Psychiatry and Clinical Psychology

In the approach of a child with ADHD it is very important that the diagnosis and treatment is carried out by a multidisciplinary team such as the one available at the Clinic, composed of different specialists who are experts in this pathology.

The psychoeducational program for parents with children with ADHD is organized in the following sessions:

• 1st Session: Information about ADHD.
• 2nd Session: Contingency Management 1: techniques to increase positive behaviors ( the importance of the use of play + praise + reinforcement).
• 3rd Session: Token Economy Program.
• 4th Session: Setting Limits.
• 5th Session: Contingency Management II: techniques to decrease behaviors ( use of extinction + application of negative consequences + application of logical and natural consequences + time-out).
• 6th Session: Conflict Resolution.

Attention Deficit Hyperactivity Disorder (ADHD) is a common psychiatric disorder, with a significant genetic inheritance basis, with high impact on all areas of a person's life, treatable and with good prognosis if treated appropriately.

Its core symptoms are inattention, hyperactivity and impulsivity, which do not all occur in the same frequency and intensity in all people who suffer from it, since there are different types of ADHD.

Adults who suffer from ADHD are usually people with a tendency to chaos and disorganization. Although they know well what they have to do, they are not able to achieve it since their recklessness and low effort capacity leads them to avoid any mental effort or routines that require perseverance and discipline.

The treatment consists of 3 basic pillars:

• The pharmacological one that helps to reach a chemical stability and a regulation of the transmitters at brain level.
• The psychoeducation that consists of that as much the patient as the people with whom it coexists know the symptoms well and between all they minimize the negative emotional impact associated with the disease in the daily life.
• The cognitive-behavioral psychotherapy helps a lot and sometimes the family psychotherapeutic approach is also necessary.

In the diagnostic interview, in addition to the basic demographic data, the reason for consultation and the personal and family history of the illness, relevant data on the illness are collected, such as history and evolution of the eating disorder, triggers or precipitating factors, eating habits and characteristics, use of purging mechanisms (vomiting, laxatives...).

An exhaustive psychopathological exploration is carried out, which also helps to establish the possible presence of comorbid alterations (mood or personality disorders, among others) and an evaluation of the patient's personality characteristics, through a psychodiagnostic study.

It is also necessary to detect any organic disease or consequence of the disorder.

The care we provide for these patients follows a protocol of action, which includes the participation of mental health specialists (psychiatrists, clinical psychologists, nurses, social workers), endocrinologists and dieticians, in addition to the necessary medical professionals, depending on the patient's clinical situation.

In accordance with the multifactorial origin of these diseases, the treatment carried out in these pathologies must also be multidisciplinary, with the joint participation of the different professionals involved, and always in accordance with the individual characteristics of the patient and the specific situation of the disease.

In the most serious cases, it is sometimes necessary to admit the patient to the hospital, in order to provide her with nutrition and stabilize her medical problems, but in most cases the care is provided in outpatient clinics, combining psychopharmacological treatments, when necessary, with psychotherapeutic treatments (individual, family, group) and the necessary occupational intervention.

The Psychiatric Hospitalization Program for the Study and Optimization of Treatment (EOT) is a service to the patient and his or her doctor in charge in his or her place of residence for a second evaluation and psychopharmacological readjustments which, due to their complexity or the patient's clinical situation, it is advisable to carry out on an inpatient basis.

It is therefore a program that attends to patients with the following characteristics:

• Although they do not present a situation of acute psychiatric decompensation, their doctor considers that a second evaluation and/or psychopharmacological readjustment is required.
• There are certain clinical conditions (association of other medical illnesses) which mean that this readjustment is associated with a greater risk and therefore a need for special clinical monitoring, which is difficult to provide on an outpatient basis (multi-pathological patients or those with multiple treatments, state of pregnancy, advanced age, etc.).

In view of this situation, the patient's doctor, always with the authorization of the interested patient, can contact the psychiatric hospitalization team to refer us an updated medical report of the patient, which may include a description of the treatment adjustment to be made.

Once the case has been analyzed, a psychiatrist from our hospitalization team will contact the patient's doctor to plan the hospitalization and agree on the therapeutic strategy and the most appropriate method for carrying out the study and medication adjustment.

Once the process has been monitored and the adjustment made, the patient is referred to his or her doctor, who is sent a copy of the medical report with the results of the tests performed and all the medical information regarding the evolution and result of the adjustment made.

The main objective of the relaxation techniques is to counteract the hyper-response or sustained activation of the autonomic nervous system that is activated in a stressful situation for the patient but that if not controlled, becomes excessive. In this way a better psychosomatic balance is achieved.

With these techniques a greater state of relaxation is achieved, a better focalization and reorientation of attention, greater self-control, an increase in the capacity to discriminate the psycho-physiological responses to certain situations and to learn how to reduce them.

The objective is that the person himself, through daily training, is able to self-regulate his level of internal tension.

Weekly sessions, individual or group, are carried out during 5-6 weeks and the patient practices at home.

In these sessions, the following topics are discussed:

• Psychoeducation of stress and anxiety.
• Breathing module.
• Relaxation module: aimed at physiological change or cognitive change.
• Module of thought management techniques, problem solving and time management.

This program is aimed at modifying lifestyles and habits, focusing on a regular awareness of our automatisms.

It is about exercising to live centered in our life, in every moment, without judging. This allows us to act in a more adaptive and less reactive way.

Skills are acquired that allow therapeutic self-observation, the conditions prior to healing. This capacity is acquired gradually, it is developed through training.

Weekly sessions, individual or group, of approximately 1 1/2 h. are carried out during 8-9 weeks and it requires regular practice at home.

Full attention, perception and cognitions (potentially harmful thoughts, judgments and conditioning), emotions (emotional regulation), stress (response reaction), pain/discomfort (tolerance), eating, conscious communication and time management are worked on.

All these contribute to:

• Reducing stress and anxiety.
• Reduce automatisms, impulsiveness, increasing the ability to respond in a non-reactive way and self-control.
• A better acceptance of reality as it is.
• Enjoying the present moment without living it as a means to achieve something.
• Understanding the nature of suffering (how it is generated, freeing the mind from unnecessary suffering) and dissatisfaction, improving psychological well-being.
• To enhance self-awareness (of the relationship between body and mind, of what is avoided, of judgments and their effect on health).
• Participate in self-care and develop self-regulation, recovering the internal balance.
• To increase attention.

It is usually the family members or people in the environment of a patient who suffers from an addiction who, once the problem has been detected, go to the doctor for help and/or advice.

In the treatment it is essential to raise the patient's awareness and motivation to actively collaborate in the treatment. The recognition of the problem will be the basis for the beginning of any subsequent intervention.

In the first place it will be necessary to carry out a detoxification. In the case of alcoholism must be suppressed abruptly and completely, and if an abstinence syndrome appears it will be treated appropriately. Sometimes it is necessary to hospitalize the patient in order to carry it out.

Once this phase is finished, the treatment of the uninhabitability must be carried out in order to prevent the patient from falling back into addiction. It must be carried out by a multidisciplinary and specialized team, using drugs and psychosocial techniques.

Subsequently, the rehabilitation and social reintegration of the patient will be carried out, with an approximate duration of 24 months. During this time, the patient must come regularly to the hospital center from 1 to 2 times per week.

The family of the patient with an addiction also needs, in many cases, medical and social attention to alleviate the negative effects of the presence of a substance-dependent patient in their midst.

Communication is a key element for the quality and stability of the marital relationship, and it is also considered one of the main tools for managing the stress of daily life.

Within the marriage it has been demonstrated that small moments of daily stress, which may seem insignificant, when maintained over time can be tremendously detrimental to the quality and satisfaction of the couple.

The program consists of 5 modules:

• Module 1: Introduction to the concept of stress.
• Module 2: Didactic strategies for coping with stress.
• Module 3: Improvement of communication within the marriage.
• Module 4: Three phases method of dealing with stress in marriage.
• Module 5: Improvement of the resolution of conflicts in marriage

The psycho-education program for parents and children who present problems consists of several interviews and work sessions.

In the first interview with the parents, the difficulties that the child presents in different areas are identified (such as at school, family, friends). In addition the parents also express their own difficulties. The parents are provided with information about ADHD, doubts about the diagnosis, symptoms, treatment, etc. are clarified. Parents are given written material.

In the second session we work with the parents on contingency management with techniques to increase behavior and we give the parents self-registration sheets and written material from the session.

In the following sessions the evolution, difficulties of the parents, etc. are discussed. Parents bring completed self-registration and we assess applied technique and outcome. Parents bring self-registration sheets and we evaluate applied techniques and result. Conflict resolution is worked on.