MODULE 34 Biomedical Therapies

I was feeling sick, losing my mind I heard about these treatments from a good friend of mine He was always happy, smile on his face He said he had a great time at the place Peace and love is here to stay And now I can wake up and face the day Happy, happy, happy all the time Shock treatment, I'm doing fine Gimme, gimme shock treatment I wanna, wanna shock treatment - The Ramones, “Gimme Gimme Shock Treatment”

Lobotomy, lobotomy, lobotomy, lobotomy! DDT did a job on me Now I am a real sickie Guess I'll have to break the news That I got no mind to lose All the girls are in love with me I'm a teenage lobotomy Slugs and snails are after me DDT keeps me happy Now I guess I'll have to tell 'em That I got no cerebellum Gonna get my Ph.D. I'm a teenage lobotomy - The Ramones, “Teenage Lobotomy”

The lunatic is in my head You raise the blade, you make the change You re-arrange me 'til I'm sane You lock the door And throw away the key There's someone in my head, but it's not me - Pink Floyd, “Brain Damage”

Biomedical therapies: the treatment of psychological disorders by changing the brain’s functioning with prescribed drugs, electroconvulsive therapy, or surgery

Drug Therapies Mid-20 th century: effective drug therapies help patients overcome symptoms – Deinstitutionalization: the release of patients from mental hospitals into the community – Many released patients who lack resources and support from family and friends wind up homeless or in prison

Antipsychotic Drugs Antipsychotic drugs: a category of medications used primarily to treat schizophrenia – Reduce the severity and number of delusions and hallucinations – Help schizophrenics focus attention on significant aspects of environment – Block the activity of neurotransmitter dopamine

– Thorazine: first dopamine-lowering drug; helped deinstitutionalization movement Negative side effects: dry mouth, blurred vision, constipation, tardive dyskinesia (muscle tremors) – Clozaril: newer, expensive drug with fewer negative effects Blood must be regularly monitored; damages white blood cells in some people

Antianxiety Drugs Antianxiety drugs: a category of medications used to treat people undergoing significant stress; they can be helpful in treating people with anxiety disorders – Significant stress: divorce, job loss, death of loved one, etc. – Drugs boost neurotransmitter GABA; helps brain reduce anxiety

– Drugs also have sedative effect and produce feelings of euphoria – Offer temporary relief, but do not solve problems – Used best in combination with psychotherapy Learn coping strategies that will eliminate the need for drugs

– Examples: Valium, Librium, Xanax Should not be taken with other central nervous system depressants like alcohol; potentially lethal combination – Risk of dependence; antidepressants now used to treat anxiety disorders

Antidepressant Drugs Antidepressant drugs: a category of medications used primarily to boost serotonin levels in the brain; they can be helpful in treating major depression Selective serotonin reuptake inhibitors (SSRIs): – Prozac, Zoloft, Paxil – Block re-absorption of serotonin in brain; remains active in synapse longer

Used best in combination with psychotherapy (particularly cognitive therapy) Medications must be taken for about a month before becoming fully effective (therapeutic lag) – Must wait to experience effectiveness and side effects Overall effectiveness difficult to judge because depression is a cyclical disorder Placebo effect is problematic

Sometimes drugs provide positive effects – Do not offer miracle cure for depression or other illnesses – May even produce suicidal behavior in some cases – Users should be under careful evaluation Lithium shown to be effective for bipolar disorder

Electroconvulsive Therapy Electroconvulsive therapy (ECT): therapy for major depression in which a brief electric current is sent through the brain of an anesthetized patient – First used in Europe in 1930s – Drug (and later electrical) induced convulsions linked to a reduction in depression

Modern ECT: – Use of muscle relaxants to reduce intensity of convulsions (minor twitching) – Use of sedatives to induce sleep (avoid rapid loss of consciousness) – Briefer electrical pulses to one side of brain Used when antidepressants are not effective Major side effect: disruption of memory

How does ECT work? – Theory: procedure stimulates brain to release neurotransmitters that elevate mood Possible alternatives: – Repetitive transcranial magnetic stimulation (rTMS); uses magnetic fields instead of electricity, usually does not produce convulsions – Vagus nerve implant; stimulates emotion center of brain

Psychosurgery Lobotomy: a now-rare form of psychosurgery once used to try to calm uncontrollably emotional or violent patients; the procedure cut the nerves that connect the frontal lobes of the brain to the deeper emotional centers – Developed in Portugal by Egas Moniz (received Nobel Prize) to treat schizophrenia – Brought to U.S. by Walter Freeman and James Watts

Procedure: ice pick-like tool inserted through eye socket – Swung back and forth to sever connections between frontal lobes and emotional centers – Used on uncontrollable and violent patients Ethical questions about appropriateness – Often reduced patients to unmotivated, immature state Eventually replaced by antipsychotic drugs