Post on 26-Mar-2015
Treatment and recovery in mental health
NICE guidelines and service user perspectives
Katherine Darton
outline
• Standard diagnosis and treatment in psychiatry
• Schizophrenia as an example - symptoms- treatments- alternative ways of understanding- alternative approaches to treatment
• CAMs – possible place?
Diagnosis• based on ICD-10 (WHO) and DSM-IV (APA) criteria
• mood disorders – depression anxiety
• psychotic disorders
• crucial for access to treatment
NICE guidelines• Depression – mild to moderate; severe• Anxiety – + panic disorder, OCD & BDD • Self-harm• Eating disorders• PTSD• Bipolar disorder• Schizophrenia• Personality disorders – antisocial; ‘dangerous and severe’;
borderline • Plus guidelines on specific treatments
Schizophrenia - symptoms
Positive symptoms• Hallucinations – voices, things seen, etc.• Delusions – being controlled by outside
force; paranoia; thought insertion; thoughts being heard; magic powers
• Lack of insight• Increased salience (dopamine)
Schizophrenia - symptoms
Negative symptoms
• Self neglect
• Lack of emotional response
• Absence of thoughts
• Apathy
Schizophrenia - treatments
• Medication – ‘antipsychotics’
• Talking treatments – CBT
• Arts therapies – art, drama, music, dance
Medication
• Antipsychotics – neuroleptic; ataraxic[ataraxy – detachment; indifference – distinct from sedation]
• Block dopamine – and other neurotransmitters
Dopamine
Brain neurotransmitter
• Salience – the importance attached to thingsassociated with psychosis
• Voluntary movement
• Prolactin
• Effects on other neurotransmitters
synapse
• Photomicrograph of synapse
Synapse - diagram
Antipsychotics – adverse effects
• Parkinsonism
• Other movement disorders - tics, spasms, tardive dyskinesia, loss of fine control
• Akathisia
• Prolactin – breast development; lactationsexual side effects
• Heart effects – disturbances of heart rhythm
Antipsychotics – adverse effects
• Metabolic syndrome – weight gain, increased blood fats, diabetes
• Blood disorders
• Antimuscarinic effects
• Constipation
• Life-limiting
• ‘not worth the candle’?
Antipsychotics – and talking
• Reduce salience – hence some psychotic symptoms
• Do not change beliefs or past experiences
• need CBT or other talking therapy to unlearn things wrongly attributed and come to terms with damaging events (Human Givens therapy)
• Arts therapies – may help deal with bad memories; park difficult ideas.
Schizophrenia – controversies
• ‘a scientific delusion’ – subjective diagnosis
• An unhelpful label – stigmatising; implies deterioration
• No evidence for discrete condition
• 4% of population hear voices – only a minority are bothered by them
Alternative approaches• Formulation vs diagnosis (sense-making)• Other cultures • Hearing Voices Network – a new approach to
symptoms (the voices have a message – need to translate it)
• Narrative approaches (tree of life)• Group therapy – helps people know themselves
Recovery• Process rather than outcome
• Person rather than symptoms/diagnosis
• Hope
• The end of ‘untreatability’ (unheilbarkeit)
• Self-determination
• Allow people to tell their story
• Come off medication
• (‘hi-jacked by professionals’)
Medication withdrawal
• Psychoactive substances
• Consequences of long-term medication – receptor changes
• Abrupt withdrawal
• Slow withdrawal – dose reductionswitch to drug with longer half-life
Alternative therapies
• Help with adverse effects
• Help with withdrawal
• help with symptoms?
Acceptance as treatment
• Need for evidence of efficacy - scientific studies in peer-reviewed journals
Personalisation – an opportunity?
ResourcesBooks• Gail Hornstein – Agnes’s jacket• Marius Romme and Sandra Escher – Accepting voices• Jim Read – Psychiatric drugs: key issues and service user perspectives• South Somerset Mind – Art of recovery
Websites• www.mind.org.uk• www.hearing-voices.org• www.mentalhealth.org.uk• www.nice.org.uk