CHAPTER 13TREATMEMENT MODALTIES

-A team approach provides the most comprehensive interventions for client with psychiatric disorder in an inpatient, partial hospitalization, or day treatment setting.

Individual therapy:-Helps client explain problem areas, define new options, & discuss how the new behavior may help solve original problem.

Group therapy:-Problem-solving oriented.-Based on repeated dynamics of individuals in group.

-Very useful for clients require a lot of attention.

-Group members will help client to understand effect of his behavior on each of them, so that client can use information when relation to significant people in his everyday life.

Family therapy-Helpful for clients as dynamics of family system are often repeated in other relationships in client’s life, such as with his boss or spouse.

-Family sessions consist of assessment of family system & explication of how family dynamics are affected by current problems that caused client to seek care.

Milieu therapy-When client is hospitalized, he becomes part of this milieu (environment).-To re-create community setting on these units (of hospital), so that client can interact with other client peers in order to identify & problem solve issues that occur while relating to others.-Community meetings may be used to delegate tasks of unit, such as cleaning off tables at the end of meal.-This meeting can be used to ask each member to think through daily goal for therapy & discuss how he plans to meet that goal.

Occupational therapy-To assess a client’s abilities & disabilities & help client increase functioning & independent living skills in area such as self-care, work, or ensure activity.-To teach adaptive skills for home, school, or jobfunctioning.-Groups such as stress management, enhancing parenting skills, conflict resolution, time management, money management, budgeting, feeling, & self-awareness are oftenplanned and controlled.

Art therapy-Using art as a means of helping the client express thoughts & feelings he may not be able to verbalize.-Helps client to understand problem areas from a symbolic standpoint.-Teaches client alternative means of expression & self-soothing.Example:A client who is feeling intense rage & has feelings of wanting to self-mutilate may use art to draw these feelings rather than act on them.

Music therapy-To help client express feelings & thoughts that may not be easily verbalized.-To help client relax & learn alternative self-soothing strategies.

Movement therapy-Teaches clients how they move their bodies when stressed & helps them learn methods of relaxation.

Recreational therapy-Helps clients explore ways without use of self- destructive behaviors, such as abusing alcohol or drugs.-Helpful for clients who have difficulty socializing because recreation strengthens social skills.

Medication therapy-Client who demonstrates violence against others may require medications to gain emotional & behavioral control over their impulses.

-Clients who are very agitated or psychotic may respond to the use of neuroleptic or anti-psychotic med.

-Clients with extreme violence who are unable to control impulse may be given IV or IM sedative-hypnotics.

-It is found that Haloperidol helped client increase global functioning, decrease hostility & increases impulse control.

-It is found that amitriptyline (TCA) decreased hostility & increases control for clients with borderline personality disorder.

Electro Convulsive Therapy (ECT)-Type of somatic Rx in which electric cure is applied to brain through electrodes placed on temples.

-Current is sufficient to induce a grand mal seizure, from which desired therapeutic effect is achieved.

Indications-Severe depression.-In conjunction with antidepressants, but preferably only after unsuccessful trial of drug therapy.

-Fast-acting Rx for very hyperactive manic pts. (physical exhaustion) & with extremely suicidal pts.

-Was originally attempted in Rx of schizophrenia, but with little success in most instance.

-Effective in Rx of acute psychoses & catatonia & schizophrenia that is accompanied by affective sx.

ContraindicationsBrain tumor, recent myocardial infarction.

Mechanism of action-Exact mechanism of ECT is unknown, but it is thought to produce biochemical changes in Brian, increase levels of Nor-Epinephrine & Serotenin-similar to effects of anti-depressants.

Side effects and nursing implicationsTemporary memory loss & confusion:-The most common side effects of ECT.-Nurse should be present when pt. awakens to attenuate fears that accompany this loss of memory.-Provide reassurance that memory loss is only temporary.-Describe to pt. what has occurred.-Reorient pt. to time & place.-Allow pt. to verbalize fears & anxieties R/T ECT.-Provide good deal of structure for pt.’s routine-action to minimize confusion.

Risks involved: Death:-Mortality rate from ECT: 0.01%-0.04%.-Major cause is cardiovascular complications, such as acute MI or cardiac arrest.-Brian damage is considered to be risk but evidenced is largely unsubstantiated.-Prolonged or permanent memory loss has beenreported by some individuals.*Although the potential for these effects appears to be minimal, pt. must be made aware of the works involved before consenting Rx.

Potential nursing diagnoses associated with ECT:-High risk for injury R/T certain risks associated ECT.

-Risk for aspiration R/T altered level of consciousness immediately following treatment.

-Decreased cardiac output R/T vagal stimulation occurring during ECT.

-Altered thought process R/T side effect of temporary memory loss & confusion.

-Knowledge deficit R/T necessity for & side effects & risks of ECT.

-Anxiety (moderate to severe) R/T impending therapy.

-Self-care deficit R/T incapacitation during poetical stage.

-Risk for activity intolerance R/T post-ECT confession & memory loss.

Nursing interventions for patient receiving ECT:1. Ensure that physician has obtained informed consent & that signed permission form is on chart.2. Ensure that most recent reports (CBC, urinalysis, ECG & x-ray) are available.3. Pt. should be NPO on morning of Rx.4. Prior to Rx, pt. should void, dress in night clothes, & remove dentures & glasses lenses.5. Take baseline vital signs.

6. Administer cholinergic blocking agent (atropine sulfate) approximately 30 min. before Rx to decrease secretion & increase heart rate (which is suppressed in response to vagal stimulation).7. Assist physician &/anesthesiologist as necessary in administration of IV meds.8. Administer O2 & provide suctioning as required.9. After procedure, take v/s q 15 min/1st hour. 10. Position pt. on side to prevent aspiration.11. Stay with pt. until he/she is fully awake.