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Psychiatry 1 – Practical # 4

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Psychiatry 1 – Practical # 4 Psychiatrická klinika LFUK a UNB, Bratislava PSYCHOTHERAPY & PSYCHIATRIC REHABILITATION Psychiatry 1 – Practical # 4 Authors: Mgr. Miroslava Zimányiová, PhD. MUDr. Dana Krajčovičová, PhD. PhDr. Michal Hajdúk, PhD. Supervision: prof. MUDr. Ján Pečeňák, PhD. Learning objectives: Overview of non-biological treatment methods in psychiatry Focus on: Psychotherapy Psychoeducation Psychosocial rehabilitation Therapeutical methods in psychiatry Biological therapies - Pharmacotherapy - Brain Stimulation Methods - Phototherapy - Sleep Deprivation Psychotherapy Psychoeducation Psychosocial rehabilitation Psychotherapy Use of psychological methods in treatment Therapeutical interaction between Psychotherapist and Client/Patient Could be used in all fields of medicine, most frequently in psychiatry as part of complex treatment (sometimes as a 1st treatment choise) Example: Depression BIO - PSYCHO - SOCIAL MODEL Biological predisposition (congenital, gained) Psychological factors Social factors Complex Therapy of Depression PHARMACOTHERAPY Antidepressants Antipsychotics Anxiolytics, Hypnotics, Sedatives, Thymoprophylactics, Perceptiveness Compliance Augmentative therapy PSYCHOTHERAPY Supportive + Fototherapy Systematic + ECT + Sleep deprivation + rTMS Basic Aspects of Psychotherapy More than 400 psychotherapeutical schools Use of various methods and techniques For all applies: Psychotherapeutical relationship Metodology Emotion processing Problem solving Psychotherapeutical Relationship The bound between therapist and patient, it si build since first meeting Basis = feeling save and secure /for patient/ Is the most important variable in psychotherapeutical effect (research: 70% efficiency with no regards of methods and intervention uses) Earch contact doctor – patient has a therapeutical effect (or anti-therapeutical) Psychotherapeutical Proces In the proces of psychotherapy patient experiences strong emotions Therapy allows new corrective experience In the proces of therapeutical change patient experience strong feelings towards therapist and he gets insights into his own relationships and life situation and he practice new attitudes and behavior What we Influence in Psychotherapy– Education about Experience SITUATION: Thoughts Thoughts: What I was thinking about? Emotions Behavior Emotions: What did I feel? Body reactions: How my body reacted? Body reactions Behaviour: What did I do? Transference and Countertransference Transference – the process by which emotions associated with one person (parent) unconsciously shifts to another Countertransference – a therapist's own repressed feelings in reaction to the emotions, experiences or problems of patient Psychotherapeutical schools Psychoanalysis and dynamic therapies Humanistic therapies Cognitive-behavioral therapies Dynamic psychotherapies Influence of past experience Bringing unconscious processes into conscious mind and their impact on actual experience Sigmund Freud – Psychoanalysis Carl Gustav Jung – Analytical psychology Alfred Adler – Individual psychology Humanistic psychotherapy Selfractualisation Development of inner experience Fullfill one´s meaning of life Frederick Pearls = Gestalt therapy Carls Rogers = PCA (Person centered approach) Viktor Frankl = Logotherapy Cognitive-behavioral psychotherapy Learning (conditioning etc.) Training Experiment Hans J. Eysenck, Albert Ellis, Aaron Beck Training programmes (Aversive therapy, Systematic desenzitisation, ...) Indication for psychotherapy - Adults Relationships Depression and anxiety Stress and stress inducted disorders Neurotic disorders Psychosomatic disorders Personality disorders Eating disorders Stabilized psychosis (supportive psychotherapy) Indications for psychotherapy: Children Anxiety Addaptation problems Neurotic disorders (enuresis, tics, pain - abdomen, head) ADHD, agressive behaviour Teenage age – selfesteeem, problems in relationships, refusal, identitiy problems, anxiety, depression, selfharming, eating disorders Contraindications of Psychotherapy Consciousness disorders Acute states in psychiatry (acute suicidal patient, acute psychotic state, severe depression with psychotic signs) Demencia, severe cognitive deficit Types of psychotherapy – number of members 1. Individual psychotherapy 2. Group psychotherapy 3. Couple psychotherapy (a couple = client) 4. Family therapy Individual psychotherapy • Session – 1 client and 1 therapist • Place of session (work-room, „safe place“) • Time frame (50 minutes, 1x week) • Aim – to understand themselves, the client´s situation, building resilience for life events, selfacceptation • Payment: client/insurance • Length: short-term – up to 25 session • Long-term – even few years Group Psychotherapy Number of members: 2-15 (optimal 5-10 members) Time frame: Max 90 min, optimal 60 min. Frequency: 1-2 x week Total time schedule: 6-8 weeks (in our Day-Care Center), few months Mechanisms: - Group dynamics - Group structure - Group cohesiveness Factors: membership, emotional support, helping others, selfexploration and selfperormance, feedback, insight, corrective experience, new behaviour pattern training, new information, new social skills Group Psychotherapy • Reaching therapeutical goals using group dynamics = relationships and interactions between group members • Mental health improvement, elimination/decreasing of social functioning malfunction and adaptation improvment Goals: • Insight into problems of group members and help them to change maladaptive attitudes • Change maladaptive patterns of behaviour • To mediate know-how about interpersonal and group processes • Support of personality maturation • Elimination of pathological symptoms (training, interpersonal conflicts solving) Group Therapy Principles 1. Honesty 2. Responsibility 3. Confidentiality 4. „STOP“ Right 5. Tolerance 6. Timing /beginning and end/ 7. One-member at a time 8. Group leader intervene only when necessary 9. Questions for all members 10. No gossips /no talking about member who is not present/ Types of groups According members: homogenous and heterogenous According functioning: Open or closed groups Accordign topic: •Biography •Thematic •Interaction Roles in group: Monopolista, Kvaziterapeut, Agitátor, Moralista, Intelektuál, Kverulant, Agresor, Autista Group leader: aktive leader, coordinator, member of group or facilitator Developmental stages of closed group: 1.Stage of orientation and dependance 2.Stage of conflicts and confrontations 3.Stage of coherence 4.Stage of productivity 5.Final stage Rehabilitation in Psychiatry Measures with the aim to include patient with mental disease back into everyday life 1.Psychoterapeutical-rehabilitation procedures: Art and creative activities (arttherapy, bibliotherapy, musiktherapy) 2.Rehabilitation procedures: Work and activation therapy (ergotherapy) Self-care skills training 3.Psychoeducation procedures: Psychoeducation program (PRELAPS and various modifications) 4. Other procedures: Physical activity (walks) Sociotherapeutical club Individual work with families Rehabilitation in Psychiatry Proces of social functioning restoration and life satisfaction of patients Professionals: • Psychiatrists • Social workers • Psychologists • Nurses and other health professionals Goal: support of symptom recovery or improvement of personal distress • Decreasing of stigmatisation and prejudice effect • Help patient with reintegration into community • Improvement of psychosocial functioning Day-Care Center at Psychiatry Clinic and LF UNB Programme • Psychotherapy – individual, group, psychoeducation • Activation therapy • Pharmacotherapy • Leisure-time activities Time-frame • maximum 3 months – covered by insurance Indications • Schizophrenia spectrum disorders • Affective disorders Psychotherapeutical approaches used at PK LF UK a UNB Forms of group therapy: • Social and cognitive training (Metacognitive training) • Social skills training (Integrated Psychotherapeutical program IPT) • Communication and assertiveness training • Therapeutic community – features of cognitive- behavioral psychotherapy and supportive psychotherapy • Individual interview with pacient in supportive psychotherapy • Relaxation and autogene training Psychoeducation – definition and goals Education Program = is a kind of psychotherapeutical treatmetn, similar to racional psychotherapy, oriented on the patient and his family. Psychoeducation goals: 1. To extend knowledge of psychiatric patient about his psychic disorder 2. Better understanding of disease, insight, warning signs of relaps, better compliance on treatment. 3. Important is also education of relatives. Psychosis treatment must be complex. One part of complex treatment is education programme. Education is not a single procedure, it is a process. Psychoeducation Effect Mechanisms • Education mechanism itself • Improvement of communication and cooperation of pacient (family) on treatment with doctor (medical stuff) • More active involvement of pacient (family) into treatment • Decreasing of Expressed Emotions intensity in the family • Insight creation and maintenance in patient • Interpersonal learning (pacient, family) • Emotional support (pacient, family) Psychoeducation Group - Management 1. Skilled and trained trainer (doctor, psychologist, nurse) 2. Information visualisation 3. Appropriate amount of information /not to overwhealm patiensts/ 4. Adujst topics to needs and requirements of patients 5. Allow patients to express their opinions - discusion 6. Evaluation, and
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