Additional Therapies (Somatic, CAM, &Therapeutic) NUR 305 Rochelle Roberts MSN RN

Somatic Therapies ECT (Electroconvulsive therapy) Phototherapy Sleep deprivation therapy Transcranial magnetic stimulation Vagus nerve stimulation

ECT First described by Cerletti and Bini (1938) as a treatment for schizophrenia. Today it is much more effective for affective disorders (primary indication is major depression).

ECT cont. A treatment in which a grand mal seizure is induced in an anesthetized patient by passing an electrical current through electrodes applied to the patient’s head. (unilateral or bifrontal) Usual course: 6-12 treatments given 2-3 times a week.

Indications for ECT The primary indication for ECT is major depression. The response rate is 80% or more. (better response rate than is associated with antidepressant meds)

Criteria for ECT ECT may play a life-saving role in patients who are suicidal, those with acute mania (hyperactivity), & those with affective disorders with psychosis. Sometimes used for Parkinson’s disease. (by enhancing dopamine ) Used when side effects are less harmful than those associated with drug therapy (elderly & women who are pregnant)

How does ECT work? It acts like tricyclic antidepressants by enhancing deficient neurotransmitters. It releases hormones (pituitary or hypothalamic) which result in antidepressant effects. It exerts a strong anticonvulsant effect which in turn, results in an antidepressant effect.

Adverse Effects of ECT Cardiovascular effects: transient changes are expected in ECT. Routine ECG’s are performed to R/O baseline problems. Systemic effects: HA’ s,nausea, muscle soreness, & drowsiness may occur. Cognitive effects: a period of confusion immediately after the seizure and memory disturbance, although few report persistent deficits.

Nursing Care in ECT Therapy Emotional support and education: allow the pt and family to express feelings. Teaching should be individualized and the nurse should respond to questions about misconceptions.

Informed Consent for ECT A dynamic process that is not completed with the signing of a formal document; rather the process continues throughout the course of treatment. For example, concentration is often impaired in depressed patients. It is essential that the nurse repeat the information at regular intervals.

Pre-Treatment Nursing Care Note abnormal labs Check that equipment is functional NPO 6-8 hours prior rot procedure Patient must remove dentures, contact lenses, hearing aids to prevent damage.

Peri-Treatment Nursing Care The nurse should remain with patient throughout the procedure to provide support. ECG leads placed on pt’s chest. Pulse oximeter is positioned. An anticholinergic and muscle relaxant is administered to decrease secretions and minimize motor response. Bite block is inserted to prevent tooth damage or gum laceration due to teeth clenching.

Post-treatment in recovery area Vital signs Emergency equipment available Reorient the confused patient Stabilize patient Pt should resume normal activities as soon as possible

Phototherapy Indications: Seasonal Affective Disorder 60-90 % response rate Consists of exposing a patient to artificial light that is 5-20 times brighter than indoor lighting (broad spectrum fluorescent bulbs sometimes called a ‘light box.”) The “light visor” shaped like a baseball cap is worn on the head suspended in front of the eyes.

Mechanism of action Phototherapy is based on biological rhythms that are related to light and darkness. The therapeutic effect appears to be mediated primarily by the eyes not the skin. Certain people have a neurochemical vulnerability, related to melatonin, that causes them to develop SAD.

Positive & Adverse Effects of Light Therapy Most patients feel relief after 3-5 days; however they relapse equally rapidly if light treatment is stopped. Patients should continue treatments throughout the winter months. Adverse effects: eyestrain and headache, fatigue, nausea, dry eyes and nasal passages.

Sleep Deprivation Therapy 60% of depressed patients improve immediately after one night of total sleep deprivation (Colombo et al, 1999) Many patients will become depressed again when they resume sleeping again. This has discouraged this therapy in clinical practice. Adverse effects: manic behavior in bipolar patients.

Transcranial Magnetic Stimulation (TMS) Involves changing a magnetic field to influence brain activity. An insulated coil is placed near or on the patient’s head, allowing a magnetic field to target brain areas.

TMS cont. Accepted in Europe and Canada as a standard clinical treatment for some neurological and psychological illnesses, it is still considered experimental in the US. Indications: Mood disorders Adverse effects: headaches (most common) potential for inducing seizures, high frequency noise can cause tinnitus and transient hearing loss.

Vagus Nerve Stimulation (VNS) Surgical implantation of a small pocket generator into a patient’s chest. An electrode is threaded into the vagus nerve on the L side of neck.

VNS cont. Indications: only approved for clinical use of epilepsy in the US. The most compelling use in psychiatry is in the treatment of depression. One pilot study suggests VNS may improve cognition in pt’s with Alzheimer’s. Adverse effects: hoarseness, throat pain, HA, and SOB.

Complementary and Alternative Therapies (CAM) A broad range of healing philosophies and approaches that focus on holistic therapies.

Herbal Products Used to treat mild depression, anxiety, SAD, and sleep disorders. Mechanism: serotonin-reuptake inhibition

Acupuncture Involves the insertion of needles into acupoints or energy channels for the purpose of restoring energy balance. It is used in treating depression & anxiety. Auricular acupuncture used in treating substance abuse disorders

Massage There are a few studies that have evaluated the effects of massage therapy for the treatment of depression. Effects may be short term.

Yoga (breathing control stretching, and meditation) Found to have efficacy in treating OCD and substance abuse disorders.

Eye movement Desensitization and reprocessing Requires the patient to generate a number of rapid lateral eye movements while engaging in imagery recall of a traumatic memory. Theory is that this type of therapy will help diffuse negative emotions and cognitions. Used to treat patients with PTSD.

Therapeutic Groups A group is a collection of people who have a relationship with one another, are interdependent, and may have common norms.

Components of Small Groups Group structure: is the underlying order (set meeting times and place, rules for behavior, rules regarding attendance.) Group size: preferred size is 7-10 members Length of session: optimum is 20-40 min. or 60-120 min. Communication: the leader’s primary task is to observe and analyze communication patterns within the group.

Components of groups cont. Group Roles: task, maintenance and individual roles. Power: is the member’s ability to influence the group as a whole. Norms: are standards of behavior; expectations of how the group will act in the future based o n its past an present experiences. Cohesion:is the strength of the member’s desire to work together toward common goals

Group Development Pre-group phase: what are the goals of the group? Initial phase: group begins to settle down to work. 3 stages here: orientation, conflict (pecking order is a concern, & cohesive phase (strong attachment among members).

TYPES OF GROUPS Task groups: are designed to accomplish a certain task. (problem-solving focus) Self-help groups: are organized around a common experience (AA.) Educational groups: goal is to provide information (childbirth preparation) Psychotherapy groups-intent is to change behavior. Activity groups: enhance psych and emotional well-being.