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Treatment and Therapies
Elspeth Cordell
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Introduced the treatment
and therapies unit
Began looking at biological
treatments and ethics
Must:
• Outline the basic
principle of this
perspective
• be able to list types of
medication, what they
are used for and how
they affect the body
• List other treatments
Look at behavioural
treatments and therapies
Should: discuss the
negatives and positives of
these treatment options
and relate them to ethical
considerations
Could support discussion
with research
Handout/ worksheet 1
• Table
Biological Psychology- towards assignment
criteria 1.1
• Basic Principle:
• To correct cognitive, emotional and
behavioural problems seen in mental
illnesses, by causing changes to the biological
functioning. Done by
• Drugs
• Surgery
• Electro-convulsive therapy
Types of drugs
Types
Condition
Drug names
Anti depressants
Depression
Fluoxetine, citalopram, Paroxetine
30 different types!
Older: caused side effects, death from
overdose
Newer: less side effects- rarely causes
death in overdose
Anxiolytics
Anxiety
Barbiturates
Benzodiazepines
Anti psychotics
Schizophrenia
Cases of Bipolar and
mania
•Chlorpromazine (older drug)
•Clozapine (Clozaril FazaClo)- Newer drugs
There are many more!
How they work: All drugs
• Neurotransmitter= Chemicals (dopamine,
serotonin, Noradrenaline)
• Blocking neurotransmitters (antagonist)
• Acting as if they are the neurotransmitter
(agonist)
• Causing transmitters to last longer in the
synaptic gap (agonist)
• Aim : to elevate the symptoms of mental
illness, but they are not a ‘cure’
Antidepressants Introduction
Handout:
http://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/antidepressants.aspx
• developed and used from the 1950s
• ‘50 million prescriptions for anti-depressants
were issued last year, the highest ever number
and 7.5% up on the year before’ (BBC, 2013)
• Annual rise in prescriptions has risen to 8.5% per
year since the banking crash, compared to 6.7%
before (Nuffield Trust and Health Foundation’s QualityWatch programme, 2013)- Now
over 50 Million prescriptions (BBC, 2014)
• More than 40,000 children and adolescents use antidepressants in the UK – on average as young as 5 years
old
Anxiolytics: supporting handout:
http://www.homehealth-uk.com/medical/barbiturates.htm
• Used as early as 1903
• Alcohol and Barbital being the first, however too
many side effects
• Benzodiasapram- 1950s
• Barbiturates are primarily hypnotic drugs, they
are like tranquillisers in that they work by
depressing the nervous system (Home Health UK, 2010)
• Large amounts can help people to sleep
• Used in treatments of other health problems
Anti-Psychotics: Introduction
Handout:
http://www.mentalhealthcare.org.uk/antipsychotic_medication
•
•
•
•
Older (Typcial-Chlorpromazine- Largactil )
Newer (atypical- Clozapine- Clozaril)
Older first appeared in 1950s
Antipsychotic medication helps weaken
delusions and hallucinations ‘Mania’. It can
control (but not cure) symptoms in about four
out of five people
• Sometimes used for patients with Dementia(180,000 people with dementia in the UK)
Evaluation of drug treatments: link to
assessment
• Effectiveness: Do they do what they are
supposed to do?
• Appropriateness: are they an appropriate
treatment?
Effectiveness: curing/managing the
illness
• Assessed by taking the % of a sample of
people using that treatment that experience a
significant improvement…
SOURCE
Type of medication
Success – clinically significant
improvement
DGP (1993)
Anti depressants
50%-54%
Barlow & Neale
(1992)
Kalat (1998)
Anti Psychotics
60%-65%
Effectiveness continued
• Drug treatment- most cases the superior
option
• 50-65% patients benefit
• Symptoms are elevated with consistent use
• taking antipsychotic medication more than
halves the risk of relapse in schizophrenic
patients (Royal College of Psychiatrists, 2012http://www.bbc.co.uk/news/health-17940070)
Appropriateness
– Bring short term improvements in most
psychological symptoms
– Patients often welcome drug therapy , as it is
quicker, easier to administer (time), and less
threatening than talking to someone
– Drugs work well with other forms of therapy
However…
Do drugs work or are we
victims of media tricks?
https://www.youtube.com/watch?v=XsBZw6q7uBU
• Some patients may still have some symptoms
• Between 35-50% of patients don’t improve
• Symptoms may return/ worsen if drug is stopped–
dependency?
• Addressing the real cause?
• Side effects mild to extreme/ death
The longer antipsychotic drugs are taken, the more chronic the
side effects become. The nature of mental illness means patients
are often prescribed medication for the rest of their lives…
• Regular doctor check-ups for anti psychotics
• Side effects may affect the person’s wish to continue,
as they can be worse then the mental illness
Drug
Symptoms
anti psychotics (E.G chlorpromazine )though newer
forms have less side effects and are better long
term
Dribbling (weakened tongue and jaws)
severe weight gain, increasing the risk of diabetes,
blood clots and cardiovascular diseases. The risk is
especially high for patients who stay on medication
for many decades.
Prozac- Seroxat
Now banned: Suicide
Anti depressants in general
Young people: suicide. NHS now not
recommending them
Generally:
•feeling sick
•dry mouth
•slight blurring of vision
•constipation
•dizziness
•drowsiness
•problems sleeping (insomnia)
•sexual dysfunction, such as erectile dysfunction in
men or difficulty achieving orgasm
Barbituates (table on page 5)
aggressive behaviour, impaired memory,
judgement and coordination, insomnia, overdose,
dependency, and death
HOWEVER…
Are the side effects worth it?
Side effects vs non medication
• "The side effects are the
price I pay for keeping
out of hospital,“
(schizophrenic sufferer)
Criteria 1.2: Ethical considerations
• Is it significant that
• Haddock and Slade
most clinical trials of
(1996)
conducted by the
• Psychiatrists (more then
company wanting to sell
half asked) would
them?
refuse to take
• Is it right to force a
antipsychotics if they
patient with
were prescribed them?
schizophrenia to take
drugs where the side
effects are sometimes
worse?
Surgical Treatments
Introduction
• Different parts of the brain control different
psychological processes
• For example= Frontal lobe
• Limbic system?
• Abnormalities in the brain can cause psychological
symptoms: Parkinson‘s
• Disconnection or destruction of those brain tissues can
alleviate /cure the problem
• Psychosurgery has scarcely been used as a treatment
for schizophrenia since the early 1970’s when it was
replaced by drug treatment (McLeod, 2008)
Supporting evidence
• http://news.bbc.co.uk/1/hi/health/2345971.s
tm - Brain tumour caused paedohilia
• http://www.cancer.net/navigating-cancercare/side-effects/mental-confusion-ordelirium- certian brain cancers causing
delirium
•
Surgical treatments: do not need
patient consent…
Procedure
Used to treat
Involves
Comments
Frontal lobotomy
Schizophrenia
Severing the entire
frontal lobe of the
brain
No longer used
Banned since 1967
(UK, 1980 USA)
Leucotomy
Schizophrenia
Anorexia
Depression
Anxiety
‘Lighter’ form of
lobotomy
Rarely used, banned
in some countries
Not used much since
1999 (UK)
Cingulotomy –
introduced 1948
Anxiety (OCD)
Severing connections Less radical, only
between frontal
used as last resort
lobes and limbic
system – via the
cingulate gyrus
Callosotomy
Epilepsy
Severing connection
between cerebral
hemispheres
http://www.bbc.co.uk/news/m
agazine-15629160
https://www.urmc.rochest
er.edu/neurosurgery/forpatients/treatments/corpu
s-callosotomy.aspx
Used in life
threatening cases
Lobotomy
How is it done??
Less radical forms:
Leucotomy
Cingulotomy
Callosotomy
Done by using
•
•
•
•
Cutting
Burning with an electrode or laser
Injecting neurotoxins
Destruction using Gamma radiation (Noninvasive
Effectiveness
• Some benefits with lobotomy- behaviour was
changed so patients became more
manageable
• More success with leucotomy
• Cingulotomy: clinically significant
improvement in 60% of cases
• Callosotomy- treats epilepsy well (cases even
cures)
• More success in removing the
hemisphere(hemispherectomy)
Appropriateness
• Surgery is used only as a last resort
• It can be the best treatment especially in
cases of tumours causing mental illness
conditions (see supporting evidence slide)
However…
What is wrong with this treatment?
• Very risky- can cause death
• Lobotomies were banned due to a patient
haemorrhaging
• The effects are irreversible
• There may be no benefit to the patient- a lot is
calculated guess work that the behaviour is
resulting from a biological factor
Ethical implications
• Is it right that patients do not need to give consent
• When Consent may not be needed - s63 Mental Health
Act 1983
• ‘A patient who has been sectioned under the Mental
Health Act may be treated without the requirement for
consent. This is only applicable for treatment for the
mental illness’ (Mental Health Act 1983)
• Surgery has been known to be abused
• What happens if it is not what the Doctor thought?
Remember surgery cannot be reversed!
ECT: Electric shock
treatment
•
•
Supporting information:
http://www.mind.org.uk/informationsupport/drugs-and-treatments/electroconvulsivetherapy-ect/#.VUE7jrdMvIU
http://www.psychiatrictimes.com/electroconvulsivetherapy/ect-ethical-treatment