Psychotherapy+versus+Medication+treatment+in+the+mentally+ill


 * Name: Jacqueline Toumbas**
 * Student Number: n8290831**
 * Tutor: Colleen**

Different paths to mental health: alternative to medication for mentally ill patients **//Artefact//** Lithium - Nirvana (Please click photo to listen to the artefact) The song Lithium by Nirvana portrays the suffering and struggle of the lead singer Kurt Cobain. Kurt was affected by bipolar disorder, also known as manic depression (Cobain, 2007, p.1). Bipolar disorder involves episodes of major depression and “mania”, effected persons moods go back and forth between two (bi) opposite (polar) emotions (Cobain, 2007, p.24). Kurt Cobain states in the lyrics of the presented song “I’m so lonely” and moments later “I’m not sad”, showing his change from one extreme to another. The title “Lithium” relates to medication which was first used in the 19th century, lithium on bipolar disorder is used by the mood-stabilizing action of the ion (Rybowski, 2010). It is thought that this is Kurt’s depiction and experiences while medicated on lithium. Sadly in 1994 Cobain died of what is thought to be suicide, so we are left thinking did the treatment of lithium really help?

**// Public Health Issue //**

The presented artifact exemplifies the use of drug medication on mental illness patients; the amount of fallacies surrounding drug treatment on the mentally ill was bought up after the death of Kurt Cobain. This essay will discuss the battle of psychotherapy versus medication treatment in the mentally ill. Analysis of the different paths to mental health: alternative to medication for mentally ill patients will be observed and reviewed through literature presenting different points of view. Critical analysis of the different severities of depression will be debated to see whether psychotherapy or medication is more effective.

** //Literature Review// **

The World Health Organization defines mental health as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community ” (WHO, 2010). There is very little evidence to suggest when mental health first became acknowledged, but hundreds of years ago around the eighteenth century, the awareness began to evolve that a selection of people needed protection because of their mental health (Jones, 1972). Treatments throughout these centuries consist of patients being hidden and housed in jails, almshouses and private homes (Bragg & Cohen, 2007). It was not until the 1950s that the discovery of drugs to treat depression and other mood disorders became evident. Later on in the mid-1950s it was discovered by accident that two drugs, isoniazid and iproniazid, used to treat tuberculosis became to be useful in enhancing the mood of patients. This discovery provoked further studies into the behavioral effects of these drugs. The antidepressant properties were shortly confirmed in depressed controlled patient trials (Jones, 2010). Today in the twenty-first century we are still developing mental health treatment in the means of medication and psychotherapy, prescribing either or to patients, sometimes both. Fournier et. al. presents a 12 month randomized study titled Antidepressant medication versus cognitive therapy in people with depression with or without personality disorder. The study looks at 180 out-patients with depression that received medication or cognitive therapy for 16 weeks. The sample of patients assigned to medication where once again split and randomly assigned medication or placebo. The antidepressant used in this treatment was paroxetine, mental illness medications vary with antidepressants being one of the three prominent types of medication. Antipsychotic and mood stabilizing medications are also used to treat different types of mental illness (U.S. Department of Health and Human Services, 2008). Cognitive therapy is derived from theorist Sigmund Freud, were “talk therapy” is used aiming to change the brains cognitive function (Beck, Freeman & Davies, 2004). Results show after 16 weeks, personality disorder status presented antidepressants at 66%, where cognitive therapy was only 44%. For patients without personality disorders, at the same follow-up time, 49% improved on antidepressants, and a remarkable 70% with cognitive therapy. The 12 month follow-up showed similar responses for both people with and without personality disorders. The lowest sustained response, 6%, came from subjects that withdrew who had personality disorders. Limitations present themselves within any study, Fournier et. al. focused there duration of active treatment around a 16 week period. Cognitive therapies and antidepressants are incomparable and the fact that the treatments were brief may of have impacted on the presented outcomes. Another point to raise is that nowhere in the Fournier et.al. report is a dosage amount of paroxetine. Though these limitations do need to come into considerations when assessing the study, the given evidence suggests that antidepressant medication is more effective than cognitive therapy.

//ADM, antidepressant medication; CT, cognitive therapy. The narrow bars display the proportion of people who met response criteria in the two treatments (antidepressants and cognitive therapy) at the end of the 16-week acute phase. The wide bars represent the estimated proportion of individuals who survived the 12-month follow-up period without a relapse. Bars on the left half of the figure represent individuals diagnosed with a comorbid personality disorder; bars on the right represent individuals who did not have a comorbid.// The cognitive therapy and research journal published a study comparing the efficiency of cognitive therapy and pharmacotherapy in the treatment of depressed outpatients. Similar to Fournier et. al. the sample groups were randomly assigned to an individual treatment, either cognitive therapy or imipramine (antidepressant). All forty-one patients diagnosed with chronic depression for an average of 8.8 years. The course for treatment was conducted over 12 weeks, with cognitive therapy patients allowed a maximum of 20 consultations, and pharmacotherapy patients received up to 250mg/ day of imipramine. On completion of treatment follow-ups were made at three and six month marks. In both cases, cognitive therapy and pharmacotherapy, there was a significant reduction in depressive symptoms.

Evidence shows that both treatments are effective in reducing depression symptoms. Levels of reduction were measured by the Beck Depression Inventory (BDI). The BDI is a self- report inventory with 21 multiple choice questions, which measure the severity of depression. Initial BDI scores did not differ by much throughout the groups. Though analysis shows that the sample group who completed cognitive therapy had a significant better improvement rate over the group who completed pharmacotherapy. In Rush et. al. report it is shown that cognitive therapy is more effective then antidepressants, however the antidepressant dosages are moderately low in comparison to other studies. This limitation makes it hard to compare the results with other studies, it is also apparent that the medication was decreased two weeks before the trial finished.


 * //Cultural and Social Analysis// **

When analyzing the health issue of mental illness treatment it is crucial to consider the social and cultural aspects of how and why this subject affects our society. Before treatment is considered mental illness at a broad aspect needs to be considered and looked at as to who is effect and how. In some cases a particular demographic or cultural group is focused on more than others. Though, a mental disorder can occur at any age and disturb any social group. Higher prevalence of mentally ill patients is found in rural and remote areas, rather than in metropolitan areas. Australia's national agency for health and welfare (2011) has established statistics that suggest people of the Aboriginal and Torres Strait Islander descent are also among the higher occurrence of mental illness. In addition to cultural and locality, gender plays a role in mental illness with young males in these groups having a much higher suicide rate than the general population.

This trend seen in men becomes fairly hypocritical when depression is more common in women, though the intense outcome of suicide is higher in men. Research shows that many men are mentally ill at the time of their death (Appleby et. al., 1999); many factors come into play when analyzing what forces and influences younger men to fall into such depression to commit suicide. Our cultural and society acceptance of men expressing their emotions of sadness, fear and disappointment is less acceptable then women. This then become a barrier for men to open up to medical professionals for help, therefore creating a higher prevalence of depression in women, but higher suicide rate in men as they rarely seek help. Seeking mental illness help should not be something ashamed of and this cultural stereotype of a ‘tough man’ needs to be changed. In recent years we have seen a slight change in stereotype with the ‘new man’ in the 1990s and ‘metrosexual’ men in this century (Rickwood, 2005). With more social acceptance of male expression mental illness treatment can take place.

Awareness of prevention is another issue which health professional need to consider in reducing prevalence of mental illness. Psychosocial risks accumulated during life can lead to increased poor mental health. These include social determinants such as stress, early life experiences, social exclusion, unemployment, and work (World Health Organization, 2003). One major issue today effecting Australia’s mental health is the global financial crisis, this is just one example of how the social determinants can increase (Macey, 2009). In 2009 the Mental Health Council of Australia calculated that Medicare figures show a 40 per cent increase in the number of Medicare claims for mental health consultations, this was speculated to have been an outcome of the global financial crisis which began in 2007 (Macey, 2009).

Once patients of mental illness are diagnosed the subject of treatment is then addressed. Psychological treatment is often the most helpful for people affected by anxiety disorders or depression, while medications are mainly helpful for people more seriously affected by mental illness. When prescribed medications for mental illness do patients have the awareness and education to make a sound decision? A study completed by Jorm et.al. assessed 999 Australian adult’s belief about the helpfulness or harmfulness of antidepressants. Results showed that a quarter of the participants believe that “antidepressants would be harmful for a person who is depressed and suicidal” (Jorm, 2006). In analysis this quarter of participants were “less educated, had less exposure to depression, showed poorer recognition of depression, was less favorable about other standard interventions including psychological ones, was less pessimistic about the long-term outcome if the person did not have treatment, and was more likely to see depression as due to weakness and to be under the individual's control” (Jorm, 2006).

Clear evidence has been provided throughout this essay showing that medication and psychotherapy is helpful in the treatment of mental illness. Therefore these results by Jorm et. al. paints a clear and precise picture of why awareness of mental illness medication is important. Much education on mental illness has been focused on the diagnosed illness itself, but medication needs to be included. Every patient has a right to make an informed educational decision. In result of analysis health professionals need to focus attention on eliminating social determinants in prevention but also educate the community on the different treatments and how they work.

**// Artefact Analysis //**

The artifact “Lithium” by Nirvana was written by front man Kurt Cobain. The lyrics written by Cobain have forever been interpreted by many in different ways. My understanding and representation of the song encounters three segments, the title, the lyrics and the sound. The title reflects a drug used to treat manic depression or bipolar, the lyrics tell a story and through this exert a range of emotions and characteristics from rage, euphoria, high energy, irritability, distractibility, and overconfidence. Thirdly the sound has a depressive theme which shifts in dynamics from quiet to loud and grungy effects. Looking at these three sections of the song show a deep and dark look into the life of someone diagnosed with bipolar. The words use to describe the lyrics (rage/euphoria etc.) are characteristics of bipolar illness. But what brings this artifact back to the topic of depression treatment and how well it works in regards to others? Kurt Cobain died of suicide, it is said that he was suffering from major clinical depression. If it is true that he was taking lithium as a treatment at this point in time, why did this not help his illness? Were other treatments looked at? Personally I believe the stigma associated with mental illness effects the case of treatment. In the process of learning about mental illness and treatment I have found that the older research trials have many limitations, options of treatment were not taken into consideration. The effects of mental illness were looked at as a “whole”, and not on an individual level, understanding that every diagnosed patient’s illness was different from the next needed to be considered. Today’s technology is increasing the breakthrough research of treatment, the stigma is slowly being eliminated and people are being educated about treatment. Before this assessment I was biased against medication for treatment of mental illness, this was mainly because of media influence. Though now I can appreciate the research and findings which have educated and allowed me to understand the difference between both medication and psychotherapy. Every mental illness is different and every patient has the right to be educated on their treatment.

//“I'm so happy. Cause today I found my friends.// //They're in my head. I'm so ugly. But that's ok.// //'Cause so are you. We've broke our mirrors.// //Sunday morning. Is everyday for all I care.// //And I'm not scared. Light my candles. In a daze cause I've found god.”// //Lyrics from Nirvana song Lithium//


 * // References // **

Appleby L. Cooper J. Amos T. Faragher B. (1999). Psychological autopsy study of suicides by people aged under 35//. British Journal of Psychiatry. (175)// 168-74. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10627801

Beck, A.T., Freeman, A.M., & Davis, D.D.(2004). Cognitive therapy of personality disorders. New York: NY.

Bragg, A.B., & Cohen, B.M. (2007). From Asylum to Hospital to Psychiatric Health Care System. //The American Journal of Psychiatry, (164),// 6, 883. Retrieved from http://ajp.psychiatryonline.org/cgi/reprint/164/6/883.pdf

Cobain, B. (2007). //When Nothing Matters Anymore: A Survival Guide for Depressed Teens.// Minneapolis: MN

Jones, A.W. (2010). Perspectives in Drug Discovery. Department of Forensic Genetics and Forensic Toxicology. National Board of Forensic Medicine, Linkoping: Sweden, retrieved from http://www.rmv.se/fileadmin/RMVFiles/pdf/Drug_Discovery_skm_ori.pdf

Jones, K. (1972). //A history of the mental health services//. Boston: MASS.

Jorm, A.F., Barney, L.J., Christensen, H., Highet, N.J., Kelly, C.M., & Kitchener, B.A.(2006). Research on mental health literacy: what we know and what we still need to know. //Australian and New Zealand Journal of Psychiatry, (40)//, 1, 3-5. doi: 10.1111/j.1440-1614.2006.01734.x

Macey, Jennifer(Reporter). (2009, May 4). Mental illness soars as global crisis hits. On //ABC News.// [Television Broadcast]. Brisbane, QLD: ABC Television. Retrieved from http://www.abc.net.au/news/2009-05- 04/mental-illness-soars-as-global-crisis-hits/1671106

National Institute of Mental Health, U.S. Department of Health and Human Services. (2008). Mental Health Medications. Retrieved from National Institute of Mental Health website http://www.nimh.nih.gov/health/publications/mental-health-medications/complete-index.shtml

 Rickwood, D., Deane, F. P., Wilson, C. J., & Ciarrochi, J. (2005). // Young people's help-seeking for mental health problems ////. Australian e-Journal for the Advancement of Mental Health, (4) //, 3, 1-34. Retrieved from http://www.acceptandchange.com/wpcontent/uploads/2011/08/Rickwood_etal_Ciarrochi_AeJAMH_Young_Peoples_Help- seeking_for_Mental_Health_Problems_2005.pdf

Rybakowski, J.K. (2010). Lithium: Sixty Years Thereafter. //Neuropsychobiology, 62//, 5-7. doi: 10.1159/000314304

Social Determinants of Health, World Health Organization. (2003). The Social Facts [2nd ed]. Retrieved from the World Health Organization website; http://www.euro.who.int/__data/assets/pdf_file/0005/98438/e81384.pdf


 * <span style="background-color: white; font-family: Arial,sans-serif; font-size: 21pt;">Commentary: **


 * <span style="background-color: white; font-family: Arial,sans-serif;">Influence of media on mental health and associated stigma **

Erin McLean

n8296413

Judith Meiklejohn

Erin,

Your piece was great to read! I really enjoyed your artefact and how such a simple image can really make you think!

Your information in the literature review was excellent. The media section was a big eye-opener. The evidence you show about the three misconceptions about people suffering from mental illness is something I have never thought about. But after reading this you can see that its somewhat true.

Throughout your analysis the information regarding dealing with stigma in our community and how to eliminate it is well said.

such a great article to read :)


 * <span style="background-color: white; font-family: Arial,sans-serif;">R U OK? - The Importance of Social Inclusion **

<span style="font-family: Arial,sans-serif;">Name: Paras Vasiliou

<span style="font-family: Arial,sans-serif;"> Student number: n8323763

<span style="font-family: Arial,sans-serif;"> Tutors name: Katie Page

Really well written! The topic you chose and the way you decided to present it worked very well and captured my attention.

Your history of mental illness and how people got treated is an eye-opener! Its really surprising to see how far we have come.

You explained social determinants and social inclusion to great extent and show how medication is not the only treatment for this public health issue.

I like how in your analysis you mention immigrants, refugees and asylum seekers as we need to understand that we cannot exclude these groups when looking at ways to minimise mental health issues.