1. Module Eleven THERAPEUTICAL INTERVENTIONS Lesson 1: Scientific approach Lesson 2: Biological therapies Lesson 3: Psychotherapy

2. Lesson 1 SCIENTIFIC APPROACH

3. Step 1: introduction 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 person’s 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: Slide projection and Discussion 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.

6. Step 2 (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 behavior. Help the person develop an appropriate behavior and eliminate the difficult behavior. Psychiatrist’s responsibility is to prescribe medication and to observe its use, helped by the information of the scientific group.

7. Step 2 (continued) Slide 11.1.4: Psychologist’s 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 person’s 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.

8. Step 2 (continued) Slide 11.1.5: Social Worker’s role Try to understand the importance of social factors in the person’s 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.

9. Step 2 (continued) Slide 11.1.6: Health visitor’s 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.

10. Step 4: Slide projection 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.

11. Step 5: Slide projection Slide 11.1.8: Basic elements in every therapeutical intervention 1. Describe the problem (s). 2. 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. 3. Determine possible alternative therapeutical interventions. 4. Choose one, apply it, and observe its result. 5. Take a long time to evaluate the application. 6. Observe other factors, like the behaviour of the personnel, important events. 7. If the result is not satisfactory, alter your intervention or choose another, but use always a enough time.

12. Step 6: Questions and comments

13. Lesson 2 BIOLOGICAL THERAPIES

14. Step 1: Introduction 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.

15. Step 2: Slide projection Slide 11.2.1: Placebo’s 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 behavior of the therapist. Placebo’s shape (size of the pill, form, color, etc). The situation for which the therapy is prescribed (mainly to acute symptoms, like headaches, nausea, etc).

16. Step 3: Theory presentation As it appears from placebo’s 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

17. Step 3 (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 20 th 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 Depression’s 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.

18. Step 4: Slide projection 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

19. Step 5: Theory presentation 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 medication’s efficiency) as a method with particular symptoms and important results.

20. Step 5 (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.

21. Step 5 (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 ).

22. Step 6: Questions and comments (5΄)

23. Lesson 3 PSYCHOTHERAPY

24. Step 1: Slide projection Slide 11.3.1:Definition of psychotherapy Psychotherapy is the development of a trust relationship, which permits free communication and leads to understanding, completion and acceptance of self.

25. Step 2: Theory presentation 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 person’s 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.

26. Step 2 (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 behavior of the person so that he /she becomes able to manage his/ her difficulties.

27. Step 3: Slide projection Slide 11.3.2: Main psychotherapy types Dynamic psychotherapy psychoanalysis existential psychotherapy short psychotherapy Group Psychotherapy Family psychotherapy Behavior therapy Cognitive therapy

28. Step 4: Theory presentation 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.

29. Step 4 (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.

30. Step 4 (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.

31. Step 4 (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.

32. Step 4 (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.

33. Step 4(continued) Behavior 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.

34. Step 4 (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.

35. Step 4 (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.

36. Step 5:Questions and comments (5΄)