Treatments Electroconvulsive Therapy (ECT) Produces a painless seizure in an anesthetized patient Indications include: Severe Depression (refractory to other treatments) Depression in pregnancy Refractory mania Neuroleptic malignant syndrome Patients unable to tolerate/contraindications to available medications Catatonic schizophrenia When an immediate response is necessary (ie acute suicidality) Depression with psychotic features, or catatonia Adverse effects: Amnesia One of most common side effects Usually temporary Anterograde/Retrograde amnesia t Usually resolves fully in 6 months Anterograde – tends to resolve quickly Retrograde – may persist for a longer period Disorientation Prolonged Seizures (ECT is not associated with an increased risk of epilepsy) Delirium Headache Nausea Skin burns Muscle soreness is a common complaint of ECT Cognitive-Behavior Therapy (CBT) Focuses on reducing automatic negative thoughts and avoidance behaviors that cause distress A standardized modality of psychotherapy that focusues on identifying and addressing persistent maladaptive thought patterns in order to change emotions and behavior It also integrates strategies such as goal setting, breathing techniques, visualization, and mindfulness to decrease emotional distress and self-defeating behaviors Treatment is generally time limited (~12 sessions) Frequently involves keeping diaries or “thought records” outside of sessions and practicing behavioral strategies learned in sessions Identifying distortions such as: Overgeneralizations of negative thoughts Catastrophizing Minimizing positive events Maximizing negative events Interpersonal Psychotherapy Interpersonal therapy targets the social and interpersonal context of the patient’s illness. It focuses on the “Here and Now” and deals with grief, dysfunctional relationships, interpersonal conflicts and role transitions. Supportive Psychotherapy Supportive psychotherapy is used to reinforce a patient’s ability to cope with stressors Techniques include: Affirmative listening Encouraging patients to express feelings Assisting patients to understand their situation with the therapist taking an active role as mentor or guide Goal is to help improve patient’s emotional resilience and develop realistic hope. Psychodynamic Psychotherapy Psychodynamic psychotherapy focuses on the role of unconscious conflict in causing the patient’s symptoms It emphasizes ways in which past experiences shape present situations It involves the exploration of transference to explore unresolved issues Transference – Feelings that the patient has towards another person which they unconsciously redirect towards the therapist It is typically used in higher-functioning patients Motivational Interviewing It is a psychotherapy technique used in substance abuse. It involves there therapist assuming a nonjudgmental stance acknowledging ambivalence, focusing on the patient’s motivation for change, and tolerating resistance to change. BioFeedback Is a treatment modality in which the goal is for patients to improve their own health by using signals from the body (eg Heart rate, muscle tension, skin temperature, blood pressure) as a guide Patients are taught to identify and control their response to various stimuli Example: Patients can learn to control their response to a stressful situation, thereby decreasing their blood pressure.