Treatments psychological therapies

The core problem with the antipsychiatry approach is its practical limitations. How exactly does it assist the distressed individual who is suffering from the delusion that they have an atomic bomb inside their body It will be shown later that psychotherapy without drug treatment is largely ineffective (as Jung and Fried both concluded), whereas psychological therapy combined with active drug treatment is the most effective therapeutic approach. 

Compare the use of pharmacotherapy alone, psychological therapy alone, and both therapies together, in the treatment of either schizophrenia or major depression. 

Bond Al, Wingrove 1, Valerie CH, Lader MH. Treatment of generalised anxiety disorder with a short course of psychological therapy, combined with buspirone or placebo. 1 Affect Disord 2002 72 267-271. 

In pharmacological treatment, because of the considerations discussed above there is often the conclusion that substitute prescribing produces the best results in opiate addicts with the added condition of personality disorder, particularly of the antisocial or borderline type. There should also be awareness of treatments which, although not specific for personality disorder, have some demonstrated utility in the condition alongside psychological therapies, including serotonergic antidepressants and low-dose antipsychotics (Markovitz 2004). 

A combination of medication and psychological therapy is the treatment of choice for panic disorder, as demonstrated by the following ... 

Careful recording of the history of treatments and their outcomes and adverse events is cracial. Though beyond the scope of this chapter, considerahon of specific psychological therapies, such as cognitive behavioural therapy, is essenhal. 

A placebo is an inactive treatment, either in the form of an inert pill for studying a new drug treatment or an inactive procedure for studying a psychological therapy. 

Department of Health (2000c). Human Resources Performance Framework. London. Department of Health (2001). Treatment Choice in Psychological Therapies and Counselling. London. 

Medications including serotonin reuptake inhibitors have been shown to be helpful and should be considered in patients that are resistant or not responsive to osteopathic treatment. Adjunctive therapy combining medication and osteopathic manipulative techniques is often more effective in severe cases than either is independently. Use of outside resources including support groups, social services, and psychological interventions may also need to be considered. 

Local Inproving Access to Psychological Therapies (lAPT) services may suffice, but Denise may need secondary care input - discuss with the team psychologist. Evidence-based treatments include ... 

Hall SM, Reus VI, Munoz RF, et al Nortriptyline and cognitive-behavioral therapy in the treatment of cigarette smoking. Arch Gen Psychiatry 55 683-690, 1998 Hall SM, Humfleet GL, Reus VI, et al Psychological intervention and antidepressant treatment in smoking cessation. Arch Gen Psychiatry 59 930-936, 2002 Hayford KE, Patten CA, Rummans TA, et al Efficacy of bupropion for smoking cessation in smokers with a former history of major depression or alcoholism. Br J Psychiatry 174 173-178, 1999... 

Systemic therapy for acne includes antibiotics, isotretinoin and hormones (Tables 11.8 and 11.9). Oral treatment is indicated in cases of 1) moderate and severe acne 2) acne with tendency to scars development and 3) psychological distress related to acne. 

For some conditions, a large placebo effect can be anticipated. For example, studies of hormone replacement therapies for hot flashes in postmenopausal women consistently show a 50% decline from baseline in the number of daily hot flashes in the placebo group. Therefore, in order to show significance, an active treatment must produce an effect that is substantially larger than 50%. A marked placebo response is commonly observed with any condition that has a subjective component, such as chronic pain (e.g. arthritis), episodic pain (e.g. headaches), psychological states (e.g. anxiety), and certain physiologic measurements (e.g. blood pressure). 

Determine appropriate pharmacologic and psychological treatments (e.g., cognitive-behavioral therapy), including what has been helpful to the patient in the past. 

Determine success of the overall treatment plan by obtaining a thorough history of adverse events experienced with the previous chemotherapy/endocrine therapy treatment and objective measures of response to therapy. Assess effects on quality-of-life measures such as physical, psychological, and social function and well-being. 

Although it has received the most attention, CBT is not the only form of psychotherapy that is effective for depression. Other psychological treatments include interpersonal psychotherapy, short-term psychodynamic therapy and non-directive supportive therapy. Interpersonal psychotherapy focuses on problems that arise in interpersonal relationships, such as marital conflict, the loss of a loved one and social isolation.20 Short-term psychodynamic therapy focuses on acquiring insight and understanding of unresolved conflicts arising from the person s childhood. It is based on Freud s psychoanalytic theory, but requires only months, rather than the years it takes for a full psychoanalysis.21 Non-directive supportive therapy provides a warm, supportive atmosphere in which the depressed person can explore life issues... 

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