Biological Therapies

Helping Professionals Who Can Administer Biological Therapies Medical specialists –Psychiatrists M.D. –Neurosurgeon M.D. Other Medical Practitioners –General practitioners M.D. –Psychiatric nurses (M.S.N. + M.S in psychopharmacology) Clinical psychologists Ph.D./Psy.D. ??

Assumptions of Biological Therapies Psychological phenomena are associated with brain functions Psychopathology is associated with abnormality of brain functions Intervention lies in changing brain function Easiest way to change brain function is with drugs –Influence rather than eliminating neural connections –May be reversible

Types of Biological Therapies Psychopharmacological Psychosurgical Other procedures (e.g. electroconvulsive therapy)

Psychopharmacology: Side Effects As with most biological therapies, psychoactive drugs have side effects –Don’t know enough about brain function –Don’t know enough about mechanics of the drugs Main effects, side effects, toxic effects “therapeutic window” of psychoactive drugs is very small State of the art for drug therapies is not “cure” –Enhancing therapeutic effects –Minimizing toxic effects

Psychopharmocology: Antipsychotics Dopamine receptor blockers –Based on “the dopamine hypothesis” Overactive dopamine systems result in positive symptoms of schizophrenia Dopamine is involved in CNS control of behavioral attention and activation of movement Appears to be a correlation between positive symptoms of schizophrenia and attention to stimuli most can ignore –Ongoing internal dialogue –Aspects of the environment –Unusual memory events –Side effects of dopamine receptor blockers Tardive dyskinesia (involuntary muscle movement; ex. mouth, lips, tongue) Parkinsonian tremors

Psychopharmacology: Antidepressants 3 major categories Similar functions Increase synaptic level of norepinephrine and/or serotonin –Norepinephrine - ANS functions like bronchodilation and heart rate; CNS control of arousal and vigilance –Serotonin - CNS mechanisms of sleep and dreaming

Psychopharmacology: Antidepressants (cont.) Tricyclics –Mechanism is unclear –May sensitize monoamine receptors –Block reuptake of norepinephrine and serotonin after fired –1-6 weeks for antidepressant effects MAO Inhibitors –Prevent the breakdown of neurotransmitters –Keeps more around for uptake –Dangerous interaction with tyramine (natural enzyme) Selective Serotonin Reuptake Inhibitors (SSRI’s) –Blocks reuptake of serotonin; more serotonin available –Not so selective –Associated with increased sleep and sexual difficulties

Next Generations of Antidepressants Wellbutrin –Increases norepinephrine in synaptic cleft –Reduces incidence of sexual dysfunction found in SSRI’s –May cause seizures Desyrel –Counteracts some of the sleep difficulties found in SSRI’s –May cause constant erection Serzone –Decreased sleep and sexual dysfunctions –Other toxic effects unknown yet

Alternative Treatment for Mood Disorders For Seasonal Affective Disorder (SAD) - Light therapy For SAD - Melatonin For Dysthymia – St. John’s Wort (herb)

Psychopharmacology: Anxiety Anxiolytics –Based on the assumption that anxiety disorders are the result of excessive activity in neural circuits of anxiety response/vigilance –Too much GABA (Gamma Amino Butyric Acid) The central nervous system’s primary inhibitory neurotransmitter; keeps general levels of neural activity “in check” –Benzodiazapines –SSRI’s –Buspirone

Psychopharmacology: Psychostimulants Ritalin, Cylert, Dexedrine Used in the treatment of ADHD Stimulates the part of the brain that selectively attends

Combined Therapies Debate is still on about whether psychotherapy alone may be effective and in the treatment of what disorders Many studies are showing that combination of psychotherapy and pharmacological therapy is more effective that drugs alone Meds used alone primarily for insurance reasons

Psychosurgery “Frontal lobotomy” has been replaced with more precise targeting of specific areas of the brain –Ex. Cingulotomy Disconnects the cingulate gyrus of the frontal lobe from the limbic areas of the temporal lobe Still very controversial Only used as experimental treatment for severe OCD that doesn’t respond to behavioral and drug therapies

Other Biological Procedures Electroconvulsive therapy (ECT) –Used to be known as shock treatment –Administered only as last resort; only in severe, unrelenting major depression unresponsive to other therapies –Treatment mechanics have improved; still unclear about the mechanics of how it works Generally increases neurotransmitter turnover Requires several treatments to influence symptoms Side effects include memory loss Recent experimentation with unilateral ECT suggests that memory loss difficulties may be ameliorated with continuing sophistication in the administration of ECT