A male patient of bipolar disorder with history of 5 episodes of mania and 1 episode of depression in last 8 years, under control by mood stabilizer, and manic symptoms appear as he tapered down the drugs. Which of the following intervention should be carried out to improve drug compliance?
Ans. a. Psychoeducation (Ref: Niraj Ahuja 7/e p67-68)In the question patient symptoms of bipolar disorder are well controlled by medication, which implies pharmacotherapy is efficient and added psychotherapy is necessary only to keep the patient compliant to the medication. In such a case, psychoeducation of the patient about adherence to strict treatment is most crucial psychotherapy modality in preventing relapse.PsychoeducationPsychoeducation refers to the education offered to individuals with a mental health condition & their families to help empower them & deal with their condition in an optimal way.Frequently psychoeducational training involves individuals with schizophrenia, clinical depression, anxiety disorders, psychotic illnesses, eating disorders, and personality disorders, as w ell as patient training courses in context of the treatment of physical illnesses.Family members are also included.A goal is for the consumer to understand and be better able to deal with the presented illness.Also, the patient's own capabilities, resources & coping skills are strengthened & used to contribute to their own health & well-being on a long-term basis.Since it is often difficult for the patient and their family members to accept the patient's diagnosis, psychoeducation also has the function of contributing to the destigmatization of psychological disturbances and to diminish barriers to treatment.The relapse risk is in this way lowered: patients & family members, who are more well- informed about the disease, feel less helplessQ.Important elements in psychoeducation are:Information transfer (symptomatology of the disturbance, causes, treatment concepts, etc.)Emotional discharge (understanding to promote, exchange of experiences with others concerning, contacts, etc.)Support of a medication or psychotherapeutic treatment, as cooperation is promoted between the mental health professional and patient (compliance, adherence).Assistance to self-help (e.g. training, as crisis situations are promptly recognized and what steps should be taken to be able to help the patient).Supportive PsychotherapyIt is a psychotherapeutic approach that integrates psychodynamic, cognitive-behavioral, & interpersonal conceptual models & techniques.The objective of the therapist is to reinforce the patient's healthy & adaptive patterns of thought behaviors in order to reduce the intrapsychic conflicts that produce symptoms of mental disorders.Unlike in psychoanalysis, in which the analyst works to maintain a neutral demeanor as a 'blank canvas' for transference, in supportive therapy, the therapist engages in a fully emotional, encouraging, and supportive relationship with the patient as a method of furthering healthy defense mechanisms, especially in the context of interpersonal relationships.This therapy has been used for patients suffering from severe cases of addiction as well as bulimia nervosa, stress and other mental illnesses.Supportive psychotherapy is used as an initial therapy, to be reduced and not to be prolonged, in situations or periods where there is a lack of means for a systematic approach or behaviorism. Examples of such situations include:Critical negotiationsVolatile but unavoidable everyday life or decisive situationsCompromises (to introduce at least minimal operational, efficient relationship conditions) in long-term, engaged relationships, based on lasting agreementsInsight-oriented PsychotherapyIt relies on conversation between the therapist & client.It helps people through understanding & expressing feelings, motivations, beliefs, fears and desires.As insight-oriented psychotherapy is a client-centered therapy, it is assumed that the client is healthy & his/her problem is a result of faulty thinking.During the therapy, the patient talks about what is on his/her mind and the therapist looks for patterns in situations in which the patient might feel stress or anxiety.Patients typically wish to explore their anxiety more deeply because of a belief that deeper exploration will lead to change.Insight-oriented psychotherapy can refer to:Psychoanalysis, a method of treatment of mental disorders by using talk-therapy to discover and process unconscious thoughts and desires.Psychodynamic psychotherapy, a more-brief & less intensive type of talk therapy that uses psychoanalytic theory & methods.
Psychoeducation
CBT
Supportive psychotherapy
Insight-oriented psychotherapy
Psychoanalysis and Psychotherapy