Download Module 73 - Biomedical Therapies

Biomedical Therapies
Module 73
Biomedical Therapies
• Medical Treatment of psychological
disorders that involve changing the brain’s
functioning by using prescribed drugs,
electroconvulsive therapy, or surgery
Drug Therapies
Psychopharmacology
• Study of drug effects on mind & behavior
• Drug’s effectiveness based on:
– Subtracting the normal recovery among untreated
persons from recovery due to placebo effect
– Do this by using double blind procedure
Pre-Drug Therapy
• Prior to the discovery of psychological drugs,
hospitals had few options with which to treat
patients
• Most early treatment techniques are today
considered archaic and sometimes cruel
• See “Early Treatment of Mental Disorders”
– Video #36 Worth’s Digital Media Archive. (5:00)
Deinstitutionalization
• With the discovery of effective drug treatments, patients
were able to leave the institutions
• The release of patients from mental hospitals to the
community at large
• The development of drug therapies led to an 80% decline in
the number of hospitalized mental patients from 1950 to
2000.
• Many of the former patients became part of the homeless
population.
Deinstitutionalization
• Widespread
use of
antipsychotic
medications
began in the
mid-1950’s
• Can be related
to number of
patients in
mental hospitals
Antipsychotic Drugs
Drugs Impact on Synaptic Transmission
Antipsychotic Drugs
• A category of medications used primarily to treat
schizophrenia
• Reduces the levels of hallucinations and delusions
and distorted thinking
• Drugs work primarily by blocking the activity of
dopamine
• Reduces responsiveness to irrelevant stimuli
Typical Antipsychotic Medications
• Typical antipsychotics (Thorazine)
– Effective against positive symptoms
of schizophrenia
– Have uncomfortable side effects
– Globally reduce brain dopamine
levels
• Side effects include: dry mouth,
blurred vision, constipation, and
tardive dyskinesia
• Tardive dyskinesia – a permanent
condition of muscle tremors
Atypical Antipsychotic Medications
• Newer drugs that may also be effective against
negative symptoms of schizophrenia
– Risperdal
– Zyprexa
• Affect levels of serotonin as well as dopamine
• Much less likely to cause movement-related side
effects because they block dopamine brain
receptors far more selectively
• Produce (sometimes dramatic) improvement in a
significant proportion of patients who have not
responded to traditional antipsychotic drugs
• Side effects – obesity & diabetes
Schizophrenia Drug Therapy
• Insert “Schizophrenia” Video #34 from
Worth’s Digital Media Archive for
Psychology. (5:15)
• How does Augustine’s behavior change
after 4 weeks on medication?
Click HERE to view in a separate
window.
OR
•View shorter version of the
Effectiveness of these drugs
with a schizophrenic (2 min)
Antianxiety Drugs
Antianxiety Drugs:
Benzodiazepines
• A category of medication used to treat people with anxiety
disorders or suffering stress
– Include: Valium, Librium, Xanax, Ativan
• Take effect quickly, usually within an hour.
• Work by boosting levels of the neurotransmitter GABA - a
neurotransmitter that inhibits the transmission of nerve
impulses in the brain and slows brain activity
• Negative reinforcement can cause dependency
• Side Effects - decreased coordination, slow reaction time,
decreased alertness
– Can cause death if mixed with alcohol
Antianxiety medications:
Non-benzodiazepine—(Buspar)
• Believed to affect brain dopamine and serotonin
levels
• Relieves anxiety while maintaining normal
alertness; it does not cause the drowsiness,
sedation, and cognitive impairment associated with
the benzodiazepines
• May take 2-3 weeks to work
Drug Therapies:
Antidepressant Drugs
Antidepressant Drugs
• A category of medications used primarily to
treat major depression
– Also effective with anxiety disorders, OCD, PTSD
• Agonists - work by increasing levels of
serotonin & norepinephrine in the brain
• Many take about a month before they become
fully effective
– Neurogenesis – may help stimulate new neuron growth
– Work well with Cognitive Behavioral Therapy (top-down
treatment)
– Placebo Effect may accounted for 75% of effect in mildly
depressed patients
Selective Serotonin Reuptake Inhibitors
• Classification of antidepressants
which work by blocking the
reuptake of serotonin after it has
been released
– Includes: Prozac, Zoloft, and Paxil
• No more effective than the older
antidepressants
• Produce fewer, and milder, side
effects
• Effexor, a dual reuptake inhibitor,
affects levels of both serotonin
and norepinephrine.
– seems to be more effective than
SSRIs in alleviating the symptoms
of depression
Mood Stabilizers:
Bipolar Disorder Drugs
Lithium
• Used to treat bipolar disorder (manic-depression)
• Used to interrupt acute manic attacks and prevent relapse
– 7 in 10 people with Bipolar Disorder benefit from taking
Lithium
• Stabilizes the availability of glutamate within a narrow,
normal range, preventing both abnormal highs and
abnormal lows
– Very narrow difference between the therapeutic dosage level and
the toxic dosage level, requiring careful monitoring of the
patient’s lithium blood level
• Bipolar disorder can also be treated with an
anticonvulsant medicine called Depakote.
– It is useful for treating patients who do not respond to lithium
and patients who rapidly cycle through bouts of bipolar disorder
several times a year
Depression & Mania
Patients and doctors talk about the experience and treatment of mania
and depression, emphasizing the importance of both medication and
psychotherapy. An animation segment illustrates what happens at the
brain synapses in people with depression and mania. (11:44)
Click HERE to view
video or on the screen
to the right.
Mood Disorders: Questions
1.
Doug Barton talks about the history of mood disorder in his
family. What is known about the inheritance and genetics of
mood disorders?
2.
From the opinions expressed in the film, what can you
conclude about the biological (endogenous) causes versus
psychological causes of depression?
3.
Is medical treatment or psychotherapy considered the best
treatment for mood disorders?
Brain Stimulation
Techniques
Brain Stimulation:
Electroconvulsive Therapy
Insulin Therapy
• Depressed & Schizophrenic patients were given an
overdose of insulin to cause a convulsion.
• Difficulties in determining the proper dosage of
insulin led to a decline in use of this therapy.
• Was replaced by Electroconvulsive Therapy (ECT)
Electroconvulsive Therapy
• Used for severe
depression
• Very effective for quick
relief of symptoms of
severe depression (can
be used until medication
begins to work)
• May have cognitive side
effects such as memory
loss
• Very controversial
treatment
ECT Facts
• Used when antidepressants fail
• 30-60 seconds of electrical current causes seizure in
brain
• About 100,000 patients a year receive ECT
• A series of 6 to 10 ECT treatments are usually spaced
over a few weeks
• Most (80%) patients report improvement
• Typically relieves symptoms within days but benefits
only last for a short time.
– About 4 in 10 relapse in 6 months
• Side effect is temporary or permanent memory loss for
the events leading up to the treatment
• How and why the process works is unknown
Electroconvulsive Therapy
• Watch “Electroconvulsive Therapy” Video
– Video #37 from Worth’s Digital Media DVD. (5:05)
• What do you notice about this therapy?
• Does it match what you thought?
• How does Mary change after treatment?
Neurostimulation:
Repetitive Transcranial Magnetic Stimulation
• Repeated magnetic
pulses stimulate areas
of the brain
• Makes Left Frontal
Lobe more active
– It’s less active during
depression
• May cause new neural
connections through
long-term potentiation
Deep Brain
Stimulation
• Place an electrode
in between frontal
lobe & limbic
system
• Pacemaker
stimulator activates
areas of the brain
that when activated
combat depression
Psychosurgery:
Surgery that removes or destroys
brain tissue
Lobotomy
• Nerves connecting the frontal lobes of the brain to the
deeper emotional centers are cut
• Used to try to calm uncontrollably emotional or violent
patients
• Regularly done before the advent of antipsychotic drugs
• Decreased person’s misery & tension but produced
permanently lethargic, immature & uncreative person
• Rarely used today
• Watch segment from The Lobotomist (5 min)
• Hear the story of a 12-year boy who received an “ice pick
lobotomy” (22 min)
– To learn more and see pictures go the NPR Website.
Therapeutic Lifestyle Change
• Stress affects body chemistry & health
• Human bodies designed for physical activity and social
engagement
• People who experience, strenuous physical activity, strong
community ties, sunlight exposure & plenty of sleep rarely
develop depression
Comparing Biomedical Therapies