Download Thinking caps (hats):

Biological Treatment
Biological treatments generally include the
administering of medication.
This is controversial.
Why do you think that is?
Biological therapy
 Drugs are the most common form of biological therapy and
are often the first thing administered to patients
 The assumption is that there is an underlying biological cause
for abnormal behaviour
 This could be due to brain structure, genetics or hormones
 What might the positive side of this be?
 What might be the negative?
Phenelzine
 Actually a form of antidepressant
 MAOI – monoamine oxidase inhibitor
 Based on the theory that depression is caused by a deficit
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of neurotransmitters called monoamines
Prevents the breakdown of monoamines therefore
increasing their availability
Has quite a few side effects, generally used when other
medicines have not been effective
There is now a new generation of MAOIs with fewer side
effects
Read: http://www.mayoclinic.org/diseasesconditions/depression/in-depth/maois/art-20043992
Neurobiology of Social Anxiety Disorder:
 Neurobiology of Social Anxiety Disorder:
Dysregulation of neurotransmitter function in the brain is
thought to play a key role in Social Phobia (SP).
 Specifically, dopamine (DA), serotonin (SE), and / or GABA
dysfunction are hypothosised in most cases of SP. in varying
degrees depending on the individual.
 So how does phenelzine work to treat social phobia?
 The MAOI antidepressant "phenelzine" boosts levels of all
three
 There is strong evidence for dopamine dysfunction in Social
Phobia
 Using the information from the website complete the
diagram on the next slide to fully understand how
MAOI’s work.
Presynaptic
neuron
Synaptic Cleft
Postsynaptic
neuron
MAO – Monoamine
Oxidase
S – Serotonin
I – Inhibitor
Physiology of Anxiety
Fearful Stimuli
Sympathetic nervous system
(brain and spinal cord) releases
hormones (i.e. adrenaline)
Fight or flight response: Increased
heart rate, enlarged pupil's, sweat
Increased anxiety helps a person
to prepare for an appropriate
course of action
Atenolol
 Beta-Blocker
 Work by blocking the transmission of nerve
impulses
 They blocking the effects of the hormone
epinephrine, also known as adrenaline. When
you take beta blockers, the heart beats more
slowly and with less force, thereby reducing
blood pressure
Read: http://patient.info/health/beta-blockers
Beta-blockers – How do they work?
 Using the information from the website complete the
diagram by adding in the labels.
Tissue cell
Beta-blocker
Receptor on
cell surface
Nerve
ending
Adrenaline
Complete the table
How do they work
Side effects
MAOI
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Beta-blockers
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Leibowitz (1988): Treatment of Social Phobia with Phenelzine
Potential
pitfalls?
Biological treatment
Key study: Leibowitz (1988)
Aim
 To see if the drug phenelzine can help treat patients with
social phobia.
 To see if phenelzine is more effective than a placebo and
atenolol in treating social phobia.
 Why use a placebo group?
Method
 A controlled experiment where patients were allocated
to one of three conditions, and treated over 8 weeks.
They were assessed for social phobia on several tests such
as:
 The Hamilton Rating Scale for Anxiety
 Leibowitz Social Phobia Scale. This had common
manifestations of social phobia and patients rated 1-4
for the fear produced and
1-4 for the steps taken to avoid the phobic situation.
Participants
 80 patients meeting DSM criteria for social phobia aged
18–50 years. They were medically healthy and had not
received phenelzine for at least two weeks before the
trial. Each was assessed to see that there were no other
disorders. Each signed a consent form before the
research.
Design
 An independent design with patients being allocated
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randomly to one of four groups:
one group was treated with phenelzine
one group was given a matching placebo
a second treatment group was given atenolol
another group was given a matching placebo.
Procedure
 Patients were assessed at the beginning, and then given
their drug or placebo, with gradual increases in dosage
of phenelzine or atenolol in the treatment groups.
 Each patient was then reassessed.
 Independent evaluators were used to carry out clinical
assessments in a double blind situation.
Findings
 After eight weeks significant differences were noted for
the phenelzine groups, with better scores on the tests for
anxiety compared to the placebo groups.
 There was no significant difference between the patients
taking atenolol and those taking a placebo.
Conclusions
 Phenelzine but not atenolol is effective in treating social
phobia after eight weeks of treatment.
Plenary
 Outline 2 advantages to drug therapy
 2 disadvantages
 Extension:
 Suggest a solution
Activity:
12 mins
Evaluate the Leibowitz study
Pair 1 Sample, generalisability, ethics
Pair 2- reliability, methodology
Pair 3 – usefulness, validity
Pair 4 – nature/nurture, reductionism/holism,
Strengths and weaknesses of Biological Treatment
Strengths
Weaknesses