Somatic Therapies

Somatic Therapies

Somatic Therapies 

The treatment approach that use physiologic or physical interventions to effect behavioral change.

Type of Somatic Therapy 

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Electroconvulsive Therapy (Electro Shock Therapy/ Shock Therapy) - introduced in 1938 by Ugo Cerletti and Luciano Bini ( Cerlettis assistant) - It is introduction of electric current passed through the brain for 0.2-0.8 seconds, causing a seizure, resulting in full grand mal convulsion

Preparation for ECT 

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The patient must have a pretreatment evaluation, including physical examination, laboratory work ( blood count, blood chemistries, urinalysis) A consent form must be signed. If possible, the routine use of benzodiazepines or barbiturates for nighttime sedation should be eliminated because of their ability to raise the seizure threshold Trained electrotherapist and anesthesiologist should be available

Nursing Responsibilities before ECT 

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NPO for 6-8 hours before ECT, except for cardiac, Anti HPN, and other medications Atropine should be given one hour before the procedure (oral or IV) to reduce secretions and subsequent risk for aspirations Cx. Should ask to urinate before the treatment ( seizure induced incontinence ) Remove hairpins, contact lenses, hearing aid, and dentures take VS

Procedure during ECT   

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IV line is inserted Electrodes are attached to the proper place on the head METHOHEXITAL (Brevital) short acting barbiturate is given IV for anesthesia SUCCYNYLCHOLINE (Anectine) is a neuromuscular blocking agent causing paralysis not sedation Ventilates the Cx. 100% 02 immediately before the treatment Monitor Cx. For heart rate and rhythm, blood pressure, and EEG Ventilation and Monitoring continue until the patient recovers

Nursing Responsibilities after ECT 

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The nurse or anesthesiologist mechanically ventilates the patient with 100% 02 until the patient can breathe unassisted Monitor for respiratory problems ECT causes confusion and disorientation; reorient Cx. To time, place, person Administer benzodiazepines, as needed Observe properly, provide time to relax the client before standing Document

Indications Major Depression Severe Mania not controlled by medications Post partum psychosis after no response to antidepressant Schizophrenia (catatonic) when non responsive to medications Movement disorders refractory to treatment (parkinson’s disorder, tardive, etc.)

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Disadvantage -Temporary Relief -Memory loss -Hypertension, Arrhythmias, alterations of cardiac output, and change in -cerebrovascular dynamics Advantage -Safe and effective than other antidepressants to some other case

PSYCHOSURGERY (LOBOTOMY) -introduced in 1935, by Antonio Egas Moniz, a neurosurgeon from Portugal -Walter Freeman, neurologist and James Watts, neurosurgeon introduced the surgery to USA -It is a surgical procedure that destroys brain tissue for the purpose of relieving intractable mental disorders not amendable to therapies Indications -OCD -Aggressiveness related to mental disorders

BRIGHT LIGHT THERAPY (BLT)  

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-formerly called phototherapy -exposes patient to intense light (5000 lux hours) each day Indications -SAD -Bulimia -Sleep maintenance insomia -nonseasonal depression

TRANSCRANIAL MAGNETIC STIMUATION (TMS) OR REPETITIVE TRANSCRANIAL MAGNETIC STIMUATION (rTMS)

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-produces a magnetic field over the brain, influencing brain activity, also increase the release of neurotransmitters and/or down regulates beta-adrenergic receptors Indications -depressive disorders -other disorders