1. Treatment and Therapies
Elspeth Cordell

2. Last lesson
This lesson
Next lesson
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
Should: discuss the negatives and positives of these treatment options and relate them to ethical considerations
Could support discussion with research
Look at behavioural treatments and therapies

3. Handout/ worksheet 1
Table

4. 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

5. 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!

6. 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’

7. Antidepressants Introduction Handout: http://www. rcpsych. ac
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 anti-depressants in the UK – on average as young as 5 years old

8. Anxiolytics: supporting handout: http://www. homehealth-uk
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

9. Anti-Psychotics: Introduction Handout: http://www. mentalhealthcare
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)

10. Evaluation of drug treatments: link to assessment
Effectiveness: Do they do what they are supposed to do?
Appropriateness: are they an appropriate treatment?

11. 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%

12. 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,

13. 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

14. However…
Do drugs work or are we victims of media tricks?

15. Regular doctor check-ups for anti psychotics
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

16. 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

17. Are the side effects worth it?
HOWEVER…
Are the side effects worth it?

18. Side effects vs non medication
"The side effects are the price I pay for keeping out of hospital,“ (schizophrenic sufferer)

19. Criteria 1.2: Ethical considerations
Is it significant that most clinical trials of conducted by the company wanting to sell them?
Is it right to force a patient with schizophrenia to take drugs where the side effects are sometimes worse?
Haddock and Slade (1996)
Psychiatrists (more then half asked) would refuse to take antipsychotics if they were prescribed them?

20. Surgical Treatments

21. 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)

22. Supporting evidence
- Brain tumour caused paedohilia
certian brain cancers causing delirium

23. 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
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 between frontal lobes and limbic system – via the cingulate gyrus
Less radical, only used as last resort
Callosotomy
Epilepsy
Severing connection between cerebral hemispheres
Used in life threatening cases

24. How is it done?? Lobotomy Cingulotomy Callosotomy
Less radical forms: Leucotomy
Lobotomy
Cingulotomy
Callosotomy

25. Done by using Cutting Burning with an electrode or laser
Injecting neurotoxins
Destruction using Gamma radiation (Non-invasive

26. 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)

27. 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)

28. However…

29. 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

30. 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!

31. ECT: Electric shock treatment
Supporting information: