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PSYCHIATRIC NURSING TREATMENT MODALITIES CREATED BY ADNAN ALLAM ID: 130278
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- PSYCHOPHARMACOLOGY Antipsychotic drugs . Antidepressants . Mood stabilizers • Anxiolytic drugs • Sedative-Hypnotic Agents • Psychostimulants • Cognitive Enhancers and treatment for Alzheimer's diseases • Drugs for substances abuse disorders
II-THERAPEUTIC GROUPS - Therapeutic 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
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.
III-FAMILY THERAPY The family defined: “A family is who they say they are.”(Wright & Leahy, 2000) Types of Families • Biological family of procreation • Nuclear family (incorporates one or more members of the extended family) • Sole- parent family • Stepfamily • Communal family • Homosexual couple or family
ULTRICES VENENATIS Boyer and Jeffrey describe six elements on which families are assessed to be either functional or dysfunctional. 1. Communication 2. Self-concept Reinforcement 3. Family Members’ Expectations 4. Handling Differences 5. Family Interactional Patterns 6. Family Climate
IV-MILIEU THERAPY THE THERAPEUTIC COMMUNITY Milieu therapy, or therapeutic community, is defined as “a scientific structuring of the environment to effect behavioral changes and to improve the psychological health and functioning of the individual.”
ROLE OF THE NURSE Through use of the nursing process, nurses manage the therapeutic environment on a 24-hour basis. Nurses have the responsibility for ensuring that the client’s physiological and psychological needs are met. Nurses are also responsible for - Medication administration - Development of a one-to-one relationship - Setting limits on unacceptable behavior - Client education
V- RELAXATION THERAPY Deep breathing exercises. Progressive relaxation. Modified (or passive) progressive relaxation. Meditation. Mental imagery. Biofeedback. Physical exercise
VI- ASSERTIVENESS TRAINING Honesty is basic to assertive behavior and is expressed in a manner that promotes self-respect and respect for others. Basic Human Rights
FOUR COMMON RESPONSE PATTERNS NONASSERTIVE BEHAVIOR. ASSERTIVE BEHAVIOR. AGGRESSIVE BEHAVIOR. PASSIVE-AGGRESSIVE BEHAVIOR.
NURSES ROLE • Education • Thought-Stopping Techniques
VII- PROMOTING SELF-ESTEEM Self-concept : is the cognitive or thinking component of the self, and generally refers to learned beliefs, attitudes, and opinions that each person holds to be true about his or her personal existence. Self-concept consists of : 1-The physical self, or body image. 2-personal identity. 3-Self-esteem
VIII- BEHAVIOR THERAPY A behavior is considered to be maladaptive when it: - Is age-inappropriate. - Interferes with adaptive functioning. - Is misunderstood by cultural inappropriateness. The behavioral approach to therapy is that people have become what they are through learning processes or through the interaction of the environment. The basic assumption is that problematic behaviors occur when there has been inadequate learning
TECHNIQUES FOR MODIFYING CLIENT BEHAVIOR • Shaping. • Modeling. • Premack principle . • Extinction. • Contingency contracting. • Token economy. • Time out. • Reciprocal inhibition. • Overt sensitization. • Covert sensitization. • Systematic desensitization. • Flooding.
ROLE OF THE NURSE Assessment. Diagnosis. Outcome. Planning. Implementation. Evalution.
IX- COGNITIVE THERAPY The foundation on which cognitive therapy is established can be identified by the statement, “Men are disturbed not by things but by the views which they take of them.”
INDICATIONS FOR COGNITIVE THERAPY Depression. Panic disorder. Generalized anxiety disorder. Social phobia. Obsessive-compulsive disorder Posttraumatic stress disorder. Substance abuse. Personality disorders. Schizophrenia. Couple’s problems. Bipolar disorder. Hypochondriasis. Somatoform disorder
X- COMPLEMENTARY THERAPIES The connection between mind and body is well recognized. Traditional medicine practiced in the United States is based on scientific methodology and is known as allopathic medicine. Practices that differ from the usual traditional practices are known as alternative medicine.
TYPES OF COMPLEMENTARY THERAPIES Herbal Medicine. • Acupressure and Acupuncture. Diet and Nutrition. Chiropractic Medicine. Therapeutic Touch. Massage. Yoga. Pet Therapy. Aromatherapy. Hypnosis. Meditation. Guided imaging. others.
XII- 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;
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;
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;
XII- CLIENT EDUCATION Patient education aims to provide adequate and relevant clinical information to patients, with the goal of increasing understanding of their illness condition and encouraging health-promoting behaviour. Psychiatric patients have a strong desire for practical advice concerning how to cope with the symptoms of the illness (Chien et all. 2001; Babacan Gümüs 2008; Mueser et al., 1992).
NURSING Assessment. Nursing Diagnosis. Outcome Identification. Planning/Implementation. Evaluation Documentation of Client Education
XIII-NUTRITIONAL THERAPY Recent research has shown that food supplements such as zinc, magnesium, omega 3, and vitamins B and D3 can help improve people's mood, relieve anxiety and depression and improve the mental capacity of people with Alzheimer's
JOURNAL ARTICLE
REFERENCES https://theconversation.com/why-nutritional-psychiatry-is-the-future-of- mental-health-treatment-92545 https://www.slideserve.com/onslow/psychiatric-nursing-psychiatric- treatment-approaches The educational needs of the patients who take treatment in psychiatric clinic in Kars pdf.
