Biomedical Therapies Module 73

Biomedical Therapies Medical Treatment of psychological disorders that involve changing the brain’s functioning by using prescribed drugs, electroconvulsive therapy, or surgery

Drug Therapies

Psychopharmacology Study of drug effects on mind & behavior Drug’s effectiveness based on: –Subtracting the normal recovery among untreated persons from recovery due to placebo effect –Do this by using double blind procedure

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 See “Early Treatment of Mental Disorders”Early Treatment of Mental Disorders –Video #36 Worth’s Digital Media Archive. (5:00)

Deinstitutionalization With the discovery of effective drug treatments, patients were able to leave the institutions 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 Many of the former patients became part of the homeless population.

Deinstitutionalization Widespread use of antipsychotic medications began in the mid-1950’s Can be related to number of patients in mental hospitals

Antipsychotic Drugs

Drugs Impact on Synaptic Transmission

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 Reduces responsiveness to irrelevant stimuli

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 tremorsTardive dyskinesia

Atypical Antipsychotic Medications Newer drugs that may also be effective against negative symptoms of schizophrenia –Risperdal –Zyprexa 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 Side effects – obesity & diabetes

Schizophrenia Drug Therapy Insert “Schizophrenia” Video #34 from Worth’s Digital Media Archive for Psychology. (5:15) How does Augustine’s behavior change after 4 weeks on medication? Click HERE to view in a separate window.HERE OR View shorter version of the Effectiveness of these drugs with a schizophrenic (2 min) Effectiveness of these drugs with a schizophrenic (2 min)

Antianxiety Drugs

Antianxiety Drugs: Benzodiazepines A category of medication used to treat people with anxiety disorders or suffering stress –Include: Valium, Librium, Xanax, Ativan 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 Negative reinforcement can cause dependency Side Effects - decreased coordination, slow reaction time, decreased alertness –Can cause death if mixed with alcohol

Antianxiety medications: Non-benzodiazepine—(Buspar) 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

Drug Therapies: Antidepressant Drugs

Antidepressant Drugs A category of medications used primarily to treat major depression –Also effective with anxiety disorders, OCD, PTSD Agonists - work by increasing levels of serotonin & norepinephrine in the brain Many take about a month before they become fully effective –Neurogenesis – may help stimulate new neuron growth –Work well with Cognitive Behavioral Therapy (top-down treatment) –Placebo Effect may accounted for 75% of effect in mildly depressed patients

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

Mood Stabilizers: Bipolar Disorder Drugs

Lithium Used to treat bipolar disorder (manic-depression) Used to interrupt acute manic attacks and prevent relapse –7 in 10 people with Bipolar Disorder benefit from taking Lithium 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 patient’s 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

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. (11:44) Depression & Mania Click HERE to view video or on the screen to the right.HERE

Mood Disorders: Questions 1.Doug Barton talks about the history of mood disorder in his family. What is known about the inheritance and genetics of mood disorders? 2.From the opinions expressed in the film, what can you conclude about the biological (endogenous) causes versus psychological causes of depression? 3.Is medical treatment or psychotherapy considered the best treatment for mood disorders?

Brain Stimulation Techniques

Brain Stimulation: Electroconvulsive Therapy

Insulin Therapy Depressed & Schizophrenic patients were 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)

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

ECT Facts Used when antidepressants fail seconds of electrical current causes seizure in brain 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. –About 4 in 10 relapse in 6 months Side effect is temporary or permanent memory loss for the events leading up to the treatment How and why the process works is unknown

Electroconvulsive Therapy Watch “Electroconvulsive Therapy” VideoElectroconvulsive Therapy –Video #37 from Worth’s Digital Media DVD. (5:05)Video #37 What do you notice about this therapy? Does it match what you thought? How does Mary change after treatment?

Neurostimulation: Repetitive Transcranial Magnetic Stimulation Repeated magnetic pulses stimulate areas of the brain Makes Left Frontal Lobe more active –It’s less active during depression May cause new neural connections through long-term potentiation

Deep Brain Stimulation Place an electrode in between frontal lobe & limbic system Pacemaker stimulator activates areas of the brain that when activated combat depression

Psychosurgery: Surgery that removes or destroys brain tissue

Lobotomy 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 Decreased person’s misery & tension but produced permanently lethargic, immature & uncreative person Rarely used today Watch segment from The Lobotomist (5 min)The Lobotomist (5 min) Hear the story of a 12-year boy who received an “ice pick lobotomy” (22 min)Hear the story of a 12-year boy who received an “ice pick lobotomy” –To learn more and see pictures go the NPR Website.NPR Website

Therapeutic Lifestyle Change Stress affects body chemistry & health Human bodies designed for physical activity and social engagement People who experience, strenuous physical activity, strong community ties, sunlight exposure & plenty of sleep rarely develop depression

Comparing Biomedical Therapies