Approaches and treatment to therapy

Biological treatments for mental disorders

Approaches to Treatment and Therapy

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OverviewBiological treatmentsKinds of psychotherapyEvaluating psychotherapy

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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

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

Antipsychotic drugsMany 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

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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,

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

Antidepressant drugsMonoamine oxidase inhibitors (MAOI’s)Elevate norepinephrine and serotonin in brain by blocking an enzyme that deactivates these neurotransmitters

Tricyclic antidepressantsBoost 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.

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TranquilizersIncrease the activity of GABA

Developed for treatment of mild anxiety

Often prescribed inappropriately by general practitioners for any patient with mood complaints

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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

4th Lithium carbonate

• Special category• It is a salt• Bipolar disorder • Dangerous, wrong amount= death

Lithium carbonateUsed to treat bipolar disorder

Moderates levels of norepinephrine by protecting cells from being overstimulated by neurotransmitter glutamateMust be given in right dose, bloodstream levels monitoredNewer treatments include Tegetrol and Depakote.

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Your turnYour 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 MAOI2. An SSRI (e.g., Prozac)3. A tranquilizer (e.g., Valium)4. Lithium carbonate

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Your turnYour 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 MAOI2. An SSRI (e.g., Prozac)3. A tranquilizer (e.g., Valium)4. Lithium carbonate

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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

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

Placebo effectThe 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.

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2nd caution

• High dropout and relapse rates• Short term success• But because of unpleasant side effects= stop

taking them• Relapse

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.

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3rd

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

Dosage problemsFinding the therapeutic window, the dosage that is enough but not too much

Drugs may be metabolized differently inMen and womenOld and youngDifferent 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.

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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

Long-term risksAntipsychotic 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.

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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

Direct brain intervention

PsychosurgeryAny 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

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Summary

• Categories of Drugs• Problems with drugs• psychosurgery