Types of treatment

Types of treatment

Medication, therapy and hospitalization – what role does each play in recovery?

Think of a mental health issue or condition like a broken bone, which may need:

• Surgery of some kind followed by bedrest
• Medication for pain management or healing and nutritional support
• Physiotherapy to regain strength and mobility

Similarly, 

• Medication supports recovery by tinkering with chemicals in the brain
• Hospitalization offers in-patient procedures for severe cases, and a place to rest and recover.
• Psychotherapy, like physiotherapy, takes time but offers long-term benefits and resilience

Here’s a look at what each of these are:

Pharmacology

Pharmacological psychiatric treatment was a complete game changer in mental health treatment. It was the invention of psychiatric medication that made the medical field realize the potential of psychiatry. Today, it continues to play an important role in treating mental health issues and disorders.

Medication is prescribed according to the nature of the diagnosis. If the difficulty is temporary in nature, the treatment will also follow suit. A patient could be prescribed a course of antidepressants to help them overcome a period of intense grief following a divorce.

Some conditions can be treated or managed with psychotherapy alone. However, if the condition is so severe that its symptoms are preventing the patient from engaging in psychotherapy, a course of medication may be prescribed to enable them to do so.

Some mental disorders may require long term use of medication. The treatment of bipolar disorder, for example, includes prescribing lithium. However, regular reviews are mandatory as the dosage needs to be monitored to prevent toxicity.

Medication may also be used purely as symptomatic treatment, adjusted regularly to fit the needs of the patient. It’s important to remember that it takes time to identify the right medication for the patient – one that meets the needs of treatment while causing the least amount of side-effects.

Classes of psychiatric medication

According to Anatomical Therapeutic Chemical (ATC) Classification

Class	What it helps with	Prescribed for
Antidepressants	Improves levels of serotonin, norepinephrine and dopamine in the brain	DepressionAnxiety
Antipsychotics	Maintain chemical balance to prevent hallucinations or delusions	PsychosisAs a mood stabilizer in low doses
Anxiolytics	Reduce anxiety by Increasing or reducing certain cell activity; or reducing reabsorption of neurotransmitters	AnxietyPanic attacksHigh levels of stress
Stimulants	Increases levels of dopamine and norepinephrine thereby improving ability to focus, concentrate and stay motivated	ADHD
Mood stabilizers	Impacting the receptors that regulate the release and maintenance of chemicals	Bipolar disorder

Psychotherapy

While pharmacological treatment helps alter the brain’s functioning to provide relief, psychotherapy aims to take on the underlying patterns of thought and behavior that lead to mental strife. 

Psychotherapies have been developed over years of combined efforts to unlock the functioning of human behavior. They can be used to:

• Alleviate symptoms that are causing interference in daily functioning
• Learn tools to cope with emotional dysregulation and negative automatic thoughts
• Work on maladaptive behaviors and habit management
• Change irrational thought patterns that fuel other symptoms
• Build resilience towards coping with stress

Psychotherapy may use talk therapy or other activities to understand the patient’s unique set of difficulties and equip them with the ability to tackle them – with the help of tools and counselling.

Most psychotherapy is time-bound and structured with goals being set at the beginning. Once the goals are met, the patient tackles life without regular therapy. Should they face a mental health crisis, they resume therapy, again for a limited amount of time.

The frequency of the sessions is determined by the need of the patient. During a crisis, they may require weekly sessions. But as their ability to cope improves, the frequency wanes until the treatment is terminated.

Finding a psychotherapist that fits is a lot like finding the right medication. The patient should be able to enter a trusting relationship where they feel free to speak without fear of judgement. Psychotherapists guarantee that whatever is shared in sessions will remain confidential unless someone is in harm’s way.

Types of psychotherapy

• Cognitive-behavioral therapy (CBT) works on replacing maladaptive or ineffective thought and behavior patterns with healthier coping strategies
• Dialectical behavior therapy (DBT) equips patients with four skills – mindfulness, emotional regulation, distress tolerance and interpersonal effectiveness [improved communication and relationships]
• Interpersonal therapy (IPT) works on fundamental interpersonal obstacles by helping patients to express and communicate in healthier ways
• Acceptance and commitment therapy (ACT) focuses on understanding and accepting emotions and modifying values and adjusting behavior to match the emotion
• Mentalization-based therapy (MBT), based on attachment theory, teaches patients to see situations from different perspectives which helps them with emotional regulation, communication and interpersonal relationships

Hospitalization

Psychiatric hospitalization has come a long way. Today’s facilities are designed to offer patients with holistic treatment via community-based care – a combination of pharmacological treatment, in-patient procedures, psychotherapy, vocational support and support recovery within the structure of routine.

The modern treatment approach is patient-centric; it prioritizes the patient’s autonomy, safety and focuses on swift recovery and discharge.

Psychiatric hospitalization may be necessary when the patient is struggling with daily functioning. The facility takes care of the patient’s basic necessities and frees them from needing to make daily decisions – about meals and the routine – and looking after themselves. This allows the patient to focus only on getting better.

The patient is occupied all day with therapy sessions, activities, social engagement and fitness. Their time at the facility is focused towards their recovery.

The duration of admission depends on the severity of the diagnosis. Some facilities offer respite stays of as low as a week to a fortnight to help patients overcome the peak of a crisis. Admission of a few months is a requirement for de-addiction programs. Some patients may require longer or frequent admissions if they have severe recurrent symptoms.

Services that may be offered at a psychiatric hospital:

• Testing and diagnostics: Evaluations, psychometric testing and diagnosis of mental health disorders
• Psychiatry: Consultation, diagnosis, treatment plan, medication prescription and management
• Therapy: Individual and group psychotherapy, vocational therapy, family therapy, support groups
• In-patient procedures: Brain stimulation therapy, de addiction programs
• Psychoeducation: Equipping the patient and their family with information on diagnosis, condition, treatment and supportive environments; reducing stigma
• Psychiatric rehabilitation: Long-term recovery to support integration and autonomy
• Collaborative care: Working with other medical departments to ensure holistic care
• Residential facility: Assisted living facilities to help patients earn and live independently while requiring care

References

Anatomical Therapeutic Chemical (ATC) Classification. (n.d.). https://www.who.int/tools/atc-ddd-toolkit/atc-classification

Mental health medications. (n.d.). National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/topics/mental-health-medications