longer present in the conscious mind. Hypnotherapy is practiced by highly trained clinicians, often psychologists, to achieve certain therapeutic goals with the patient, such as recovering memories lost through the defense mechanism of repression, learning to be less anxious when faced with anxiety-provoking situations, or reducing or eliminating undesirable behavior such as smoking. The patient undergoing hypnotherapy must be relaxed and receptive to the procedure (https:// positivepsychology.com/hypnotherapy/). Psychiatric nurses should familiarize themselves with the various modalities of psychotherapy, the medications used in the treatment of psychiatric illness, as well as the complementary and alternative therapies and the various somatic therapies used in the treatment of psychiatric disorders. Psychiatric nurses provide psychoeducational services to patients and their families and should have a thorough understanding of the treatment modalities commonly used in psychiatric practice.
Self-Assessment Quiz Question #7 Which complementary alternative medicine interferes with
anticoagulants? a. Chamomile. b. Ginseng. c. Ginkgo biloba. d. St. John’s wort.
Self-Assessment Quiz Question #8 Which complementary alternative medicine should be avoided in patients who report heavy alcohol use? a. St. John’s Wort. b. Ginseng. c. Valerian root. d. Kava kava.
OTHER THERAPIES IN MENTAL HEALTH
Electroconvulsive therapy Mental health professionals once used ECT, introduced in the 1930s, to treat a broad range of psychiatric disturbances (George et al., 2020). With strong advances and refinements in the field, professionals may still use ECT to treat certain conditions such as severe depression (major depression), mania, or psychosis (George, et. al, 2020). To perform ECT, the patient is given a short-acting sedative, followed by a muscle relaxant. The muscle relaxant prevents tonic-clonic jerking of the body caused by seizure activity that, historically, was the cause of physical injuries to the patient. After the patient is anesthetized, electrodes are placed on the sides of their head and an electrical stimulus that is sufficient to trigger a seizure is given. Ideally, the seizure activity lasts about 15 seconds (Townsend, 2014). Breathing is supported during the procedure by nurse anesthetists or anesthesiologists. The ECT session is repeated Transcranial magnetic stimulation Transcranial magnetic stimulation (TMS) is a noninvasive treatment for depression. The patient is exposed to electrical energy that is passed through a coil of wires to produce a powerful magnetic field (George, et. al, 2020). Magnetic waves pass through the brain and skull painlessly, while the patient remains awake for the procedure. It is most effective Vagus nerve stimulation Vagus nerve stimulation (VNS) is an adjunctive, long-term, invasive therapy for adult patients with serious and persistent depression (George, et. al, 2020). Most of these individuals have shown no improvement in condition after trials of four or more antidepressants before attempting VNS therapy. A VNS implant is a small, battery-powered device, similar to a cardiac pacemaker, that is surgically implanted subcutaneously under the skin of the upper left or right chest. Internally, a wire runs Case study 1 Mrs. Jones was admitted as an involuntary patient to the psychiatric unit. She was brought to the emergency department by her daughter, who reported her mother was showing “new and bizarre” behaviors. She has a history of schizophrenia, which has been well controlled until this episode. The psychiatric nurse begins the mental status exam of Mrs. Jones. The nurse notes that she is wearing a short dress that is on backwards. She appears disheveled and unkempt; she has not eaten any of her breakfast. Further, the nurse observes that Mrs. Jones has taken the blankets off the bed and laid them out on the floor. She has also taken the toilet paper and unrolled it into a pile on the floor. When the nurse introduces herself, Mrs. Jones is at the window talking in nonsensical words. She is wringing her hands and
two to three times a week for 3 to 4 weeks and is often done on an outpatient basis (Townsend, 2019). Providers usually use medications and therapy before deciding to use ECT. ECT has an effectiveness rate of approximately 60% to 70% in the treatment of depression (George, et. al, 2020). There are few contraindications to ECT; however, caution should be used in pregnancy, patients with cardiac conditions, or patients with intracranial pressure because of disease (Townsend, 2019). Side effects of ECT include memory loss and some confusion in recalling events right before and after the procedure. Some people complain of long-term memory and cognitive problems. Also, complications related to the use of anesthetics (allergic reaction, respiratory suppression) can occur. when administered for 40 minutes daily for 4 to 6 weeks. It is thought to work by stimulating nerve cells to produce the neurotransmitters that relieve depression. Side effects of TMS are few, with patients reporting only mild headaches. TMS cannot be used if the patient has implanted or permanent metal in the skull or brain (George, et. al, 2020). from the device to the vagus nerve, which then carries electrical impulses to the brain. These impulses are emitted every few minutes. The device is thought to work by electrically stimulating the production of neurotransmitters that are associated with depression treatment. The side effects of VNS include a tickle in the throat (may trigger a cough reflex), mild hoarseness or other voice changes, and, rarely, difficulty swallowing, shortness of breath, neck pain, and a prickling sensation in the skin. appears to be fixated on something outside. She does not acknowledge the nurse. Later, she turns around and exclaims, “Sally, I am so glad you are here. Tea is almost ready. Flubrubaroo?” She moves to the pile of blankets and stands in the middle of them, smiling at the nurse. The nurse smiles and begins to talk to Mrs. Jones. The nurse explains again that she is a psychiatric nurse and is there to care for her. She states, “Oh no, dear, have you tokenitnd?” The nurse notes that Mrs. Jones’ affect is flat as she stares out at the window but animated when speaking in nonsensical words. The nurse asks her name. Suddenly, the patient turns to the nurse and starts talking very quickly, saying, “I know it is late. What was the dog’s name again? I must go to the store. More milk.”
Book Code: ANCCUS3023
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