Mental Health (Psychology) (cont.)
Roxanne Dryden-Edwards, MD
Roxanne Dryden-Edwards, MD
Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
What is the treatment for a mental health problem?
Talk therapy (psychotherapy) is usually considered the first line of care in helping a person with a mental illness. It is an important part of helping individuals with a mental disorder achieve the highest level of functioning possible. These interventions are therefore seen by some as being forms of occupational therapy for people with mental illness. While medication can be quite helpful in alleviating and preventing overt symptoms for many psychiatric conditions, they do not address the many complex social and psychological issues that can play a major role in how the person with such a disease functions at work, at home, and in his or her relationships. For example, since about 60% of people with bipolar disorder take less than 30% of their medications as prescribed, any support that can promote compliance with treatment and otherwise promote the health of individuals in the mentally disordered population is valuable.
Psychotherapies that have been found to be effective in treating many mental disorders include family focused therapy, psycho-education, cognitive therapy, interpersonal therapy, and social rhythm therapy. Family focused therapy involves education of family members about the disorder and how to help (psycho-education), communication-enhancement training, and teaching family members problem-solving skills training. Psycho-education services involve teaching the person with the illness and their family members about the symptoms of the sufferer, as well as any warning signs (for example, change in sleep pattern or appetite, increased irritability) that the person is beginning to experience another episode of the illness, when applicable. In cognitive behavioral therapy, the mental-health professional works to help the person with a psychiatric condition identify, challenge, and decrease negative thinking and otherwise dysfunctional belief systems. The goal of interpersonal therapy tends to be identifying and managing problems the sufferers of a mental illness may have in their relationships with others. Social rhythm therapy encourages stability of sleep-wake cycles, with the goal of preventing or alleviating the sleep disturbances that may be associated with a psychiatric disorder.
Medications may play an important role in the treatment of a mental illness, particularly when the symptoms are severe or do not adequately respond to psychotherapy. For example, treatment of bipolar disorder with medications tends to address two aspects: relieving already existing symptoms of mania or depression and preventing symptoms from returning. Medications that are thought to be particularly effective in treating manic and mixed symptoms include olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), paliperidone (Invega), and asenapine (Saphis). These medications belong to a group of medications called neuroleptics and are known for having the ability to work quickly compared to many other psychiatric medications. As a group of medications, side effects that occur most often include sleepiness, dizziness, and increased appetite. Weight gain, which may be associated with higher blood sugar, higher lipid levels, and sometimes increased levels of a hormone called prolactin may also occur. Although older medications in this class that were not mentioned here are more likely to cause muscle stiffness, shakiness, and very rarely uncoordinated muscle twitches (tardive dyskinesia) that can be permanent, health-care practitioners appropriately monitor the people they treat for these potential side effects as well. Mood-stabilizer medications like lithium, divalproex (Depakote), carbamazepine (Tegretol), and lamotrigine (Lamictal) can be useful in treating active (acute) symptoms of manic or mixed episodes. These medications may take a bit longer to work compared to the neuroleptic medications, and some (for example, lithium, divalproex, and carbamazepine) require monitoring of medication blood levels. Further, some of these medications can be associated with birth defects when taken by pregnant women.
Antidepressant medications are the primary medical treatment for the anxiety characterized by anxiety disorders, as well as the depressive symptoms of depressive disorders and bipolar disorder. Examples of those medications that are commonly prescribed for those purposes include serotonergic (SSRI) medications like fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro) and combination serotonergic/adrenergic medications (SNRIs) like venlafaxine (Effexor) and duloxetine (Cymbalta), as well as buproprion (Wellbutrin), which is a dopaminergic antidepressant.
Medications like clonazepam (Klonopin) and lorazepam (Ativan) from the benzodiazepine group are often used to treat anxiety, particularly when it is sudden and severe, as in panic attacks. Medications from the beta-blocker family (for example, propranolol [Inderal]) are sometimes used to treat the physical symptoms associated with anxiety as well.
Alzheimer's and other forms of dementia are often treated with medications like memantine (Namenda), galantamine (Razadyne), donezepil (Aricept), rivastigmine (Exelon), and tacrine (Cognex). These medications tend to slow the progression of dementia, thereby helping sufferers of dementia remain functional longer than they would without treatment.
Despite its stigmatized history, electroconvulsive therapy (ECT) can be a viable treatment for people whose symptoms of depression, bipolar, or thought disorder have inadequately responded to psychotherapies and a number of medication trials. Although alternative treatments for mood disorders like St. John's wort or ginkgo biloba are not recognized standard care for bipolar disorder, as many as one-third of some patients being treated for a mental illness use them.
Reviewed by Melissa Conrad Stöppler, MD on 10/28/2011
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