Treatments for Narcissistic Personality Disorder
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Delusional disorders:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Effective treatment of delusional disorders, consisting of a combination of drug therapy and psychotherapy, must correct the behavior and mood disturbances that result from the patient’s mistaken beliefs. Treatment may also include mobilizing a support system for the isolated elderly patient.
Drug treatment with antipsychotic agents is similar to that used in schizophrenic disorders. Antipsychotics appear to work by blocking postsynaptic dopamine receptors. These drugs reduce the incidence of psychotic symptoms, such as hallucinations and delusions, and relieve anxiety and agitation. Other psychiatric drugs, such as antidepressants and anxiolytics, may be prescribed to control associated symptoms.
A patient’s history of medication response is the best guide when selecting treatment. The lowest dose should be started initially and increased slowly based on the patient’s response. If the symptoms don’t improve during a 6-week trial, other classes of antipsychotics may be tried. Haloperidol, fluphenazine decanoate, and fluphenazine enanthate are depot formulations that are implanted I.M. to release the drug gradually over a 30-day period, improving compliance. Usually, however, this type of treatment isn’t necessary. Pimozide may be particularly effective in delusional disorders.
Clozapine, which differs chemically from other antipsychotic drugs, may be prescribed for severely ill patients who fail to respond to standard treatment. This agent effectively controls a wider range of psychotic symptoms without the usual adverse effects.
However, clozapine can cause drowsiness, sedation, excessive salivation, tachycardia, dizziness, and seizures. Agranulocytosis, a potentially fatal blood disorder characterized by a low white blood cell count and pronounced neutropenia, may also occur. Routine blood monitoring is essential to detect the estimated 1% to 2% of all patients taking clozapine who develop agranulocytosis. If caught in the early stages, this disorder is reversible.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Generalized anxiety disorder:
Treatment
(Professional Guide to Diseases (Eighth Edition))
A combination of drug therapy and psychotherapy may help a patient with generalized anxiety disorder. Benzodiazepines may relieve mild anxiety and improve the patient’s ability to cope.
ELDER TIP A benzodiazepine with a long half-life tends to accumulate in an older patient’s system and may cause oversedation. Benzodiazepines are sometimes given along with opioids to add to the analgesic effect or as a preanesthetic. Remember, if the elderly psychiatric patient is scheduled for surgery, he may take longer to recover from anesthesia if these combinations are used.
Tricyclic antidepressants or higher doses of short-acting benzodiazepines may relieve severe anxiety and panic attacks. Buspirone, an antianxiety drug, causes the patient less sedation and poses less risk of physical and psychological dependence than the benzodiazepines.
Psychotherapy for generalized anxiety disorder has two goals: helping the patient identify and deal with the cause of the anxiety and eliminating environmental factors that precipitate an anxious reaction. In addition, the patient can learn relaxation techniques, such as deep breathing, progressive muscle relaxation, focused relaxation, and visualization.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Personality disorders:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Personality disorders are difficult to treat. Successful therapy requires a trusting relationship in which the therapist can use a direct approach. The type of therapy chosen depends on the patient’s symptoms. Family and group therapies are usually effective. Cognitive and self-help groups have also been beneficial.
Drug therapy is effective in some types of personality disorders; for example, pimozide has been successfully used to reduce paranoia ideation in some patients with paranoid personality disorder. Antipsychotic drugs (olanzapine or risperidone) may be used to treat severe agitation or delusional thinking. Selective serotonin reuptake inhibitors, such as fluoxetine, may be used to treat irritability, anger, and obsessional thinking. Antianxiety drugs may be used to treat severe anxiety that interferes with normal thinking.
Hospital inpatient milieu therapy can be effective in crisis situations and possibly for long-term treatment of some disorders. Inpatient treatment is controversial, however, because most patients with personality disorders don’t comply with extended therapeutic regimens; for such patients, outpatient therapy may be more helpful.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Delusional disorders:
Treatment
(Handbook of Diseases)
Effective treatment of delusional disorders, consisting of a combination of drug therapy and psychotherapy, must correct the behavior and mood disturbances that result from the patient’s mistaken belief system. Treatment may also include mobilizing a support system for the isolated elderly patient.
Antipsychotic drug therapy
Drug treatment with antipsychotic agents is similar to that used in schizophrenic disorders. Antipsychotics appear to work by blocking postsynaptic dopamine receptors. These drugs reduce the incidence of psychotic symptoms, such as hallucinations and delusions, and relieve anxiety and agitation.
Other psychiatric drugs, such as antidepressants and anxiolytics, may be prescribed to control associated symptoms.
High-potency antipsychotics include fluphenazine, haloperidol, thiothixene, and trifluoperazine. Loxapine, molindone, and perphenazine are intermediate in potency, and chlorpromazine and thioridazine are low-potency agents.
Haloperidol, fluphenazine , and fluphenazine are depot formulations that are implanted I.M. They release the drug gradually over a 30-day period, improving compliance.
Clozapine, which differs chemically from other antipsychotic drugs, may be prescribed for severely ill patients who fail to respond to standard treatment. This agent effectively controls a wider range of psychotic symptoms without the usual adverse effects.
However, clozapine can cause drowsiness, sedation, excessive salivation, tachycardia, dizziness, and seizures as well as agranulocytosis, a potentially fatal blood disorder characterized by a low white blood cell count and pronounced neutropenia.
Routine blood monitoring is essential to detect the estimated 1%to 2% of all patients taking clozapine who develop agranulocytosis. If caught in the early stages, this disorder is reversible.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Personality disorders:
Treatment
(Handbook of Diseases)
Personality disorders are difficult to treat. Successful therapy requires a trusting relationship in which the therapist can use a direct approach. The type of therapy chosen depends on the patient’s symptoms.
Drug therapy is ineffective but may be used to relieve acute anxiety and depression. Family and group therapy usually are effective.
Hospital inpatient milieu therapy can be effective in crisis situations and possibly for long-term treatment for borderline personality disorders. Inpatient treatment is controversial, however, because most patients with personality disorders don’t comply with extended therapeutic regimens; for such patients, outpatient therapy may be more useful.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Anxiety disorder, generalized:
Treatment
(Handbook of Diseases)
A combination of drug therapy and psychotherapy may help a patient with generalized anxiety disorder. Benzodiazepine anxiolytics relieve mild anxiety and improve the patient’s ability to cope. They should be used cautiously, however, because they can be addictive. Buspirone, a nonbenzodiazepine anxiolytic, is an alternative to the benzodiazepines because it causes less sedation and poses less risk of physical and psychological dependence.
Psychotherapy for generalized anxiety disorder has two goals: helping the patient identify and deal with the underlying emotional and psychological issues and eliminating environmental factors that precipitate an anxious reaction. In addition, the patient can learn relaxation techniques, such as deep breathing, progressive muscle relaxation, focused relaxation, and visualization.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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