Nashwan Nadhim Hasan

Mental Health and illness Lec\10

Therapeutic Modalities in Psychiatry (Treatment modalities)
The various treatment modalities in psychiatry are broadly divided as:

I. Somatic (physical) therapies

II. Psychological therapies
III. Milieu therapy
IV. Therapeutic community
V. Activity therapy

I .Somatic (physical) therapies

1. Psychopharmacology
2. Electroconvulsive Therapy (ECT)
3. Psychosurgery
1- Psychopharmacology: Drugs used in psychiatry are called as psychotropic (or
psychoactive) drugs.

General Guidelines in Psychopharmacology

1. The nurse should administer any drug ONLY WITH A written order.
2. Consult the doctor when in doubt
3. All medications given must be charted on the patient's case record sheet.
4. Always address the patient by name and make certain of his identification
5. Do not leave the patient until the drug is swallowed
6. Do not permit the patient to go to the bathroom to take the medication
7. Do not leave the tray within the reach of the patient.
8. Bottles should be tightly closed and labeled

Classification of Psychopharmacology (Psychotropic) Drugs

a) Antipsychotics
b) Antidepressants
c) Mood stabilizing drugs
d) Anxiolytics and hypno-sedatives
e) Antiepileptic drugs
f) Antiparkinsonian drugs
g) Miscellaneous drugs which include stimulants, drugs used in eating disorders,
deaddiction, child psychiatry, vitamins, calcium channel blockers, etc.…

1
 a. Antipsychotics also known as neuroleptics
The first of the antipsychotics (also known as neuroleptics), chlorpromazine, was introduced in 1951 for
anesthetic premedication and was noted to reduce delusions and hallucinations in schizophrenia.
Classified to ________Classical ________and _________atypical
• Chlorpromazine • Clozapine
• Promazine • Risperidone
• Triflupromazine • Olanzapine
• Thioridazine • Quetiapine
• Stelazine Trifluoperazine • Ziprasidone
• Fluphenazine • Aripiprazole
• Prochlorperazine • Pimozide
• Loxapine • Parliperidone
• Haloperidol • Sertindole
• Droperidol • Zotepine
Indications
1- Organic psychiatric disorders
• Delirium
• Dementia
• Delirium tremens
• Drug-induced psychosis
2- Psychiatric disorders
• Schizophrenia
• Mania
• Major depression with psychotic symptoms
3- Childhood disorders
• Attention-deficit hyperactivity disorder
• Autism
• Conduct disorder
4- Medical disorders
• Tic disorder
Adverse Effects of Antipsychotic Drugs
Extrapyramidal symptoms (EPS)
1. Neuroleptic-induced parkinsonism:
2. Acute dystonia:
3. Akathisia:
4. Tardive dyskinesia:
5. Neuroleptic malignant syndrome
Nurse's Responsibility for a Patient Receiving Antipsychotics
1. Instruct the patient to take sips of water frequently to relieve dryness of mouth.
2. A high-fiber diet, increased fluid intake
3. Advise the patient to get up from the bed or chair very slowly.
4. Observe the patient regularly for abnormal movements.
5. Patient should be warned about driving a car or operating machinery when first treated with
antipsychotics.

2
 b. Antidepressants
Types
i. Monoamine oxidase MAOI’s e.g. (Phenelzine, Isocarboxazid, tranylcypromine)
ii. Tricyclic Antidepressants TCA’s e.g. (Amitryptiline, Clomipramine, Imipramine
Trimipramine)
iii. Selective serotonin reuptake Antidepressants SSRI’s e.g. (Citalopram and
Escitalopram, Flouxetine, Fluvoxamine, Paroxetine, Sertraline)
iv. Atypical Antidepressants e.g. (Trazadone, Amineptine, Bupropion).

Indications
 Depressive Disorders
 Childhood psychiatric disorders (Separation anxiety disorder, School phobia, Night terrors)
 Anxiety disorders & OCD
Side Effects
1. Autonomic side-effects: Dry mouth, constipation, mydriasis, urinary retention,
orthostatic hypotension, impotence, impaired ejaculation.
2. CNS effects: Sedation, tremor, seizures, precipitation of mania.

3. Cardiac: Tachycardia, ECG changes, arrhythmias

4. Allergic side-effects

5. Metabolic and endocrine side-effects: Weight gain.

6. Special effects of MAOI drugs: Hypertensive crises, hyperpyrexia.

Nurse's Responsibility
• Patients on MAO is should be warned against the danger of ingesting tyramine-rich
foods which can result in hypertensive crisis.
• Some of these foods are beef liver, chicken liver, dried fish, overripe fruits, chocolate
and beverages like wine, beer and coffee.
• Caution the patient to change his position slowly to minimize orthostatic hypotension.
c. Mood Stabilizers
Mood Stabilizing Drugs
 Lithium
 Carbamazepine (Tegretol)
 Sodium valproate
Indications
• Bipolar and related disorders
• Impulsive and aggression

3
 d. Anxiolytics
Benzodiazepines:
 Chlordiazepoxide
 Diazepam
 Oxazepam
 Chlorazepate
 Lorazepam
 Halazepam
 Alprazolam
Indications
• Anxiety disorders and Obsessive-compulsive disorder (OCD)
• Insomnia
• Depression
• Post-traumatic stress disorder

2- Electroconvulsive Therapy
The lecture in the clinical
3- Psychosurgery
"a surgical intervention, to destroy fibers connecting one part of the brain with another
with the intent of modifying behavior, thought or mood disturbances.

II. Psychological Therapies

1. Psychoanalytic therapy
2. Behavior therapy
3. Cognitive therapy
4. Hypnosis
5. Abreaction therapy
6. Individual psychotherapy
7. Supportive psychotherapy
8. Group therapy
9. Family and marital therapy