THERAPEUTIC MODALITIES IN MENTAL HEALTH.pptx

2. INTRODUCTION • Mental health disorders can affect physical and psychological behaviors. • Therapeutic modalities can provide useful guidance for the prevention and treatment of mental health disorders and the care of the people. • Therapeutic modalities in mental health refers to the various ways of management of people with mental illness. © 2017 Thomas Owondo. All rights reserved. 2

3. TYPES OF THERAPEUTIC MODALITIES 1. Pharmacotherapy/ Drug therapy. 2. Psychotherapy/ Talk therapy. 3. Electroconvulsive therapy (ECT). 4. Occupational therapy. © 2017 Thomas Owondo. All rights reserved. 3

4. PHARMACOTHERAPY/ DRUG THERAPY. • This is the treatment of disease through the administration of drugs. • Most medications are used by mental health specialists in much the same way that medications are used to treat high blood pressure or diabetes. • After completing thorough evaluations, mental health specialists can prescribe medications to help treat mental disorders. • Psychiatric medications can help correct imbalances in brain chemistry that are thought to be involved in some mental disorders. Patients on long-term medication treatment will need to meet with their mental health specialist periodically to monitor the effectiveness of the medication and any potential side effects. © 2017 Thomas Owondo. All rights reserved. 4

5. PHARMACOTHERAPY/ DRUG THERAPY • Class of Medications used in mental health include: Antidepressants – used to treat depression, panic disorder, PTSD, anxiety, obsessive-compulsive disorder, borderline personality disorder and eating disorders. Antipsychotic medications – used to treat psychotic symptoms (delusions and hallucinations), schizophrenia, bipolar disorder. Sedatives and anxiolytics – used to treat anxiety and insomnia. Hypnotics – used to induce and maintain sleep. Mood stabilizers – used to treat bipolar disorder. Anticonvulsants- used to treat epilepsy and other seizure disorders. © 2017 Thomas Owondo. All rights reserved. 5

6. PSYCHOTHERAPY/ TALK THERAPY • If any single therapeutic modality can be said to be the mainstay of mental health treatment, it is psychotherapy. The talking relationship between a therapist and client or patient is the best known tool in mental health. • Psychotherapy, sometimes called talk therapy, is a treatment that involves a talking relationship between a therapist and patient. • It can be used to treat a broad variety of mental disorders and emotional difficulties. • The goal of psychotherapy is to eliminate or control disabling or troubling symptoms so the patient can function better. • Depending on the extent of the problem, treatment may take just a few sessions over a week or two or may take many sessions over a period of years. Psychotherapy can be done individually, as a couple, with a family, or in a group. © 2017 Thomas Owondo. All rights reserved. 6

7. Psychotherapy/ Talk therapy • There are many forms of psychotherapy. There are psychotherapies that help patients change behaviors or thought patterns, psychotherapies that help patients explore the effect of past relationships and experiences on present behaviors, and psychotherapies that are tailored to help solve other problems in specific ways. • There are more than fifty types of therapeutic approaches. Only a few of them are common, though. There are also some that act as broad categories and contain subtypes.ytt Note: Remember, most therapists blend therapeutic approaches and customize an integrated approach for each client. © 2017 Thomas Owondo. All rights reserved. 7

8. Psychotherapy/ Talk therapy • A theory of psychotherapy acts as a roadmap for psychologists: It guides them through the process of understanding clients and their problems and developing solutions. • Approaches to psychotherapy fall into five broad categories: Psychoanalysis and psychodynamic therapies Behavior therapy Cognitive therapy Humanistic therapy. Integrative or holistic therapy © 2017 Thomas Owondo. All rights reserved. 8

9. Psychotherapy/ Talk therapy  Psychoanalysis and psychodynamic therapies. This approach focuses on changing problematic behaviors, feelings, and thoughts by discovering their unconscious meanings and motivations. Psychoanalytically oriented therapies are characterized by a close working partnership between therapist and patient. Patients learn about themselves by exploring their interactions in the therapeutic relationship. While psychoanalysis is closely identified with Sigmund Freud, it has been extended and modified since his early formulations.  Cognitive therapy. Cognitive therapy emphasizes what people think rather than what they do. • Cognitive therapists believe that it's dysfunctional thinking that leads to dysfunctional emotions or behaviors. By changing their thoughts, people can change how they feel and what they do. • Major figures in cognitive therapy include Albert Ellis and Aaron Beck. © 2017 Thomas Owondo. All rights reserved. 9

10. Psychotherapy/ Talk therapy Behavior therapy. This approach focuses on learning's role in developing both normal and abnormal behaviors. • Ivan Pavlov made important contributions to behavior therapy by discovering classical conditioning, or associative learning. Pavlov's famous dogs, for example, began drooling when they heard their dinner bell, because they associated the sound with food. • "Desensitizing" is classical conditioning in action: A therapist might help a client with a phobia through repeated exposure to whatever it is that causes anxiety. • Another important thinker was E.L. Thorndike, who discovered operant conditioning. This type of learning relies on rewards and punishments to shape people's behavior. BF Skinner is regarded as the father of Operant Conditioning, but his work was based on Thorndike’s (1898) law of effect. © 2017 Thomas Owondo. All rights reserved. 10

11. Psychotherapy/ Talk therapy  Humanistic therapy. This approach emphasizes people's capacity to make rational choices and develop to their maximum potential. Concern and respect for others are also important themes. • Humanistic philosophers like Jean-Paul Sartre, Martin Buber and Søren Kierkegaard influenced this type of therapy. • Three types of humanistic therapy are especially influential. Client- centered therapy rejects the idea of therapists as authorities on their clients' inner experiences. Instead, therapists help clients change by emphasizing their concern, care and interest. • Gestalt therapy emphasizes what it calls "organismic holism," the importance of being aware of the here and now and accepting responsibility for yourself. • Existential therapy focuses on free will, self-determination and the search for meaning. © 2017 Thomas Owondo. All rights reserved. 11

12. Psychotherapy/ Talk therapy Integrative or holistic therapy. Many therapists don't tie themselves to any one approach. Instead, they blend elements from different approaches and tailor their treatment according to each client's needs. © 2017 Thomas Owondo. All rights reserved. 12

13. Psychotherapy/ Talk therapy • Examples of psychotherapy include;  Client-Centered Therapy [Person-Centered Therapy, PCT, CCT or Rogerian Therapy] (Part of the Humanistic Category of Therapy)  Cognitive or Cognitive Behavioral Therapy [CBT] (part of the behavioral category)  Rational Emotive therapy  Behavioural therapy © 2017 Thomas Owondo. All rights reserved. 13

15. ELECTROCONVULSIVE THERAPY (ECT) • Electroconvulsive therapy (ECT) is a medical treatment most commonly used in patients with severe major depression or bipolar disorder that has not responded to other treatments. • ECT involves a brief electrical stimulation of the brain while the patient is under anesthesia. It is typically administered by a team of trained medical professionals that includes a psychiatrist, an anesthesiologist, and a nurse. • During this therapy, electrical currents are sent through the brain to induce a seizure. The procedure has been shown to help 78 percent of people with clinical depression. © 2017 Thomas Owondo. All rights reserved. 15

16. ELECTROCONVULSIVE THERAPY (ECT) • ECT has a checkered past. When ECT was first introduced in the 1930s, it was known as “electroshock therapy.” In its early use, patients regularly suffered broken bones and related injuries during therapy. Muscle relaxants weren’t available to control the violent convulsions caused by ECT. Because of this, it’s considered one of the most controversial treatments in modern psychiatry. • In modern ECT, electrical currents are administered more carefully. Also, the patient is sedated to reduce the risk of injury. © 2017 Thomas Owondo. All rights reserved. 16

17. INDICATIONS OF ECT • ECT is typically used when other treatments, including medications and psychotherapy, haven’t worked. • ECT is also used for people who require a rapid treatment response because of the severity of their condition, such as being at risk for suicide. • Acute catatonia: characterized by lack of movement, fast or strange movements, lack of speech, and other symptoms. It's associated with schizophrenia and certain other psychiatric disorders. In some cases, catatonia is caused by a medical illness. • Severe depression • Acute mania • Mood disorders with psychotic features. © 2017 Thomas Owondo. All rights reserved. 17

18. INDICATIONS OF ECT • Although ECT can be very effective for many individuals with serious mental illness, it is not a cure. To prevent a return of the illness, most people treated with ECT need to continue with some type of maintenance treatment. This typically means psychotherapy and/or medication or, in some circumstances, ongoing ECT treatments. © 2017 Thomas Owondo. All rights reserved. 18

19. CONTRAINDICATIONS • Contraindications to ECT include brain tumors, space- occupying lesions, and other brain diseases that cause increased intracranial pressure. © 2017 Thomas Owondo. All rights reserved. 19

20. TYPES OF ECT • There are two major types of ECT: unilateral and bilateral.  In bilateral ECT, electrodes are placed on either side of your head. The treatment affects your entire brain.  In unilateral ECT, one electrode is placed on the top of your head. The other is placed on your right temple. This treatment affects only the right side of your brain. • Some hospitals employ “ultra-brief” pulses during ECT. These last less than half a millisecond, compared to the standard one-millisecond pulse. The shorter pulses are believed to help prevent memory loss. © 2017 Thomas Owondo. All rights reserved. 20

21. EQUIPMENT FOR ECT • Treatment devices and supplies, including electrode paste and gel, gauze pads , saline, electro encephalogram electrodes and chart paper. • Monitoring equipment including ECG and EEG electrodes • BP cuffs, peripheral nerve stimulator and pulse oxymeter • Stethoscope • Reflex hammer • Intravenous and venipuncture supplies • Stretchers with firm mattress with side rails with the capacity of raising the head and foot end • Bite blocks © 2017 Thomas Owondo. All rights reserved. 21

22. EQUIPMENT FOR ECT • Suction device • Ventilation equipment, including tubing , masks, Ambu bag, oral airways , intubations equipment with an oxygen delivery system capable of providing positive- pressure oxygen • Emergency and other medications as recommended by the anesthesia staff • Miscellaneous medications not supplied by anesthesia staff for medical management during ECT such as midazolam, diazepam, thiopental sodium, glycopyrolate, succinyl choline etc. © 2017 Thomas Owondo. All rights reserved. 22

23. NURSING ROLES BEFORE AND AFTER ELECTROCONVULSIVE THERAPY • Electroconvulsive therapy is treated like a minor surgical procedure that requires preoperative preparation and postoperative care. • The nurse's multifaceted role in ECT is enacted by providing education and support, performing pretreatment assessments, monitoring the procedure, and observing and interpreting posttreatment patient responses. • There are four components of nursing care in ECT.  Providing educational and emotional support.  Pre-treatment planning and assessment.  Preparing and monitoring the patient during the actual procedure.  Post-treatment care and evaluation © 2017 Thomas Owondo. All rights reserved. 23

24. NURSING ROLES BEFORE AND AFTER ELECTROCONVULSIVE THERAPY Providing Educational and emotional support: • Explain the procedure to the patient • Obtain an informed consent from the patient and the carer. • Respond to patient’s concerns and feelings. • Educate the patient concerning the procedure and explain to the patient the necessary tasks associated with ECT. • Initiate education interventions based on knowledge deficits. © 2017 Thomas Owondo. All rights reserved. 24

25. NURSING ROLES BEFORE AND AFTER ELECTROCONVULSIVE THERAPY Pre-treatment Nursing care: • Preparation of treatment suite for the ECT procedure. • An adjustable height stretcher trolley • Complete the pre-treatment check list. • The patient’s identity is checked and the patient wears an identity bracelet. • Ensure safekeeping of the patient’s valuables. • The patient’s hair should be clean and dry to allow for electrode contact. • Hairpins, bracelets, body piercing should be removed to avoid burns. • The patient should be encouraged to pass urine before the treatment to avoid incontinence during the procedure. • Minimise anxiety through anxiety management techniques, ensuring short waiting time and offering reassurance and support. © 2017 Thomas Owondo. All rights reserved. 25

26. NURSING ROLES BEFORE AND AFTER ELECTROCONVULSIVE THERAPY Nursing Care during ECT Procedure • Transfer the patient on a trolley from the waiting room to the ECT room on a well padded bed and placed in a comfortable dorsal position or supine position. A small pillow is placed under the lumber curve. • Apply ECG electrodes, BP cuff, and pulse oximetry sensor (not on same extremity as BP cuff). • Give a short acting anesthetic agent. Thiopental .25mg to .5 mg , IV and secoline (succynyl choline) 30-50 mg. The dose of drug may vary from patient to patient. • Prepare EEG electrodes, per treatment specifications. • Prepare scalp and stimulus ECT electrodes (unilateral vs. bilateral) and apply paste to electrodes. © 2017 Thomas Owondo. All rights reserved. 26

27. NURSING ROLES BEFORE AND AFTER ELECTROCONVULSIVE THERAPY • Support the shoulder and arms of the patient. Restraint the thigh with the help of a sheet. • Hyperextension of the head with support to the chin. • Administer oxygen. • Apply jelly to the electrodes. • Make the observations of the convulsions. • The presence of initial tonic stage which lasts for 10-15 seconds followed by clonic stage which lasts for 25-30 sec then there is a phase of muscular relaxation with stertorus respiration i.e. flaccid stage. • Do suction immediately • Restore respiration by giving O2 if necessary. 27

28. NURSING ROLES BEFORE AND AFTER ELECTROCONVULSIVE THERAPY Post-ECT Care • Observe and record the vital parameters • Place the patient on side lying position, clean the secretions • Transfer the patient from recovery room . record vital signs every 15 min for 30 min and once in every 30 min till the patient recover to the normal stage. • Allow the patient to sleep for 30 min to one hour • Reassure the client and reorient to the ward • Allow the patient to have tea or any drinks • Record the procedure © 2017 Thomas Owondo. All rights reserved. 28

29. RISKS, SIDE EFFECTS AND COMPLICATIONS OF ECT • Although ECT is generally safe, risks and side effects associated with ECT are uncommon and generally mild. • Confusion. Immediately after treatment, you may experience confusion, which can last from a few minutes to several hours. You may not know where you are or why you're there. Rarely, confusion may last several days or longer. Confusion is generally more noticeable in older adults. • Memory loss. Some people have trouble remembering events that occurred right before treatment or in the weeks or months before treatment or, rarely, from previous years. This condition is called retrograde amnesia. You may also have trouble recalling events that occurred during the weeks of your treatment. For most people, these memory problems usually improve within a couple of months after treatment ends. © 2017 Thomas Owondo. All rights reserved. 29

30. RISKS, SIDE EFFECTS AND COMPLICATIONS OF ECT • Physical side effects. On the days of an ECT treatment, some people experience nausea, headache, jaw pain or muscle ache. These generally can be treated with medications. • Medical complications. As with any type of medical procedure, especially one that involves anesthesia, there are risks of medical complications. During ECT, heart rate and blood pressure increase, and in rare cases, that can lead to serious heart problems. If you have heart problems, ECT may be more risky. • Death is a rare but severe outcome of ECT treatment. It is a result of various complications of ECT such as reactions to anesthesia, cardiovascular complications, pulmonary complications, or stroke. Potential mitigating factors include those proposed for each of these key risks. © 2017 Thomas Owondo. All rights reserved. 30

32. OCCUPATIONAL THERAPY • Many people associate occupational therapy with pediatric services or physical rehabilitation. They are surprised to find occupational therapists also working in mental health settings. • Occupational therapy is a mode of treatment that uses purposeful activities of self-care, work and play/leisure to increase independence, enhance development and/or prevent disability. © 2017 Thomas Owondo. All rights reserved. 32

33. OCCUPATIONAL THERAPY • Like social work, occupational therapy is a broad profession that works in many areas. In general, occupational therapists work to help clients participate in the things they want and need to do through the therapeutic use of everyday activities, or “occupations.” • The origins of occupational therapy are rooted in mental health, as the creation of the profession dovetailed with the early 20th century's mental hygiene movement. With the call for deinstitutionalization of individuals with mental illness, which culminated in the 1963 Community Mental Health Act, occupational therapists began working in community mental health. • Today, occupational therapy practitioners provide services in community settings including, but not limited to mental health clients. © 2017 Thomas Owondo. All rights reserved. 33

34. Where do Occupational Therapists work? • Hospitals • Schools/Special schools • Mental Health Facilities • Armed forces • Old Homes • Private Clinics • Rehabilitation Centers • Community Health Centers • Insurance Companies • Client Homes • Client Work Places

35. Who do Occupational Therapists work with? Children Adolescents Adults Seniors

36. OCCUPATIONAL THERAPY • In the past, there was an adherence to the medical model; now the focus is on incorporating the recovery model. This model acknowledges that recovery is a long-term process, with the ultimate goal being full participation in community activities. • These activities may include obtaining and maintaining employment, going to school, and living independently. • The philosophical base of the recovery model is a good fit with occupational therapy because the purpose of occupational therapy in mental health is to increase an individual's ability to live as independently as possible in the community while engaging in meaningful and productive life roles. Because occupational therapy facilitates participation and is client-centered, it plays an important role in the success of those recovering in the community. © 2017 Thomas Owondo. All rights reserved. 36

37. OCCUPATIONAL THERAPY • Occupational therapy often is misunderstood in this process. According to the American Occupational Therapy Association, the primary goal of occupational therapy is to support and enable each person’s “health and participation in life through engagement in occupation.” • “Occupation” does not solely mean work. Some examples of occupations include time spent on personal hygiene, preparing a meal, managing finances, painting a picture, attending a community leisure course, and socializing with others. Occupational therapists enhance people’s ability to live meaningful and satisfying lives. © 2017 Thomas Owondo. All rights reserved. 37

38. ROLES OF OTs IN MENTAL HEALTH • Individuals of all ages who are diagnosed with a mental illness can benefit from occupational therapy. Furthermore, friends and family members can also benefit from these services to learn ways to deal with the stress of caregiving and how to balance their daily responsibilities to allow them to continue to lead productive and meaningful lives. • OTs help people to identify the things they want and need to do in their lives, identify areas where skills development is needed and assess how the environment helps or hinders people in achieving their goals. © 2017 Thomas Owondo. All rights reserved. 38

39. ROLES OF OTs IN MENTAL HEALTH • Occupational therapists working in the mental health settings focus on enabling individuals to re-engage in meaningful occupations through a variety of skill sets such as skills development, establishing positive habits and routines, setting therapy goals, using cognitive-behavioral techniques (CBT), and understanding underlying physiological influences. • Specifically, occupational therapy within the setting of child and adolescent mental health focuses on those underlying physiological influences and teaching patients to identify and utilize self-regulation strategies in order for patients to get back to participating in meaningful occupations such as going to school, being with friends, and participating within the family system. © 2017 Thomas Owondo. All rights reserved. 39

40. APPROACHES OT’S USE WITH CLIENTS/PATIENTS • Providing education on coping skills and self-regulation skills to use in a variety of contexts • Providing education on sensory exploration and implementation of sensory approaches for self-regulation • Incorporating yoga and movement interventions to provide sensory input and achieve self- regulation • Utilizing CBT approaches to facilitate participation in desired activities • Identifying and implementing healthy, positive habits and structure into daily routines • Providing education and implementation of skills related to social competence, such as making and keeping friends, coping with anger, solving problems, learning about social etiquette, and following school rules • Evaluating factors interfering with success in school, home, community, etc. • Modifying the environment to support improved attention, participation and decrease sensory overload in the classroom © 2017 Thomas Owondo. All rights reserved. 40

41. APPROACHES OT’S USE WITH CLIENTS/PATIENTS • Providing parents with education on behavioral and psychosocial approaches to enhance the child’s daily functioning • Reducing restraints and seclusions in the inpatient setting by conducting comprehensive assessments to determine facilitators and barriers to participation in life tasks, promoting the use of self- awareness and skills development, collaborating with the client to develop attainable goals, modifying the environment for optimal fit, promoting use of self-regulation and sensory strategies, and educating the interdisciplinary team on prevention techniques. © 2017 Thomas Owondo. All rights reserved. 41

42. ASSESSMENTS A CLIENT FOR OCCUPATIONAL THERAPY • When working with someone with a mental health condition, occupational therapists employ a variety of assessments. Once the necessary information has been obtained, the therapist creates a personalized occupational profile. This profile is used for goal-setting and treatment planning. • Common areas of assessment include: Activities of daily living (e.g., bathing, dressing, eating), Instrumental activities of daily living (e.g., driving, money management, shopping), Work (paid and volunteer), Social participation, Mental and cognitive processing skills, Communication and interaction skills, Leisure, Habits, roles and routines etc. © 2017 Thomas Owondo. All rights reserved. 42

43. ASSESSMENTS A CLIENT FOR OCCUPATIONAL THERAPY • For example, an occupational therapist may assess a client with schizophrenia who is living in a residential hospital in order to help to determine the best placement in the community. • The assessment may include standardized evaluation tools, individual interview, and observation to determine ability to function and live alone safely, and identify important roles and occupations. • This information is then used to determine the skills, supports, and environmental modifications the person may need to live as independently as possible. © 2017 Thomas Owondo. All rights reserved. 43

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