Additional Therapies (Somatic, CAM, &Therapeutic)

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

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

3. 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).

4. 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.

5. 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)

6. 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)

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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

14. 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.

15. 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.

16. 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.

17. 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.

18. 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.

19. 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.

20. 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.

21. 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.

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

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

24. 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

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

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

27. 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.

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

29. 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.

30. 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

31. 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).

32. 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.