UW2 - Psychiatric Treatments [2014]

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:
 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
Prolonged Seizures (ECT is not associated with an increased risk of epilepsy)
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
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.
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.