Biomedical Therapies

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Biomedical Therapies
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Biomedical Therapies

• Medical Treatment of psychological disorders that
  involve changing the brains functioning by using
  prescribed drugs, electroconvulsive therapy, or
  surgery

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Drug Therapies
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Pre-Drug Therapy

• Prior to the discovery of psychological drugs,
  hospitals had few options with which to treat
  patients
• Most early treatment techniques are today
  considered archaic and sometimes cruel

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Early Treatment of Mental Disorders

• Insert Early Treatment of Mental Disorders
  Video 36 from Worths Digital Media Archive for
  Psychology. (500)

Click HERE to view in a new window.
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Post-Drug Therapy

• With the discovery of effective drug treatments,
  patients were able to leave the institutions
  (deinstitutionalization).

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Deinstitutionalization

• The release of patients from mental hospitals to
  the community at large
• The development of drug therapies led to an 80
  decline in the number of hospitalized mental
  patients from 1950 to 2000.
• Many of the former patients became part of the
  homeless population.

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Biomedical Therapies
Widespread use of antipsychotic medications
began in the mid-1950s Can be related to
number of patients in mental hospitals
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Drug Therapies Antipsychotic Drugs
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Antipsychotic Drugs

• A category of medications used primarily to treat
  schizophrenia
• Reduces the levels of hallucinations and
  delusions and distorted thinking
• Drugs work primarily by blocking the activity of
  dopamine
• View the Effectiveness of these drugs with a
  schizophrenic (2 min)
• 2 Types Typical and Atypical

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Typical Antipsychotic Medications

• Typical antipsychotics (Thorazine)
• Effective against positive symptoms of
  schizophrenia
• Have uncomfortable side effects
• Globally reduce brain dopamine levels
• Side effects include dry mouth, blurred vision,
  constipation, and tardive dyskinesia
• Tardive dyskinesia a permanent condition of
  muscle tremors Thorazine
• One of the first antipsychotic drugs

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Schizophrenia Drug Therapy

• Insert Schizophrenia Video 34 from Worths
  Digital Media Archive for Psychology. (515)
• How does Augustines behavior change after 4
  weeks on medication?

Click HERE to view in a separate window.
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Drawbacks of Antipsychotic Medications

• The early antipsychotics didnt actually cure
  schizophrenia psychotic symptoms often returned
  if a person stopped taking the medication
• They were not effective in eliminating the
  negative symptoms of schizophrenia
• They often produced unwanted side effects
• They globally altered brain levels of dopamine,
  sometimes producing motor-related side effects
  long-term use can cause tardive dyskinesia
• Patients go through a revolving door pattern of
  hospitalization, discharge, and rehospitalization
  
• View some of the Drawbacks of Antipsychotic Drugs
  (1 min)

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Atypical Antipsychotic Medications

• Newer drugs that may also be effective against
  negative symptoms of schizophrenia
• Affect levels of serotonin as well as dopamine
• Much less likely to cause movement-related side
  effects because they block dopamine brain
  receptors far more selectively
• Produce (sometimes dramatic) improvement in a
  significant proportion of patients who have not
  responded to traditional antipsychotic drugs

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Clozapine and Risperidone

• Clozaril less side effects than thorazine but
  can cause damage to white blood cells therefore
  patients need to be tested
• Risperdal no damage to white blood cells
• Both Clozaril and Risperdal are very expensive.
• Newer atypical antipsychotic medicationsolaanzapi
  ne, sertindole, and quetiapineproduce greater
  benefits, far fewer side effects, and a lower
  relapse rate

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Drug Therapies Antianxiety Drugs
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Antianxiety Drugs Benzodiazepines

• A category of medication used to treat people
  with anxiety disorders or suffering stress
• Include Valium, Librium, and Xanax
• Take effect quickly, usually within an hour.
• Work by boosting levels of the neurotransmitter
  GABA - a neurotransmitter that inhibits the
  transmission of nerve impulses in the brain and
  slows brain activity
• Can produce dependency, decreased coordination,
  slow reaction time, decreased alertness
• Can cause death if mixed with alcohol

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Antianxiety medications Non-benzodiazepine(Busp
ar)

• Believed to affect brain dopamine and serotonin
  levels
• Relieves anxiety while maintaining normal
  alertness it does not cause the drowsiness,
  sedation, and cognitive impairment associated
  with the benzodiazepines
• May take 2-3 weeks to work

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Drug Therapies Bipolar Disorder Drugs
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Lithium

• Used to treat bipolar disorder (manic-depression)
• Used to interrupt acute manic attacks and prevent
  relapse
• Stabilizes the availability of glutamate within a
  narrow, normal range, preventing both abnormal
  highs and abnormal lows
• Very narrow difference between the therapeutic
  dosage level and the toxic dosage level,
  requiring careful monitoring of the patients
  lithium blood level
• Bipolar disorder can also be treated with an
  anticonvulsant medicine called Depakote. It is
  useful for treating patients who do not respond
  to lithium and patients who rapidly cycle through
  bouts of bipolar disorder several times a year

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Drug Therapies Antidepressant Drugs
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Antidepressant Drugs

• A category of medications used primarily to treat
  major depression
• Work by influencing levels of serotonin in the
  brain
• Many take about a month before they become fully
  effective
• 2 classes of drugs called tricyclics and MAO
  inhibitors

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First generationtricyclics and MAO inhibitors

• Affect multiple neurotransmitter pathways in the
  brain and work by increasing the availability of
  norepinephrine and serotonin
• Effective for about 75 of patients
• Produce troubling side effects
• MAO inhibitors can lead to dangerously high blood
  pressure, leading to stroke or even death if
  people who are taking them consume foods with a
  chemical found in cheese, smoked meats, and red
  wine
• Tricyclics caused weight gain, dry mouth,
  dizziness, sedation

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Second generation Anti-Depressant Medication

• Chemically different but no more effective than
  earlier drugs (Wellbutrin, Desyrel)
• Have many of the same side effects

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Selective Serotonin Reuptake Inhibitors

• Classification of antidepressants which work by
  blocking the reuptake of serotonin after it has
  been released
• Includes Prozac, Zoloft, and Paxil
• No more effective than the older antidepressants
• Produce fewer, and milder, side effects
• Effexor, a dual reuptake inhibitor, affects
  levels of both serotonin and norepinephrine.
• seems to be more effective than SSRIs in
  alleviating the symptoms of depression

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Patients and doctors talk about the experience
and treatment of mania and depression,
emphasizing the importance of both medication and
psychotherapy. An animation segment illustrates
what happens at the brain synapses in people with
depression and mania. (1144)
Depression Mania
Click HERE to view video or on the screen to the
right.
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Mood Disorders Questions

• Doug Barton talks about the history of mood
  disorder in his family. What is known about the
  inheritance and genetics of mood disorders?
• From the opinions expressed in the film, what can
  you conclude about the biological (endogenous)
  causes versus psychological causes of depression?
• Is medical treatment or psychotherapy considered
  the best treatment for mood disorders?

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Electroconvulsive Therapy
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Insulin Therapy

• Depressed patients are given an overdose of
  insulin to cause a convulsion.
• Difficulties in determining the proper dosage of
  insulin led to a decline in use of this therapy.
• Was replaced by Electroconvulsive Therapy (ECT)

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Electroconvulsive Therapy

• Used for severe depression
• Very effective for quick relief of symptoms of
  severe depression (can be used until medication
  begins to work)
• May have cognitive side effects such as memory
  loss
• Very controversial treatment

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ECT Facts

• Used when antidepressants fail
• About 100,000 patients a year receive ECT
• A series of 6 to 10 ECT treatments are usually
  spaced over a few weeks
• Most (80) patients report improvement
• Typically relieves symptoms within days but
  benefits only last for a short time.
• Side effect is temporary or permanent memory loss
  for the events leading up to the treatment
• How and why the process works is unknown

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ECT
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Electroconvulsive Therapy

• Insert Electroconvulsive Therapy Video 37 from
  Worths Digital Media Archive for Psychology.
  (505)

Click HERE to view video in separate window.
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Psychosurgery
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Lobotomy

• A form of psychosurgery where the nerves
  connecting the frontal lobes of the brain to the
  deeper emotional centers are cut
• Used to try to calm uncontrollably emotional or
  violent patients
• Regularly done before the advent of antipsychotic
  drugs
• Rarely used today

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Comparing Psychotherapy and Antidepressant
Medications

• On PET scans, compared with nondepressed adults,
  depressed individuals show increased activity in
  the prefrontal cortex, the caudate nucleus, and
  the thalamus
• Studies showed that depressive symptoms improved,
  with either an antidepressant (Paxil) or
  interpersonal therapy and PET scans showed a
  trend toward normalization in brain functioning