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Biological treatments for
Psychopathology
Drug treatment
Drug therapy (chemotherapy) is the main
treatment for psychopathology and is based
on the assumption that chemical imbalance
is the cause of the problem. Drugs for
mental disorders include the following:
Anti-depressant drugs, e.g. MAOIs (monoamine-oxidase
inhibitors), TCAs (tricyclics) and SSRIs (selective serotonin reuptake inhibitors). MAOIs and trycyclics were the first drugs used
to treat depression and raise levels of serotonin and noradrenaline
in the brain. MAOIs block the action of an enzyme that breaks
down serotonin, so increasing its availability in the nervous
system. However, a newer group of drugs – SSRIs – were
introduced in the 1990s (e.g. Prozac) which selectively raise levels
of serotonin in the brain (and thought to be more effective and
safer than MAOIs and trycyclics).
Anti-psychotic drugs, e.g. major tranquillizers such as the
chlorpromazine – these sedate patients and alleviate symptoms
(e.g. hallucinations and delusions) of the person suffering from
psychotic disorders such as schizophrenia. They work by reducing
dopamine activity in the brain. Chlorpromazine was the first drug
used to treat schizophrenia but can have unpleasant side effects.
Newer drugs such as clozapine have fewer side effects than
chlorpromazine and act on a wide range of neurotransmitters in
the brain such as dopamine and serotonin.
Anti-anxiety drugs, e.g. minor tranquillizers called benzodiazepines
(BZs) such as Valium. These have a calming effect by inhibiting
the nervous system and causing muscles to relax. BZs work by
enhancing the action of the neurotransmitter, GABA, which acts to
calm brain activity.
Abnormality
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Biological treatments for
Psychopathology
Electro-convulsive therapy [ECT]
The patient lies on a bed and receives an anaesthetic and muscle
relaxant before treatment. A current is passed through the brain
for about half a second which is done by fixing electrodes to the
patient’s temples. In the past, electrodes were put on each side of
the forehead. Nowadays it is more common to use ECT on one
side of the brain as this reduces side effects. The current induces
convulsions that last for approximately one minute. Once the
patient comes round from the anaesthetic they recall nothing
about the procedure.
ECT is now used mainly to treat people with severe depression
when all other treatments have failed. Treatments are given
typically two or three times a week for three or four weeks. ECT
was particularly popular in the 1940s, fell out of favour during the
1960s but is still widely used today.
Evaluation of ECT
Effectiveness – ECT is a quick form of treatment compared with
drugs or psychological therapies. It can be an effective short-term
treatment for depression with 60-70 per cent of patients showing
improvement (Sackheim 1988). However, approximately 60 per
cent of patients will become depressed again within a year
(Sackheim et al. 1993).
Side effects – When ECT was first introduced there were serious
side effects including bone fractures and memory loss. Side
effects have been reduced but opinions are divided regarding the
severity of cognitive and emotional impairments following
treatment.
Ethical issues – ECT has a history of abuse, being used as a means
of punishing or controlling people in mental hospitals. However,
the Mental Health Act (2007) states that ECT is prohibited if the
patient is capable of making a decision and refuses treatment
unless it is immediately necessary to save life.
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Biological treatments for
Psychopathology
Psychosurgery
Psychosurgery is brain surgery to treat psychological disorders. It
is the most invasive form of biological therapy because in involves
removal of brain tissue and the effects are irreversible. The first
modern psychosurgery technique was the pre-frontal lobotomy,
developed in the 1940s as a cure for schizophrenia. This method
involved cutting pathways between the higher thought centres of
the frontal cortex and the lower centres of the brain by inserting a
scalpel through a drilled hole in the skull. There was no evidence
that it improved the specific symptoms of schizophrenia, but it
made patients more manageable.
Nowadays, psychosurgery techniques involve less damage to
neural tissue and precise localisation of damaged brain areas.
Psychosurgery is rarely used, and is only offered as a last resort
for treating severe depression when other treatments have been
ineffective.
Evaluation of psychosurgery
Controversial treatment – In the 1950s, psychosurgery was
performed on thousands of people in the absence of other
effective treatments and in an attempt to reduce the numbers of
people crammed into mental institutions. People with severe
disorders are unlikely to fully understand the procedure and be
able to give informed consent.
A last resort – Although psychosurgery is rarely performed today
and is seen as a treatment of last resort, some procedures, carried
out to alleviate the symptoms of severe anxiety or obsessivecompulsive disorders, have been beneficial (Beck and Cowley
1990).
Abnormality
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