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Biological Treatments The biological approach believes that treatment should be physical. Three main types – Anti-Anxiety Anti-Depressive Anti-Psychotic Drug treatment Drug treatment is sometimes known as Chemotherapy Main treatment based on the assumption that it is a chemical imbalance (neurotransmitter/ hormone) which causes the abnormality. Drugs can INCREASE and DECREASE levels of neurotransmitters. When neurotransmitters are released into the synaptic gap, not all of it attaches to the receptor sites on the receiving neuron. The remaining neurotransmitter must be removed to allow the synapse to return to its normal state. This is done by 2 ways: Pumped back into the pre-synaptic neuron by a re-uptake pump in the synapse Broken down into a different substance by an enzyme. Drugs which INCREASE the levels of the neurotransmitter SSRIs are prescribed for depression because low levels of serotonin are thought to cause this disorder. SSRIs (e.g. prozac) block the re-uptake pump in the synapse. This reduces the rate of re absorption, therefore increasing serotonin levels by allowing more serotonin to attach to receptors. REUPTAKE PUMP 1 Drugs which INCREASE the levels of the neurotransmitter MAOIs (monoamine oxidase inhibitors) can also treat depression. This type of drug blocks the enzymes in the synapse which breaks down any excess neurotransmitter. ENZYME This allows more serotonin to attach to receptors on the post-synaptic neuron. Drugs which DECREASE the levels of neurotransmitters Anti-psychotics (Eg. Chlorpromazine) relieve the symptoms of schizophrenia caused by excessive dopamine. They block the post-synaptic receptor sites so that not as much dopamine cross the synapse. Now complete the table below using p237 in the Cardwell textbook Anti-anxiety drugs Anti-depressant drugs Anti-psychotic drugs 2 Drug treatment – evaluation Using Cardwell p237 Many drug treatments are cost effective and easy to use and here is much evidence to show there effectiveness. Efficacy (effectiveness) Side effects Treating the symptoms not the cause. Ethical issues in use of drugs However there are also implications for the patient when they come off the drugs 3 ECT - description Patient lies down and given a muscle relaxant and anaesthetic. An electric current (70 – 130 volts) is passed through the brain for about half a second via electrodes on the patient’s head. The electric current induces convulsions, depending on the level of treatment this can be for one minutes or more. It is thought to produce long lasting biochemical changes in the brain. How is this carried out today? See Cardwell p238 Patients recall nothing about the procedure once they come around from the anaesthetic ECT was originally used by Cerletti and Bini (1938) when trying to treat a patient with schizophrenia. How is depression treated using ECT? How many people in England were treated using ECT in 1999 according to Johnstone (03)? ECT – evaluation Efficacy It is an effective short-term treatment in 60-70% of patients. However 60% relapse and become depressed again within a year. (Sackheim et al 1993) 4 Mode of action It is not exactly clear how ECT actually works, but it may boost the levels of some neurotransmitters Side effects Memory problems Bone fractures When to use. Should only be use when anti-depressants have had no effect and there is risk of suicide. Ethical issues There is a history of abuse and has been used as a punishment in or a mode of control in mental hospitals. What does the 2007 Mental Health Act state in relation to ECT? Psychosurgery Brain surgery involving the removal of parts of the brain Common in the 20th century. A pre-frontal lobotomy destroys fibres that connect the frontal cortex with lower deeper parts of the brain. Today psychosurgery is use but there is considerably less damage to the lower centres of the brain It is rarely used and often is the last resort for treating an otherwise untreatable condition. Psychosurgery - evaluation Not reversible Rarely used now and only considered as a last resort due to the procedure being irreversible. 5 Controversial treatment. 1950’s this was used a lot as other treatment were not available and there was an effort to reduce the patient numbers in mental hospitals Supporting evidence Beck and Cowley (1990) have found some procedures can alleviate severe anxiety and OCD Last resort This is only used as a very last resort for such disorders as extreme OCD or severe anxiety Activity: Outline and evaluate the key features of the biological approach to psychopathology. (12 marks) Outline and evaluate ONE biological therapy for treating abnormality. (6 marks) 6