How to deal with psychopharmacotherapeutic inefficiency

W leczeniu farmakologicznym, a zwłaszcza psychofarmakologicznym, powinny być w większym stopniu uwzględniane czynniki psychologiczne, które wpływają na skuteczność lub brak skuteczności leczenia. Ważne jest wzięcie pod uwagę konieczności całościowego podejścia do pacjenta, a w ramach takiego podejścia koncepcja wzajemnej relacji „mózgu−umysłu” jest czynnikiem, który nie może być pominięty. Brak skuteczności farmakoterapii, oporność wobec leczenia farmakologicznego, trudności w przestrzeganiu zaleceń, efekt nocebo to jedynie kilka przykładów zjawisk, których zrozumienie i poradzenie sobie z nimi wymagają podejścia psychodynamicznego i pewnego rodzaju kreatywności w sposobie stosowania farmakoterapii. Autorka proponuje zastosowanie zasad i metod psychodynamicznej psychofarmakoterapii w celu rozwiazywania problemów w trakcie prowadzenia terapii lekami psychotropowymi, a także uwzględnienie zjawisk opisywanych przez teorię przywiązania w kontekście poprawy współpracy w leczeniu, stosowania się do zaleceń oraz w celu tworzenia wzajemnej relacji terapeutycznej w ramach poprawy skuteczności farmakoterapii.There is more need in the pharmacotherapeutical treatment, particularly in psychopharmacotherapy, to take into account the psychological factors that influence the effectiveness or ineffectiveness of treatment. It’s important to takes into account the holistic approach to the patient and a “brain-mind” concept is also inevitable in this approach. Inefficiency of pharmacotherapy, treatment-resistence, non-adherence, nocebo etc. are only some of the phenomena that require a psychodynamic approach and the kind of creativity in prescribing drugs

PSYCHIATRIC ASPECTS OF BASAL GANGLIA DISEASES

This review clarifies the fact that basal ganglia diseases are psychiatric as much as neurological diseases. It illustrates psychiatric aspects in Parkinson\u27s disease and other hereditary basal ganglia diseases such as Wilson\u27s disease, Huntington\u27s chorea and others. In these diseases, psychological disorders can be difficult to diagnose, whether they are concomitant with the primary (neurological) disease, they are its consequence, or they are the result of a specific pharmacotherapy prescribed for these disease, etc. Thus, the choice of appropriate psychopharmacotherapy for these disorders represents a very subtle problem

Empathy in Group Psychoanalytic Psychotherapy: Questionnaire Development

The aim of this study is to develop a questionnaire that can observe empathy in group psychoanalytic psychotherapy and examine the structure of its factors. A questionnaire comprised of 160 items in five-point Likert-type scale was developed through analysis of communication and interaction related to empathizing during group sessions. The questionnaire was applied on 256 patients from 40 therapy groups in 9 cities in Croatia. All 20 group analysts are trained in the Institute for Group Analysis in Zagreb. The patients were selected based on group analysis criteria. After item discrimination and principal component analysis limited to five factors were assessed, 80 items were isolated, 20 of which made a control scale for socially desirable responses. Two parallel questionnaire forms were developed: Group-Analysis-Empathy 1 (GA-Em1) and Group-Analysis-Empathy 2 (GA-Em2). A new, reliable and valid questionnaire for empathy observation employable in group psychotherapy was designed. The following factors were isolated by means of factor analysis: 1. Emotional disclosure and sensibility; 2. Containing and metabolizing; 3. Immersion; 4. Resonance and responsiveness; 5. Insight. A new questionnaire on empathy in group-analytical psychotherapy can measure the capacity for emotional communication among group members and between the group and the group analyst – conductor

EFFECTS OF MEANING OR PSYCHODYNAMIC PSYCOPHARMACOTHERAPY

Despite advances in psychiatry, treatment outcomes are still a big problem, and are not always substantially better than it was in the past time. Treatment resistance remains a serious psychiatric problem. One of the reasons for that is that the pendulum has swung from a psychodynamic framework to a biological one, and the impact of meaning (i.e. the role of psychodynamic and psychosocial factors in treatment-refractory illness) has been relatively neglected. Dynamic factors in psychopharmacology play a pivotal role in pharmacological treatment responsiveness. There is a small but impressive evidence base that shows that psychological and interpersonal factors play that role. Psychodynamic psycho pharmacotherapy combines rational prescribing with tools to identify irrational interferences with effective use of medications, i.e. to resolve the problems of the pharmacologicaltreatment resistance. Psychodynamic psychopharmacology represents an integration of biological psychiatry and psychodynamic insights and techniques

Group Members’ Assessment of Their Conductor in Small Analytic Group

In this pilot study the authors present the group members’ assessment of their conductor in group analysis – the treatment conducted in accordance with concept »groupas- a-whole« of S. H. Foulkes. There will be presented the results obtained by scale for evaluation of characteristics of the group therapist. In the scale, developed by the authors of the study, there were 30 items and by factorial analysis it gave three interpretable factors: authenticity, empathy and distrust. By self-evaluation the members of three small groups, i.e. 20 patients, ranked characteristics of their conductor. The patients, assessing the degree of their accordance with 30 items of the evaluation scale, expressed whether and how much they experienced their conductor as an authentic, empathic and trustworthy person. While in the beginning of the group analytic process the conductor’s role was important, his importance decreased as the group-as-a-whole developed. Group experience became more important than the conductor. In other words, the group itself became the therapist, what is one more the proof of the Foulkes’ concept of »the groupas- a-whole«

PSYCHOLOGICAL SUPPORT TO BURN PATIENTS

Teške opekline i njihovo liječenje spadaju među najbolnija iskustva koja osoba može doživjeti. Emocionalne potrebe bolesnika s opeklinama dugo su bile zasjenjene naglaskom na preživljavanje. danas, kada je stopa preživljavanja neusporedivo veća nego u prošlosti, porasla je i potreba za psihološkim i psihosocijalnim angažmanom u radu sa žrtvama teških opeklina. Bolesnik prolazi različite faze prilagodbe i suočava se s emocionalnim izazovima koje prate tjelesni oporavak. prilagodba na opeklinsku ozljedu uključuje složenu međuigru između bolesnikovih osobina prije nastanka opekline, okolinskih čimbenika, te prirode same opekline i potrebne medicinske skrbi. prilagodba podrazumijeva usvajanje nove predodžbe o sebi i svom tijelu, nove slike tijela i sebe. dakako da psihijatrijsko i psihološko liječenje mora biti ukomponirano u centre za liječenje opeklina u sklopu multidisciplinarnog timskog liječenja. psihološki i psihoterapijski treba se baviti problemom gubitka, žalovanjem, prihvaćanjem slike tijela i sebstva, a u psihijatrijskom smislu stanjima delirija, akutnim stresnim poremećajem, posttraumatskim stresnim poremećajem, anksioznošću, depresijom i drugim psihijatrijskim poremećajima. Stručnu pomoć i podršku treba pružiti i članovima bolesnikove obitelji. U nekim slučajevima psihosocijalno liječenje nikad ne završava, već traje i godinama poslije sanirane opekline.Severe burns and their treatment are among the most painful experiences a person can have. Emotional needs of burn patients have long been overshadowed by the focus on survival. Today, when the survival rate is much higher than in the past, the need of psychological and psychosocial engagement in working with victims of severe burns has emerged. A patient undergoing various stages of adjustment is faced with emotional challenges that accompany physical recovery. Adapting to burn injury involves a complex interplay between patient characteristics before the occurrence of burn, environmental factors, and the nature of the burns and medical care required. Adaptation implies adoption of new ideas about themselves and their body, new body image and new self image. Psychiatric and psychological treatment must be incorporated in burn treatment centers within a multidisciplinary treatment team. Psychology and psychotherapy should address the problem of loss, grief, acceptance of body image and self image, in terms of psychiatric conditions of delirium, acute stress disorder, posttraumatic stress disorder, anxiety, depression and other psychiatric disorders. Technical assistance and support should be provided to the patient family members. In some cases, psychosocial treatment never ends; it takes years, later related to rehabilitated burns

Changes of Defense Mechanisms and Personality Profile during Group Analytic Treatment

Researching efficiency of group-analytic treatment and following Foulkes’ principle of the »group-as-a-whole«, the methodology was applied. That enabled the evaluation of expected changes of group members individually, as well as the group-as-a-whole. In this study three small groups (20 patients) were followed up and changes were evaluated after second and after fourths years of group analysis. Two measuring instruments – The Life Style Index and Defence Mechanisms Scale (LS-DM) and Minnesota Multiphase Personality Inventory (MMPI-201) were applied. Each member of the group was assessed by self-evaluation as well as the group-as-a-whole. The results of the research indicated that changes of the personality occurred. Changes consisted in lowering of defensive activities that was tending towards more mature defences. Changes also consisted in lowering ratings on the pathological parts of the MMPI-scales reflecting shifting of the conflict level. The results could be predictive for positive outcome of group analysis. More studies are needed

Aggression in Group Psychoanalytic Psychotherapy: Questionnaire Development (GA-Ag)

The aim of this study is developing of a questionnaire that observes aggression in group psychoanalytic psychotherapy and examines its factor structure. The questionnaire comprised of 160 statements in five-point Likert-type scale was developed through analysis of the content of aggressive communication among patients during group sessions. The questionnaire was applied on 253 patients that attended 40 small therapy groups in 9 cities in Croatia. All 20 group analysts are trained in the Institute for Group Analysis Zagreb. The patients were selected based on indications for group analysis. Two parallel questionnaire forms were designed of 80 items that were isolated through assessment of item discrimination and principal components analysis limited to five factors. A new, reliable and valid questionnaire that can be employed in group psychotherapy has been developed. The following has been isolated through factor analysis: 1. Difficulty in communication, 2. Distrust in the group therapist and the group, 3. Withdrawal from relationships and communication, 4. Low containing capacity, and 5. Mutual lack of understanding. This questionnaire can measure the level of difficulty in communication, distrust in the therapist and the group, passive aggression, containing capacity, lack of understanding among group participants and in the group as a whole

WHY BENZODIAZEPINES ARE STILL IN WIDE USE?

Benzodiazepini su se u povijesti dokazali kao miorelaksansi i antikonvulzivi u neurologiji, kao anksiolitici u psihijatriji, uz hipnotičko djelovanje u terapiji izbora za insomniju, a takđ er i u odvikavanju od alkoholne ovisnosti. Također su opravdali svoju široku primjenu u anesteziologiji i drugim kliničkim granama. Vremenom su se u psihijatrijskoj primjeni benzodiazepina pojavile kontroverze koje je pokrenula mogućnost zloporabe, štetnog djelovanja, intoksikacija, te ovisnosti. S druge strane revolucionarna pojava selektivnih inhibitora ponovne pohrane serotonina (SIPPS) benzodiazepine je pomaknula u sjenu. Uz to su se pojavile preporuke raznih znanstvenih i stručnih institucija kojima je uporaba benzodiazepina ili isključena ili reducirana ili svedena na kratkotrajnu mjeru liječenja. Klinička nam iskustva međutim pokazuju da se benzodiazepini i dalje često rabe u dugotrajnom tretmanu i to iz više razloga: zbog same tradicije propisivanja; zbog toga što ih sami pacijenti preferiraju; zbog poteškoća koje se javljaju kod prekida uzimanja čak i onda kad su uzimane niske doze; zbog brzog djelovanja i dobre učinkovitosti a s vrlo malo početnih nuspojava. Drugi lijekovi, odnosno alternativa benzodijazepinima - SIPPS, nemaju brzo očekivani odgovor, a nuspojave su im puno neugodnije. Stoga neki autori smatraju da je razlog prelaska s benzodiazepina na SIPPS u mnogim preporučenim slučajevima često nedostatno opravdan.The advent of benzodiazepines in the 1960s provided their wide use in neurology and psychiatry. They proved to be myorelaxant and anticonvulsive therapy in neurology; their anxiolytic and hypnotic properties have made them the treatment of choice for insomnia and anxiety problems; they have also been used in alcohol withdrawal and in anesthesia, and for a wide range of treatments in other clinical branches. However, reports giving rise to a prescription controversy including abuse, harmful effects, intoxication and dependence toward addiction appeared soon. On the other hand, the revolutionary appearance of selective serotonin reuptake inhibitors (SSRIs) overshadowed benzodiazepines. According to recommendations of many scientiic and professional institutions, the use of benzodiazepines has been gradually excluded or reduced or limited to short-term use. However, clinical experience showed that benzodiazepines are frequently used for long-term treatment, and there are many reasons for this, e.g., prescribing tradition, patient preference, dificulties associated with benzodiazepine withdrawal (even in patients taking low doses) because they have a rapid clinical onset of action, and good eficacy with few initial adverse effects. Moreover, SSRIs as alternative drugs are associated with incomplete therapeutic response and more uncomfortable adverse effects. Some authors therefore point out that the rationale for the shift from benzodiazepines to SSRIs is inappropriate