TREATMENT

MODALITIES

MNMH
THERAPEUTIC APPROACHES
 Psychopharmacology
 Psychotherapy
 ECT
PSYCHOPHARMACOLOGY
Antipsychotic drugs
 Antidepressants
 Mood stabilizers
 Anticonvulsant
 Anxiolytic drugs
 Sedative-Hypnotic Agents
Antiepileptic drugs
ANTI-PSYCHOTIC DRUGS
Antipsychotics are psychotropic medications primarily
used to manage psychosis.
Psychosis is an abnormal condition of the mind that results
in difficulties determining what is real and what is not real.
Psychotic symptoms are believed to develop due to
hyperactivity of dopamine,
PSYCHOTIC SYMPTOMS
Positive symptoms
 Hallucinations
Illusion
 Delusions
Negative symptoms
 Asociality (social withdraw)
Alogia (reduced speech)
Affective flattening(lack of emotional expressiveness/blunted
affect)
Anhedonia (reduce interest)
Avolition (lack of motivation)
CLASSES OF ANTIPSYCHOTIC DRUGS
Typical antipsychotics ( first generation)
Atypical antipsychotics( second generation)
 TYPICAL ANTIPSYCHOTICS
 Acting on D2 Receptors
 Treat positive symptoms of psychosis
 Less expensive
 More extrapyramidal effects (such as)
PADT
 Neuroleptic induce parkinsonism symptoms may include tremors, slower thought
processes ,slower movements , rigid muscles, difficulty speaking and facial stiffness.
 Akathisia sense of restlessness which cause inability to sit still and constant urge to move
 Acute Dystonic reaction(ADR), involuntarily contraction of muscles
 Tardive dyskinesia, etc. ( a condition affecting the nervous system often caused by long term
use of antipsychotics) repetitive involuntary movements such as grimacing , eye blinking
Drugs
 Haloperidol
 Chlorpromazine
 Fluphenazine deconoate
HALOPERIDOL
• Typical antipsychotic is more potent
• Available as IM and oral formulation
• Metabolized in the liver into hydroxyhaloperidol.
• Excreted through feces and urine
• Has a half life of 14hrs and Haloperidol deconoate [IM] has
half life of 3weeks.
• Bioavailability of 60% to 70%
• Onset of action 30-60min [IM] and 2-6hrs for oral.
• Dosage 0.5-5mg/day, not to exceed 30mg/day
CHLORPROMAZINE
• Typical antipsychotic more sedative
• Bioavailability; 20%
• Onset 30-60min
• Protein bound 92-97%
• Metabolized by the liver
• Half life 30hrs
• Excreted in urine
• Available in oral and IV formulation
• Dosage PO 200mg/day to 800mg/day not to exceed
2000mg/day.
ATYPICAL ANTIPSYCHOTICS

Second generation antipsychotics

They are mainly serotonin-dopamine antagonists
They affect more receptors than typical antipsychotic
They have less extra-pyramidal side effects compared to typical antipsychotics
Treat both positive and negative symptoms
Very expensive
Acting on D1, D2, D4, 5HT-2A , Serotonin
High affinity for D4 receptors than D2

Drugs
Olanzapine
Risperidone
OLANZAPINE

• Peak plasma time 6hrs [po], 15-45min [short-acting IM] and 7

days [extended release IM]
• 93% protein bound
• Metabolized in the liver into inactive metabolites
• Half life of 21-54 [immediate release] and 30days [extended
release]
• Excreted in the urine[57%] and feces[30%]
• Dosage for oral 5-10mg/day initially can be titrated by
5mg/day in intervals of 1 week. Not to exceed 20mg/day
RISPERIDONE
• Effective 81%
• Peak plasma time 3hrs in extensive metabolizer and 17hrs in
poor metabolizer
• 90% protein bound( human plasma)
• Metabolized in the liver into inactive metabolites
• Half life of 20 hrs. when taken by mouth and 3-6 days IM
• Excreted in the urine[70%] and feces[14%]
• Dosage for oral 2-3mg/day initially can be titrated by 4mg/day
 CLOZAPINE
• Atypical antipsychotic
• Available in tablets and oral suspension
• Bioavailability 50%-60%
• Onset 15min
• 97% protein bound
• Metabolized in the liver by CYP1A2
• Half life 12hrs
• Dosage target 300-450mg/day, not to exceed 900mg/day.
OTHER SIDE EFFECTS
Common with atypical antipsychotics
Hypotension
Sexual dysfunction
Dry mouth
Blurred vision
Constipation
Urinary retention
Sedation
Weight gain
Increases risk of diabetes
ANTIDEPRESSANTS
Indications for antidepressants including major depression, 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.
Drugs
Tricyclic and Heterocyclic - Amitriptyline, Imipramine,
Clomipramine
MAOIs -Phenelzine
Selective Serotonin, Reuptake Inhibitors (SSRIs)-Fluoxetine,
paroxetine
MOOD STABILIZERS
Its drugs fall in two categories
 Mood stabilizers
 drugs anticonvulsants
Drugs
Carbamazepine
Sodium Valproate
Lithium Carbonate
ANTICONVULSANT
Anticonvulsants are a diverse group of pharmacological agents used in
treatment of epileptic seizures
Anticonvulsants are also increasingly being used in treatment of bipolar
disorder and borderline personality disorders its actin as mood stabilizers and
treatment of neuropathic pain
Anticonvulsants suppress the excessive rapid firing of neurons during
seizure
Prevent the spread of seizure within the brain
Block sodium channels or enhance y – aminobutyric acid (GABA)
Drugs
Carbamazepine
Sodium Valproate
ANXIOLYTIC DRUGS
Drugs used in treatment of anxiety and anxiety disorder.

Diazepam and lorazepam were some of the first agents shown to be

effective in decreasing anxiety, but has addictive tendency in
overdose.

Along with medication interventions, psycho-education and psycho

therapeutic interventions are often part of treatment anxiety disorders.
SEDATIVE-HYPNOTIC AGENTS

• Sedative –hypnotics a that cause dependent depression of CNS

function inducing sedation sleep and sometime unconscious with
increasing the dose
• Medications used to control the condition of insomnia. Insomnia is
common disabling medical and psychiatric conditions
• Benzodiazepines is used to sedate aggressive patients mostly
during admission
• Also known as anxiolytics
Classified into:
a. Benzodiazepines as Valium, Ativan,
b. Sedative-Hypnotics as Barbiturates
• Benzodiazepines is risk for abuse and physiological dependence
are the least likely complications
PSYCHOTHERAPY
Psychotherapy is a general term for treating mental health problems by
talking with a mental health provider.
 Psychotherapy help to learn about client condition such as moods,
feelings, thoughts and behaviors.
Psychotherapy helps to learn how to take control of life emotional
problem and respond to challenging situations with healthy coping
skills.
There are many types of psychotherapy, each with its own approach.
The type of psychotherapy that's right for you depends on your
individual situation.
Psychotherapy is also known as
Talk therapy,
Psychosocial therapy or
CONT……
• Psychotherapy can be helpful in treating most mental health problems,
including:
• Anxiety disorders, such as obsessive-compulsive disorder (OCD),
phobias, panic disorder or post-traumatic stress disorder (PTSD)
• Mood disorders, such as depression or bipolar disorder
• Addictions, such as alcoholism, drug dependence or compulsive
gambling
• Eating disorders, such as anorexia or bulimia
• Personality disorders, such as borderline personality disorder or
dependent personality disorder
• Schizophrenia or other disorders that cause detachment from reality
(psychotic disorders)
CONT……
Not everyone who benefits from psychotherapy is diagnosed with a mental illness.
Psychotherapy can help with a number of life's stresses and conflicts that can affect
anyone. For example, it may help you:
Resolve conflicts with your partner or someone else in your life
Relieve anxiety or stress due to work or other situations
Cope with major life changes, such as divorce, the death of a loved one or the loss
of a job
Learn to manage unhealthy reactions, such as road rage or passive-aggressive
behavior
Come to terms with an ongoing or serious physical health problem, such as
diabetes, cancer or long-term (chronic) pain
Recover from physical or sexual abuse or witnessing violence
Cope with sexual problems, whether they're due to a physical or psychological
cause
Sleep better, if you have trouble getting to sleep or staying asleep (insomnia)
TYPES OF THERAPIES
 Cognitive behavioral therapy (CBT)
-Helps to identify unhealthy, negative beliefs and behaviors and replace
them with healthy, positive ones(changing specific behaviors)
-Identifying the reinforcements and punishments contributing to a
persons maladaptive behaviors
 Family therapy
-Patient and his/her relative assembled together and everyone listen the
complaints.
This is useful in:
-Marital problem
-Child parents conflict
-To educate family of psychotic patient on symptoms of psychosis and
importance of medication
CONT…..
 Group therapy
- A group of 6-8 patients with common problem and age meet at weekly
interval for about 2 hours and discuss their problems under the guidance of
therapy
-Learn how to socialize with each other
-Alleviate psychological trauma since the painful emotions are ventilated in
group
- Report each individual deviation needing readjustment
Example of group therapy
-Alcoholic Anonymous session ( AA )
-Narcotic Anonymous session(NA)
CONT…..
 Occupational therapy
-Occupational therapy prescribe activities as the treatment or means of restoring
physical and intellectual functions of the patient within the hospital.
- It is a rehabilitative procedure guided by qualified occupational therapist as well as
means of help the patient.
- This is useful to patients under prolonged hospitalization as the normal habits of
working tend to deteriorate , making the patient apathetic and useless
Aims of Occupational therapy are to:
-Restore patients physical functioning
-Teach patient self help activities (ADL)
-Help the patient readjust to home routines
-Develop work tolerance and maintain special skills required by the patients
profession
-Pre vocationally explore the patients physical capability ,interests, work habits and
skills
-Promote recovery
CONT…
Advantages of OT
-It diverts patient’s attention from him/herself into other activities
-Patient’s interests and energy are directed to work
- Maintains normal work habit
- Enables the patient develop feeling of satisfaction upon completion of the task
- Stimulates interest and attention
- Aids production of positive attitude by teaching the patient new skills and hobbies
- Build self esteem
NB:
This depend
-Stage of illness
-Level of education
-Occupation therapy attracted to her/his
 CONT…..
 Recreation therapy
-Recreation therapy involve recreational activities includes football,
netball, music, dancing, indoor games eg. Bao cards, draft
-Advantages of RT
-Recreation therapy assist in socialization and communication
-Direct patients thoughts and ideas towards reality
-Enable patients to control feeling and express them in acceptable
manner
-Recreate self confidence and give sense of responsibility
 CONT….
 Insight orientation therapy
Focus on increasing your awareness of unconscious thoughts and behaviors,
developing new insights into motivations, and resolving conflicts

 Interpersonal psychotherapy( Individual therapy)

Focuses on addressing problems with your current relationships with other
people to improve your interpersonal skills — how you relate to others, such as
family, friends and colleagues

Supportive psychotherapy
Reinforces ability to cope with stress and difficult situations
CONT…..
Dialectical behavior therapy,
A type of CBT that teaches behavioral skills help to handle stress,
manage your emotions and improve your relationships with others

Acceptance and commitment therapy,

Helps to become aware of and accept your thoughts and feelings and
commit to making changes, increasing your ability to cope with and adjust
to situations
ELECTROCONVULSIVE THERAPY (ECT)
Electroconvulsive therapy (ECT) is a procedure, done under general
anesthesia, in which small electric currents are passed through the brain,
intentionally triggering a brief seizure.
 ECT seems to cause changes in brain chemistry that can quickly reverse
symptoms of certain mental health conditions.
ECT often works when other treatments are unsuccessful and when the full
course of treatment is completed, but it may not work for everyone.
Much of the stigma attached to ECT is based on early treatments in which high
doses of electricity were administered without anesthesia, leading to memory
loss, fractured bones and other serious side effects.
ECT is much safer today. Although ECT may still cause some side effects, it
now uses electric currents given in a controlled setting to achieve the most
benefit with the fewest possible risks.
CONT….
• Electroconvulsive therapy (ECT) can provide rapid, significant improvements in severe
symptoms of several mental health conditions. ECT is used to treat:
• Severe depression, particularly when accompanied by detachment from reality (psychosis), a
desire to commit suicide or refusal to eat.
• Treatment-resistant depression, a severe depression that doesn't improve with medications or
other treatments.
• Severe mania, a state of intense euphoria, agitation or hyperactivity that occurs as part of
bipolar disorder. Other signs of mania include impaired decision-making, impulsive or risky
behavior, substance abuse, and psychosis.
• Catatonia, characterized by lack of movement, fast or strange movements, lack of speech, and
other symptoms. It's associated with schizophrenia and certain other psychiatric disorders. In
some cases, catatonia is caused by a medical illness.
• Agitation and aggression in people with dementia, which can be difficult to treat and
negatively affect quality of life
CONT….
Although ECT is generally safe, risks and side effects may include:
• Confusion. Immediately after treatment, you may experience confusion, which can last from a
few minutes to several hours. You may not know where you are or why you're there. Rarely,
confusion may last several days or longer. Confusion is generally more noticeable in older adults.
• Memory loss. Some people have trouble remembering events that occurred right before treatment
or in the weeks or months before treatment or, rarely, from previous years. This condition is
called retrograde amnesia. You may also have trouble recalling events that occurred during the
weeks of your treatment. For most people, these memory problems usually improve within a
couple of months after treatment ends.
• Physical side effects. On the days of an ECT treatment, some people experience nausea,
headache, jaw pain or muscle ache. These generally can be treated with medications.
• Medical complications. As with any type of medical procedure, especially one that involves
anesthesia, there are risks of medical complications. During ECT, heart rate and blood pressure
increase, and in rare cases, that can lead to serious heart problems. If you have heart problems,
ECT may be more risky.
THE END