Treatment of mental illness
Encyclopedia
Mental disorders are classified as a psychological condition marked primarily by sufficient disorganization of personality, mind, and emotions to seriously impair the normal psychological and often social functioning of the individual. Individuals diagnosed with mental disorders are typically deemed unable to function in society. Mental disorders occasionally consist of a combination of affective, behavioral, cognitive and perceptual components. The acknowledgement and understanding of mental health conditions has changed over time and across cultures, and there are still variations in the definition, classification, and treatment of mental disorders.

History

The history of treatment of mental disorders consist in a development through years in both psychotherapy (Cognitive therapy, Behavior therapy, Group Therapy, and ECT) and psychopharmacology (drugs used in mental disorders). Psychotherapy is a relatively new method used in treatment of mental disorders. The practice of individual psychotherapy as a treatment of mental disorders is about 100 years old. Sigmund Freud (1856–1939) was the first one to introduce this concept in psychoanalysis. Cognitive therapy is a more recent therapy that was founded by Aaron T. Beck ( born in 1921), an American psychiatrist. It is a more systematic and structured part of psychotherapy. It consist in helping the patient learn effective ways to overcome their problems and difficulties that causes them distress. Behavior therapy has its roots in experimental psychology. E.L Thorndike and B.F Skinner were among the first to work on behavior therapy. Convulsive therapy was introduced by Ladislas Meduna in 1934. He induced seizures, by using pentetrazol, as a way to reduce depression. Meanwhile in Italy, Ugo Cerletti substituted metrazol (which was used in Convulsive theory) with electricity. Because of this substitution the new theory was called Electro-Convulsive Therapy (ECT). Beside psychotherapy, a wide range of medication is used in the treatment of mental disorders. The first drugs used for this purpose were extracted from plants with psychoactive properties. Louis Lewin, in 1924, was the first one to introduce a classification of drugs and plants that had these kind of properties. The history of the medications used in mental disorders has developed a lot through years. The discovery of modern drugs prevailed during the 19th century.. Lithium was discovered as a treatment of mania, by John F. Cade in 1949. In 1937, Daniel Bovet and Anne-Marie Staub discovered the first antihistamine (Neuroleptic). In 1950 the Paul Charpentier synthesized chlorpromazine (Neuroleptic).

Influences

There are numerous numbers of individuals who have influenced the treatment of modern mental disorders. One of the most important doctors was the "Father of American Psychiatry", Benjamin Rush. Benjamin Rush (1746–1813) was considered the Father of American Psychiatry for his many works in the mental field of study. He published several books on the matter. He also tried to classify different types of mental disorders, he theorized about their causes, and tried to find possible cures for them. Rush believed that mental disorders were caused by poor blood circulation, though he was wrong. He also described Savant Syndrome and had an approach to addictions.

Other important early pychiatrists include George Parkman
George Parkman
George Parkman , a Boston Brahmin , belonged to one of Boston's richest families...

, Oliver Wendell Holmes, Sr.
Oliver Wendell Holmes, Sr.
Oliver Wendell Holmes, Sr. was an American physician, professor, lecturer, and author. Regarded by his peers as one of the best writers of the 19th century, he is considered a member of the Fireside Poets. His most famous prose works are the "Breakfast-Table" series, which began with The Autocrat...

, George A. Zeller, Carl Jung
Carl Jung
Carl Gustav Jung was a Swiss psychiatrist and the founder of Analytical Psychology. Jung is considered the first modern psychiatrist to view the human psyche as "by nature religious" and make it the focus of exploration. Jung is one of the best known researchers in the field of dream analysis and...

, Leo Kanner
Leo Kanner
Leo Kanner was a Jewish American psychiatrist and physician known for his work related to autism. Kanner's work formed the foundation of child and adolescent psychiatry in the U.S. and worldwide....

, and Peter Breggin
Peter Breggin
Peter Roger Breggin is an American psychiatrist and critic of biological psychiatry and psychiatric medication. In his books, he advocates replacing psychiatry's use of drugs and electroconvulsive therapy with humanistic approaches, such as psychotherapy, education, and broader human...

. George Parkman (1790–1849) got his medical degree at the University of Aberdeen in Scotland. He was influenced by Benjamin Rush
Benjamin Rush
Benjamin Rush was a Founding Father of the United States. Rush lived in the state of Pennsylvania and was a physician, writer, educator, humanitarian and a Christian Universalist, as well as the founder of Dickinson College in Carlisle, Pennsylvania....

, who inspired him to take interest in the state asylums. He trained at the Parisian Asylum. Parkman wrote several papers on treatment for the mentally ill. Oliver Wendell Holmes Sr.(1809–1894) was an American Physician who wrote many famous writings on medical treatments. George H. Zeller (1858–1938) was famous for is way of treating the mentally ill. He believed they should be treated like people and did so in a caring manner. He banned narcotics, mechanical restraints, and imprisonment while he was in charge at Peoria State Asylum. Peter Breggin (1939–present) disagrees with the practices of harsh psychiatry such as electroconvulsive theropy.

Psychotherapy

A common form of treatment for many mental disorders is psychotherapy
Psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...

. Psychotherapy is an interpersonal intervention, usually provided by a mental health professional
Mental health professional
A mental health professional is a health care practitioner who offers services for the purpose of improving an individual's mental health or to treat mental illness. This broad category includes psychiatrists, clinical psychologists, clinical social workers, psychiatric nurses, mental health...

 such as a clinical psychologist, that employs any of a range of specific psychological techniques. There are several main types. Cognitive behavioral therapy (CBT) is used for a wide variety of disorders, based on modifying the patterns of thought and behavior associated with a particular disorder. There are various kinds of CBT therapy, and offshoots such as dialectical behavior therapy. Psychoanalysis
Psychoanalysis
Psychoanalysis is a psychological theory developed in the late 19th and early 20th centuries by Austrian neurologist Sigmund Freud. Psychoanalysis has expanded, been criticized and developed in different directions, mostly by some of Freud's former students, such as Alfred Adler and Carl Gustav...

, addressing underlying psychic conflicts and defenses, has been a dominant school of psychotherapy and is still in use. Systemic therapy
Systemic Therapy
Systemic therapy is a form of psychotherapy which seeks to address people not on individual level, as had been the focus of earlier forms of therapy, but as people in relationship, dealing with the interactions of groups and their interactional patterns and dynamics.- History :Systemic therapy has...

 or family therapy
Family therapy
Family therapy, also referred to as couple and family therapy, family systems therapy, and family counseling, is a branch of psychotherapy that works with families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of...

 is sometimes used, addressing a network of relationships as well as individuals themselves. Some psychotherapies are based on a humanistic
Humanistic psychology
Humanistic psychology is a psychological perspective which rose to prominence in the mid-20th century, drawing on the work of early pioneers like Carl Rogers and the philosophies of existentialism and phenomenology...

 approach. Some therapies are for a specific disorder only, for example interpersonal and social rhythm therapy
Interpersonal and social rhythm therapy
Interpersonal and Social Rhythm Therapy or simply Social rhythm therapy is a type of behavioral therapy used to treat the disruption in circadian rhythms that is related to bipolar disorder. ISRT provides a biopsychosocial model for bipolar disorder and recognizes that the illness cannot be fully...

. Mental health professionals often pick and choose techniques, employing an eclectic or integrative approach
Integrative Psychotherapy
Integrative psychotherapy may involve the fusion of different schools of psychotherapy. The word 'integrative' in Integrative psychotherapy may also refer to integrating the personality and making it cohesive, and to the bringing together of the "affective, cognitive, behavioral, and physiological...

 tailored to a particular disorder and individual. Much may depend on the therapeutic relationship
Therapeutic relationship
The therapeutic relationship, also called the helping alliance, the therapeutic alliance, and the working alliance, refers to the relationship between a healthcare professional and a client...

, and there may be issues of trust, confidentiality
Confidentiality
Confidentiality is an ethical principle associated with several professions . In ethics, and in law and alternative forms of legal resolution such as mediation, some types of communication between a person and one of these professionals are "privileged" and may not be discussed or divulged to...

 and engagement
Engagement
An engagement or betrothal is a promise to marry, and also the period of time between proposal and marriage which may be lengthy or trivial. During this period, a couple is said to be betrothed, affianced, engaged to be married, or simply engaged...

.

Medication

Psychiatric medication
Psychiatric medication
A psychiatric medication is a licensed psychoactive drug taken to exert an effect on the mental state and used to treat mental disorders. Usually prescribed in psychiatric settings, these medications are typically made of synthetic chemical compounds, although some are naturally occurring, or at...

 is also widely used to treat mental disorders. These are licenced psychoactive drugs usually prescribed by a psychiatrist
Psychiatrist
A psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...

 or family doctor. There are several main groups. Antidepressants are used for the treatment of clinical depression
Clinical depression
Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...

 as well as often for anxiety and other disorders. Anxiolytics are used, generally shorter-term, for anxiety disorders and related problems such as insomnia. Mood stabilizers are used primarily in bipolar disorder
Bipolar disorder
Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...

, mainly targeting mania
Mania
Mania, the presence of which is a criterion for certain psychiatric diagnoses, is a state of abnormally elevated or irritable mood, arousal, and/ or energy levels. In a sense, it is the opposite of depression...

 rather than depression. Antipsychotics are used for psychotic disorders, notably in schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...

. Stimulants are commonly used, notably for ADHD.

Despite the different conventional names of the drug groups, there can be considerable overlap in the kinds of disorders for which they are actually indicated. There may also be off-label use
Off-label use
Off-label use is the practice of prescribing pharmaceuticals for an unapproved indication or in an unapproved age group, unapproved dose or unapproved form of administration...

. There can be problems with adverse effects and adherence
Compliance (medicine)
In medicine, compliance describes the degree to which a patient correctly follows medical advice...

.

Antipsychotics

The addition of atypical antipsychotics in cases of inadequate response to antidepressant therapy is an increasingly popular strategy that is well supported in the literature,3 though these medications may result in greater discontinuation due to adverse events. Aripiprazole was the first drug approved by the US Food and Drug Administration for adjunctive treatment of MDD in adults with inadequate response to antidepressant therapy in the current episode. Recommended doses of aripiprazole range from 2 mg/d to 15 mg/d based on 2 large, multicenter randomized, double-blind, placebo-controlled studies,4,5 which were later supported by a third large trial.6

Most conventional antipsychotics, such as the phenothiazines, work by blocking the D2 Dopamine receptors. Atypical antipsychotics, such as clozapine block both the D2 Dopamine receptors as well as 5HT2A serotonin receptors. Atypical antipsychotics are favored over conventional antipsychotics because they reduce the prevalence of pseudoparkinsonism which causes tremors and muscular rigidity similar to Parkinson’s disease. The most severe side effect of antipsychotics is agranulocytosis, a depression of white blood cell count with unknown cause, and some patients may also experience photosensitivity.

Antidepressants

Early antidepressants were discovered through research on treating tuberculosis and yielded the class of antidepressants known as monoamine oxidase inhibitors (MAO). Only two MAO inhibitors remain on the market in the United States because they alter the metabolism of the dietary amino acid tyramine which can lead to a hypertensive crisis. Research on improving phenothiazine antipsychotics led to the development of tricyclic antidepressants which inhibit synaptic uptake of the neurotransmitters norepinephrine, dopamine, and serotonin. Later research on this class of antidepressants focused mostly on the effects of norepinephrine. These drugs share many similarities with the tricyclic antidepressants but are more selective in their action. The greatest risk of the SSRIs is an increase in violent and suicidal behavior, particularly in children and adolescents. In 2003 antidepressant sales worldwide totaled $15 billion USD and as of 2006 antidepressants accounted of seven of the 100 most prescribed drugs.

Other

Electroconvulsive therapy (known as ECT
Electroconvulsive therapy
Electroconvulsive therapy , formerly known as electroshock, is a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Its mode of action is unknown...

) is sometimes used, for example in prolonged mood disorder unresponsive to other interventions. Psychosurgery
Psychosurgery
Psychosurgery, also called neurosurgery for mental disorder , is the neurosurgical treatment of mental disorder. Psychosurgery has always been a controversial medical field. The modern history of psychosurgery begins in the 1880s under the Swiss psychiatrist Gottlieb Burckhardt...

, including deep brain stimulation
Deep brain stimulation
Deep brain stimulation is a surgical treatment involving the implantation of a medical device called a brain pacemaker, which sends electrical impulses to specific parts of the brain...

, is another available treatment for some disorders.

Creative therapies are sometimes used, including music therapy
Music therapy
Music therapy is an allied health profession and one of the expressive therapies, consisting of an interpersonal process in which a trained music therapist uses music and all of its facets—physical, emotional, mental, social, aesthetic, and spiritual—to help clients to improve or maintain their...

, art therapy
Art therapy
Because of its dual origins in art and psychotherapy, art therapy definitions vary. They commonly either lean more toward the ART art-making process as therapeutic in and of itself, "art as therapy," or focus on the psychotherapeutic transference process between the therapist and the client who...

 or drama therapy
Drama therapy
Drama Therapy is the use of theatre techniques to facilitate personal growth and promote mental health. Dramatherapy is used in a wide variety of settings, including hospitals, schools, mental health centers, prisons, and businesses...

.

Lifestyle adjustments and supportive measures are often used, including peer support
Peer support
Peer support occurs when people provide knowledge, experience, emotional, social or practical help to each other. It commonly refers to an initiative consisting of trained supporters, and can take a number of forms such as peer mentoring, listening, or counseling...

, self-help
Self-help
Self-help, or self-improvement, is a self-guided improvement—economically, intellectually, or emotionally—often with a substantial psychological basis. There are many different self-help movements and each has its own focus, techniques, associated beliefs, proponents and in some cases, leaders...

 and supported housing
House
A house is a building or structure that has the ability to be occupied for dwelling by human beings or other creatures. The term house includes many kinds of different dwellings ranging from rudimentary huts of nomadic tribes to free standing individual structures...

 or employment
Employment
Employment is a contract between two parties, one being the employer and the other being the employee. An employee may be defined as:- Employee :...

. Some advocate dietary supplements. Many things have been found to help at least some people. A placebo
Placebo
A placebo is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient...

 effect may play a role.

Services

Often an individual may engage in different treatment modalities and use various mental health services. These may be under case management
Case management (mental health)
Case management is the coordination of community services for mental health patients by allocating a professional to be responsible for the assessment of need and implementation of care plans. It is usually required for individuals who have a serious mental illness and need ongoing support in areas...

 (sometimes referred to as "service coordination"), use inpatient or day treatment
Partial hospitalization
Partial hospitalization, also known as PHP , is a type of program used to treat mental illness and substance abuse. In partial hospitalization, the patient continues to reside at home, but commutes to a treatment center up to seven days a week...

, utilize a psychosocial rehabilitation
Clubhouse Model of Psychosocial Rehabilitation
The of Psychosocial Rehabilitation is a comprehensive and dynamic program of support and opportunities for people with severe and persistent mental illnesses...

 program, and/or take part in an Assertive Community Treatment
Assertive Community Treatment
Assertive community treatment, or ACT, is an intensive and highly integrated approach for community mental health service delivery. ACT programs serve people whose symptoms of mental illness result in severe functional difficulties that interfere with their ability to achieve personally meaningful...

 program. Providing optimal treatments earlier in the course of a mental health disorder may prevent further relapses and ongoing disability and has led to a new early intervention in psychosis
Early intervention in psychosis
Early intervention in psychosis is a clinical approach to those experiencing symptoms of psychosis for the first time. It forms part of a new prevention paradigm for psychiatry and is leading to reform of mental health services, especially in the United Kingdom....

 service approach for psychosis.

Mental health services may be based in hospitals, clinics or the community.

Some approaches are based on a recovery model of mental disorder, and may focus on challenging stigma
Social stigma
Social stigma is the severe disapproval of or discontent with a person on the grounds of characteristics that distinguish them from other members of a society.Almost all stigma is based on a person differing from social or cultural norms...

 and social exclusion
Social exclusion
Social exclusion is a concept used in many parts of the world to characterise contemporary forms of social disadvantage. Dr. Lynn Todman, director of the Institute on Social Exclusion at the Adler School of Professional Psychology, suggests that social exclusion refers to processes in which...

 and creating empowerment and hope.

In America, half of people with severe symptoms of a mental health condition were found to have received no treatment in the prior 12 months.

Fear of disclosure, rejection by friends, and ultimately discrimination are a few reasons why people with mental health conditions often don't seek help.

List of treatments

  • Somatotherapy
    Somatotherapy
    Psychiatric somatotherapy is the treatment of mental illness by physical means rather than psychotherapy....

     (type of pharmacotherapy
    Pharmacotherapy
    Pharmacotherapy is the treatment of disease through the administration of drugs. As such, it is considered part of the larger category of therapy....

    ; biology
    Biology
    Biology is a natural science concerned with the study of life and living organisms, including their structure, function, growth, origin, evolution, distribution, and taxonomy. Biology is a vast subject containing many subdivisions, topics, and disciplines...

    -based treatments)
    • Psychiatric medication
      Psychiatric medication
      A psychiatric medication is a licensed psychoactive drug taken to exert an effect on the mental state and used to treat mental disorders. Usually prescribed in psychiatric settings, these medications are typically made of synthetic chemical compounds, although some are naturally occurring, or at...

      s (psychoactive drugs used in psychiatry
      Psychiatry
      Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...

      )
      • Antianxiety drugs (anxiolytics)
      • Antidepressant drugs
        Antidepressant
        An antidepressant is a psychiatric medication used to alleviate mood disorders, such as major depression and dysthymia and anxiety disorders such as social anxiety disorder. According to Gelder, Mayou &*Geddes people with a depressive illness will experience a therapeutic effect to their mood;...

      • Antipsychotic drugs
        Antipsychotic
        An antipsychotic is a tranquilizing psychiatric medication primarily used to manage psychosis , particularly in schizophrenia and bipolar disorder. A first generation of antipsychotics, known as typical antipsychotics, was discovered in the 1950s...

      • Mood stabilizer
        Mood stabilizer
        A mood stabilizer is a psychiatric medication used to treat mood disorders characterized by intense and sustained mood shifts, typically bipolar disorder.-Uses:...

        s
    • Shock therapy
      Electroconvulsive therapy
      Electroconvulsive therapy , formerly known as electroshock, is a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Its mode of action is unknown...

       also known as convulsive therapies
      • Insulin shock therapy
        Insulin shock therapy
        Insulin shock therapy or insulin coma therapy was a form of psychiatric treatment in which patients were repeatedly injected with large doses of insulin in order to produce daily comas over several weeks...

         (no longer practiced)
      • Electroconvulsive therapy
        Electroconvulsive therapy
        Electroconvulsive therapy , formerly known as electroshock, is a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Its mode of action is unknown...

    • Psychosurgery
      Psychosurgery
      Psychosurgery, also called neurosurgery for mental disorder , is the neurosurgical treatment of mental disorder. Psychosurgery has always been a controversial medical field. The modern history of psychosurgery begins in the 1880s under the Swiss psychiatrist Gottlieb Burckhardt...

      • Leukotomy (prefrontal lobotomy; no longer practiced)
      • Bilateral cingulotomy
        Bilateral cingulotomy
        Bilateral cingulotomy is a form of psychosurgery, introduced in 1948 as an alternative to lobotomy. Today, it is mainly used in the treatment of obsessive-compulsive disorder, depression and addiction. It is also, rarely, used in the treatment of chronic pain...

      • Deep brain stimulation
        Deep brain stimulation
        Deep brain stimulation is a surgical treatment involving the implantation of a medical device called a brain pacemaker, which sends electrical impulses to specific parts of the brain...

  • Psychotherapy
    Psychotherapy
    Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...

     (psychology
    Psychology
    Psychology is the study of the mind and behavior. Its immediate goal is to understand individuals and groups by both establishing general principles and researching specific cases. For many, the ultimate goal of psychology is to benefit society...

    -based treatment)
    • Cognitive Behavior Therapy
    • Psychoanalysis
      Psychoanalysis
      Psychoanalysis is a psychological theory developed in the late 19th and early 20th centuries by Austrian neurologist Sigmund Freud. Psychoanalysis has expanded, been criticized and developed in different directions, mostly by some of Freud's former students, such as Alfred Adler and Carl Gustav...

    • Gestalt Therapy
      Gestalt therapy
      Gestalt therapy is an existential/experiential form of psychotherapy that emphasizes personal responsibility, and that focuses upon the individual's experience in the present moment, the therapist-client relationship, the environmental and social contexts of a person's life, and the self-regulating...

    • Interpersonal psychotherapy
      Interpersonal psychotherapy
      Interpersonal Psychotherapy is a time-limited psychotherapy that focuses on the interpersonal context and on building interpersonal skills. IPT is based on the belief that interpersonal factors may contribute heavily to psychological problems. It is commonly distinguished from other forms of...

    • EMDR
    • Behavior Therapy

Further reading

  • Consensus document on European brain research J. Neurol. Neurosurg. Psychiatry 1 August 2006: i1-i49.
  • Mind, Brain, and Personality Disorders Am. J. Psychiatry 1 April 2005: 648-655.
  • The eye's mind: brain mapping and psychiatry Br. J. Psychiatry 1 May 2003: 381-384
  • General Psychiatry JAMA 16 September 1998: 961-962
  • The practice of medicinal chemistry, Camille Georges Wermuth
  • Theories of Psychotherapy & Counseling: Concepts and Cases, Richard S. Sharf
  • Cognitive behavioural interventions in physiotherapy and occupational therapy, Marie Donaghy, Maggie Nicol, Kate M. Davidson
  • Key concepts in psychotherapy integration, Jerold R. Gold
  • Hart &Ksir, Drugs, Society, & Human Behavior, 14th edition.
The source of this article is wikipedia, the free encyclopedia.  The text of this article is licensed under the GFDL.
 
x
OK