What are the main principles of psychotherapy
Develop therapeutic relationship
Listen to patient concerns
Empathetic approach
Provide information, support, and advice
Allow expression of emotions
Encourage self-help
What is cognitive behavioural therapy
Aim to identify and challenge automatic negative beliefs, and then modify abnormal underlying core beliefs
Thinking errors
- Selective abstraction (focus on minor details)
- All or nothing thinking
- Magnification/minimisation
- Catastrophic thinking
- Overgeneralisation
- Arbitrary inference (conclusions in absence of evidence)
What are the different types of behavioural therapy
Relaxation training
Systemic desensitisation
- Gradual exposure
Flooding
- Rapid exposure
Exposure and response prevention
Behavioural activation
- Make realistic plans, gradually increase activity
What is psychodynamic psychotherapy
Aim to develop insight into maladaptive behaviour
Much longer duration than CBT
Indications
- Dissociative disorders
- Somatoform disorders
- Psychosexual disorders
- Some personality disorders
- Recurrent depression
What is simple psychotherapy
Psychoeducation
Counselling
Supportive psychotherapy
Problem-solving therapy
What are the new psychotherapies
Interpersonal therapy
- Focus on difficulties in relationships
Eye movement desensitisation and reprocessing
- Access traumatic memories, eventually resolve them
Cognitive analytic therapy
- Identify how problems begin in order to resolve them
What is the seizure threshold in ECT
Minimum electrical stimulus needed to induce a seizure
Increased by
- Anaesthetic drugs anticonvulsants, benzodiazepines, barbiturates
Reduced by
- Antipsychotics, antidepressants, lithium
What are the indications for ECT
Prolonged severe mania
Catatonia
Severe depression
- Treatment-resistant
- Serious risk to self/others
- Refusal to eat/drink
What are the side effects of ECT
Short term
- Peripheral nerve palsies
- Cardiac arrhythmias
- Confusion
- Dental trauma
- Anaesthetic risk
- Muscle aches
- Headaches
- Short term memory loss
- Status epilepticus
Long term
- Anterograde and retrograde amnesia
What are the contraindications for ECT
MI <3 months ago
Major unstable fracture
Cerebral aneurysm
Raised intracranial pressure
Stroke <1 month ago
History of status epilepticus
Severe anaesthetic risk
