PSYCHIATRY SELF NOTES AT ROTATION:

Psychotherapy (modified from Wolberg)

Def: Establishing a professional relationshipwith the patient to,
1. Remove, modify or retard existing symptoms,
2. Mediate disturbed patterns of behaviour, and/or
3. Promote positive personality growth and development

Through: verbal or non-verbal means

Types:

Psychoanalysis
Def: is a set of theories and therapeutic techniques of the unconscious mind, used to treat
mental-health disorders. (Early 1890s by Austrian neurologist Sigmund Freud)

Aim: by interpretation…to changing the personality itself rather than just ameliorating the symptoms
(therefore their usefulness is uncertain, particularly in florid depressive or manic episode) (but can be
helpful dysthymic disorder, depression co-morbid with personality disorders, or depression with history of
childhood loss/child abuse)

Visits: 2-5 visits/ week by the patient for a period of 3-5 years (or more)

Patient: allowed to communicate unguided, by using ‘free association’, helped to interprate lies on the
couch,

Therapist: remains passive, non-directive; however, constantly challenges the existing defenses and
interprets resistance (during the therapy) and transference (patient’s feelings, behaviours and relationship
with the therapist), no direct advice sitting just out of vision.

Behavior Therapy
short-term moda lities such as social skills training; problem solving techniques,
assertiveness training, self-control the rapy, activity scheduling and decision-making techniques.
indications: mild cases of depression or as an adjunct to antidepressants in moderate depression

Group Therapy
Indication: mild depression and bipolar disorder

How: psycho -education

Family and Marital Therapy

Educating the family about:

1. nature of illness & interfamilial and inter personal difficulties in order to  Reduce or modify
stressors
2. Usefulness of somatic treatment

Indication 2: mood disorders to ensure continuity of treatment (such as lithium prevention in patients with
bipolar disorder) and adequate drug concordance

Psychoanalytically-oriented (Psychodynamic) Psychotherapy

… is a much more direct form of psychoanalysis.

Duration: briefer > psychoanalysis

Advice: is given to the patient occasionally.

Orientation: patient and therapist may sit face-to-face or else couch is used.

The rest of technique is nearly the same as psychoanalysis.

However, additional modes of treatment, including drug therapy can be used.

Indication: presence of long-standing mental conflicts (although are unconscious,
produce significant symptomatology)

Prerequisites:

 patient should be: motivated for therapy, should have strong ‘ ego-structure’ (which can bear
frustrations of impulses during the therapy), should be psychologically-minded and
 should not: have recent significant life stressors.

Indication: neu rotic disorders and personality disorders (or charac tero logical difficulties).

Behaviour Therapy
based on: theories of learning,

Aims: modifying maladaptive behaviour and substituting it with adaptive behaviour.

Although there are many theories of learn ing, majority of behaviour therapy

Techniques: operant conditioning model (Skinner) and classical conditioning model (Pavlov).

Many of the ideas actually seem like (and are) common sense principles.
The learning theories assume that all behaviour is
learned behaviour. The behaviour that is followed
by a reward is more likely to occur again (operant
model), and that behaviour is learned more easily if
taught in small steps.
Behaviour therapy is typically a short duration
therapy; therapists are easy to train and it is usually
cost-effective. The total duration of therapy is usually
6-8 weeks. Initial sessions are scheduled daily but
the later sessions are more spaced out. A behavioural
analysis is usually carried out before planning behaviour therapy. One of the simplest methods of behaviour
analysis is called as ABC charting, which involves a
close look at the:
i. Antecedent (e.g. circumstances under which
the behaviour began; who, if any, were present;
other details),
ii. Behaviour (description of the behaviour in
detail), and
iii. Consequence (what happened afterwards; what
factors helped to maintain behaviour).
Some of the important behavioural techni ques are
described briefly.

Systematic Desensitisation 214 (226 / 273) JP JP JP