What Are the different forms of treatment for the mentally ill?

 

Psychotherapy (also psychological therapy or talking therapy) is the use of psychological methods, particularly when based on regular personal interaction with adults, to help a person change behavior and overcome problems in desired ways. Psychotherapy aims to improve an individual's well-being and mental health, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills. There are also numerous types of psychotherapy designed for children and adolescents, such as play therapy. Certain psychotherapies are considered evidence-based for treating some diagnosed mental disorders.  

                             

There are hundreds of psychotherapy techniques, some being minor variations, while others are based on quite different conceptions of psychology. Most involve one-to-one sessions, between the client and therapist, but some are conducted with groups, including families.

 

Psychotherapists may be mental health professionals such as psychiatrists, psychologists, mental health nurses, clinical social workers, marriage and family therapists, or professional counselors. Psychotherapists may also come from a variety of other backgrounds, and depending on the jurisdiction may be legally regulated, voluntarily regulated, or unregulation.

 

As you can see, there are numerous variations of psychotherapy, but the stereotype is a one-on-one relationship between the patient and a practicing psychiatrist.  As mentioned in a previous article it is this form of psychotherapy that has troublesome economic implications.  During the first 40-minute weekly session one  learns that this form of psychotherapy will typically cost between $300.00 and $500.00 per session, cash with no accounting for health insurance.  This form of care is reserved for the upper middle class and above.

Medications     As an opening glittering generality, psychotropic drugs do not outright cure mental illness; when they work well the patient’s problems are moderated and make possible living a relatively normal life.  While every mental drug produced will not be covered in this article, there are approximate 200 different FDA approved mental health drugs.

On the other hand, as will follow, many of these medications could result in severe complications and/or dependencies.            

Antidepressants are medications commonly used to treat depression.  These drugs are also used for other health conditions, such as anxiety, pain, and insomnia.  Although antidepressant are not FDA-approved specifically to treat ADHD, antidepressants are sometimes used to treat ADHD in adults.

 

The most popular types of antidepressants are called selective serotonin reuptake inhibitors (SSRIs).  Examples of SSRI include:

·         Fluoxetine

·        Citalopram

·        Sertraline

·         Paroxetine

·        Escitalopram         

 

Other types of antidepressants are serotonin and norepinephrine reuptake inhibitors (SNRIs).  SNRIs are like SSRIs and include venlafaxine and duloxetine. 

 

Another antidepressant that is commonly used is bupropion.  Bupropion is a third type of antidepressant which works differently than either SSRIs or SNRIs.  Bupropion is also used to treat seasonal affective disorder and to help people stop smoking.

 

SSRI’s and SNRIs and Bupropion are popular because they do not cause as many side effects as older classes of antidepressants and seem to help a broader group of depressive and anxiety disorders.  Older antidepressant medications include tricyclics, tetracyclic, and monoamine oxidase inhibitors (MAOIs).  For some people, tricyclics or MAOIs may be the best medications.

 

For reasons not yet well understood, some people respond better to some antidepressant medications than to others. 

 

Therefore, it is important to know that some people may not feel better with the first medicine they try and may need to try several medicines to find the one that works best for them. 

 

Some antidepressants may cause more side effects than others.  You may try several antidepressant medications before finding the one that improves your symptoms and that causes side effects that you can manage.

 

The most common side effects listed by the FDA include:

 

·         Nausea and vomiting

·        Weight gain

·        Diarrhea

·        Sleepiness

·        Sexual problems

Call your doctor right away if you have any of the following symptoms, especially if they are new, worsening, or worry you (U. S. Food and Drug Administration, 2011).

 

·         Thoughts about suicide or dying

·        Attempts to commit suicide

·        New or worsening depression

·        New or worsening anxiety

·        Feeling very agitated or restless

·        Panic attacks

·        Trouble Sleeping

·        Irritability

·        Acting aggressively, being angry, or violent

·        An extreme increase in activity and talking (mania)

·        Other unusual changes in behavior or mood

Anti-Anxiety Medications   help reduce the symptoms of anxiety such as panic attacks, or extreme fear and worry.  The most common anti-anxiety medications are called benzodiazepines.  Benzodiazepines can treat generalized anxiety usually second-line treatments behind SSRIs or other antidepressants.

 

Benzodiazepines used to treat anxiety disorders include:

·         Clonazepam

·        Alprazolam

·        Lorazepam

Taking these medications for a short period of time can help the person keep physical symptoms under control and can be used “as needed” to reduce acute anxiety. 

A major public health crisis is that somewhere between the patient and prescribing physician, benzodiazepines are frequently abused.   They are highly addictive.  The patient builds up a tolerance to the medication and ever higher dosages are required to obtain the same relief.  Later higher doses are required with no relief; they simply must be taken to prevent the adverse withdrawal effects of stopping the medication.   In extremely cases a patient can suffer seizures if the long-term use of the medication is abruptly terminated.

 

Mood Stabilizers:  Mood stabilizers are used to treat bipolar disorder, mood swings associated with other mental disorders, and in some cases, to augment the effect of other medications used to treat depression.  Mood stabilizers work by decreasing abnormal activity in the brain and are also sometimes used to treat:

 

·         Depression (usually along with an antidepressant)

·        Schizoaffective Disorder

·        Disorders of impulse control

·        Certain mental illnesses in children

Lithium, which is an effective mood stabilizer, is approved for the treatment of mania and the maintenance treatment of bipolar disorder.  Several cohort studies describe anti-suicide benefits of lithium for individuals on long-term maintenance. 

Anticonvulsant medications are also used as mood stabilizers.  They were originally developed to treat seizures, but they were found to help control unstable moods as well.  One anticonvulsant commonly used as a mood stabilizer is valproic acid (also called divalproex sodium).  For some people, especially those with “mixed symptoms of mania and depression or those with rapid-cycling bi-polar disorder, valproic acid may work better than lithium.  Other anticonvulsants used as mood stabilizers used as mood stabilizers include:

 

·         Carbamazepine

·        Lamotrigine

·        Oxcarbazepine

 

Mood stabilizers can cause several side effects, and some of them may become serious, especially at excessively high blood levels.  These side effects include:

·         Itching

·        Excessive thirst

·        Frequent urination

·        Tremor (shakiness) of the hands

·        Nausea and Vomiting

·        Slurred speech

·        Fast, slow, irregular, or pounding heartbeat

·        Blackouts

·        Changes in Vision

·        Seizures

·        Hallucinations (seeing things or hearing voices that do not exist

·        Loss of coordination

·        Swelling of the eyes, face, tongue, throat, hands feet, ankles, or lower legs.

If a person with bipolar is being treated with lithium, he or she should visit the doctor regularly to check the lithium levels his or her blood, and make sure the kidneys and the thyroid are working normally.

For some possible side effects of Carbamazepine, Lamotrigine, and Oxcarbazepine.

 

Some possible side effects linked to anticonvulsants (such as valproic acid include:

·         Drowsiness

·        Dizziness

·        Headache

·        Diarrhea

·        Constipation

·        Changes in appetite

·        Weight changes

·        Back pain

·        Agitation

·        Mood swings

·        Abnormal thinking

·        Uncontrollable shaking of a part of the body

·        Loss of coordination

·        Uncontrollable movements of the eyes

·        Blurred or double vision

·        Ringing in the ears

·        Hair loss

What are Antipsychotics?

Antipsychotic medications are primarily used to manage psychosis.  The word “psychosis” is used to describe conditions that affect the mind, and in which there has been some loss of contact with reality, often including delusions (false, fixed beliefs) or hallucinations (hearing or seeing things that are not there).  It can be a symptom of a physical condition such as drug abuse or a mental disorder such as schizophrenia, bipolar disorder, or very severe depression (also known as psychotic depression”).

 

Antipsychotic medications are often used in combination with other medications to treat delirium, dementia, and mental health conditions, including:

·         Attention-Deficit Hyperactivity Disorder (ADHD)

·        Severe Depression

·        Eating Disorders

·        Post-traumatic stress disorder (PTSD)

·        Obsessive Compulsive Disorder (OCD)

·        Generalized Anxiety Disorde

 

Antipsychotic medications do not cure these conditions.  They are used to help relieve symptoms and improve quality of life.

 

What are Stimulants?

 

As the name suggests, stimulants increase alertness, attention, and energy, as well as elevate blood pressure, heart rate, and respiration (National Institute on Drug Abuse, 2014).  Stimulant medications are often prescribed to treat children, adolescents, or adults diagnosed with ADHD.

Stimulants used to treat ADHD include:

·         Methylphenidate

·        Amphetamine

·        Dextroamphetamine

·        Lisdexamfetamine Dimesylate

 

How do people respond to stimulants? 

 

Prescription stimulants have a calming and “focusing” effect on individuals with ADHD.  Stimulant medications are safe when given under a doctor’s supervision.  Some children taking them may feel slightly different or “funny.

 

What are Psychiatric Hospitals

 

Psychiatric hospitals, also known as mental health units or behavioral health units, are hospitals or wards specializing in the treatment of serious mental disorders, such as major depressive disorder, schizophrenia, and bipolar disorder. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialize only in short-term or outpatient therapy for low-risk patients. Others may specialize in the temporary or permanent containment of patients who need routine assistance, treatment, or a specialized and controlled environment due to a psychological disorder. Patients often choose voluntary commitment, but those whom psychiatrists believe to pose significant danger to themselves, or others may be subject to involuntary commitment and involuntary treatment.  Psychiatric hospitals may also be called psychiatric wards/units (or "psych" wards/units) when they are a subunit of a regular hospital.

 

The modern psychiatric hospital evolved from and eventually replaced the older lunatic asylum. The treatment of inmates in early lunatic asylums was sometimes brutal and focused on containment and restraint.  With successive waves of reform, and the introduction of effective evidence-based treatments, most modern psychiatric hospitals emphasize treatment, and attempt where possible to help patients control their lives in the outside world, with the use of a combination of psychiatric drugs and psychotherapy. Exceptions include Japan, where many psychiatric hospitals still use physical restraints on patients, tying them to their beds for days or even months at a time, and India, where the use of restraint and seclusion is endemic

 

What are support groups

 

In a support group, members provide each other with various types of help, usually nonprofessional and nonmaterial, for a particular shared, usually burdensome, characteristic. Members with the same issues can come together for sharing coping strategies, to feel more empowered and for a sense of community. The help may take the form of providing and evaluating relevant information, relating personal experiences, listening to, and accepting others' experiences, providing sympathetic understanding, and establishing social networks. A support group may also work to inform the public or engage in advocacy.

 

What is Complementary & Alternative Medicine?

 

Complementary and alternative medicines (CAMs) are treatments that fall outside of mainstream healthcare.

These medicines and treatments range from acupuncture and homeopathy, to aromatherapy, meditation, and colonic irrigation.

Defining CAMs

There is no universally agreed definition of CAMs.

Although "complementary and alternative practitioner" is often used as a single category, it can be useful to make a distinction between the 2 terms.

 

The US National Center for Complementary and Integrative Health (NCCIH) uses this distinction:

When a non-mainstream practice is used together with conventional medicine, it is considered "complementary".

When a non-mainstream practice is used instead of conventional medicine, it is considered "alternative".

There can be overlap between these categories.

For example, aromatherapy may sometimes be used as a complementary treatment, and in other circumstances is used as an alternative treatment.

Several complementary and alternative treatments are typically used with the intention of treating or curing a health condition.

Examples include:

homeopathy

acupuncture

osteopathy

chiropractic

herbal medicines

Deciding to use complementary or alternative treatments

To understand whether a treatment is safe and effective, we need to check the evidence.

You can learn more about the evidence for CAMs by reading about individual types of treatment.

 

Some complementary and alternative medicines or treatments are based on principles and an evidence base that are not recognized by most independent scientists.

Others have been proven to work for a limited number of health conditions.

For example, there's evidence that osteopathy and chiropractic practices are effective for treating lower back pain.

When a person uses any health treatment, including a CAM, and experiences an improvement, this may be due to the placebo effect.

The availability of CAMs is limited, and in most cases the service will not offer such treatments.

The National Institute for Health and Care Excellence (NICE) provides guidance on effective treatments that are value for money.

NICE has recommended the use of CAMs in a limited number of circumstances.

 

If you think you may have a health condition, first see your GP. Do not visit a CAM practitioner instead of seeing your GP.

 

It is particularly important to talk to your GP if you have a pre-existing health condition or are pregnant.

 

Some CAMs may interact with medicines that you are taking or should not be taken if you are pregnant.

 

CAMs and regulation

The practice of conventional medicine is regulated by laws that ensure that practitioners are properly qualified and adhere to certain standards or codes of practice. This is called statutory professional regulation.

Professionals of 2 complementary and alternative treatments – osteopathy and chiropractic – are regulated in the same way.

There is no statutory professional regulation of any other CAM practitioners.

Finding an osteopath or chiropractor

Osteopathy and chiropractic are regulated in the same way as conventional medicine.

All osteopaths must be registered with the General Osteopathic Council. You can use the General Osteopathic Council website to find a registered osteopath near you or check if someone offering osteopathic services is registered.

All chiropractors must be registered with the General Chiropractic Council. You can use the General Chiropractic Council website to find a registered chiropractor near you or check if someone offering chiropractic services is registered.

 

Finding other CAM practitioners

Apart from osteopathy and chiropractic, there is no professional statutory regulation of complementary and alternative treatments in the UK.

This means:

It is legal for anyone to practice the treatment, even if they have no or limited formal qualifications or experience

These practitioners are not legally required to adhere to any standards of practice or to join an association or register

If you decide to use a CAM, it is up to you to find a practitioner who will carry out the treatment in a way that is acceptable to you. Professional bodies and voluntary registers can help you do this.

Some regulated healthcare professionals, such as GPs, also practice unregulated CAMs

In these instances, the CAM practice is not regulated by the organization that regulates the healthcare professional (such as the General Medical Council), but these organizations will investigate complaints that relate to the professional conduct of their member.

Professional associations and accredited registers for CAMs. Many CAMs have voluntary registers (some of which are accredited by the Professional Standards Authority for Health and Social Care, or the PSA) or professional associations that practitioners can join if they choose.

Usually, these associations or registers demand that practitioners hold certain qualifications and agree to practice to a certain standard.

Organizations with PSA-accredited voluntary registers include:

the British Acupuncture Council

the Complementary & Natural Healthcare Council

the Federation of Holistic Therapists

This means that these organizations have met the PSA's demanding standards, which are designed to help people make an informed choice when they are looking for a practitioner

 

Find more information on the PSA's accredited registers

 

Questions to ask before starting a treatment:

Once you have found a practitioner, it is a good idea to ask them some questions to help you decide if you want to go ahead with treatment.

 

You could ask:

 

about the cost of treatment

how long the treatment will last

whether there are any people who should not use this treatment

what side effects the treatment might cause

whether there is anything you should do to prepare for treatment

what system the practitioner has for dealing with complaints about their treatment or service

for documentary proof of their qualifications

for documentary proof that they are a member of their professional association or voluntary register

for documentary proof that they are insured

for written references

What are Self Help Plans?

 

Self-help groups for mental health are voluntary associations of people who share a common desire to overcome mental illness or otherwise increase their level of cognitive or emotional wellbeing. Despite the different approaches, many of the psychosocial processes in the groups are the same. Self-help groups have had varying relationships with mental health professionals. Due to the nature of these groups, self-help groups can help defray the costs of mental health treatment and implementation into the existing mental health system could help provide treatment to a greater number of the mentally ill population.

 

What is Peer Support for mental health patients?

Clinical care is an integral component of an individual’s broader network of mental health support, but it can be hard to find a community of individuals with shared experiences around workplace mental health despite the benefits that peer support can provide.

In fact, mental health peer support services are considered an evidence-based mental health model of care. In meta-analyses, peer group participants have displayed a reduction in clinical symptoms of anxiety and depression and an increase in subjective quality of life as well as hope, self-esteem, and empowerment—factors also correlated with self-stigma.

Internalized stigma, in turn, has been shown to be associated with symptom severity as well as lower treatment adherence due to the fear of the label of mentally ill. Providing peer support to others has also been shown to reap other benefits, including increased self-confidence, emotional stability, sense of purpose, and meaning in life. 

 

What is Electroconvulsive Therapy?

 

Electroconvulsive therapy (ECT) is a procedure, done under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure.  ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions.

ECT often works when other treatments are unsuccessful and when the full course of treatment is completed, but it may not work for everyone.

Much of the stigma attached to ECT is based on early treatments in which high doses of electricity were administered without anesthesia, leading to memory loss, fractured bones, and other serious side effects.

ECT is much safer today.  Although ECT may still cause some side effects, it now uses electric currents given in a controlled setting to achieve the most benefit with the fewest possible risks.

 

 

Jan Ricks Jennings

Senior Consultant

Senior Management Services

 

Jan.Jennings@EagleTalons.net

JanJennings@Blog.Blogspot.com

 

June 11, 2021