytic psychotherapy is mainly focused
in current conflicts, is shorter and particularly
effective.
The last decades appeared, for practical reasons,
the short term psychotherapies, which are short,
focus in the problem and have good results.
Step 5 (continued)
Group psychotherapy
 Carefully chosen persons are set in a group which
is guided from a trainee psychotherapist with the
intention that one patient helps the other so that
they achieve behaviour or personality change.
 There are many kinds according the group
composition, the kind of the therapeutical
development, the way of coordination and
guidance from the therapist, the theoretical
background, etc.
Step 5 (continued)
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The therapeutic factors include:
The interpersonal learning and emotional
approach of the members.
The socializing effect of the group.
The knowledge of the universality of the
problems.
Give hope.
guidance.
Imitation of others behaviour.
Expiation.
Altruism.
Corrective experiences.
Step 5 (continued)
Family psychotherapy
 Simultaneous psychotherapy for all the family
based on the opinion that the interaction of its
members is so important that any change to come
cannot be achieved with the participation of one
only member.
 There are various kinds according to the
theoretical background, but as the time pass there
is combination between elements related to the
interaction and the communication of the
members and to social learning.
 It is an immediate and short therapy, focused in
present problems and demands from the therapist
an active and controversial style.
Step 5 (continued)
Behaviour therapy
 Based on learning theory.
 Applies to particular symptoms or
behaviour problems (mainly phobias,
obsessions – compulsions, sexual
dysfunctions, marital problems, etc).
 Is focused in the observation of the
behaviour, attention to the symptoms, clear
goals, objective evaluation of results.
Step 5 (continued)
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The most common models of behavioral
therapy include:
Systematic sensitization, with gradual and
in relaxation approach of stressful events.
The exposure, where the person faces
directly the stressful event.
The encouragement, with approval or
reward of the behaviour.
Step 5 (continued)
Cognitive therapy
 As behavioral therapy uses methods of guidance
and treats present problems.
 In contrary to this, the inner procedures of the
person are considered particularly important and
tries to change them.
 Aims changes of skeptical context.
 It is usually used to treat depression as well as
anxiety disorders.
 Considers that depression and anxiety are
primarily rational disorders, that lead to the
negative emotion afterwards.
Step 6: Exercise (25΄)
Leaflet 11.3.1: Clinical cases
Pen and paper
There is a possibility to apply all
psychotherapy types. Choose the most
appropriate in your opinion and justify
your choice giving at least three reasons
for each case.
Step 7: Discussion (10΄)
What is your opinion and experience about
psychotherapy?
Step 8:Questions and
comments (5΄)
Step 9: Lesson’s evaluation
(5΄)