Reality Therapy

Glasser, W. Reality Therapy A New Approach to Psychiatry. New York Harper Row, 1965. 

Social detoxification, which involves the nonpharmacological treatment of alcohol withdrawal, has been shown to be effective (see Naranjo et al. 1983). It consists of frequent reassurance, reality orientation, monitoring of vital signs, personal attention, and general nursing care (Naranjo and Sellers 1986). Social detoxification is most appropriate for patients in mild-to-mod-erate withdrawal. The medical problems commonly associated with alcoholism (Sullivan and O Connor 2004) may substantially complicate therapy, so that care must be taken to refer patients whose condition requires medical management. 

People with dementia and their carers require access to a variety of health and social care services for treatment, information and counselling, community-based support, respite care and long-term residential care. Treatment may include behavioural therapies (e.g. reality orientation, cognitive stimulation and validation therapy) or pharmacological treatment with acetylcholinesterase inhibitors. 

Zanetti O, Frisoni GB, De Leo D, Dello Buono M, Bianchetti A and Trabucchi M (1995). Reality orientation therapy in Alzheimer disease useful or not A controlled study. Alzheimer Disease and Associated Disorders, 9, 132-138. 

The theoretical complications posed by random chromosomal integration became a medical reality in 2002, when two children who had received retroviral-based gene therapy 2 years previously developed a leukaemic-like condition. The initial clinical trial aimed to treat X-linked severe combined immunodeficiency (SCID-X1), a hereditary disorder in which T-lymphocytes and NK cells in particular do not develop, due to a mutation in the gene coding for the yc cytokine receptor subunit. The clinical consequence is near abolition of a functional immune system. 

RNAi technology has obvious therapeutic potential as an antisense agent, and initial therapeutic targets of RNAi include viral infection, neurological diseases and cancer therapy. The synthesis of dsRNA displaying the desired nucleotide sequence is straightforward. However, as in the case of additional nucleic-acid-based therapeutic approaches, major technical hurdles remain to be overcome before RNAi becomes a therapeutic reality. Naked unmodified siRNAs for example display a serum half-life of less than 1 min, due to serum nuclease degradation. Approaches to improve the RNAi pharmacokinetic profile include chemical modification of the nucleotide backbone, to render it nuclease resistant, and the use of viral or non-viral vectors, to achieve safe product delivery to cells. As such, the jury remains out in terms of the development and approval of RNAi-based medicines, in the short to medium term at least. 

As genomic research progresses, the possibility of replacing a person s faulty genes with normal genes becomes a reality (Chapter 4). Currently, there are many ethical and scientihc issues facing gene therapy. 

The clinician will be faced with assessing the overall risk for adverse effects, which have to be weighed against potential benefits as well as the availability of alternative therapies and the costs. The reality is that clinicians will have to make their decisions based on the risk assessment gathered from large, population-based studies. However, this information is not available at this moment. 

Spatial cooperation is a term coined to describe a situation when disease in one particular anatomic site is missed by one modality but is treated adequately by another. The essence of this is that radiation is a local therapy that will not impact on metastatic disease beyond the planned field borders. Systemic cytotoxic chemotherapy is traditionally used to address the potential distant spread of cancer. In the original description of this mechanism there is no assumption of an interaction between the drugs and radiation with the idea being that the best radiation and best chemotherapy be administered independently of toxicities. The classic example used in several textbooks to illustrate this is the treatment of childhood leukemia with systemic chemotherapy, while their central nervous system, a potential sanctuary site where disease is not treated adequately by chemotherapy, is treated by radiation (28). The reality of the interaction between radiation and chemotherapy is that the dose and timing of radiation are adjusted accordingly to minimize their impact on the neural tissues. 

Developing active and effective education for patients and the general public, including children and young people, in the realities of medical practice, the nature and inevitability of risk, in reasonable expectations of therapy and in the rational and discriminating use of dmgs. 

Novices to drug therapy should be apprised of another reality. Most of us expect that for every illness we bring to a physician there is a clear medication choice. Finding appropriate drugs to treat psychiatric symptoms, by contrast, often involves lengthy experimentation. Here s what my interviewees had to say ... 

Figure 6.2 Virtual reality uses computer graphics to simulate the experience of being in a 3-D world. This type of therapy is used to treat phobias. By wearing a headset and entering a virtual world, patients can come face-to-face with their fears while remaining in a safe environment.

Today s healthcare policy-makers, including government officials, health insurance companies and managed-care organizations, are faced with the reality of limited resources for healthcare and the knowledge that much medical care is of uncertain value. The value of vitamin E therapy in Alzheimer s disease, for example, is still unclear, but some physicians have recommended it for years without any real measures of its effect on the disease. 

This section describes the role of interferons as cancer drug therapies, emphasizing key contributions of recombinant biotechnology that made these therapeutic advances a reality. Additionally, some of the mechanisms by which the IFNs elicit antiproliferative or antitumor effects wiU be explored. 

The complex of imatinib and other small-molecule ABLl inhibitors as determined by analysis of crystal structures will continue to assist in the development and optimization of inhibitors that are active against mutations conferring resistance in CML (120). The rapidity with which these developments have been occurring is truly astounding and underlies the continued optimism that the treatment of CML and disorders related to it and other disorders where the molecular mechanisms of disease are being unraveled, will become more and more treatable in the future. There is little doubt that combination therapy of CML and related disorders will be a reality in the not-distant future (121). 

---