Journey through the mental health branch
Paul Illingworth, Laura Singleton in Mental Health Nursing, 2013
A module on therapeutic approaches may also include some of the main therapeutic interventions that are used in mental health care, such as cognitive behaviour therapy (CBT), solution focused brief therapy (SFBT), dialectical behaviour therapy (DBT), family/systemic interventions, psychosocial nursing and psychodynamic approaches. There are many books and papers that cover these therapies, so they are not discussed further here. Therapeutic approaches may also cover interpersonal communication skills with service users with a range of mental health problems and of various ages, as while good interpersonal communication skills are similar for all people, different approaches may be useful depending on age, culture and potentially on the person’s current mental state. Medication and other interventions such as electro-convulsive therapy (ECT) may also be included in therapeutic approaches, and usually recognition is given to the importance of incorporating pharmacological interventions with psychotherapeutic interventions such as those listed in this paragraph.
Treating Depression in Elderly People
José León-Carrión, Margaret J. Giannini in Behavioral Neurology in the Elderly, 2001
Today, electroconvulsive therapy (ECT) is considered a safe and effective technique for the elderly population. The effectiveness oscillates between 70 and 80% of total recuperations or very important improvements for this age group. Steck et al.,36 after reviewing 18 studies on effectiveness, found a percentage between 50 and 100% for significant clinical improvements. In addition, in general, ECT is tolerated better than psychiatric drugs and there are no clear data on cognitive decline in the long term associated with this therapy, although as a precaution, the initial use of nondominant unilateral ECT is recommended. Additionally, it is necessary to modify the dosage of the drugs normally used and to increase the intensity of the convulsive stimulus (with age, the threshold increases). In practice, while the patients receive ECT treatment they should continue taking antidepressants as well, maintaining the dose for at least 6 months, because ECT does not prevent relapses.
Electricity, magnetism and mood
Stephen Curran, John P Wattis in Practical Management of Affective Disorders in Older People, 2018
Cognitive side-effects of ECT have been extensively studied: the Systematic Review of the Efficacy and Safety of Electroconvulsive Therapy47 and the American Psychiatric Task Force Report15 both reviewed the literature on this topic. In the case of older adults with severe depressive illness, they may well have problems on memory testing prior to treatment, and tests of memory carried out after ECT may show improvement, presumably because the memory deficits associated with depression have improved in response to treatment.67,68 Weiner69 highlighted the complex relationship between objective and subjective memory impairment. Although a small proportion of people complain of persisting memory difficulty after treatment and may have persisting loss of memory for events during the period before, during and after ECT,70,71 objective memory impairment (as demonstrated on objective tests) is generally reversible after conclusion of the ECT course.
Retinal Nerve Fiber Layer Thickness Alterations after Electroconvulsive Therapy in Patients with Mental Illness
Published in Seminars in Ophthalmology, 2018
Didar Ucar, Nazım Yıldız, Mustafa Hepokur, Fatih Baltu, Elvin Guliyev, Murat Emul, Ahmet Murat Sarıcı
Electroconvulsive therapy (ECT) is an alternative, efficient, and safe treatment modality, especially in certain treatment-resistant neuropsychiatric disorders. In one comprehensive review, the ongoing neurotrophic effects of ECT in clinical studies and electroconvulsive shock (ECS) in preclinical studies were emphasized in the hippocampus, prefrontal cortex, amygdala, and hypothalamus.7 Although there are prospective magnetic resonance imaging (MRI) studies investigating the effects of ECT on the gray matter in the literature, we could not find any studies searching for alterations in the gray matter after ECT sessions by measuring the RNFL thickness using OCT. We hypothesized that there might be some alterations in the RNFL thicknesses between the pre- and post-ECT values in patients with mental illnesses. Therefore, for the first time, we investigated the ECT-induced alterations in the RNFL in patients who underwent ECT and compared them with the values obtained from healthy controls.
Immune-based strategies for mood disorders: facts and challenges
Published in Expert Review of Neurotherapeutics, 2018
Gabriela D. Colpo, Marion Leboyer, Robert Dantzer, Mahdukar H. Trivedi, Antonio L. Teixeira
Electroconvulsive therapy (ECT) is an effective treatment for depression, being used in medication-resistant patients or patients suffering from severe psychotic depression. IL-6 activity was increased after a single session of ECT [169]. Fluitman et al. (2011) observed that a single session of ECT was associated with increased production of IL-6, IL-10, and TNF-α, as well as decreased production of IFN-γ in peripheral monocyte cells culture [170]. After a single session of ECT, plasma IL-1β and IL-6 concentrations increased over the following 3 h, returning to baseline concentrations in 24 h [171]. Hestad et al. found that, although ECT increased TNF-α 1 h after the first session, repeated treatments gradually reduced TNF-α that reached levels comparable to healthy controls at the end of the study [172]. Recently, Freire et al. showed that the combination of ECT with pharmacotherapy was associated with IL-6 reduction, but IFN-γ and TNF-α increase. No significant results were found for IL-2, IL-4, IL-10, and IL-17 [173]. These results suggest that ECT has significant immunomodulatory effects in patients both in the short and long-terms.
Do Psychiatrists Hear Their Patients' Voices? The Importance of Qualitative Research on Brain-Related Technologies
Published in AJOB Neuroscience, 2018
The lack of attentiveness to patients’ subjective experience, in the context of the clinical use of brain-related technologies, may be problematic from clinical and ethical perspectives. For example, researchers assume that electroencephalogram (EEG) studies have no potential of causing any physical harm. However, this perception, which is probably correct from an “outward” objective biological perspective with regard to normal subjects, may be mistaken for some psychiatric patients, due to “inward” subjective reasons. The data pertaining to electroconvulsive therapy (ECT)-related anxiety (Obbels et al. 2017) may suggest that undergoing a procedure that includes a direct attachment to a patient's head may provoke realistic and unrealistic fears. This may be especially disturbing with regard to subjects who suffer from psychotic disorders. It is not unrealistic to assume that for some of these patients, the utilization of an unfamiliar (especially in the case of an invasive) brain-related technology may give rise to a paranoid attitude toward the medical staff conducting the study. Theoretically, this concern is more disturbing with regard to patients with delusional content relating to thought insertion or thought broadcasting. In turn, one can expect that the patient's adherence to therapy will be reduced. In this scenario, the brain-related intervention will indirectly result in a negative effect on the patient's well-being. Indeed, subjective experiences have been found to be a contributing factor to nonadherence to antipsychotics (Moritz et al. 2014; Taira et al. 2006).
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