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Establishing a treatment relationship with a mental healthcare provider can be difficult for myriad reasons. This chapter discusses the different types of mental healthcare providers, including prescribing clinicians, psychotherapists, and behavior analysts. All bring a unique and useful perspective to treatment. When deciding on the right provider, it is important to consider the symptoms and behaviors to be addressed. Providers can be found through recommendations of primary care physicians, PWS associations, professional organizations, state licensing boards, and recommendations of friends or family members. Finally, while ending a relationship with a provider can be difficult, there are times when it may be necessary in order to provide continuity or improve the quality of care you or your loved one is receiving. A collaborative relationship with your loved one’s treating clinician is based on trust and strengthened overtime. With careful cultivation, your relationship with a provider can prove to be long-lasting support to your loved one with PWS.
The definition and classification of polycystic ovary syndrome (PCOS) have been an important but controversial topic for many decades with significant implications for treatment and prognosis. The 2018 international guideline incorporates evidence-based evaluation of the condition together with clinical, consumer, academic and industry contributions to set up the most accepted approach to diagnosis, evaluation and treatment available internationally.
Globally, problem gambling prevalence is estimated at between 0.1% and 5.8%. Problem gambling can have many negative consequences; including on physical, and psychological health, and social functioning. There is a need to better understand treatment uptake as only a small proportion seek treatment. This is the first Irish national study using routinely gathered health surveillance data to describe treated problem gambling. Results will inform service policy and planning.
An analysis of episodes treated for problem gambling collected by the National Drug Treatment Reporting System was undertaken. Included were episodes entering treatment between 2008 and 2019 (n = 2999). Variables of interest included service types accessed, demographics, socioeconomic information, referral and assessment details, current problems (up to five) and treatment history.
The majority (93.8%) were male. One fifth (20.9%) lived with dependent children, 7.4% were homeless. There were high levels of employment (35.4%) and formal education qualifications; half (53.8%) had completed second or third level education. Problem gambling frequently co-occurred with problem use of other substances (47.3%), which was most commonly alcohol (85.6%), followed by cannabis (32.3%), cocaine (28.0%) and benzodiazepines (10.9%). The majority were treated at inpatient settings (56.1%) with many self-referrals (46.3%).
This study provides insights into treated problem gambling nationally. Monitoring and surveillance can play a crucial role in measuring the successful efforts and help inform planning and treatment. The findings may have implications for treatment pathways.
The chapter focuses on the methodological debate between Empiricist and Rationalist schools of medicine, as portrayed in Galen’s early treatise On Medical Experience (Med.Exp.). This dense and philosophically-sophisticated text, preserved for the most part only in an Arabic translation, supposedly presents the substance of a dispute, witnessed by the young Galen, between his Rationalist teacher Pelops and an Empiricist opponent, about the respective roles of experience and reason in medicine. Analysing the arguments on both sides, in particular as they concern the question of inductive generalisation and the nature and validity of the empirical procedure known as epilogimos, the chapter shows how Galen’s presentation of a sequence of responses and counter-responses between the two protagonists serves to prefigure his own complex and hugely influential synthesis of the empirical and rationalist procedures in his own mature methodology.
Eye movement desensitization and reprocessing (EMDR) is an established treatment for post-traumatic stress disorders (PTSD). Some patients diagnosed with amyotrophic lateral sclerosis (ALS) experience PTSD following choking or suffocation in the course of progressive loss of the ability to breathe. Although a loss of breathing functions in ALS is relatively common, there are currently no studies available on treatment for the fear of choking following advanced ALS.
In this case study, we describe the positive effects of EMDR, an evidence-based form of trauma therapy, in a 48-year-old female, suffering from advanced ALS. As the consequence of ALS, she was not able to speak or breath independently, but could communicate through a speech-generating device. She experienced panic attacks, flashbacks, nightmares, and severe anxiety after her tracheostomy jammed, and she almost suffocated.
Mediative treatment was started by instructing the care staff to respond neutrally with step-by-step instructions following tracheostomy jam, resulting in significantly less panic attacks and flashbacks. EMDR was initiated two weeks later, and resulted in full remittance of the trauma symptomatology.
Significance of the results
The present case study suggests that symptoms of PTSD, namely the strong fear of suffocation, can be successfully treated by means of mediative behavioral therapy combined with EMDR.
Yoga was developed primarily as a tool for self-mastery and spiritual progress. However, over the past few decades, the therapeutic applications of yoga in mental healthcare have been explored with promising results. This article aims to inform psychiatrists about the clinical usefulness of yoga for mental disorders. We discuss the rationale and latest evidence base for the use of yoga in psychiatric practice, including the neurobiological mechanisms and indications and contraindications for yoga therapy. We suggest practical yoga techniques that can be used as an add-on for managing common psychiatric conditions. Finally, we discuss the setting up and running of yoga clinical services in a tertiary psychiatric hospital in India and explore what can be learnt to facilitate yoga as a therapeutic approach in the Western world.
TBT-S has been studied in a 40-hour, 1-week group format that consists of novel interventions that integrate temperament and Supports in structured interactive treatment approaches for YA and SE-AN. TBT-S neurobiological information and temperament approach could be “seasoned” into segments in multiple levels of ED treatment. The clinician schedules members of the ED treatment team, like dietitians and medical professions and Supports to participate with the adult client in various combinations of ways to address key aspects of treatment planning and skill/tool development. This ensures consistency inside and outside of treatment. Clinicians and programs could flexibly apply TBT-S core principles and components into ongoing ED treatment.
Approaching AN from a temperament-based neurobiological perspective provides a biological foundation and conceptual framework from which to view symptoms and the underlying mechanisms that drive behavior. Temperament informs targeted interventions directed at the cause of the behavior, rather than the behavior itself. This is a paradigm shift for many. TBT-S has five core principles derived from neurobiological research. (1) Eating disorders are brain and biologically based illnesses. (2) Treat to the trait or the temperament underpinnings. (3) Food is medicine. (4) Supports are needed and a necessary part of the treatment process. d (5) Action or movement is fundamental to change.
TBT-S modules can be selected and arranged to supplement outpatient sessions or create multi-day neurobiologically based interactive programs that can be inserted into ongoing ED residential, partial hospital, or free-standing treatment programs.
Clinicians are recommended to introduce clients to the need for Supports during session 1 when the opportunity is ripe to actualize interdependency, consistency, and biological information inside and outside of treatment. One or more Supports are identified in the first few sessions of treatment, to learn neurobiological information, and participate in treatment goals and skills development to promote consistency outside of treatment.
Late life depression is common and treatable. Mania is less common but requires treatment and care from a capable team. The eidemiology, assessment, treatment and care of people with mood disorders in late life is addressed.
Temperament Based Therapy with Support (TBT-S) is an emerging neurobiologically informed treatment approach designed to augment existing treatments. This book describes how and why TBT-S has been developed for adults with anorexia nervosa (AN), recognizing it has the capacity to be applied to other psychological disorders. TBT-S fills the gap between research and clinical practice by acknowledging and treating underlying brain-based factors. TBT-S recognizes that there is a biological basis to psychological illnesses that involves temperament and altered brain function. It is developed as a modular treatment virtually or face-to-face. The “S” of TBT-S means “Support,” the word chosen by adults clients with AN to describe anyone who offers support. Clinicians can insert TBT-S modules into ongoing therapies ranging from one module in an outpatient treatment settings to a day of TBT-S to the 5-day,40-hour, 1e-week TBT-S program that was studied.
The manual is divided into four parts. Part 1 introduces clinicians to TBT-S, its fundamental philosophy and neurobiologically based principles upon which treatment has been developed to augment other ED therapies. Part 2 outlines the logistics to prepare for and apply TBT-S in multiple treatment settings. Part 3 details TBT-S treatment modules and activities. It is the heart of the manual for treatment providers. Part 4 describes how TBT-S can be applied in various treatment settings Experiential TBT-S activities, glossary, client and Support handouts, and treatment schedules are provided in the addenda.