Integrating Drugs, Therapy a Delicate Balancing Act. (Drugs May Inhibit Psychotherapy)

Article excerpt

DESTIN, FLA. -- Achieving success with pharmacotherapy in a psychiatric patient requires good psychotherapy with that patient, Dr. Daniel K. Winstead said at a psychiatric conference sponsored by Tulane University.

Only by knowing and working with the patient in psychotherapy can issues that might interfere with pharmacologic treatment be recognized and understood, said Dr. Winstead, chair of the department of psychiatry and neurology at Tulane University in New Orleans.

It is important to recognize that pharmacotherapy and psychotherapy can affect each other, he said. One of the negative effects that drug therapy can have on psychotherapy is reduced motivation for psychotherapy due to symptom reduction and undercutting of psychological defenses.

One potential positive effect of drug therapy is increased motivation for psychotherapy. Often, this is true in patients whose symptoms were so severe prior to pharmacologic treatment that it was difficult to gain their cooperation.

Other positive effects might include improvement of basic ego functions, which could improve the psychiatrist's ability to engage the patient productively in the psychotherapeutic relationship, and the reduction in stigma associated with psychiatric illness. If an illness is defined as a biologically based disease that can be treated with medication, stigma is reduced, and self-esteem may be improved.

Psychotherapy can have negative and positive effects on pharmacotherapy. Negative effects might include reduced motivation or increased resistance to taking medication. Pr0obing or psychological uncovering could aggravate symptoms.

Positive effects include the potential for helping patients to correct secondary difficulties, as with relationships, self-esteem, and maintenance of equilibrium once symptoms are relieved by pharmacotherapy. Integration of psychotherapy and pharmacotherapy might also facilitate drug compliance and reinforce symptom reduction through synergistic benefits.

Psychotherapy can shed light on the numerous factors that might interfere with adherence to pharmacotherapeutic treatment. It can allow for assessment of the suitability of the diagnosis, of the symptoms of the greatest concern for the patient, of comorbid diagnoses, and of the patient's level of denial, Dr. Winstead said.

Take time to address accessibility effects. Patients with a chaotic life or lack of daily routine, patients with financial challenges, and patients with a lack of social support for their treatment are among those who may be at risk for nonadherence, he said. …