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Lecture  №1 Object and task of psychiatry and narcology, their place among other medical disciplines. History of developme...
<ul><li>  Psychiatry </li></ul><ul><li>(from the Greek words  &quot;psyche&quot;  - the soul,  &quot;iatreia&quot;  - trea...
Tasks psychiatry <ul><li>to study the aetiology and pathogenesis of mental disorders; </li></ul><ul><li>to carry out their...
History of development of psychiatry <ul><li>the first period (pre-scientific), characterised by primitive religious under...
<ul><li>the fourth period, from the beginning of the XVIII to the beginning of XIX century was the stage of formation of p...
FRAME OF PSYCHIATRY. <ul><li>General psychopathology - studies the basic laws of an etiopathogenesis, clinic, diagnostics,...
<ul><li>Addictology - studies influence of the psychotropic substances on a condition of the person. </li></ul><ul><li>Tra...
CONTRA-INDICATION FOR HOSPITALIZATION IN PSYCHIATRIC CLINIC: <ul><li>Mentally healthy man. </li></ul><ul><li>Persons in a ...
The criteria of mental health <ul><li>awareness and feeling of continuity, constancy and identity of one's physical and me...
Levels of mental health : <ul><li>Ideal or standard health. </li></ul><ul><li>Average statistical health. </li></ul><ul><l...
Basic classification categories: <ul><li>1 .  Menial retardation:  impairment of intellectual functioning present continuo...
Classification m ental disorders  (ICD-10) <ul><li>F00-09Organic, including symptomatic, mental disorders </li></ul><ul><l...
Classification of mental disorders on the basis of aetiology  and pathogenesis <ul><li>1) endogenous disorders (schizophre...
The methods of investigation  <ul><li>clinical interview and collection of anamnesis data; </li></ul><ul><li>physical exam...
Psychotropic drugs <ul><li>Antipsychotics  </li></ul><ul><li>Antidepressants </li></ul><ul><li>Mood stabilizers </li></ul>...
ANTIPSYCHOTICS  (Neuroleptics, Major Tranquillisers)  <ul><li>Antipsychotics are used principally in the treatment of psyc...
TYPICAL ANTIPSYCHOTICS <ul><li>SHORT  ACTING INJECTIBLES </li></ul><ul><li>GENERIC NAME  BRAND NAME   </li></ul><ul><li>ch...
ATYPICAL ANTIPSYCHOTICS <ul><li>GENERIC NAME  BRAND NAME(S) </li></ul><ul><li>amisulpride  Solian  </li></ul><ul><li>aripi...
ANTIPSYCHOTICS – GENERAL PRECAUTIONS <ul><li>All antipsychotics are central nervous system depressants  and metabolised in...
ANTICHOLINERGICS  (Side Effect Drugs, Antiparkinsonians)   <ul><li>These drugs are used principally for the treatment of P...
ANTI-DEPRESSANTS <ul><li>These drugs are used to treat major depressive disorder. All anti-depressants can treat depressio...
Classification  anti-depressants   <ul><li>1.  TRICYCLICS </li></ul><ul><li>2.  MONOAMINE OXIDASE INHIBITORS  </li></ul><u...
1.TRICYCLICS  antidepressants <ul><li>GENERIC NAME  BRAND NAME(S) </li></ul><ul><li>amitriptyline  Tryptanol, Endep  </li>...
2. MONOAMINE OXIDASE INHIBITORS <ul><li>These were used in patients resistant to tricyclic treatment and in phobic anxiety...
3. REVERSIBLE INHIBITOR OF MONOAMINE OXIDASE  A <ul><li>Reversible inhibition of the MAO enzyme limits the problem of food...
4. SELECTIVE  SEROTONIN REUPTAKE INHIBITORS <ul><li>This class of antidepressant is well tolerated, and relatively safe in...
5. SELECTIVE SEROTONIN NORADRENALINE REUPTAKE INHIBITOR <ul><li>At low doses venlafaxine acts like an SSRI.and at higher d...
7.  HETEROCYCLIC  <ul><li>GENERIC NAME BRAND NAME(S)  </li></ul><ul><li>mianserin  Tolvon, Lumin   </li></ul><ul><li>8.   ...
MOOD STABILISERS <ul><li>This group of drugs effectively treat a current episode of mania or depression. They also help pr...
ANXIOLYTICS  (Antianxiety Drugs) <ul><li>These compounds are effective in relieving the symptoms of anxiety.  The main com...
BENZODIAZEPINES  <ul><li>  GENERIC NAME BRAND NAME(S)  </li></ul><ul><li>alprazolam  Xanax, Kalma  </li></ul><ul><li>broma...
BUSPIRONE  <ul><li>Buspirone is a non-benzodiazepine anxiolytic. Symptom relief is delayed (unlike the benzodiazepines, wh...
SEDATIVE – HYPNOTIC AGENTS  <ul><li>These agents are used to help in the short–term management of insomnia. Generally the ...
BENZODIAZEPINES <ul><li>  GENERIC NAME BRAND NAME(S)  </li></ul><ul><li>flunitrazepam  Hypnodorm  </li></ul><ul><li>nitraz...
PSYCHOSTIMULANTS  <ul><li>These medicines are used to treat attention deficit disorder, usually in children. They may also...
Electroconvulsive therapy (ECT) <ul><li>Electroconvulsive therapy , also known as electroshock, is a well-established, alb...
Psychotherapy   <ul><li>Psychoanalytic   </li></ul><ul><li>Cognitive behavioral  </li></ul><ul><li>Psychodynamic   </li></...
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  1. 1. Lecture №1 Object and task of psychiatry and narcology, their place among other medical disciplines. History of development and modern state of psychiatry and narcology. Psychonosology and diseases. Principles of therapy, prophylaxis and rehabilitation of psychic disorders Lecturer Savka Svitlana Dmytrivna
  2. 2. <ul><li> Psychiatry </li></ul><ul><li>(from the Greek words &quot;psyche&quot; - the soul, &quot;iatreia&quot; - treatment) is a branch of medicine concerned with the study, diagnosis, treatment and prevention of mental disorders. </li></ul>
  3. 3. Tasks psychiatry <ul><li>to study the aetiology and pathogenesis of mental disorders; </li></ul><ul><li>to carry out their classification; </li></ul><ul><li>to investigate the epidemiology of mental disturbances; </li></ul><ul><li>to study the symptoms and signs, as well as syndromes and the clinical course of different mental disorders; </li></ul><ul><li>to develop find practice effective methods of their diagnosing; </li></ul><ul><li>to work out and use efficient treatment methods; </li></ul><ul><li>to develop a network of mental health services for the population; </li></ul><ul><li>to develop a system for the prevention of mental disorders. </li></ul>
  4. 4. History of development of psychiatry <ul><li>the first period (pre-scientific), characterised by primitive religious understanding of the mentally ill people's abnormal behaviour; </li></ul><ul><li>the secend period of ancient antique medicine, a more progressive period, when the first attempts at organising mental health treatment were made; </li></ul><ul><li>the third period, corresponding to the Middle Ages, was in general a period or regress, when psychiatry returned to its prescientific period (theological scholastics); </li></ul>
  5. 5. <ul><li>the fourth period, from the beginning of the XVIII to the beginning of XIX century was the stage of formation of psychiatry part of the medical science; </li></ul><ul><li>the fifth period was the epoch of E. Krepellin's nosological psychiatry. The creation of a nosological classification of mental disorders was the main outcome of this stage; </li></ul><ul><li>the sixth period, modern stage of development of psychiatry, formed in the XX century can be called the period of social psychiatry; it is characterised by wide development community, social forms of mental health services; somatological aspects of mental disorders got more attention. </li></ul>
  6. 6. FRAME OF PSYCHIATRY. <ul><li>General psychopathology - studies the basic laws of an etiopathogenesis, clinic, diagnostics, therapy and prophylaxis of alienations. </li></ul><ul><li>Private psychiatry - studies separate mental diseases. </li></ul><ul><li>Age psychiatry. </li></ul><ul><li>Organizational psychiatry. </li></ul><ul><li>Judicial psychiatry - solves questions of a sanity and capacity for acting. </li></ul><ul><li>Psychopharmacotherapy - studying of action on mentality of medicinal substances. </li></ul><ul><li>Social psychiatry. </li></ul>
  7. 7. <ul><li>Addictology - studies influence of the psychotropic substances on a condition of the person. </li></ul><ul><li>Trans-cultural psychiatry - is engaged in comparison of a mental pathology in the different countries, cultures. </li></ul><ul><li>Orthopsychiatry - surveys alienations from the point of view of different disciplines. </li></ul><ul><li>Biological psychiatry. </li></ul><ul><li>Sexology. </li></ul><ul><li>Suicidology. </li></ul><ul><li>Military psychiatry - studies posttraumatic stressful frustration, psychopathology a wartime. </li></ul><ul><li>Ecological psychiatry - studies influence of ecological factors on mentality. </li></ul>
  8. 8. CONTRA-INDICATION FOR HOSPITALIZATION IN PSYCHIATRIC CLINIC: <ul><li>Mentally healthy man. </li></ul><ul><li>Persons in a state of simple and, even, heavy degree of alcoholic intoxication. </li></ul><ul><li>Persons in the state of intoxication. </li></ul><ul><li>Persons with the affects reactions and antisocial forms conducts, which do not suffer by the psychical diseases. </li></ul><ul><li>Persons with psychopath’s character traits. </li></ul><ul><li>Persons in which found out the neurotic reactions. </li></ul><ul><li>Persons with a mental backwardness (after the exception of examination). </li></ul><ul><li>Persons with total dementia. </li></ul><ul><li>Mentally ill with acute somatic pathology which requires surgical intervention. </li></ul>
  9. 9. The criteria of mental health <ul><li>awareness and feeling of continuity, constancy and identity of one's physical and mental self; </li></ul><ul><li>feeling of constancy and identity of experience in similar circumstances; </li></ul><ul><li>insight (good judgement) concerning oneself, one's own mental production and its results; </li></ul><ul><li>accordance (adequacy) of mental reactions to intensity and frequency of environmental influences,, social circumstances and situations; </li></ul><ul><li>capacity to self-regulation of one's behaviour in accordance with social norms, rules and laws; </li></ul><ul><li>capacity to plan one's life activities and to realise these plans; </li></ul><ul><li>capacity to change one's behaviour depending on the changes of life situations and circumstances. </li></ul>
  10. 10. Levels of mental health : <ul><li>Ideal or standard health. </li></ul><ul><li>Average statistical health. </li></ul><ul><li>Constitutional health. </li></ul><ul><li>Accentuation — a variant of mental health (norm), characterized by increased, emphasized character features and certain personality disharmony, which decreases the level of adjustment. </li></ul><ul><li>Pre-illness — appearance of first episodic mild symptoms of disorder, which cause slight dysfunction and social maladjustment. </li></ul>
  11. 11. Basic classification categories: <ul><li>1 . Menial retardation: impairment of intellectual functioning present continuously from early life. </li></ul><ul><li>2 . Personality disorders: dispositions to behave in certain abnormal ways present continuously from early adult life. </li></ul><ul><li>3. Adjustment disorders: disorders that are less severe than mental disorders and occur in relation to stressful events or changed circumstances. </li></ul><ul><li>4. Mental disorders: abnormalities of behaviour or psychological experience with a recognisable onset after a period of normal functioning. </li></ul><ul><li>5. Other disorders: conditions that do not fit into the first four groups, for example abnormalities of sexual preference and drug dependence. </li></ul>
  12. 12. Classification m ental disorders (ICD-10) <ul><li>F00-09Organic, including symptomatic, mental disorders </li></ul><ul><li>F10-19 Mental and behavioural disorders due to psychoactive substance use </li></ul><ul><li>F20-29 Schizophrenia, schizotypal and delusional disorders </li></ul><ul><li>F30-39 Mood (affective) disorders </li></ul><ul><li>F40-48Neurotic,stress-related and somatoform disorders </li></ul><ul><li>F50-59 Behavioural syndromes associated with physiological disturbances and physical factors </li></ul><ul><li>F60-69 Disorders of adult personality and behaviour </li></ul><ul><li>F70-79 Mental retardation </li></ul><ul><li>F80-89 Disorders of psychological development </li></ul><ul><li>F90-98 Behavioural and emotional disorders with onset usually occurring in childhood and adolescence </li></ul>
  13. 13. Classification of mental disorders on the basis of aetiology and pathogenesis <ul><li>1) endogenous disorders (schizophrenia, bipolar affective disorder and genuine epilepsy) caused by internal mechanisms, the nature of which isn't yet quite clear; these are disorders with he­reditary predisposition. </li></ul><ul><li>2) exogenous disorders, caused by ex­ternal reasons: infection, intoxication, head injury, etc.; </li></ul><ul><li>3) psychogenous disorders are caused by psychological trauma (posttraumatic stress syndrome) and other psychological factors (adjustment dis­orders, behavioural disorders, neuroses, etc.). </li></ul>
  14. 14. The methods of investigation <ul><li>clinical interview and collection of anamnesis data; </li></ul><ul><li>physical examination; </li></ul><ul><li>observation; </li></ul><ul><li>psychological investigation; </li></ul><ul><li>additional investigations: </li></ul><ul><li>a) neurophysiological investigations </li></ul><ul><li>b) X-ray investigations </li></ul><ul><li>c) laboratory tests </li></ul>
  15. 15. Psychotropic drugs <ul><li>Antipsychotics </li></ul><ul><li>Antidepressants </li></ul><ul><li>Mood stabilizers </li></ul><ul><li>Anxiolytics </li></ul><ul><li>Hypnotics </li></ul><ul><li>Cognitive enhancers </li></ul><ul><li>Stimulants </li></ul>
  16. 16. ANTIPSYCHOTICS (Neuroleptics, Major Tranquillisers) <ul><li>Antipsychotics are used principally in the treatment of psychoses. They diminish the agitation, delusions, hallucinations and thought disorder of these illnesses. The drugs have less effect on the symptoms of apathy and withdrawal. Treatment response is most dramatic during the first six weeks thereafter it tapers off. </li></ul>
  17. 17. TYPICAL ANTIPSYCHOTICS <ul><li>SHORT ACTING INJECTIBLES </li></ul><ul><li>GENERIC NAME BRAND NAME </li></ul><ul><li>chlorpromazine Largactil </li></ul><ul><li>haloperidol Serenace </li></ul><ul><li>trifluoperazine Stelazine </li></ul><ul><li>LONG ACTING INJECTIBLES </li></ul><ul><li>GENERIC NAME BRAND NAME </li></ul><ul><li>flupenthixol decanoate Fluanxol </li></ul><ul><li>fluphenazine decanoate Modecate </li></ul><ul><li>haloperidol decanoate Haldo </li></ul><ul><li>zuclopenthixol decanoate Clopixol Depot </li></ul>
  18. 18. ATYPICAL ANTIPSYCHOTICS <ul><li>GENERIC NAME BRAND NAME(S) </li></ul><ul><li>amisulpride Solian </li></ul><ul><li>aripiprazole Abilify </li></ul><ul><li>clozapine Clozaril, Clopine </li></ul><ul><li>olanzapine Zyprexa, Zydis (wafers) </li></ul><ul><li>quetiapine Seroquel </li></ul><ul><li>risperidone Risperdal </li></ul>
  19. 19. ANTIPSYCHOTICS – GENERAL PRECAUTIONS <ul><li>All antipsychotics are central nervous system depressants and metabolised in the liver therefore care should be taken when: </li></ul><ul><li>• prescribing them for persons with respiratory or cardiac problems; </li></ul><ul><li>• using with other central nervous system depressants including alcohol; </li></ul><ul><li>• driving a car or as reaction times can be slowed. </li></ul><ul><li>• prescribing for persons with liver problems; </li></ul><ul><li>• prescribing with other drugs metabolised in the liver. </li></ul><ul><li>Lower doses are usually required in the elderly. </li></ul><ul><li>They should be used with caution in children and adolescents. </li></ul><ul><li>These drugs should not be prescribed for persons with known hypersensitivity to the drugs. </li></ul>
  20. 20. ANTICHOLINERGICS (Side Effect Drugs, Antiparkinsonians) <ul><li>These drugs are used principally for the treatment of Parkinson’s Disease. In this context,they are used to treat drug-induced parkinsonism and other movement disorders caused by the administration of antipsychotic medications. They may be taken orally or given by injection as the situation warrants. </li></ul>
  21. 21. ANTI-DEPRESSANTS <ul><li>These drugs are used to treat major depressive disorder. All anti-depressants can treat depression, however, not all depression sufferers will respond to treatment. The medicines have an immediate action in the body but the desired improvement in mood and depressive symptoms may take some weeks. </li></ul>
  22. 22. Classification anti-depressants <ul><li>1. TRICYCLICS </li></ul><ul><li>2. MONOAMINE OXIDASE INHIBITORS </li></ul><ul><li>3. REVERSIBLE INHIBITOR OF MONOAMINE OXIDASE </li></ul><ul><li>4. SELECTIVE SEROTONIN REUPTAKE INHIBITORS </li></ul><ul><li>5. SELECTIVE SEROTONIN NORADRENALINE REUPTAKE INHIBITOR </li></ul><ul><li>6. NORADRENERGIC AND SPECIFIC SEROTONIN ANTAGONIST </li></ul><ul><li>7. HETEROCYCLIC </li></ul><ul><li>8. SELECTIVE NORADRENALINE REUPTAKE INHIBITORS </li></ul>
  23. 23. 1.TRICYCLICS antidepressants <ul><li>GENERIC NAME BRAND NAME(S) </li></ul><ul><li>amitriptyline Tryptanol, Endep </li></ul><ul><li>clomipramine Anafranil, Placil, ETC </li></ul><ul><li>dothiepin Prothiaden, Dothep </li></ul><ul><li>doxepin Sinequan, Deptran </li></ul><ul><li>imipramine Tofranil, Melipramine </li></ul><ul><li>nortriptyline Allegron </li></ul><ul><li>trimipramine Surmontil </li></ul>
  24. 24. 2. MONOAMINE OXIDASE INHIBITORS <ul><li>These were used in patients resistant to tricyclic treatment and in phobic anxiety disorders, but are now rarely prescribed. </li></ul><ul><li>GENERIC NAME BRAND NAME </li></ul><ul><li>phenelzine Nardil </li></ul><ul><li>tranylcypromine Parnale </li></ul>
  25. 25. 3. REVERSIBLE INHIBITOR OF MONOAMINE OXIDASE A <ul><li>Reversible inhibition of the MAO enzyme limits the problem of food and drug interactions. This class of drug is a safer alternative to MAOIs and no major dietary precautions are needed. RIMAs have fewer interactions, fewer cardiovascular effects and greater safety in overdose. </li></ul><ul><li>GENERIC NAME BRAND NAME(S) </li></ul><ul><li>moclobemide Aurorix, Arima </li></ul>
  26. 26. 4. SELECTIVE SEROTONIN REUPTAKE INHIBITORS <ul><li>This class of antidepressant is well tolerated, and relatively safe in overdose. </li></ul><ul><li>GENERIC NAME BRAND NAME(S) </li></ul><ul><li>citalopram Cipramil, Celepram, Talohexal,etc </li></ul><ul><li>Escitalopram Lexapro </li></ul><ul><li>fluoxetine Prozac-20, Lovan, Erocap, Zactin, etc </li></ul><ul><li>fluvoxamine Luvox, Faverin, Movox </li></ul><ul><li>paroxetine Aropax, Paxtine, Oxtine, etc </li></ul><ul><li>sertraline Zoloft,Xydem </li></ul>
  27. 27. 5. SELECTIVE SEROTONIN NORADRENALINE REUPTAKE INHIBITOR <ul><li>At low doses venlafaxine acts like an SSRI.and at higher doses it is a bit more like a tricylic without some of the adverse effects. </li></ul><ul><li>GENERIC NAME BRAND NAME </li></ul><ul><li>venlafaxine Efexor, Efexor XR </li></ul><ul><li>6 . NORADRENERGIC AND SPECIFIC SEROTONIN ANTAGONIST </li></ul><ul><li>GENERIC NAME BRAND NAME(S) </li></ul><ul><li>mirtazapine Avanza, Remeron, etc </li></ul>
  28. 28. 7. HETEROCYCLIC <ul><li>GENERIC NAME BRAND NAME(S) </li></ul><ul><li>mianserin Tolvon, Lumin </li></ul><ul><li>8. SELECTIVE NORADRENALINE REUPTAKE INHIBITORS </li></ul><ul><li>GENERIC NAME BRAND NAME </li></ul><ul><li>reboxetine Edronax </li></ul>
  29. 29. MOOD STABILISERS <ul><li>This group of drugs effectively treat a current episode of mania or depression. They also help prevent future episodes of mania and depression when taken consistently. </li></ul><ul><li>GENERIC NAME BRAND NAME(S) </li></ul><ul><li>lithium carbonate Lithicarb, Quilonum SR </li></ul><ul><li>carbamazepine Tegretol, Teril </li></ul><ul><li>sodium valproate Epilim, Valpro </li></ul><ul><li>lamotrigine Lamictil </li></ul>
  30. 30. ANXIOLYTICS (Antianxiety Drugs) <ul><li>These compounds are effective in relieving the symptoms of anxiety. The main compounds in this category are the benzodiazepines. </li></ul><ul><li>SIDE EFFECTS </li></ul><ul><li>Drowsiness </li></ul><ul><li>Impairment of concentration and reaction times </li></ul><ul><li>Impairment of some memory functions </li></ul><ul><li>Muscle incoordination – especially in the elderly which can lead to falls </li></ul><ul><li>Muscle weakness </li></ul><ul><li>Blurred vision </li></ul>
  31. 31. BENZODIAZEPINES <ul><li> GENERIC NAME BRAND NAME(S) </li></ul><ul><li>alprazolam Xanax, Kalma </li></ul><ul><li>bromazepam Lexotan </li></ul><ul><li>clobazam Frisium </li></ul><ul><li>clonazepam Rivotril, Paxam </li></ul><ul><li>diazepam Antenex, Ducene, Valium </li></ul><ul><li>lorazepam Ativan </li></ul><ul><li>oxazepam Alepam, Murelax, Serepax </li></ul>
  32. 32. BUSPIRONE <ul><li>Buspirone is a non-benzodiazepine anxiolytic. Symptom relief is delayed (unlike the benzodiazepines, which are immediately relieve symptoms). It is generally well tolerated. It does not impair alertness, attention, memory, reaction time or driving. </li></ul><ul><li>Its use does not lead to abuse, tolerance or withdrawal neither does it influence the effects of alcohol or sedative-hypnotics. </li></ul>
  33. 33. SEDATIVE – HYPNOTIC AGENTS <ul><li>These agents are used to help in the short–term management of insomnia. Generally the medications are prescribed for 2-4 weeks to help re-establish normal sleeping patterns. Occasionally, they are prescribed for a longer period of time. The main agents used are benzodiazepines. Other non-benzodiazepine agents have also been used. The disadvantages of the hypnotics are similar to anxiolytics. Tolerance and physical dependence can develop rapidly hence their indication for short-term intervention in sleep disturbance. </li></ul>
  34. 34. BENZODIAZEPINES <ul><li> GENERIC NAME BRAND NAME(S) </li></ul><ul><li>flunitrazepam Hypnodorm </li></ul><ul><li>nitrazepam Mogadon, Alodorm </li></ul><ul><li>temazepam Euhypnos, Normison, Temaze, Temtab </li></ul><ul><li>triazolam Halcion </li></ul><ul><li>NON-BENZODIAZEPINES </li></ul><ul><li> GENERIC NAME BRAND NAME </li></ul><ul><li>zopiclone Imovane </li></ul><ul><li>zolpidem Stillnox </li></ul>
  35. 35. PSYCHOSTIMULANTS <ul><li>These medicines are used to treat attention deficit disorder, usually in children. They may also be used in narcolepsy. </li></ul><ul><li> GENERIC NAME BRAND NAME </li></ul><ul><li>Atomoxetine Strattera </li></ul><ul><li>Dexamphetamine </li></ul><ul><li>Methylphenidate Ritalin, Attenta </li></ul>
  36. 36. Electroconvulsive therapy (ECT) <ul><li>Electroconvulsive therapy , also known as electroshock, is a well-established, albeit controversial, psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Today, ECT is most often used as a treatment for severe major depression which has not responded to other treatment, and is also used in the treatment of mania (often in bipolar disorder), catatonia and schizophrenia. </li></ul>
  37. 37. Psychotherapy <ul><li>Psychoanalytic </li></ul><ul><li>Cognitive behavioral </li></ul><ul><li>Psychodynamic </li></ul><ul><li>Existential </li></ul><ul><li>Humanistic </li></ul><ul><li>Transpersonal </li></ul><ul><li>Hypnotherapy </li></ul><ul><li>Gestalt Therapy </li></ul>
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