Psychopharmacology The study of how drugs effect the mind & behavior Psychopharmatherapy

2. 73.1 – Identify and describe the drug therapies, and explain how double-bind studies help researchers evaluate a drug’s effectiveness. Psychological disorders, which have physical causes, have been treated with drugs and other medical procedures. Psychoactive Drugs • The emergence and increased use of psychoactive drugs has become the most popular biomedical therapy. Psychoactive drugs are especially effective for people who have physical and psychological causes associated with their disorder.

3. 73.1 – Identify and describe the drug therapies, and explain how double-bind studies help researchers evaluate a drug’s effectiveness. • Psychopharmacology • The study of how drugs effect the mind & behavior • Psychopharmatherapy • The treatment of mental disorders with medication; also known as drug therapy • Major reasons for widespread use of drugs? • Drugs are effective in treating disorders, especially serious disorders • Drug therapies are often less expensive than psychotherapy

4. 73.1 – Identify and describe the drug therapies, and explain how double-bind studies help researchers evaluate a drug’s effectiveness. Neuroleptics • Neuroleptics, or antipsychotics, have been used to treat psychotic symptoms related to the positive symptoms of schizophrenia such as hallucinations, delusions, disordered thinking, and confused speech. Chlorpromazine (thorazine in the United States) and haloperidol are two of the most widely used antipsychotic medications. Haloperido is similar to chlorpromazine, but does not produce as much sleepiness. Patients taking these drugs have shown improvements, but also experience negative side effects, complaining of dry mouth and dizziness. Other side effects resemble Parkinson’s disease and include muscle problems, tremors, agitation, and slowed movement. Some of these side effects could be treated with other medications, but patients who took chlorpromazine and haloperidol for a number of years experience tardive dyskinesia, an irreversible movement disorder characterized by uncontrollable repetitive actions that involve facial twitching and rapid movements of the arms and legs.

5. 73.1 – Identify and describe the drug therapies, and explain how double-bind studies help researchers evaluate a drug’s effectiveness. Neuroleptics • The newer generation of antipsychotic drugs (also called atypical neuroleptics) causes fewer movement disorders. Clozapine (clozaril) is an example of these newer antipsychotic drugs. Clozapine has been successful for those who did not respond to chlorpromazine and haloperidol. Clozapine has been proven to be successful for controlling the negative symptoms of schizophrenia, such as social withdrawal and lack of emotion. One concern with clozapine is that it may cause a fatal blood disease called agranulocytosis. Use of this medication requires weekly blood tests, which patients may find cost prohibitive.

6. 73.1 – Identify and describe the drug therapies, and explain how double-bind studies help researchers evaluate a drug’s effectiveness. Neuroleptics • Lately other atypical neuroleptics including Risperdal, Zyprexa, and Seroquel, which have fewer side effect than clozapine, have been introduced. They also treat the negative symptoms and are effective in controlling the positive symptoms, as clozapine does.

7. 73.1 – Identify and describe the drug therapies, and explain how double-bind studies help researchers evaluate a drug’s effectiveness. • Antipsychotic Drugs (Neuroleptics) • Used to Treat • Schizophrenia or psychosis • Biological Function • Block dopamine receptors in the brain • Side Effects/Issues • Drowsiness, dry mouth, muscular rigidity, tardive dyskinesia • Examples • Thorazine & Haldol (first generation) • Clozapine, Risperdal & Zyprexa (second generation) • Effectiveness • 60-70% show improvement in symptoms

8. 73.1 – Identify and describe the drug therapies, and explain how double-bind studies help researchers evaluate a drug’s effectiveness. Antidepressants • Antidepressants, prescribed to treat depression, increase the amount of the neurotransmitters norepinephrine and serotonin. Even though these neurotransmitters are quickly increased, people using antidepressants often don’t notice improvements for several weeks. The first generation of antidepressants consisted of tricyclics and MAO inhibitors, which immediately affected the production of norepinephrine and serotonin. These drugs were available for several years, but negative side effects included dizziness, dry mouth, and weight gain. In addition, because these drugs affect the cardiovascular system an overdose could prove fatal.

9. 73.1 – Identify and describe the drug therapies, and explain how double-bind studies help researchers evaluate a drug’s effectiveness. Antidepressants • Second-generation antidepressants, including trazodone and bupropion, produced fewer side effects. Even though these drugs were different from the first-generation antidepressants, there were not as effective and the side effects – though fewer – were similar.

10. 73.1 – Identify and describe the drug therapies, and explain how double-bind studies help researchers evaluate a drug’s effectiveness. Antidepressants • The third group of antidepressants has proven more successful. Referred to as selective serotonin reuptake inhibitors (SSRIs), these drugs do not act on multiple neurological pathways, focusing only on serotonin. SSRIs block the reuptake of serotonin, allowing this neurotransmitter to remain in the synapses, increasing the chances that serotonin will be more available the next time the neuron fires. The resulting increase in serotonin alleviates the symptoms associated with depression. Prozac was one of the first SSRIs to be released; it was quickly followed by the similar drugs Zoloft and Paxil. Prozac is not more effective that the original tricyclics or MAO inhibitors, but has proven to have fewer side effects.

11. 73.1 – Identify and describe the drug therapies, and explain how double-bind studies help researchers evaluate a drug’s effectiveness. Antidepressants • Since SSRIs, new antidepressant medications, called dual action antidepressants, have been released. These newer drugs affect serotonin and norepinephrine levels, but have proven to have more side effects then the original SSRIs.

12. 73.1 – Identify and describe the drug therapies, and explain how double-bind studies help researchers evaluate a drug’s effectiveness. • Antidepressant Drugs (Thymoleptics) • Used to Treat • Mood disorders, anxiety disorders (OCD), plus others… • Biological Function • Monoamine Oxidase Inhibitors (MAOIs) • Increase the amount of serotonin & norepinephrine • Selective Serotonin Reuptake Inhibitors (SSRIs) • Block the reuptake of serotonin

13. 73.1 – Identify and describe the drug therapies, and explain how double-bind studies help researchers evaluate a drug’s effectiveness. • Antidepressant Drugs (Thymoleptics) • Side Effects • MAOIs • Dry mouth, weight gain, heart complications, dizzy spells • SSRIs • Sleepiness, reduced sex drive

15. 73.1 – Identify and describe the drug therapies, and explain how double-bind studies help researchers evaluate a drug’s effectiveness. Antianxiety Medications • Antianxiety medications, also referred to as anxiolytics, are prescribed to help people deal with anxiety. The most popular types of antianxiety medication are the benzodiazepines, which include valium, and xanax. These drugs reduce the symptoms of anxiety, nervousness, and sleeping problems by increasing the level of the neurotransmitter GABA, GABA inhibits nerve impulses in the brain, and when released reduces the symptoms of anxiety. Benzodiazepines, like other drugs, have side effects, including reduced coordination, alertness, and reaction time. The drug can also be intensified if combined with alcohol, which would result in death. In addition, these drugs are highly addictive; doctors have to strictly monitor how many prescriptions are being written for them. • A newer antianxiety drug, buSpar, has fewer side effects. BuSpar still relieves symptoms of anxiety, but doesn’t affect alertness. However, buSpar must be taken for at least a couple of weeks before symptoms are alleviated.

16. 73.1 – Identify and describe the drug therapies, and explain how double-bind studies help researchers evaluate a drug’s effectiveness. Antianxiety Medications • Lithiumis used to treat bipolar disorder. Lithium is a naturally produced substance that affects both the manic and the depressive symptoms of bipolar disorder. Lithium first alleviates manic episodes, and then, when taken over time, can prevent reoccurrences of both mania and depression. Lithium levels in the blood must be closely monitored. If lithium levels are too low, manic and depressive episodes could return; if too high, vomiting and muscle weakness could result. Lithium has been effective in controlling the levels of the neurotransmitter glutamate levels within a normal range. • For people who don’t respond to lithium, Depakote, an anticonvulsant medication originally used to prevent seizures, has proven a successful alternative.

17. 73.1 – Identify and describe the drug therapies, and explain how double-bind studies help researchers evaluate a drug’s effectiveness. • Antianxiety Drugs (Anxiolytics) • Used to Treat • Anxiety disorders; often referred to as tranquilizers • Biological Function • Depress the central nervous system; thereby, producing a calm & mild euphoria • Side Effects/Issues • Physical dependence & withdrawal symptoms when drug is abruptly discontinued • Examples • Xanax, Valium, Librium, Ativan

18. 73.1 – Identify and describe the drug therapies, and explain how double-bind studies help researchers evaluate a drug’s effectiveness. • Antimania Drugs (Mood Stabilizers) • Used to Treat • Bipolar Disorder • Biological Function • Scientific mystery…seriously… • Side Effects/Issues • Difficulties in establishing proper dosage • Difficulties in stopping medication once symptoms ease • Example • Lithium • Effectiveness • 70-80% show improvement in symptoms

19. 73.1 – Identify and describe the drug therapies, and explain how double-bind studies help researchers evaluate a drug’s effectiveness. • Antianxiety Drugs (Anxiolytics) • Used to Treat • Anxiety disorders; often referred to as tranquilizers • Biological Function • Depress the central nervous system; thereby, producing a calm & mild euphoria • Side Effects/Issues • Physical dependence & withdrawal symptoms when drug is abruptly discontinued • Examples • Xanax, Valium, Librium, Ativan

20. 73.2 – Describe the use of brain stimulation techniques and psychosurgery in treating specific disorders. • Psychosurgery destroys tissue in regions of the brain for treating psychological disorders. Egas Moniz use a procedure called prefrontal lobotomy, which involved inserting a sharp instrument into the front part of the brain and moving it from side to side, severing neural connections between the prefrontal cortex and the rest of the brain. It was thought that severing these connections would reduce the emotional responses that resulted from increased activity in the frontal cortex. For a period during the 1940s and 1950s, prefrontal lobotomies became routine for treating schizophrenia, depression, and anxiety. Today, psychosurgery is considered risky, often producing side effects that are irreversible; as a result, psychosurgery is rarely practiced.

21. 73.2 – Describe the use of brain stimulation techniques and psychosurgery in treating specific disorders. • Electroconvulsive therapy (ECT) is used for depressive patients who didn’t respond to drug treatments; a brief electrical shock was thought to stimulate and increase neural activity in the brain, alleviating symptoms of depression and schizophrenia. ECT is a risky procedure that sometimes produces memory loss, seizures, speech disorders, and confusion. Another problem associated with ECT is that patients almost always have a relapse. Therapists have tried to improve ECT methods by giving the patient an anesthetic and muscle relaxant to prevent discomfort and to prevent bones from possible fracturing. The duration of the shock also does not last as long as it used to. ECT is not used as much now – only for severe depression, and then it is usually followed immediately with medication. Nobody is quite sure how ECT works, but in some cases it has been successful, especially when combined with medication.

22. 73.2 – Describe the use of brain stimulation techniques and psychosurgery in treating specific disorders. • Electroconvulsive Therapy (ECT) • Used to Treat • Severe (unresponsive) depression • Biological Function • Scientific mystery…yes, again… • Brief convulsions & temporary loss of consciousness • Side Effects/Issues • Memory loss • Difficulty in learning • Alternatives • Repetitive Transcranial Magnetic Stimulation (rTMS)

23. 73.2 – Describe the use of brain stimulation techniques and psychosurgery in treating specific disorders. • Psychosurgery(Lobotomy) – Egas Moniz • Used to Treat • Not much, if anything…? • Biological Function • Brain surgery performed to change a person’s behavior or emotional state • Severs brain connections • Side Effects/Issues • Duh… • Examples • Prefrontal Lobotomy • Transorbital Lobotomy

24. 73.2 – Describe the use of brain stimulation techniques and psychosurgery in treating specific disorders. Repetitive Transcranial Magnetic Stimulation (rTMS) • in rTMS, a pulsating magnetic coil is placed over prefrontal regions of the brain to treat depression with minimal side effects. • how does it work? • one possible explanation is that the stimulation energized depressed patients’ relatively inactive left frontal lobe.

25. 73.3 – Describe how, by taking care of themselves with a healthy lifestyle, people might find some relief from depression, and explain how this reflects our being biopsychosocial systems. Therapeutic Lifestyle Changes • mind-body interaction – the biomedical therapies assume that mind and body are a unit: affect one and you will affect the other. • humans were never designed for 21st century American life. Our ancestors exhibited little evidence of disabling depression. • What can be done? • aerobic exercise • adequate sleep • light exposure • social connection • anti-rumination • proper nutrition

26. 73.3 – Describe how, by taking care of themselves with a healthy lifestyle, people might find some relief from depression, and explain how this reflects our being biopsychosocial systems. Comparing Biomedical Therapies 1) Drug Therapies • Presumed problem: neurotransmitter malfunction • Therapy Aim: control symptoms of psychological disorders • Therapy Technique: alter brain chemistry through drugs 2) Brain Stimulation • Presumed problem: severe “treatment-resistant” depression • Therapy Aim: alleviate depression that is unresponsive to drug therapy • Therapy Technique: stimulate brain though electroconvulsive shock, magnetic impulses, or deep-brain stimulation. 3) Psychosurgery • Presumed problem: brain malfunction • Therapy Aim: relieve severe disorders • Therapy Technique: remove or destroy brain tissue 4) Therapeutic Lifestyle Change • Presumed problem: stress and unhealthy lifestyle • Therapy Aim: restore healthy biological state • Therapy Technique: alter lifestyle through adequate exercise, sleep, and other changes