1. The Biomedical Therapies Module 42
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31. Light exposure therapy is most effective in treating(AP13)
(A) schizophrenia
(B) seasonal affective disorder
(C) obsessive-compulsive disorder
(D) antisocial personality disorder
(E) autism
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2. See my other products at my store on Teachers Pay Teachers
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3. The Biomedical Therapies
These include physical, medicinal, and other forms of biological therapies.
Drug Therapies
Brain Stimulation
Psychosurgery
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4. Psychopharmacology is the study of drug effects on mind and behavior.
Drug Therapies
Psychopharmacology is the study of drug effects on mind and behavior.
Preview Question 11: What are the most common forms of biomedical therapies? What criticisms have been leveled against drug therapies?
The precipitous decline of the inpatient populations of state and county mental hospitals since the 1950's can be attributed to which of the following? (AP99)
I. Declining incidence of severe mental illnesses
II. A policy of deinstitutionalization
III. New drug therapies
(A) I only
(B) II only
(C) III only
(D) II and III only
(E) I, II, and III
But some do not stay on their drugs….
With the advent of antipsychotics, hospitalization in mental institutions has rapidly declined.
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5. By the time I Began prescribing psychiatric drugs in the l970s, these old medicines had been mostly superseded by the newly discovered … wonder drugs in psychiatry Thorazine for psychosis, lithium for mania, and Klavil and Nardil for depression. But giving these medicines to patients was still a relatively new thing and a big deal. I trained on the first unit in the United States to use lithium, and we were frankly scared to death of it, an overdose could kill patients or destroy their kidneys, and we were not yet completely sure what were the most effective doses and the safest blood levels. It turned out that the Thorazine doses we were using were way too high and transformed our agitated patients into drugged zombies. The antidepressants available a t the time were all extremely risky for use… just a week's worth of pills could be lethal. Because the medicines could cause arrhythmias, a fancy cardiac workup had to precede their initiation. Nardil required extremely strident dietary precautions because it interacted dangerously with many foods and with red wine, a little blue cheese, fava beans, or Chiatni could be deadly. All of the first psychotropic drugs were SO risky and unpleasant to take that only the sickest patients received them, and only well-trained psychiatrists felt comfortable prescribing them,…
Saving Normal: An Insider's Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life Hardcover by Allen Frances
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6. Double-Blind Procedures
To test the effectiveness of a drug, patients are tested with the drug and a placebo.
The patients and researchers are unaware of who is taking the drug and who is taking the placebo.
Eliminate expectation effects.
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7. Classical antipsychotics [chlorpromazine (Thorazine)]:
Antipsychotic Drugs
Classical antipsychotics [chlorpromazine (Thorazine)]:
Remove a number of positive symptoms associated with schizophrenia such as agitation, delusions, and hallucinations.
The difference between "positive" and "negative" symptoms is not whether they are bad--they all are.  The difference is whether they are "visible."  The positive symptoms are delusions, hallucinations, disorganized speech, disorganized behavior and catatonia.  The negative symptoms are lack of emotional responsiveness, extreme apathy--not visible. 
…25 percent of nursing home residents are given antipsychotics.4 In Canada between 2005 and 2009, the use of psychostimulants went up by 36 percent, and SSRIs by 44 percent.5 Loose diagnosis is causing a national drug overdose of medication. Six percent of our people are addicted to prescription drugs, and there are now more emergency room visits and deaths due to legal prescription drugs than to illegal street drugs.6 When their products are used carelessly, the drug companies can be as dangerous as the drug cartels. A case in point: Since 2005 there has been a remarkable eightfold increase in psychiatric prescriptions among our active duty troops. An incredible 110,000 soldiers are now taking at least one psychotropic drug, many are on more than one, and hundreds die every year from accidental overdoses.7 Psychiatric meds are now the star revenue producers for the drug companies in 2011, over $18 billion for antipsychotics (an amazing 6 percent of all drug sales); $11 billion on antidepressants, and nearly $8 billion for ADHD drugs.8 Expenditure on antipsychotics has tripled,6 and antidepressant use nearly quadrupled from 1988 to And the wrong doctors are giving out the pills. Eighty percent of prescriptions are written by primary-care physicians with little training in their proper use, under intense pressure from drug salespeople and misled patients, after rushed seven-minute appointments, with no systematic auditing." I here is also a topsy-turvy misallocation of resources: way too "much treatment is given to the normal "worried well" who are harmed by it; far too little help is available for those who are really ill and desperately need it.
Saving Normal: An Insider's Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life Hardcover by Allen Frances
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8. (A) Administration of L-dopa (B) Prefrontal lobotomy
Which of the following has been most effective in the treatment of schizophrenia? (AP94)
(A) Administration of L-dopa
(B) Prefrontal lobotomy
(C) Psychoanalytic therapy
(D) Drug therapy that blocks neurotransmitter sites
(E) Drug therapy that increases the activity of limbic system neurons
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9. Possible Side Effects of Antipsychotic Drugs
Generic Name
Trade Name
Comments
Aripiprazole
Abilify
New antipsychotic medication that may work on dopamine and serotonin systems.
Chlorpromazine
Thorazine
The first antipsychotic medication developed
Chlorprothixene
Taractan
Clozapine
Clozaril
Does not have "tardive dyskinesia" (see below, side effects) as a side effect, but there is a 1-2% chance of developing a low white blood cell count
Fluphenazine
Prolixin
A phenothiazine type drug
Haloperidol
Haldol
Loxapine
Loxantane
NOT a phenothiazine type drug
Mesoridazine
Serentil
Molindone
Moban
Olanzapine
Zyprexa
Blocks serotonin and dopamine receptors
Perphenazine
Trilafon
Quetiapine
Seroquel
Blocks some serotonin and dopamine receptors; Introduced in 1997
Risperidone
Risperdal
Blocks some serotonin and dopamine receptors
Thioridazine
Mellaril
Also used as a tranquilizer
Thiothixene
Navane
Trifluoperazine
Stelazine
Also used to control anxiety and nausea
Possible Side Effects of Antipsychotic Drugs
1. Parkinson's disease-like symptoms - tremor, muscle rigidity, loss of facial expression
2. Dystonia - contraction of muscles
3. Restlessness
4. Tardive dyskinesia - involuntary, abnormal movements of the face, mouth, and/or body. This includes lip smacking and chewing movements. About 25-40% of patients who take antipsychotic mediations for several years develop these side effects.
5. Weight gain
6. Skin problems
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10. Atypical Antipsychotic
Clozapine (Clozaril) blocks receptors for dopamine and serotonin to remove the negative symptoms of schizophrenia.
Atypical antipsychotics [clozapine (Clozaril)]: Remove negative symptoms associated with schizophrenia such as apathy, jumbled thoughts, concentration difficulties, and difficulties in interacting with others.
The difference between "positive" and "negative" symptoms is not whether they are bad--they all are.  The difference is whether they are "visible."  The positive symptoms are delusions, hallucinations, disorganized speech, disorganized behavior and catatonia.  The negative symptoms are lack of emotional responsiveness, extreme apathy--not visible. 
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11. Serotonin is involved with mood regulation.
Prozac works by keeping serotonin in the synapse longer, giving it more time to exert an effect (blocking reuptake)
Preview Question 4: How do neurotransmitters influence human behavior?
Involved in sleep
Involved in depression/mood
Suicide victims have consistently lower serotonin metabolites (Bach-Mizrachi 2006)
Prozac & other anti depressants raise serotonin
Prozac works by keeping serotonin in the synapse longer, giving it more time to exert an effect
Mood, Hunger, sleep, arousal,…undersupply linked to depression
Carbs increase serotonin (Bernstein)
Malfunctions in serotonin feedback may be responsible to for some kinds of obesity, pms & depression (Lira 2003)
4 or 42? 74. Prozac functions as an antidepressant medication because it (AP04)
(A) Enhances production of acetylcholine
(B) Blocks the reuptake of the neurotransmitter serotonin
(C) Causes select memory loss for depression producing events
(D) Produces a steady, mild state of euphoria
(E) Inhibits frontal lobe activity related to depression
Lsd and seratonin at nat geo
Seratonin out of balance in mice makes them anxious 14 Quirk, Hanna Holmes, one strain has no serotonin but is healthy
LSD and Seratonin at Nat Geo 2:21
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12. Dopamine Important for movement, rewards & pleasure.
Involved with diseases such as schizophrenia and Parkinson’s disease.
Learning, movement, attention and emotion
Dopamine imbalance also involved in schizophrenia
Schizophrenia treatments chlorpromazine & Reserpine (Biopsych 142& 143)…reserpine blocks release of monoamine neurotransmitters.
Loss of dopamine- producing neurons is cause of Parkinson’s Disease, (exposure to pesticides 70% increase Parkinson's (Ascherio 2006)
Results from loss of dopamine-producing neurons in the substantia nigra
Symptoms include: difficulty starting and stopping voluntary movements, tremors at rest, stooped posture, rigidity, poor balance
Treatments: L-dopa – increases dopamine levels by deactivating enzymes that break down dopamine (Biopsychology p145), transplants of fetal dopamine-producing substantia nigra cells, adrenal gland transplants, electrical stimulation of the thalamus to stop tremors
Link dopamine flood at Nat Geo 3:44
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14. Mechanisms for agonists biopsychology 145
4 or Dopamine, norepinephrine, and acetylcholine are all (AP94)
(A) Hormones excreted by the endocrine glands
(B) Secretions of the exocrine glands
(C) Drugs used in the therapeutic treatment of memory disorders
(D) Enzymes involved with the degradation of interneuron signals
(E) Neurotransmitters that excite or inhibit a neural signal across a synapse
Mechanisms for agonists biopsychology 145
Excessive dopamine in basal ganglia lead to disorders known as choreas, uncontrollable movements. Vilayanur S. Ramachandran The Tell Tale Brain pg. 19
Dopamine flood on coke at nat geo
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15. Antianxiety Drugs
Antianxiety drugs (Xanax and Ativan) depress the central nervous system and reduce anxiety and tension by elevating the levels of the Gamma-aminobutyric acid (GABA) neurotransmitter.
Possible psychological dependence
AM The Mind
33. Mood Disorders: Medication and Talk Therapy
Shows the effectiveness of combining drug therapies with traditional psychotherapy.
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16. Gamma-Aminobutyric Acid (GABA)
Main inhibitory neurotransmitter of the CNS when you sleep
Benzodiazepines (which include tranquilizers such as Valium) and alcohol work on GABA receptors
Malfunctions in GABA system can contribute to severe anxiety
Huntington's disease involves loss of neurons in striatum that utilize GABA
Huntington’s not sex linked.
Symptoms:
jerky involuntary movements
mental deterioration
GABA inhibits dopamine-Without GABA dopamine runs wild, impairs motor and cognitive functions
Drugs that block GABA produce seizures, and may contribute to epilepsy
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17. Antidepressant Drugs
Antidepressant drugs like Prozac, Zoloft, and Paxil are Selective Serotonin Reuptake Inhibitors (SSRIs) that improve the mood by elevating levels of serotonin by inhibiting reuptake.
Prozac = Fluoxetine
Antidepressants side effects – dry mouth, weight gain, hypertension, dizzy spells
Effects often take 4 wks.
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18. Mood-Stabilizing Medications
Lithium Carbonate, a common salt, has been used to stabilize manic episodes in bipolar disorders.
It moderates the levels of norepinephrine and glutamate neurotransmitters.
7 out of 10 bipolar patients benefit (Solomon)
Suicide risk 1/6th of non medicated (Tondo)
57. Lithium carbonate has been useful in some instances in the treatment of (AP12)
A. bipolar disorder
B. dissociative identity disorder
C. autistic disorder
D. hypochondriasis
E. anorexia nervosa
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19. Most effective for depressed patients who do not respond to drugs.
Brain Stimulation
Electroconvulsive Therapy (ECT): Produces racking convulsions & brief unconsciousness
Most effective for depressed patients who do not respond to drugs.
Preview Question 12: What is electroconvulsive therapy? When is it used?
The patient is anesthetized and given a muscle relaxant. Patients usually get a 100 volt shock that relieves them of depression.
Produces racking convulsions & brief unconsciousness
3 weekly sessions for 2 wks, 80% of patients have improvement, some memory loss
AM The Mind 34. Treating Depression: Electroconvulsive Therapy
Provides a clear and dramatic presentation of the process and some of the effects of electroconvulsive therapy (ECT).
Electroconvulsive therapy has been most successful in the treatment of (AP94)
(A) Phobias
(B) Schizophrenia
(C) Psychogenic amnesia
(D) Multiple personality
(E) Clinical depression
54. Research on electroconvulsive therapy (ECT) has shown that it is most effective for treating which of the following disorders? (AP13)
(A) Conversion
(B) Obsessive-compulsive
(C) Major depressive
(D) Antisocial personality
(E) Posttraumatic stress
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20. http://www. google. com/url
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21. rTMS: Repetitive Transcranial Magnetic Stimulation
Alternatives to ECT
rTMS: Repetitive Transcranial Magnetic Stimulation
In rTMS, a pulsating magnetic coil is placed over prefrontal regions of the brain to treat depression with minimal side effects.
20-30 minute treatments, 2-4 weeks, no seizures, no memory loss, or other side effects
Shallow depth
TMS at PBS
TMS at PBS
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22. http://www. google. com/url
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23. Psychosurgery Psychosurgery was popular even in Neolithic times.
Although used sparingly today, about
200 such operations do take place in the US.
Link
Preview Question 13: Under what conditions might psychosurgery be considered for changing behavior or moods?
Egaz Moniz developed the lobotomy and won the Nobel prize
Leucotomes-tools for lobotomy
1050’s 30,000 lobotomies in the US
Side effects – lethargic, impulsive, immature personality
Not needed with modern methods
A lobotomy patient said he just doesn’t care, has a very levelized emotional response.
Link
Lobotomy vid at…
My lobotomy
Oral histories of lobotomies
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24. Ancient Psychosurgery
Ancient Treatments of psychological disorders included Trephination.
Preview Question 2: What theoretical models or perspectives can help us understand psychological disorders?
Trephination (boring holes in the skull to remove evil forces)
John W. Verano
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25. Psychosurgery
Psychosurgery is used as a last resort in alleviating psychological disturbances. Psychosurgery is irreversible. Removal of brain tissue changes the mind.
Split brain patients.
Remember the girl with half a brain, and cutting the corpus callosum to deal with severe epilepsy.
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26. James Watts (left) and Walter Freeman performing a lobotomy
My lobotomy at npr
Wikipedia
While the procedure, initially termed a leucotomy, has been controversial since its inception in 1935, it was a mainstream procedure for more than two decades, prescribed for psychiatric (and occasionally other) conditions—this despite general recognition of frequent and serious side-effects. The Nobel Prize for Physiology or Medicine of 1949 was awarded to António Egas Moniz "for his discovery of the therapeutic value of leucotomy in certain psychoses".[2] The heyday of its usage was from the early 1940s until the mid-1950s when modern neuroleptic (antipsychotic) medications were introduced. By 1951 almost 20,000 lobotomies had been performed in the United States. The decline of the procedure was gradual rather than precipitous. In Ottawa's psychiatric hospitals, for instance, the 153 lobotomies performed in 1953 were reduced to 58 by 1961, after the arrival in Canada of the antipsychotic drug chlorpromazine in 1954.[3][4]
According to the same source, prefrontal lobotomy reduces:
anxiety feelings and introspective activities; and feelings of inadequacy and self-consciousness are thereby lessened. Lobotomy reduces the emotional tension associated with hallucinations and does away with the catatonic state. Because nearly all psychosurgical procedures have undesirable side effects, they are ordinarily resorted to only after all other methods have failed. The less disorganized the personality of the patient, the more obvious are post-operative side effects. ...[44]
Convulsive seizures are reported as sequelae of prefrontal lobotomy in 5 to 10 percent of all cases. Such seizures are ordinarily well controlled with the usual anti-convulsive drugs. Post-operative blunting of the personality, apathy, and irresponsibility are the rule rather than the exception. Other side effects include distractibility, childishness, facetiousness, lack of tact or discipline, and post-operative incntinence.[44]
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29. I’d rather have a bottle in front of me than a frontal lobotomy.
Link 5:11
Caption: This axial (cross sectional) CT image of the brain shows low density (dark) extensively involving both frontal lobes.
Frontal lobotomies used to be performed to intentionally damage the regions involved in emotion in an attempt to cure or improve individuals with severe aggression or other affective disorders.
This was performed by drilling burr holes into the frontal calvarium (skull). After the burr holes were placed cutting needles were placed into the frontal lobe parenchyma and rocked back and forth to severe the axonal connection of the frontal brain parenchym.
The Frontal Cortex is the highest and most complex integration center in the human brain; the essential function area for "volition," i.e., planning and carrying out meaningful, goal directed activities. Lesions in the left frontal cortex create deficits in attention, abstract thinking, foresight, mature judgment, integration of thought and perception, reality testing, initiative, and perseverance and induce a state of pseudo-depression characterized by apathy, lack of motivation, withdrawal, and loss of sexual interest. Lesions in the right lobe have a disinhibiting effect, revealed in wide mood swings, immature behavior, irresponsibility, inappropriate sexual behavior and/or hypersexuality.
From ppt NIMH National Institute for Mental Health
Link
Lobotomy on pbs at youtube 29
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30.
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31. Cingulotomy
…sometimes. Neurosurgeons may perform this procedure on people with vastly crippling depressions that are resistant to drugs, ECT, or other forms of therapy.
…disconnects just one area toward the front of the cortex, called the anterior cingulate cortex (ACC).
A bit of a mini-lobotomy
On an incredibly simplistic level you can think of depression as occurring when your cortex thinks an abstract negative thought and manages to convince the rest of the brain that this is as real as a physical stressor. In this view, people with chronic depressions are those whose cortex habitually whispers sad thoughts to the rest of the brain. Thus, an astonishingly crude prediction: cut the connections between the cortex and the rest of a depressive's brain, and the cortex will no longer be able to get the rest of the brain depressed. Remarkably, it actually works sometimes. Neurosurgeons may perform this procedure on people with vastly crippling depressions that are resistant to drugs, ECT, or other forms of therapy. Afterward, depressive symptoms seem to abate.* Obviously, this is a simplified picture no one actually disconnects the entire cortex from the rest of the brain. After all, the cortex does more than mope around feeling bad about the final chapter of Of Mice and Men. The surgical procedure, called a cingulotomy, or a cingulum bundle cut, actually disconnects just one area toward the front of the cortex, called the anterior cingulate cortex (ACC).
Why Zebras Don’t Get Ulcers, By Dr. Robert Sapolsky
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32. Corpus Callosotomy
A condition in which the two hemispheres of the brain are isolated by cutting the corpus Callosum for the treatment of epilepsy.
Corpus Callosum
largest bundle of neural fibers
connects the two brain hemispheres
carries messages between the hemispheres
4 16. Neurosurgeons cut the corpus callosum in the brain disrupting communication (AP04)between the right and left hemispheres to
(A) Prevent the spread of epileptic seizures
(B) Reduce anxiety attacks and phobic reactions
(C) Reduce the incidence of violent behaviors
(D) Treat schizophrenia
(E) Reduce mood swings
AM The Brain #5 The Divided Brain
This module begins with graphic representations of the cerebral hemispheres’ specialized functions. It continues with a description of the brain’s asymmetry, showing diagrams of how the two halves communicate. The extreme case of a patient who has undergone split-brain surgery for treatment of epilepsy illustrates the role of hemispheric organization in sensory perception and verbal skills. 32
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33. End
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34. Approaches at AM Link Link
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35. Les Snider/ The Image Works
Drug Therapies
However, many patients are left homeless on the streets due to their ill-preparedness to cope independently outside in society.
Some don’t take medication, need other support etc.
Les Snider/ The Image Works
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