Levels of psychoprophylaxis and non-pharmacological treatment
Psychoprophylaxis is traditionally divided into several levels, each with its own specific tasks. Primary prevention focuses on preventing the very occurrence of the disease. The most crucial tool at this stage is recognized to be genetic counseling, which allows for the assessment of hereditary predisposition.
In turn, tertiary prevention comes into play when a patient has already been suffering from a chronic pathology for a long time. The main goal here is to overcome the phenomenon of hospitalism—a specific state that develops during a patient's prolonged stay in a hospital and leads to the loss of social skills.
An integral part of treatment is psychotherapy, although it has strict limitations. Psychotherapeutic interventions are strictly contraindicated for patients in a state of acute psychosis. The choice of a specific method depends on the nosology:
- For personality disorder correction, group psychotherapy methods are best suited.
- Hypnosis is classified as a suggestive method (a method of suggestion).
Strategies for psychopharmacotherapy
Pharmacological intervention is based on precise indications and consideration of pharmacodynamics:
- Neuroleptics (antipsychotics). Used for a wide variety of mental illnesses, including schizophrenia. Their mechanism of action is associated with receptor blockade. The dynamics of productive symptom reduction are such that delusions and hallucinations disappear or lose relevance gradually—the therapeutic effect develops over several weeks or months.
- Antidepressants. Have expanded indications: in addition to depression, they are successfully used to treat obsessive-compulsive disorder (OCD). Drugs from the SSRI (selective serotonin reuptake inhibitor) group can additionally reduce appetite. The full effect, as with neuroleptics, unfolds over several weeks or months. For classical endogenous (inhibited) depression, antidepressants with a pronounced sedative effect become the drugs of choice.
- Nootropics. Are the drugs of choice for treating asthenia provoked by prolonged and excessive loads.
- Cholinesterase inhibitors. Act as specific therapy for Alzheimer's disease.
- Benzodiazepine tranquilizers. In geriatric psychopharmacology, dosages must necessarily be reduced. When choosing a drug for an outpatient, the duration of action is taken into account first.
Adverse events, contraindications, and monitoring
The safety of pharmacotherapy requires strict consideration of somatic pathologies and potential complications:
- Tricyclic antidepressants (TCAs) have a number of strict somatic contraindications. They are prohibited from being prescribed for heart disease, glaucoma, prostatic hyperplasia, and chronic constipation.
- Benzodiazepine tranquilizers carry the risk of developing tolerance and dependence. In addition, they cause the most severe complications in patients suffering from myasthenia gravis.
- Neuroleptics frequently cause extrapyramidal symptoms, which include parkinsonism, akathisia, and hyperkinesia.
- Anticonvulsants with regular intake can lead to such a typical complication as macrocytic anemia.
To ensure the safety of treatment with certain drugs, it is critically necessary to conduct therapeutic drug monitoring (TDM)—regular testing of the substance concentration in the blood. In particular, this control is mandatory during therapy with lithium salts (mood stabilizers).
Briefly: answers to topical questions
What are the absolute contraindications to psychotherapy?
An absolute contraindication to psychotherapy is acute psychosis. Psychotherapy is conducted for a wide variety of mental disorders, with the exception of acute psychosis.
In which somatic diseases is the prescription of tricyclic antidepressants contraindicated?
The prescription of tricyclic antidepressants is strictly contraindicated in a number of somatic diseases due to the risk of severe complications. These pathologies include:
- Heart disease—due to the risk of rhythm disorders up to cardiac arrest.
- Glaucoma—due to the risk of an acute attack against the background of mydriasis.
- Prostatic hyperplasia—due to the risk of developing acute urinary retention.
- Chronic constipation—due to the pronounced anticholinergic effect of the drugs.
Which extrapyramidal symptoms are considered complications of neuroleptic therapy?
Extrapyramidal symptoms arising as a complication of neuroleptic therapy include several neurological syndromes. The main ones are:
- Acute spasms (dystonia)—painful spasms of the facial, neck, and tongue muscles.
- Drug-induced parkinsonism—develops when high doses of active antipsychotics are used.
- Akathisia—a constant urge to change body position and continuous movement.
- Tardive dyskinesia—persistent hyperkinesia of the face and head that do not disappear, but worsen upon drug withdrawal.
For which psychotropic drugs is therapeutic drug monitoring mandatory?
Therapeutic drug monitoring is necessary when taking lithium salts: the concentration of the drug in the blood is regularly tested.
Which drug groups are used for the specific therapy of Alzheimer's disease?
For the specific therapy of Alzheimer's disease, drugs that replenish the deficiency of acetylcholine in the central nervous system are used. The main groups include:
- Acetylcholine precursors—for example, choline alphoscerate.
- Non-selective cholinesterase inhibitors—pilocarpine and neostigmine methylsulfate (have a pronounced peripheral effect).
- Selective cholinesterase inhibitors—ipidacrine, galantamine, rivastigmine, and donepezil, which are the drugs of choice due to their targeted action on the central nervous system.
What are the main goals of tertiary psychoprophylaxis?
The main goal of tertiary psychoprophylaxis is to overcome the phenomenon of hospitalism.
Which mental disorders, besides depression, are indications for prescribing antidepressants?
In addition to depression, antidepressants are widely prescribed for the treatment of a number of other mental and psychosomatic disorders. The main indications include:
- Neuroses—especially obsessive-compulsive disorder (OCD) and panic attacks.
- Dysthymia—pessimism and low mood as a persistent personality trait.
- Anxiety disorders—anxiety as a personality trait and panic attacks.
- Psychosomatic diseases—for relieving somatic symptoms and correcting behavior in anxious and suspicious patients.
What complications can regular intake of benzodiazepine tranquilizers cause?
Regular and prolonged intake of benzodiazepine tranquilizers can cause a number of serious complications. The main negative consequences include:
- Habituation—rapid development of tolerance leading to a decrease in therapeutic efficacy.
- Dependence—pathological craving that occurs when trying to increase the dose of the drug.
- Neurological disorders are common side effects presenting as dizziness, headache, drowsiness, and ataxia.
Due to these risks, medications are prescribed for a short term (no more than 2-3 weeks).
What psychotherapy methods are used to treat mental disorders?
Various psychotherapy methods are used to treat mental disorders, including:
- suggestive methods, which include hypnosis;
- group methods, recommended for personality disorders;
- transactional analysis, which belongs to the psychoanalytical approach.
To memorize somatic contraindications for TCAs, imagine an "elderly patient": their motor is acting up (heart), vision is failing (glaucoma), and they have bathroom issues (prostate adenoma and chronic constipation).
Class and exam questions
Which psychotherapy method is optimal for treating personality disorders?
Group psychotherapy methods are best suited for treating personality disorders, as they allow for the effective processing of social interaction patterns.
What is the main objective of tertiary psychoprophylaxis?
The main goal of tertiary prevention is to overcome hospitalism—negative changes that develop in patients due to a prolonged stay in a psychiatric hospital.
How quickly do hallucinations disappear when prescribing antipsychotics?
Delusions and hallucinations usually do not disappear or lose their relevance immediately. A pronounced therapeutic effect develops over several weeks or months.
What is the main criterion when choosing a tranquilizer for an outpatient?
When choosing a benzodiazepine tranquilizer for an outpatient, the duration of the drug's action is the primary consideration.
What else to study on this topic
- Receptor blockade mechanisms in the use of antipsychotics.
- Differences in the mechanisms of action of SSRI antidepressants and MAO inhibitors.
- Extrapyramidal disorders: pathogenesis of parkinsonism and hyperkinesia.
- The role of therapeutic drug monitoring (TDM) when prescribing lithium salts.
- Mechanisms of tolerance and dependence development for benzodiazepine tranquilizers.
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