PSYCHIATRIC NURSING

Psychiatric treatment approaches

Dr. Naiema Gaber El-sayed

Learning Objectives

• Determine the components of Psychiatric treatment approaches.

• Discuss the mechanism of action of each modality

• Explain the nursing role in each modality

Therapeutic Approaches

• Psychopharmacology• Therapeutic Groups• Intervention with

Families• Mileu Therapy• Relaxation Therapy• Assertiveness Therapy• Promoting Self-Esteem

• Cognitive Therapy• Behavioral Therapy• Nutritional therapy• Electroconvulsive

Therapy• Complementary

Therapy• Client Education

I- Psychopharmacology1. Antipsychotic drugs2. Antidepressants3. Mood stabilizers4. Anxiolytic drugs5. Sedative-Hypnotic Agents6. Psychostimulants7. Cognitive Enhancers and treatment for

Alzheimer's diseases8. Drugs for substances abuse disorders

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PSYCHOPHARMACOLOGY

1-ANTI-PSYCHOTIC DRUGS

Antipsychotic agents are effective for treating nearly every medical and psychiatric condition where psychotic symptoms or aggression are present. They are currently used routinely in

the management of psychosis and/or agitation associated with psychotic diordersExamples : 1- First degenerations as Haldol an Loxitane)2-Second degeneration as: Clozaril and Zyprexa)

2 -ANTIDEPRESSANTS• indications for antidepressants including panic

disorder (PD), obsessive–compulsive disorder(OCD), bulimia and posttraumatic stress disorder (PTSD).

• Many of these illnesses respond best to combination treatment modalities that include medication and various forms of psychotherapy.

Example lo Antidepressant

• Monoamine Oxides' Inhibitors as Trazodone,• Serotonin Reuptake Inhibitors as DuloxetineSIDE EFFECTS• Once the choice of an antidepressant has

been made, the main goal is to maximize therapeutic effects and minimize side effect

3 -MOOD STABILIZERS

Mood stabilizers fall into three families: (1) lithium (2) anti-epileptic drugs (anticonvulsants) (3) second-generation antipsychotics.

4 -ANXIOLYTIC DRUGS Drugs used in treatment of anxiety and anxiety

disorder.

• Barbiturates and meprobamate were some of the first agents shown to be effective in decreasing anxiety, but were addictive in overdose.

• Along with medication interventions, psycho-education and psycho therapeutic interventions are often part of treatment anxiety disorders.

5 -SEDATIVE–HYPNOTICAGENTS

• Medications used to control the condition could cause insomnia. Insomnia is common disabling medical and psychiatric conditions

• Benzodiazepines is an example of hypnotics. The risk for abuse and physiological dependence are the least likely complications

6- PSYCHOSTIMULANTS

• The term Psychostimulants refers to the ability of these compounds to increase CNS activity in some but not all brain regions.

• The Psychostimulants methylphenidate, amphetamines, and atomoxetine reduce the core symptoms of childhood attention deficit/

hyperactivity disorder

7- COGNITIVE ENHANCERS AND TREATMENTS FOR ALZHEIMER’S

DISEASE

• The Choline Inhibitors (ChIs ) are approved for the treatment of mild to moderate Alzheimer’s disease.

• Memantine is currently the only agent approved for the treatment of moderate to severe Alzheimer’s disease

8- DRUGS FOR TREATING SUBSTANCE ABUSE DISORDERS• Disorders of substance abuse are one of the

commonest of psychiatric illnesses. They often complicate other psychiatric disorders together with their complications.

• Examples of abuse substances are: Alcohol Intoxication, Sedative–Hypnotic Intoxication, Opiate Intoxication, Cocaine and Amphetamine Intoxication.

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– Foods high in TYRAMINE:• A – aged cheese and avocado• B – bananas, beer• C – chocolate, coffee, chicken and pork

liver• D – dried and preserved foods (pickles)• E – etc (yogurt, sausage)• F – fermented foods (beer, wine)

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9-ANTI-MANIC DRUGS (Mood Stabilizers)

LITHIUM Is used for manic phase of manic-

depressive illness and refractory depression;

The exact action of lithium is UNKNOWN

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10- ANTIANXIETY DRUGS

• Are also known as anxiolytics;

• Classified into:a. Benzodiazepines as Valium,

Ativan,

b. Sedative-Hypnotics as Barbiturates

The role of the nurse in Psycho-pharmachogy therapy

• Carry out the treatment on prescriptive time • Monitoring the patient’s condition to detect the effect

of the drug on health status• Reassure that symptoms will decrease in 2 - 4 weeks• Increase fiber and fluid diet.• Assess for adverse drug reactions.• Assess for suicide potential.• Detect signs of early drug toxicity: as Vomiting –

Diarrhea and Drowsiness, Muscular weakness, Lack of coordination, Polyuria

2-Therapeutic GroupsTherapeutic groups Focus is on group relations,

interactions between group members, and the consideration of a selected issue.

Functions of a Group• Socialization.• Support. • Task completion. • Camaraderie. • Informational.• Normative. • Empowerment.• Governance.

Types of Therapeutic Groups• Task groups. to accomplish a specific outcome.• Teaching groups. to convey knowledge and information to a

number of individuals.• Supportive/therapeutic groups. to prevent possible future

upsets by teaching effective ways of dealing with emotional stress.

• Self-help groups: composed of individuals with a similar problem Serve to reduce the possibilities of further emotional distress leading to pathology and necessary treatment. May or may not have a professional leader. Run by members, and leadership often rotates from member to member

Therapeutic groups vs. group therapy

• Group therapy has a sound theoretical base, and leaders generally have advanced degrees in psychology, social work, nursing, or medicine.

• Therapeutic groups are based to a lesser extent on theory. Focus is on group relations, interactions between group members, and the consideration of a selected issue.

• Leaders of both types of groups must be knowledgeable about group process (the way in which group members interact with each other) as well as group content (the topic or issue being discussed in the group).

The Role of the Nurse in Group Therapy

• Guidelines set forth by the American Nurses Association specify that nurses who serve as group psychotherapists should have a minimum of a master’s degree in psychiatric nursing.

Curative Factors of Groups• Instillation of hope. • Universality. • Imparting of information. • Altruism. • Corrective recapitulation of the primary family group. • Development of socializing techniques.• Imitative behavior. • Interpersonal learning. • Group cohesiveness. • Catharsis. • Existential factors.

Phases of Group DevelopmentInitial or Orientation Phase• Leader and members work together to establish rules and goals for the group.• Leader promotes trust and ensures that rules do not interfere with fulfillment of

the goals.• Members are superficial and overly polite. Trust has not yet been established.Middle or Working Phase• Productive work toward completion of the task is undertaken.• Leader role diminishes and becomes more one of facilitator.• Trust has been established between the members, and cohesiveness exists.• Conflict is managed by the group members themselves.Final or Termination Phase• A sense of loss, precipitating the grief process, may be experienced by group members.• The leader encourages the group members to discuss these feelings of loss and to

reminisce about the accomplishments of the group.• Feelings of abandonment may be experienced by some members. Grief for

previous losses may be triggered.

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ELECTROCONVULSIVE THERAPY• An electrical current (70-150 v) passes thru electrodes applied to

the patient’s temple to induce a generalized tonic-clonic seizure (or Grand Mal) and unconsciousness;

• Is use when other traditional therapies failed;

• Length of application: 0.5 - 2 secs;

• Length of seizure: 30 - 60 secs;

• The cumulative effect of ECT is approx 220 - 250 secs.

• Used to treat patients with depression, bipolar disorders, manic, and psychotic symptoms;

• The exact action of ECT remains unknown;

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∞ Nursing Interventions:• Obtain an informed consent from the patient, family, or

legal representative of the patient;

• Teach the family and the patient about the treatment and what to expect like:– Short-term memory loss – resolve after 4-8 weeks;– Disorientation– Confusion – Respiratory depression

• NPO post-midnight to prevent aspiration and vomiting; at least 8 hrs.

• Remove all prostheses including hairpins and dentures;

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• Administer all preop meds as indicated like:1. AtSO4 – to decrease oral and nasal secretions*;2. Succinylcholine – muscle relaxant;3. Short-acting barbiturates* – Does not affect seizure threshold– Ex. Methohexital

• Vital signs must be monitored before and after the procedures;

• Tongue guard is inserted to prevent tongue injury during seizure;

• Monitor heart rate and rhythm, blood pressure, and EEG;