Module Eleven THERAPEUTICAL INTERVENTIONS

1
Module ElevenTHERAPEUTICAL INTERVENTIONS

• Lesson 1 Scientific approach (3
  training hours)
• Lesson 2 Biological therapies (2
  training hours)
• Lesson 3 Psychotherapy (3
  training hours)
• TOTAL TIME 8 TRAINING HOURS OF 45 MINUTES

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Lesson 1

• SCIENTIFIC APPROACH
• TIME
• 135 minutes (3 training hours of 45 minutes)
•  

3
Step 1 introduction (10?)

• Scientific approach is useful to the coordination
  of several persons offer who contribute to the
  care of a person.
• This approach permits the examination of all
  characteristics of a persons life and does not
  examine only one.

4
Step 1 (continued)

• Slide 11.1.1 Members of the scientific
  therapeutical team  
• Personnel of immediate care (Nurses, Caretakers)
• Psychiatrists
• Psychologists
• Social Workers
• Health visitors
• Work therapists
• Physiotherapists
• General doctors or Pathologists
• Others

5
Step 2 Exercise (20?)

• Pen and paper
• What can be the specific role of
• Personnel of immediate care?
• Psychiatrist?
• Psychologist?
• Social Worker?
• Health Visitor?

6
Step 3 Slide projection and Discussion (15?)

• Slide 11.1.2 Role of immediate care personnel  
• Know the person better than anyone else
• Evaluate the desires/ dislikes / opinions/
  reactions of the patient.
• Help the person develop a pleasant everyday life.
• Help the person prepare for difficulties or
  changes of his/her life.
• Collect information, observe changes and help to
  the progress of cases or intervention programs.

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Step 3 (continued)

• Slide 11.1.3 Psychiatrist's role  
• Evaluate, diagnose, face and manage a mental
  disorder.
• Work as a member of a scientific group for the
  management of a difficult behaviour.
• Help the person develop an appropriate behaviour
  and eliminate the difficult behaviour.
• Psychiatrists responsibility is to prescribe
  medication and to observe its use, helped by the
  information of the scientific group.

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Step 3 (continued)

• Slide 11.1.4 Psychologists role
• Try to understand the function and the causes of
  the difficult behaviour and develop ways that can
  help the persons learn more appropriate
  behaviours.
• Facilitate the group understand the persons
  behaviour collecting objective elements for the
  behaviour and his / her environment using
  psychometric tests.
• Furthermore, the psychiatrist collaborates with
  the scientific group in order to develop
  appropriate strategies of intervention and also
  observe any other change.

9
Step 3 (continued)

• Slide 11.1.5 Social Workers role
• Try to understand the importance of social
  factors in the persons life to the maintenance
  of the psychiatric problems.
• Facilitate the group understand the social side
  of these problems collecting information
  regarding the family, the residence, the
  profession and the social relationships of the
  person.
• Collaborate with the group in developing the
  necessary interventions and finding social
  support groups.

10
Step 3 (continued)

• Slide 11.1.6 Health visitors role
• Understand the mental disorder and evaluate its
  possible progress.
• Organize in collaboration with the therapeutical
  group the necessary therapeutical interventions
  for treating the continuous needs of the person
  and preventing the possible subsides.
• Be a flexible connection between the person with
  psychiatric problems and the psychiatric group or
  other service that observes the person.

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Step 4 Group Discussion (15?)

• Which do you think are the functions of a
  scientific therapeutical group ?

12
Step 5 Slide projection (15?)

• Slide 11.1.7 Functions of scientific group
• Diagnose the mental disorder.
• Develop an objective evaluation of the person.
• Try to understand the behaviours function.
• Understand the context of this behaviour.
• Evaluate the environment.
• Develop a supposition.
• Decide for the interventions.
• If there is no progress, to develop a second
  supposition and a different intervention.
• Develop strategies that will eliminate the danger
  of reappearance of the symptoms and behaviours.

13
Step 6 Group discussion (15?)

• Which particular intervention techniques used by
  members of the scientific group for persons with
  psychiatric problems do you know?

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Step 7 Slide projection(5?)

• Slide 11.1.8 Basic elements in every
  therapeutical intervention
• Describe the problem (s). 
• Make sure that the evaluation and the diagnose
  include a detailed history, physical and
  psychiatric examination, information for the
  skills and needs of the person. 
• Determine possible alternative therapeutical
  interventions. 
• Choose one, apply it, and observe its result. 
• Take a long time to evaluate the application. 
• Observe other factors, like the behaviour of the
  personnel, important events. 
• If the result is not satisfactory, alter your
  intervention or choose another, but use always a
  enough time.

15
Step 8 Exercise study of a clinical case (15?)

• Leaflet 11.1.1 study of clinical case
  therapeutical intervention
• Pen and paper
• What are the actions you would proceed to solve
  the problem?
• What kind of information would you collect for
  better understanding Annas behaviour?

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Step 9 Discussion (15?)

• Leaflet 11.1.2 example of intervention

17
Step 10 Questions and comments (5?)

18
Step 11 Lessons evaluation (5?)

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Lesson 2

• BIOLOGICAL THERAPIES
• TIME
• 90 minutes (2 training hours of 45 minutes)
•  

20
Step 1 Introduction (10?)

• Biological therapies of mental disorders are
  mainly empirical.
• Practically many have been proved effective and
  consist the priority therapy for particular
  disorders.
• Biological therapies used nowadays is
  pharmacotherapy and electrospasmic therapy.
• In the past other methods were used as well which
  are now abandoned (insulin comma and psycho
  surgery).
• Biological therapies aim to correct mental
  functions using chemical or physical means.

21
Step 2 Discussion (10?)

• Have you ever heart about placebos action?
• What do you think that happens if instead of the
  normal drug, the patient take a similar to shape,
  which does not include the medical substance?

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Step 3 Slide projection (10?)

• Slide 11.2.1 Placebos action  
• Amelioration of symptoms caused by
  
• the patients expectations for amelioration
  (mainly in younger patients with low
  intelligence, distress, extroverts and of female
  gender).
• The prestige and the behaviour of the therapist.
• Placebos shape (size of the pill, form, color,
  etc).
• The situation for which the therapy is prescribed
  (mainly to acute symptoms, like headaches,
  nausea, etc).

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Step 4 Theory presentation (15?)

• As it appears from placebos action as well, in
  the practice of pharmacotherapy many factors are
  involved and not only the action of the medical
  substance itself. Such factors are
• Medication choice
• Prescription      
• Way of taking
• Psychological perception of the medication
• Environments influence

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Step 4 (continued)

• Regarding medication used in psychiatry, even if
  society is negative, it is a fact that
• The appearance of antipsychotic medication during
  the second half of 20th century had as a result
  to make unnecessary the long stay of psychotic
  persons in psychiatric clinics and ameliorate
  their life in general.
• Antidepressant medication has very satisfactory
  results for most of Depressions types.
• Modern medication of all categories appear
  constantly and is more effective and with less
  side effects.
• Certainly this medications cannot cure mental
  disorders, but eliminate the symptoms and
  ameliorate decisively the quality of patients
  life.

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Step 5 Exercise (15?)

• Leaflet 11.2.1 Appropriate pharmacotherapy
• Complete next to every mental disorder or problem
  the number that corresponds to the categories of
  medication used for the therapy of this disorder.

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Step 6 Slide projection(10?)

• Slide 11.2.2 Principal medication categories
  used in psychiatry and symptoms of each one
• Antipsychotics Schizophrenia, Mania, Other
  Disorders
• Antiparkinson medication acute detuning ecto -
  pyramid syndromes
• Antidepressants Depression, Obsessive Compulsive
  Disorder, Panic Disorder, chronic pain,
  Hypochondriasis
• Mood stabilizers Mania control, as protection
  for Bipolar Disorder, Schizoemotional Disorder,
  Aggressive behaviour
• Anxiolytics Anxiety, Insomnia, Withdrawal
  symptoms

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Step 7 Theory presentation (10?)

• Electrospasmic therapy
• It is presented to public in the most negative
  way, as violent and inhuman.
• It still exists (but it is limited because of
  medications efficiency) as a method with
  particular symptoms and important results.

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Step 7 (continued)

• The principal symptoms consist in
• Depression that does not subside in medication
• suicidal depression,
• Depression accompanied by denial of food or
  liquids,
• Catatonic syndromes
• Acute Schizophrenia.

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Step 7 (continued)

• It is done with the application of electric
  stimulus through electrodes placed on one or both
  sides of encephalic hemispheres and generalize an
  epileptic seizure.
• The patient should provide his /her consent after
  being informed.
• Before therapy the patient undergoes general
  anesthesia and muscle relaxation.
• Typically, ECT is given three times a week for a
  total of 6 to 12 sessions.
• The most common side effect is short memory loss,
  which recovers within few months (usually 6-9).

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Step 8 Questions and comments (5?)

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Step 9 Lessons evaluation (5?)

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Lesson 3

• PSYCHOTHERAPY
• TIME
• 135 minutes (3 training hours of 45 minutes)
•  

33
Step 1 Brainstorming (10?)

• What is psychotherapy and what do you know about
  it?

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Step 2 Slide projection (5?)

• Slide 11.3.1Definition of psychotherapy
•  
• Psychotherapy is the development of a trust
  relationship, which permits free communication
  and leads to understanding, completion and
  acceptance of self.

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Step 3 Theory presentation (20?)

• There are many types of psychotherapy, but these
  have the following common characteristics
• Include a emotionally intense relationship with a
  person or a team.
• Are based on a theory that explains the problem
  and suggests methods of treatment.
• Give information for the origin of the problem,
  its progress and give possible alternatives
  offering hope for release.
• They comprise indirect ways of enforcing persons
  Self esteem.
• Give the opportunity to the person to experience
  success.
• Enforce emotional excitation.
• Are conducted in an environment determined as
  protected space of therapy.

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Step 3 (continued)

• Psychotherapy can be done in several levels
• Unofficially between friends, relatives or
  support groups.
• As a general approach from professionals in
  mental health. This aims to offer support in a
  period of crisis, support persons who are not
  able to change or ameliorate their state, guide
  and give advice, focus in particular difficulties
  or problems in order to find solutions.
• Officially from professionals of mental health
  with special training to a particular category.
  The aim in this case is to achieve more radical
  changes in personality and behaviour of the
  person so that he /she becomes able to manage
  his/ her difficulties.

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Step 4 Slide projection (10?)

• Slide 11.3.2 Main psychotherapy types
•  
• Dynamic psychotherapy
• psychoanalysis
• existential psychotherapy
• short psychotherapy
• Group Psychotherapy
• Family psychotherapy
• Behavior therapy
• Cognitive therapy

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Step 5 Theory presentation (45?)

• Existential therapy
• Based on existential theory.
• The aim is to change the personality and the
  behaviour of the person.
• For achieving this goal there are used
  psychological methods such as self
  determination, interpretation and juxtaposition.
• It is appropriate for people who want to
  understand their problem through psychological
  terms, have the ability to face tension that
  comes from inner dilemmas and are able to
  establish and maintain a psychotherapeutic
  relationship.

39
Step 5 (continued)

• Classic psychoanalysis is mainly focused in the
  conflicts of early childhood, is long, costly and
  is applied rarely nowadays.
• Psychoanalytic psychotherapy is mainly focused in
  current conflicts, is shorter and particularly
  effective.
• The last decades appeared, for practical reasons,
  the short term psychotherapies, which are short,
  focus in the problem and have good results.

40
Step 5 (continued)

• Group psychotherapy
• Carefully chosen persons are set in a group which
  is guided from a trainee psychotherapist with the
  intention that one patient helps the other so
  that they achieve behaviour or personality
  change.
• There are many kinds according the group
  composition, the kind of the therapeutical
  development, the way of coordination and guidance
  from the therapist, the theoretical background,
  etc.

41
Step 5 (continued)

• The therapeutic factors include
• The interpersonal learning and emotional approach
  of the members.
• The socializing effect of the group.
• The knowledge of the universality of the
  problems.
• Give hope.
• guidance.
• Imitation of others behaviour.
• Expiation.
• Altruism.
• Corrective experiences.

42
Step 5 (continued)

• Family psychotherapy
• Simultaneous psychotherapy for all the family
  based on the opinion that the interaction of its
  members is so important that any change to come
  cannot be achieved with the participation of one
  only member.
• There are various kinds according to the
  theoretical background, but as the time pass
  there is combination between elements related to
  the interaction and the communication of the
  members and to social learning.
• It is an immediate and short therapy, focused in
  present problems and demands from the therapist
  an active and controversial style.

43
Step 5 (continued)

• Behaviour therapy
• Based on learning theory.
• Applies to particular symptoms or behaviour
  problems (mainly phobias, obsessions
  compulsions, sexual dysfunctions, marital
  problems, etc).
• Is focused in the observation of the behaviour,
  attention to the symptoms, clear goals, objective
  evaluation of results.

44
Step 5 (continued)

• The most common models of behavioral therapy
  include
• Systematic sensitization, with gradual and in
  relaxation approach of stressful events.
• The exposure, where the person faces directly the
  stressful event.
• The encouragement, with approval or reward of the
  behaviour.

45
Step 5 (continued)

• Cognitive therapy
• As behavioral therapy uses methods of guidance
  and treats present problems.
• In contrary to this, the inner procedures of the
  person are considered particularly important and
  tries to change them.
• Aims changes of skeptical context.
• It is usually used to treat depression as well as
  anxiety disorders.
• Considers that depression and anxiety are
  primarily rational disorders, that lead to the
  negative emotion afterwards.

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Step 6 Exercise (25?)

• Leaflet 11.3.1 Clinical cases
• Pen and paper
• There is a possibility to apply all psychotherapy
  types. Choose the most appropriate in your
  opinion and justify your choice giving at least
  three reasons for each case.

47
Step 7 Discussion (10?)

• What is your opinion and experience about
  psychotherapy?

48
Step 8Questions and comments (5?)

49
Step 9 Lessons evaluation(5?)