Approaches and treatment to therapy

1. Approaches and treatment to therapy Biological treatments for mental disorders

2. chapter 12 Approaches to Treatment and Therapy

3. chapter 12 Overview • Biological treatments • Kinds of psychotherapy • Evaluating psychotherapy

4. Objectives • Explain the biological treatment method- drugs or direct intervention in brain function of treatment • List 4 types of treatment drugs • List cautions/concerns/ about drug treatments • analyze psychosurgery

5. The Question of Drugs • The most commonly used biological treatment or application of the biological method. • Widely prescribed • Disorders like schizophrenia • Anxiety • Depression • Need to understand what drugs are, how can they best be used, and limitations

6. chapter 12 Antipsychotic drugs Many block or reduce sensitivity of dopamine receptors. Some increase levels of serotonin, a neurotransmitter that inhibits dopamine activity Can relieve positive symptoms of schizophrenia, but ineffective—or even worsen—negative symptoms

7. 1st Antipsychotic drugs • neuroleptics- Thorazine, Haldol • Schizophrenia, psychotic disorders • Block or reduce sensitivity to brain receptors for dopamine • Increase levels of serotonin • Side effects: hand tremors,

8. 2nd Antidepressant drugs • Depression, anxiety , phobias • Monoamine oxidase inhibitors- MAOI’s • Nardil- elevate levels of serotonin • norepinephrine= block enzyme that deactivates these neurotransmitters • Boost levels in cells, SSRI- Prozac, Selective Serotonin reuptake inhibitors • Non addictive but physical reactions • Dry mouth, headaches

9. chapter 12 Antidepressant drugs Monoamine oxidase inhibitors (MAOI’s) Elevate norepinephrine and serotonin in brain by blocking an enzyme that deactivates these neurotransmitters Tricyclic antidepressants Boost norepinephrine and serotonin by preventing reuptake Selective serotonin reuptake inhibitors (SSRI’s) Boost serotonin by preventing reuptake Herbs such as St. John’s Wort have also been used.

10. chapter 12 Tranquilizers Increase the activity of GABA Developed for treatment of mild anxiety Often prescribed inappropriately by general practitioners for any patient with mood complaints

11. 3rd Tranquilizers • Valium, Xanax • Increase activity of GABA- neurotransmitter • Originally for mild anxiety but now for patients with more serious mood disorders • Not long term solution • Symptoms almost always return if meds stopped

12. 4th Lithium carbonate • Special category • It is a salt • Bipolar disorder • Dangerous, wrong amount= death

13. chapter 12 Lithium carbonate Used to treat bipolar disorder Moderates levels of norepinephrine by protecting cells from being overstimulated by neurotransmitter glutamate Must be given in right dose, bloodstream levels monitored Newer treatments include Tegetrol and Depakote.

14. chapter 12 Your turn Your friend has largely withdrawn from social activities, and has stopped maintaining her appearance or apartment. If she goes to see a doctor, what do you expect her doctor to prescribe? 1. An MAOI 2. An SSRI (e.g., Prozac) 3. A tranquilizer (e.g., Valium) 4. Lithium carbonate

15. chapter 12 Your turn Your friend has largely withdrawn from social activities, and has stopped maintaining her appearance or apartment. If she goes to see a doctor, what do you expect her doctor to prescribe? 1. An MAOI 2. An SSRI (e.g., Prozac) 3. A tranquilizer (e.g., Valium) 4. Lithium carbonate

16. Some Cautions About Drug Treatments • Without question have helped many; O.C.D., Depression, emotional despair • However psychiatrists, drug companies, trumpeting benefits without informing public of limitations

17. First caution • The placebo effect • Ensures people will respond positively to new drug because of enthusiasm surrounding it and their expectations • “miracle” drug may wear off

18. chapter 12 Placebo effect The apparent success of a treatment due to patient’s expectation rather than the treatment itself Meta-analysis indicates that clinicians consider medication helpful, yet patient ratings in treatment groups were no greater than those in placebo groups.

19. 2nd caution • High dropout and relapse rates • Short term success • But because of unpleasant side effects= stop taking them • Relapse

20. chapter 12 High relapse and dropout rate There may be short-term success, but 50–66% of patients stop taking medication due to side effects. Individuals who take antidepressants without learning to cope with problems are more likely to relapse.

21. 3rd • Dosage problems • Therapeutic window= not to much, or to little • Men/women • Biological factors/Family history • Culture difference- Chinese/ Africa

22. chapter 12 Dosage problems Finding the therapeutic window, the dosage that is enough but not too much Drugs may be metabolized differently in Men and women Old and young Different ethnic groups Appropriate dosage also affected by metabolic rates, amount of body fat, number and type of drug receptors in the brain, smoking, and eating habits.

23. 4th concern • Unknown long term risks • Many negative reports never published • Tested on a few 100 people for a few weeks or month • Research is expensive

24. chapter 12 Long-term risks Antipsychotic drugs can be dangerous, even fatal if taken for many years. Tardive dyskinesia Antidepressants are assumed to be safe, but no long-term studies have been conducted.

25. Direct Brain Intervention • Psychosurgery is any surgical procedure that destroys selected areas of the brain believed to be involved in emotional disorders or violent, impulsive behavior- prefrontal lobotomy • First Prefrontal labotomy was performed in 1935, by Antonio Egas Moniz, Portugese neurologist…drilled holes in head,cut out and crushed fibers in prefrontal cortex • Electroconvulsive therapy (ECT) is a procedure used in cases of prolonged and severe major depression, in which a brief brain seizure is induced- shock therapy

26. chapter 12 Direct brain intervention Psychosurgery Any surgical procedure that destroys selected areas of the brain believed to be involved in emotional disorders or violent, impulsive behavior. Electroconvulsive therapy (ECT) Procedure used in cases of prolonged and severe major depression Brief brain seizure is induced

27. Summary • Categories of Drugs • Problems with drugs • psychosurgery