Psychiatric therapy basis

Pauling recently introduced the concept of orthomolecular psychiatry in an attempt to redefine the basis of mental disease and the treatment thereof. He suggests that aberrant mental function and behavior may be due to inadequate brain levels of essential nutrients (e.g., vitamins, amino acids, fatty acids, etc.). Orthomolecular psychiatric therapy, therefore, would provide optimum concentrations of these vital substances in order to correct alleged cerebral deficiencies. Diagnostic methods for determining optimum levels of a pertinent nutrient for individual patients are not yet available. One critic has already taken issue with these views. Other investigators have independently considered the possibility that abnormal plasma levels of free fatty acids may influence the erratic dietary intake of schizophrenic children. 

Guidance on the clinical indications for benzodiazepine therapy is available from various sources (Task Force Report of the American Psychiatric Association 1990 Ballenger et al. 1998a Bandelow et al. 2002). Long-term therapy is most likely to present problems with discontinuation and is usually reserved for cases that have proved resistant to treatment with antidepressants alone. Patients may benefit from a 2-4 week course of a benzodiazepine whilst antidepressant therapy is initiated, as this counteracts the increased anxiety caused by some drugs (Goddard et al. 2001). A benzodiazepine maybe useful as a hypnotic in some cases of anxiety disorder, and can be used by phobic patients on an occasional basis before exposure to a feared situation. 

Patient assessment is the basis from which a pharmaceutical care plan evolves. Problem identification and therapeutic monitoring cannot occnr nntU a thorongh assessment is complete. The initial assessment is also the basis for evalnating response to therapy throughout the course of treatment. Psychiatric assessment requires sensitivity and good listening skills on the part of the clinician because it is based primarily on a subjective interview and not objective tests. With careful data collection, clinicians can make substantial contributions to care that improve patient outcomes. 

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