And psychotherapy

Ion Anghelescu, Isabella Heuser Department of Psychiatty and Psychotherapy, Charite, CBF, Berlin, Germany... 

In research and clinical treatment of substance use disorders, pharmacotherapy and psychotherapy are frequently combined. Medication is often used as a maintenance drug, to reduce cravings or intoxication, or to produce aversion to a substance, while the focus of psychotherapy may be to encourage abstinence, teach the patient new coping skills, or improve motivation to address drug or alcohol problems. 

O Malley SS, Jaffe AJ, Chang G, et al Six-month follow-up of naltrexone and psychotherapy for alcohol dependence. Arch Gen Psychiatry 53 217—224, 1996... 

Educate the patient about nonpharmacologic measures such as stimulus avoidance, dietary changes, acupressure or acupuncture, and psychotherapy. 

A wide range of treatment options are now available for men with ED. These include medical devices, pharmacologic treatments, lifestyle modifications, surgery, and psychotherapy. 

Hauke, Christopher. "The Phallus, alchemy and Christ Jungian analyis and the sublime." In On the sublime in psychoanalysis, archetypal psychology and psychotherapy, ed. Petruska Clarkson, 123-144. London Whurr Publishers, 1997. 

This issue focuses on the themes of certainty and doubt, fragility and tenacious identity, in the psychotherapeutic process. Newman s paper explores some central tensions in the relation between consciousness and unconsciousness. Rowan offers a masterly account of what he plausibly claims are established salient features of the psychotherapeutic process, in terms of the analogy of alchemy. Balick s account of the 7th UKCP Professional Conference evokes the tensions activated by the interface between neuro-science and psychotherapy. And Tan and Zhong face us with the challenge of a communally and certainty based method, in relation to some antisocial sexual patterns, which appears to be more effective than more cautious established Western approaches... 

Psychotherapy looks even better when its long-term effectiveness is assessed.17 Formerly depressed patients are far more likely to relapse and become depressed again after treatment with antidepressants than they are after psychotherapy. As a result, psychotherapy is significantly more effective than medication when measured some time after treatment has ended, and the more time that has passed since the end of treatment, the larger the difference between drugs and psychotherapy. This long-term advantage of psychotherapy over medication is independent of the severity of the depression. Psychotherapy outperforms antidepressants for severely depressed patients as much as it does for those who are mildly or moderately depressed.18... 

If both drugs and psychotherapy alleviate depression, maybe the combination of the two would work even better. This could be true even if the effects of antidepressants are placebo effects. As we saw in Chapter 4, taking two placebos can be more effective than taking only one. 

Nondrug therapies include emotional support from family and friends, education about the condition, and psychotherapy. 

For years, psychiatric and drug abuse disorders were not even treated together. Now we know they commonly co-occur, which means for many years clients were getting only partial treatment. Even today we are still not sure how to treat these co-occurring conditions simultaneously in a consistently effective way with both psychotherapy and pharmacotherapy (see Chapter 5). The next century is likely to see many advances in both pharmacotherapy and psychotherapy to treat co-occurring conditions. There are effective methods to treat drug abuse and to treat other co-occurring psychiatric disorders. The next frontier in research is to learn how to combine these approaches in a way that can treat multiple disorders at once ... 

Treatment can make a major difference in your life. The treatment process often includes components of psychoeducation (learning new information about changing your behavior) and psychotherapy (learning new skills to reach your goals and learning new information about yourself). The duration of these sessions varies and often is completed on an outpatient basis (although some people may opt for inpatient services if they feel they need extra structure and support). Psychoeducation and psychotherapy provide new opportunities to improve your life in very significant ways. 

Relapse Prevention as Part of Treatment, Aftercare, and Psychotherapy... 

Although I had to drive 25 miles to reach his trailer, the results of treatment were gratifying. Providing him with Dexedrine and psychotherapy for a few months produced remarkable improvement. Not only could he go out for short walks, but he also reported with pride that he had resumed having sex with his wife. 

Nierenberg AA, Petersen TJ, Alpert JE. Prevention of relapse and recurrence in depression the role of long-term pharmacotherapy and psychotherapy. J Clin Psychiatry 2003 64(Supplement 15) 13-17. 

Treatment Resistance. Many patients with PTSD remain symptomatic despite antidepressant treatment and psychotherapy. Thus, augmentation strategies are... 

Molecular and Clinical Psychobiology, Department of Psychiatry and Psychotherapy, University of Wurzburg, Fuchsleinstr. 15, 97080 Wurzburg, Germany kplesch mail.uni-wuerzburg.de... 

The Multimodal Treatment of ADHD (MTA) Study, a large, multisite study of ADHD treatment (MTA Cooperative Group, 1999), highlights the importance of this therapeutic alliance. When outcome was measured only in terms of the child s inattention, stimulant medication alone did as well as medication plus psychosocial treatment. However, the combination of medication and psychotherapy had the best outcome in parent satisfaction and in reducing disruptive behaviors (Hinshaw et ah, 2000), which are important factors in longer-term compliance with treatment and outcome. 

Psychopharmacotherapy is the combined use of psychoactive medication and psychotherapy. Brent and Kolko (1998) define the latter as a treatment modality in which therapist and patient collaborate to ease functional psychopathological impairment through attention to (1) the therapeutic relationship, (2) the patient s behavior, thoughts, attitudes and affect (the working diagnosis), and (3) the social context and development (this is especially salient in the work of the child and adolescent psychiatrist). 

Combining pharmacotherapy and psychotherapy an evidence-based approach... 

Much of the time, treatment-extant literature doesn t provide much guidance when the patient has multiple comorbidities or already has failed best-practice initial interventions. The few available comparative treatment trials that include both medication and psychotherapy all focus on acute treatment or, less commonly, the heroic management of treatment-refractory patients. This leaves out the majority of patients for whom combined treatment is appropriate if not de rigueur, namely those who are partial responders to initial treatment and/or who require a combination of treatments because of comorbidity. Furthermore, for many clinically important decisions, it is unlikely that there will ever be randomized evidence. For example, how many SSRI trials should precede a clomipramine trial in the partially responsive child with OCD Flow long does one wait before adding a SSRI when treating a child with OCD who is not particularly responsive to weekly CBT ... 

From our clinical experience, we have found that youth with more severe and chronic depressions and those with significant comorbid disorders or who experience parental conflict often fail to respond to either monotherapy alone (Clarke et ah, 1992 Brent et ah, 1998 Emslie et ah, 1998). Therefore, severe and chronic depressions should be treated with both antidepressants and psychotherapy, and other risk factors for poor outcome (e.g., parent depression, ADHD) should be addressed with additional psychosocial and/or pharmacological interventions. 

Case reports have suggested that adding stimulant medications or combining a SSRI and a TCA or bupropion may also be effective (APA, 2000), but these combinations need to be done with caution, given the possibility of drug interactions (e.g., SSRIs cytochrome inhibition leading to toxic TCA levels). Additionally, in adults, the combination of antidepressants and psychotherapy (CBT, IPT) for patients with severe or treatment-resistant depression has been found useful (APA, 2000 Keller et al., 2000). 

---