Other Medical Treatments and Psychotherapy PDF

11/14/23, 4:22 AM Realizeit for Student Other Medical Treatments and Psychotherapy Electroconvulsive Therapy. Psychiatrists may use electroconvulsive therapy (ECT) to treat depression in select groups, such as clients who do not respond to antidepressants or those who experience intolerable side e...

11/14/23, 4:22 AM Realizeit for Student Other Medical Treatments and Psychotherapy Electroconvulsive Therapy. Psychiatrists may use electroconvulsive therapy (ECT) to treat depression in select groups, such as clients who do not respond to antidepressants or those who experience intolerable side effects at therapeutic doses (particularly true for older adults). In addition, pregnant women can safely have ECT while many medications are not safe for use during pregnancy. Clients who are actively suicidal may be given ECT if there is concern for their safety while waiting weeks for the full effects of antidepressant medication. It has also shown a high degree of efficacy for patients with psychotic features and marked psychomotor disturbances (Heijnen et al., 2018). ECT involves application of electrodes to the head of the client to deliver an electrical impulse to the brain; this causes a seizure. It is believed that the shock stimulates brain chemistry to correct the chemical imbalance of depression. Historically, clients did not receive any anesthetic or other medication before ECT, and they had full-blown grand mal seizures that often resulted in injuries ranging from biting the tongue to breaking bones. ECT fell into disfavor for a period and was seen as “barbaric.” Today, although ECT is administered in a safe and humane way with almost no injuries, there are still critics of the treatment. Clients usually receive a series of six to 15 treatments scheduled three times a week. Generally, a minimum of six treatments are needed to see sustained improvement in depressive symptoms. Maximum benefit is achieved in 12 to 15 treatments. Preparation of a client for ECT is similar to preparation for any outpatient minor surgical procedure: The client receives nothing by mouth (is NPO) after midnight, removes any fingernail polish, and voids just before the procedure. An intravenous line is started for the administration of medication. Initially, the client receives a -acting anesthetic so that he or she is not awake during the procedure. Next, he or she receives a muscle relaxant/paralytic, usually succinylcholine, which relaxes all muscles to reduce greatly the outward signs of the seizure (e.g., clonic–tonic muscle contractions). Electrodes are placed on the client’s head: one on either side (bilateral) or both on one side (unilateral). The electrical stimulation is delivered, which causes seizure activity in the brain that is monitored by an electroencephalogram (EEG). The client receives oxygen and is assisted to breathe with an Ambu bag. He or she generally begins to awaken after a few minutes. Vital signs are monitored, and the client is assessed for the return of a gag reflex. After ECT treatment, the client may be mildly confused or briefly disoriented. He or she is tired and often has a headache. The symptoms are just like those of anyone who has had a grand mal seizure. In addition, the client will have some short-term memory impairment. After a treatment, the client may eat as soon as he or she is hungry and usually sleeps for a period. Headaches are treated symptomatically. Unilateral ECT results in less memory loss for the client, but more treatments may be needed to see sustained improvement. Bilateral ECT results in more rapid improvement but with increased short-term memory loss. Some studies report that ECT is as effective as medication for depression, while other studies report only short-term improvement. Likewise, some studies report that memory loss side effects of ECT are short lived, while others report they are serious and long term. ECT is also used for relapse prevention in depression. Clients may continue to receive treatments, such as one per month, to maintain mood improvement. Often, clients are given antidepressant therapy after ECT to prevent relapse. Studies have found maintenance ECT to be effective in relapse prevention (Ahmadi, Moss, Hauser, Nemeroff, & Atre-Vaidya, 2018). Psychotherapy. A combination of psychotherapy and medications is considered the most effective treatment for depressive disorders in both children and adults (Mullen, 2018). There is no one specific type of therapy that is better for the treatment of depression. The goals of combined therapy are symptom remission, psychosocial restoration, prevention of relapse or recurrence, reduced secondary consequences such as marital discord or occupational difficulties, and increasing treatment compliance. Interpersonal therapy focuses on difficulties in relationships, such as grief reactions, role disputes, and role transitions. For example, a person who, as a child, never learned how to make and trust a friend outside the family structure has difficulty establishing friendships as an adult. Interpersonal therapy helps the person find ways to accomplish this developmental task. Behavior therapy seeks to increase the frequency of the client’s positively reinforcing interactions with the environment and to decrease negative interactions. It may also focus on improving social skills. Cognitive therapy focuses on how the person thinks about the self, others, and the future and interprets his or her experiences. This model focuses on the person’s distorted thinking, which, in turn, influences feelings, behavior, and functional abilities. Table 17.5 describes the cognitive distortions that are the focus of cognitive therapy. TABLE 17.5 Distortions Addressed by Cognitive Therapy Cognitive Distortion Definition https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IfJptSaQyKVU6fCViRBWvgvguH3vKolDdcpeLoCjDSxUdp… 1/2 11/14/23, 4:22 AM Realizeit for Student Absolute, dichotomous thinking Tendency to view everything in polar categories (i.e., all or none, black or white) Arbitrary inference Drawing a specific conclusion without sufficient evidence (i.e., jumping to [negative] conclusions) Specific abstraction Focusing on a single (often minor) detail while ignoring other, more significant aspects of the experience [negative] detail while discounting positive aspects) Overgeneralization Forming conclusions based on too little or too narrow experience (i.e., if one experience was negative, th negative) Magnification and minimization Overvaluing or undervaluing the significance of a particular event (i.e., one small negative event is the end experience is totally discounted) Personalization Tendency to self-reference external events without basis (i.e., believing that events are directly related to New and Investigational Treatments. Other treatments for depression are being tested. These include transcranial magnetic stimulation (TMS), magnetic seizure therapy, deep brain stimulation, and vagal nerve stimulation. TMS is a U.S. Food and Drug Administration–approved treatment for major depression in treatment-resistant clients. When used as an adjunct to antidepressant medications, TMS was found to be safe and effective. When used alone, TMS is most effective for mild or moderate depression (Husain, McClintock, & Croakin, 2017). https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IfJptSaQyKVU6fCViRBWvgvguH3vKolDdcpeLoCjDSxUdp… 2/2