Clinical Services /Therapeutic Module
As a result, many mental conditions can be effectively treated with one or a combination of the following therapeutic modules:
Mental illness affects a person’s mood, thinking, feelings, and the ability to relate to others, disrupting everyday life functions. Many factors are thought to play a role in the development of a mental illness, from genetic predispositions to environmental aspects. Mental health disorders are highly treatable, and positive outcomes increase with early intervention.
The following types of medication can be used for treating psychiatric disorders:
- Antipsychotic Medication
- Antidepressant Medication
- Anti anxiety Medication
- Mood Stabilizers
- Detox Medication
Schizophrenia affects one percent of the population, and it can be a severe and disabling disorder, although medications can help manage the agitation, hallucinations, and delusions. Antipsychotic and atypical antipsychotic medications are often used to successfully decrease symptoms of schizophrenia.
As with any medication or drug, side effects may occur and can include drowsiness, dizziness, restlessness, rapid heart rate, muscle spasms, rashes, and menstrual issues in women, blurred vision, rigidity, and sensitivity to the sun. Side effects may increase with substance abuse also. The most common substance use disorder to co-occur with schizophrenia is nicotine dependence related to smoking, and those suffering from schizophrenia are three times more likely than their peers to smoke. Smoking is liable to decrease the effectiveness of atypical antipsychotic medications as well. Clozapine is an atypical antipsychotic medication that has been shown to be successful reducing both psychotic symptoms of schizophrenia as well as substance abuse and smoking. Research also shows similar positive results in the medication quetiapine in those with a dual diagnosis, particularly those who abused cocaine, alcohol, or amphetamines. Atypical antipsychotic medications may also be used to treat symptoms of bipolar disorder.
Antidepressant medications are commonly prescribed to treat depression, mood disorders, and anxiety disorders. Depression is classified by a pervasive sadness that affects daily life. Many times, depression may go undiagnosed or untreated, and substance abuse is used in an attempt to numb the pain. Nearly one-third of those suffering from major depressive disorder may also suffer from substance abuse disorder. The most commonly prescribed antidepressants are selective serotonin reuptake inhibitors (SSRIs), which include medications like Prozac, Celexa, Zoloft, Lexapro and Paxil.
Older medications included tricyclics like Norpramin and Tofranil and monoamine oxidase inhibitors (MAOIs) such as Nardil, Emsam, Parnate and Marplan. MAOIs interact with certain foods with potential life-threatening complications, and tricyclics may cause an unsafe drop in blood pressure upon standing, so these medications are usually only used if SSRIs or other antidepressants prove ineffective.
Unlike older antidepressant medications, SSRIs do not artificially produce euphoria; instead, they work to block the absorption of the neurotransmitters your brain produces naturally that increase happiness and bolster moods. SSRIs, therefore, likely have a lower rate of abuse and addiction potential than other pharmaceuticals, although some researchers argue that the presence of withdrawal symptoms upon discontinuation may indeed indicate a dependence or addiction.
Other side effects of antidepressant medications include:
- Sexual dysfunction
- Bladder issues
- Dry mouth
- Blurred vision
Many of these side effects will decrease over time, although mixing these medications with other drugs or alcohol may heighten the risk factors. It is also important not to stop taking antidepressants without the permission and monitoring of your doctor. SSRIs discontinuation syndrome can occur if you stop taking these medications suddenly, and it may produce flu-like symptoms and an alteration in touch sensations.
It is estimated that around half of those diagnosed with depression or a depressive disorder also suffer from an anxiety disorder as well. SSRIs, SRNIs and tricyclic antidepressants are often used to treat anxiety disorders, as are anti-anxiety medications including benzodiazepines and beta blockers like propranolol, which is more commonly used for treating heart conditions and high blood pressure, but may also be effective on physical anxiety symptoms like sweating and trembling.
Beta blockers may make symptoms of asthma or diabetes worse and therefore are not recommended for those patients. Other side effects of beta blockers may include cold hands, weakness, dizziness and fatigue. Buspar is another anti-anxiety medication useful for controlling the rapid heart rate, trouble sleeping, irritability, and sweating indicative of anxiety disorders. It may take up to two weeks to take effect. Side effects include nervousness, lightheadedness, nausea, headaches, trouble sleeping and excitability.
Bipolar disorder, characterized by episodes of mania and depression, as well as borderline personality disorder, wherein troubles with interpersonal relationships, instability of emotions, and self-image are symptoms, may be managed with mood stabilizers. This class of medications works best on the episodes of mania and mood regulation.
Lithium is continues to be used today. Lithium is estimated to improve symptoms over 50 percent of the time. Lithium may take up to three weeks to reduce manic symptoms and six weeks for depressive symptoms. Use of the drug needs to be closely and regularly monitored through a renal function, or blood test, due to the way it is processed and retained in the kidneys. Thyroid checks also need to be performed as lithium can affect thyroid performance also.
Other potential side effects of lithium use include:
- Excessive thirst
- Frequent urination
- Impaired coordination
- Slurred speech
- Irregular heart rate
- Rash or itching
- Changes in vision
Typically, the treatment of bipolar disorder requires the use of another adjunct medication, such as an antidepressant, in order to manage both the high and low mood swings. Anticonvulsant medications have also proven to be effective when used as mood stabilizers and include medications, such as Depakote, Tegritol, Lamictal, Trioptal and the antiepileptic drug Topamax. Fluctuations in weight are common with these medications, and loss of appetite may also be a side effect, in addition to stomach pain, nausea and vomiting. Depakote may be particularly useful in stabilizing moods for those also suffering from substance abuse.
Physical stability is the initial goal and often the first step in substance abuse treatment, and it is especially important for those also suffering from a mental health disorder. The purging of toxins from the body is called detox, which often includes the use of medications to ensure safety and help manage potential withdrawal symptoms. Medical detox is performed in a specialized facility under constant medical supervision.
Opioid withdrawal can be extremely uncomfortable, and the use of buprenorphine medications such as Suboxone and Subutex can reduce discomfort. Buprenorphine is a long-acting partial opioid agonist that binds to opioid receptor sites in the brain, dispelling potential withdrawal symptoms without producing the same high as more potent opioids. Naloxone is an opioid antagonist that affectively blocks opioid receptor sites, preventing the interaction of other opioids if and when they are introduced. Naloxone is added to Suboxone along with buprenorphine, and it is often used during substance abuse treatment in order to prevent relapse. Naloxone is also sometimes used to deter alcoholics from relapsing. Dual diagnosis treatment requires simultaneous and integrated care by prescribing physicians, counselors, and therapists to ensure medications will be safe and useful in treating both disorders.
Electroconvulsive therapy (ECT) is a medical treatment most commonly used in patients with Suicidal risk, unmanageable behaviors, Schizophrenia, severe major depression or bipolar disorder that has not responded to other treatments. ECT involves a brief electrical stimulation of the brain while the patient is under anesthesia. It is typically administered by a team of trained medical professionals that includes a psychiatrist, an anesthesiologist, and a nurse or physician assistant.
Does ECT work?
Extensive research has found ECT to be highly effective for the relief of major depression. Clinical evidence indicates that for individuals with uncomplicated, but severe major depression, ECT will produce substantial improvement in approximately 80 percent of patients. It is also used for other severe mental illnesses, such as bipolar disorder and schizophrenia. ECT is sometimes used in treating individuals with catatonia, a condition in which a person can become increasingly agitated and unresponsive. A person with catatonia can seriously injure themselves or develop severe dehydration from not eating or drinking.
ECT is typically used when other treatments, including medications and psychotherapy, haven’t worked. ECT is also used for people who require a rapid treatment response because of the severity of their condition, such as being at risk for suicide.
ECT’s effectiveness in treating severe mental illnesses is recognized by the American Psychiatric Association, the American Medical Association, the National Institute of Mental Health, and similar organizations in Canada, Great Britain and many other countries.
Although ECT can be very effective for many individuals with serious mental illness, it is not a cure. To prevent a return of the illness, most people treated with ECT need to continue with some type of maintenance treatment. This typically means psychotherapy and/or medication or, in some circumstances, ongoing ECT treatments.
Psychotherapy, or talk therapy, is a way to help people with a broad variety of mental illnesses and emotional difficulties. Psychotherapy can help eliminate or control troubling symptoms so a person can function better and can increase well-being and healing.
Problems helped by psychotherapy include difficulties in coping with daily life; the impact of trauma, medical illness or loss, like the death of a loved one; and specific mental disorders, like depression or anxiety. There are several different types of psychotherapy and some types may work better with certain problems or issues. Psychotherapy may be used in combination with medication or other therapies.
Therapy may be conducted in an individual, family, couple, or group setting, and can help both children and adults. Sessions are typically held once a week for about 30 to 50. Both patient and therapist need to be actively involved in psychotherapy. The trust and relationship between a person and his/her therapist is essential to working together effectively and benefiting from psychotherapy.
Psychotherapy can be short-term (a few sessions), dealing with immediate issues, or long-term (months or years), dealing with longstanding and complex issues. The goals of treatment and arrangements for how often and how long to meet are planned jointly by the patient and therapist.
Confidentiality is a basic requirement of psychotherapy. Also, although patients share personal feelings and thoughts, intimate physical contact with a therapist is never appropriate, acceptable, or useful.
Psychotherapy and Medication
Psychotherapy is often used in combination with medication to treat mental health conditions. In some circumstances medication may be clearly useful and in others psychotherapy may be the best option. For many people combined medication and psychotherapy treatment is better than either alone. Healthy lifestyle improvements, such as good nutrition, regular exercise and adequate sleep, can be important in supporting recovery and overall wellness.
Does Psychotherapy Work?
Research shows that most people who receive psychotherapy experience symptom relief and are better able to function in their lives. About 75 percent of people who enter psychotherapy show some benefit from it. Psychotherapy has been shown to improve emotions and behaviors and to be linked with positive changes in the brain and body. The benefits also include fewer sick days, less disability, fewer medical problems, and increased work satisfaction.
With the use of brain imaging techniques researchers have been able to see changes in the brain after a person has undergone psychotherapy. Numerous studies have identified brain changes in people with mental illness (including depression, panic disorder, PTSD and other conditions) as a result of undergoing psychotherapy. In most cases the brain changes resulting from psychotherapy were similar to changes resulting from medication.
To help get the most out of psychotherapy, approach the therapy as a collaborative effort, be open and honest, and follow your agreed upon plan for treatment. Follow through with any assignments between sessions, such as writing in a journal or practicing what you’ve talked about.
Types of Psychotherapy
Psychiatrists and other mental health professionals use several types of therapy. The choice of therapy type depends on the patient’s particular illness and circumstances and his/her preference. Therapists may combine elements from different approaches to best meet the needs of the person receiving treatment.
Cognitive behavioral therapy (CBT)
It helps people identify and change thinking and behavior patterns that are harmful or ineffective, replacing them with more accurate thoughts and functional behaviors. It can help a person focus on current problems and how to solve them. It often involves practicing new skills in the “real world.”
CBT can be helpful in treating a variety of disorders, including depression, anxiety, trauma related disorders, and eating disorders. For example, CBT can help a person with depression recognize and change negative thought patterns or behaviors that are contributing to the depression.
Interpersonal therapy (IPT)
It is a short-term form of treatment. It helps patients understand underlying interpersonal issues that are troublesome, like unresolved grief, changes in social or work roles, conflicts with significant others, and problems relating to others. It can help people learn healthy ways to express emotions and ways to improve communication and how they relate to others. It is most often used to treat depression.
Dialectical behavior therapy (DBT)
It is a specific type of CBT that helps regulate emotions. It is often used to treat people with chronic suicidal thoughts and people with borderline personality disorder, eating disorders and PTSD. It teaches new skills to help people take personal responsibility to change unhealthy or disruptive behavior. It involves both individual and group therapy.
It is based on the idea that behavior and mental well-being are influenced by childhood experiences and inappropriate repetitive thoughts or feelings that are unconscious (outside of the person’s awareness). A person works with the therapist to improve self-awareness and to change old patterns so he/she can more fully take charge of his/her life.
Psychoanalysis is a more intensive form of psychodynamic therapy. Sessions are typically conducted three or more times a week.
It uses guidance and encouragement to help patients develop their own resources. It helps build self-esteem, reduce anxiety, strengthen coping mechanisms, and improve social and community functioning. Supportive psychotherapy helps patients deal with issues related to their mental health conditions which in turn affect the rest of their lives.
Transcranial magnetic stimulation (TMS) is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. TMS is typically used when other depression treatments haven’t been effective. Transcranial Magnetic Stimulation (TMS) is used to treat depression and involves the use of rapidly alternating magnetic fields to stimulate specific areas of the brain. TMS typically only has mild side effects including headaches, muscle twitches and pain at the stimulation site. TMS is usually administered four or five times a week for four-to-six weeks. This treatment for depression involves delivering repetitive magnetic pulses, so it’s called repetitive TMS or rTMS.
How it works
During an rTMS session, an electromagnetic coil is placed against your scalp near your forehead. The electromagnet painlessly delivers a magnetic pulse that stimulates nerve cells in the region of your brain involved in mood control and depression. It’s thought to activate regions of the brain that have decreased activity in depression. Though the biology of why rTMS works isn’t completely understood, the stimulation appears to impact how the brain is working, which in turn seems to ease depression symptoms and improve mood.
There are different ways to perform the procedure, and techniques may change as experts learn more about the most effective ways to perform treatments. Depression is a treatable condition, but for some people, standard treatments aren’t effective. Repetitive TMS is typically used when standard treatments such as medications and talk therapy (psychotherapy) don’t work.
Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique that is painless, relatively cheap, portable, and safe. This simple technology comprises a battery-driven stimulator that delivers weak currents (0.5–2 mA) typically through saline-soaked sponges. Usually, one electrode is used to stimulate an area of interest, while another is placed close to the circuit and serves as a reference electrode. tDCS can enhance cognitive performance in healthy older subjects and patients with neurological disorders typically manifesting in the elderly, such as Alzheimer’s disease, fronto-temporal dementia, and Parkinson’s disease. Although the clinical efficacy of tDCS awaits confirmation in large, clinical, randomized controlled studies, results for managing cognitive dysfunctions related to neurological disorders in the elderly seem promising.
Neurofeedback, also referred to as Biofeedback or Neuropathy, is a state of art, therapeutic training tool that can be used to improve a variety of health conditions or increase personal potential. Neurofeedback is at root simply another form of biofeedback- e.g. a learning process in which people are taught to improve their health and performance by observing signals generated from their own organs. In neurofeed-back, electrodes are attached to your scalp under the hair with a special paste and the ever changing, very faint electrical signals of your brain waves are amplified, recorded and analyzed by a computer and display to you on a computer screen in a form that you can understand and use to learn how to modify your brain’s electrical activity.
BFT-Brain Function Therapy is one of the earliest computer based cognitive retraining programs developed for use with brain damaged patients. BFT is a highly professional program for improving speed and accuracy of neurocognitive processes and measures the improvements in speed in terms of millisecond.
Brain function therapy refers to the process of training the brain to acquire cognitive functions lost because of damage in trauma and diseases of the brain.
The human brain is the most complex single object known to science, and firm footing is needed as we reach upward to understand complex cognitive function. It focuses on the role of cognitive processes in vision, learning, memory, thinking, problem solving, and decision making, and taking advantage of the wealth of knowledge. It also includes online cognitive training..
The main aim of cognitive training is to enhance and improve cognitive function by practicing of cognitive task. The task is related to cognitive domain, and given to subject according to increased difficulty level, and age. Cognitive training helps to improve quality of life, and strengthening cognitive functions. Every learning struggle has a cause. That cause is most likely cognitive skills weakness. The good news is, those skills can be trained and strengthened.