INTEGRATED TREATMENT OF PSYCHIATRIC DISORDERS COMBINING PHARMACOTHERAPY WITH PSYCHOTHERAPY J. S. Giouzepas MD, PhD Combining Medication with Psychodynamic Psychotherapy S. Donias MD, PhD Integration in Psychotherapy: The case of Cognitive Analytic Therapy G. Simos MD PhD Cognitive Behavior Therapy and Medication. Additive Effects? G. C. Lavrentiadis MD, PhD Psychotherapy, the Biological Dimension Hellenic Psychiatric Association World Psychiatric Association REGIONAL AND INTERSECTIONAL CONGRESS, March 12 – 15, 2005, ATHENS

INTEGRATED TREATMENT UNANSWERED SCIENTIFIC QUESTIONS Under what conditions is integrated treatment by a psychiatrist superior to split treatment? For what disorders should psychotherapy precede medication? For what disorders should both medication and psychotherapy be instituted from the outset treatment? Are some psychiatrist more effective in using integrated treatment? If so, why? For which disorders is integrated treatment cost effective? What factors are critical in the success of split treatment? What are the benefits of brief integrated therapies of 12 – 16 sessions compared with longer treatments for some disorders?

INTEGRATED TREATMENT OF PSYCHIATRIC DISORDERS COMBINING PHARMACOTHERAPY WITH PSYCHOTHERAPY COMBINING MEDICATION WITH PSYCHODYNAMIC PSYCHOTHERAPY: SOME GENERAL CONSIDERATIONS J. S. GIOUZEPAS MD, PhD Associated Professor of Psychiatry Aristotle University of Thessaloniki Hellenic Psychiatric Association World Psychiatric Association REGIONAL AND INTERSECTIONAL CONGRESS: ADVANCES IN PSYCHIATRY March 12 – 15, 2005, ATHENS

The Mind – Body Dualism The Mind – Body Conflict

SOME IMPORTANT QUESTIONS For which patients should one consider combining medication and psychodynamic treatment? If medication is to be prescribed, who should supervise the part of the treatment? One – person model Two – person model

TIME OF PRESCRIBING After Initial Evaluation In the Midphase of Psychodynamic Treatment

Patients feelings about the Psychiatrist in Integrated Treatment POSITIVE Genuine acknowledgment of pain Interest in patients feelings Support and safety Hopefulness about symptom relief Appreciation of clinician’s skills Comfort with consistency of prescribing NEGATIVE Discomfort with patients plight Lack of interest in patient’s feelings Physician’s control of patient Minimization of patient’s problems Fear of limited skills of clinician Anger over clinician’s refusal to prescribe what patient desires or feels is needed J. Kay (2001) Integrated Treatment. An Overview in Integrated Treatment of Psychiatric Disorders. A.P.A. Publishing Inc., Washington DC

Patients feelings about the Medication in Integrated Treatment POSITIVE Relief that correct intervention is offered Reassurance about gradual onset of action Trust worthy and effective intervention Appreciation of integrative treatment plan NEGATIVE Evidence of patient’s weakness Fear that psychiatrist is inept or uncaring Fear of toxic or hurtful suggestion Resentment that effective component of treatment is unclear J. Kay (2001) Integrated Treatment. An Overview in Integrated Treatment of Psychiatric Disorders. A.P.A. Publishing Inc., Washington DC

PRESCRIBING IN THE MIDPHASE Therapist’s Countertransference Patient’s Outrage and Despair

Conclusions For medication and psychodynamic therapies to be effectively combined, phenomenology and metapsychology should be understood in parallel

Conclusions If these two forms of treatment are to be integrated, then psychodynamic metapsychology must be revised to recognize affects as not simply manifestations of psychic conflict but rather as powerful and primary forces in determining both behavior and the organization of psychic structures

Conclusions We must not confuse affects with affective disorders, nor anxiety with anxiety disorders. Depression and anxiety do not simply reflect intrapsychic and interpersonal events; they also create them

Conclusions Effective medication treatment in combination with psychodynamic therapy often does more than treat the illness: it changes the person