Treatment and Therapies Elspeth Cordell

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

Handout/ worksheet 1 Table

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

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!

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’

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

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

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)

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

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%

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, 2012- http://www.bbc.co.uk/news/health-17940070)

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

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

Regular doctor check-ups for anti psychotics https://www.youtube.com/watch?v=XsBZw6q7uBU 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

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

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

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

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?

Surgical Treatments

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)

Supporting evidence http://news.bbc.co.uk/1/hi/health/2345971.stm - Brain tumour caused paedohilia http://www.cancer.net/navigating-cancer-care/side-effects/mental-confusion-or-delirium- certian brain cancers causing delirium

Surgical treatments: do not need patient consent… Procedure Used to treat Involves Comments Frontal lobotomy http://www.bbc.co.uk/news/magazine-15629160 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 https://www.urmc.rochester.edu/neurosurgery/for-patients/treatments/corpus-callosotomy.aspx Epilepsy Severing connection between cerebral hemispheres Used in life threatening cases

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

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

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)

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)

However…

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

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!

ECT: Electric shock treatment Supporting information: http://www.mind.org.uk/information-support/drugs-and-treatments/electroconvulsive-therapy-ect/#.VUE7jrdMvIU http://www.psychiatrictimes.com/electroconvulsive-therapy/ect-ethical-treatment