The Biomedical Therapies Therapies aimed at altering body chemistry.

Drug Therapies Antipsychotics, Anti-anxiety, Antidepressants, and Mood- Stabilizing Medications

Drug Therapies With the advent of drugs, hospitalization in mental institutions has rapidly declined. However, many patients are left homeless on the streets due to their ill-preparedness to cope independently out in society.

Figure 15.13: Relapse rates in the Reynolds et al. (1999) study. Following up over a period of three years, Reynolds et al. (1999) compared the preventive value of (1) monthly interpersonal therapy and medication, (2) medication alone, (3) monthly interpersonal therapy and placebo medication, and (4) placebo medication alone in a sample of elderly patients prone to recurrent depression. The combined treatment of insight therapy and medication yielded the lowest relapse rates and thus proved superior to either insight therapy or drug therapy alone. (Data from Reynolds et al., 1999)

Psychopharmacology Biomedical therapies are physiological interventions intended to reduce symptoms associated with psychological disorders. They assume that these disorders are caused, at least in part, by biological malfunctions. Psychopharmacology is the study of the effects of drugs on mind and behavior. Psychopharmacotherapy is the treatment of mental disorders with medication…drug therapy. Drugs used to treat psychological disorders fall into 3 major categories: –Antipsychotic –Anti-anxiety –Antidepressant –(Mood stabilizers do not fit well into any of these categories, but they are very important drugs in the treatment of bipolar disorder.)

Testing New Drugs When a new drug is released, there is always too much enthusiasm. New drugs must be tested using a double-blind procedure to combat placebo and experimental effects. –Double blind – To test the effectiveness of a drug, patients are tested with the drug and a placebo. Two groups of patients and medical health professionals are unaware of who is taking the drug and who is taking the placebo.

Antipsychotic Drugs Antipsychotic drugs (like Thorazine, Mellaril, and Haldol) are used to gradually reduce psychotic symptoms, including hyperactivity, mental confusion, hallucinations, and delusions. Antipsychotic drugs appear to decrease activity at dopamine synapses, sometimes producing unfortunate side-effects such as symptoms of Parkinson’s disease and tardive dyskinesia, an incurable neurological disorder marked by involuntary writhing and tick-like movements of the mouth, tongue, face, hands, or feet.

Classical vs. Atypical Antipsychotics Classical antipsychotics [chlorpromazine (sold as Thorazine)]: Remove a number of positive symptoms associated with schizophrenia such as agitation, delusions, and hallucinations. Atypical antipsychotics [clozapine (sold as Clozaril)]: Blocks receptors for dopamine and serotonin to remove the negative symptoms associated with schizophrenia such as apathy, jumbled thoughts, concentration difficulties, and difficulties in interacting with others. They enable “awakenings.” –These newer drugs, which have a different mechanism of action, have fewer motor side effects but are not risk free. They may increase the risk of obesity and diabetes. The Therapeutic Effect of Antipsychotic Drugs The Therapeutic Effect of Antipsychotic Drugs Watch at home: 1st.grandblanc.high.schoolfusion.us/module s/locker/files/group_files.phtml?gid= &parent= &msg_notify=&sessionid= 435f8e903eb7a003598df d18ahttp://ap-psychology- 1st.grandblanc.high.schoolfusion.us/module s/locker/files/group_files.phtml?gid= &parent= &msg_notify=&sessionid= 435f8e903eb7a003598df d18a Undesired Effects of Conventional Antipsychotic Drugs Undesired Effects of Conventional Antipsychotic Drugs Watch at home: 1st.grandblanc.high.schoolfusion.us/modules/l ocker/files/group_files.phtml?gid= &pa rent= &msg_notify=&sessionid=435f8 e903eb7a003598df d18a 1st.grandblanc.high.schoolfusion.us/modules/l ocker/files/group_files.phtml?gid= &pa rent= &msg_notify=&sessionid=435f8 e903eb7a003598df d18a

Anti-Anxiety Drugs Antianxiety drugs depress the central nervous system and reduce anxiety, apprehension, nervousness, and tension by elevating the levels of the Gamma-aminobutyric acid (GABA) neurotransmitter. –Includes drugs like Valium, Xanax, Buspar, Librium, and Ativan Most widely abused drugs.

Antidepressant Drugs Antidepressants gradually elevate mood and help bring people out of a depression. They improve the mood by elevating levels of serotonin by inhibiting reuptake. The 3 major classes of antidepressant drugs include: –Tricyclics – Elavil, Tofranil –Mao inhibitors (MAOIs) – Nardil –Selective serotonin reuptake inhibitors (SSRIs) – Prozac, Paxil, Zoloft Today, the SSRIs are the most frequently prescribed. Figure 15.12: Antidepressant drugs’ mechanisms of action. The three types of antidepressant drugs all increase activity at serotonin synapses, which is probably the principal basis for their therapeutic effects. However, they increase serotonin activity in different ways, with different spillover effects (Marangell et al. 1999). Tricyclics and MAO inhibitors have effects at a much greater variety of synapses, which presumably explains why they have more side effects. The more recently developed SSRIs are more specific in targeting serotonin synapses.

SSRIs – Prozac, Paxil, Zoloft Selective Serotonin Reuptake Inhibitors

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. It is very successful at preventing future episodes of mania and depression, but it can be toxic and requires careful monitoring.

Brain Stimulation Electroconvulsive Therapy and Repetitive Transcranial Magnetic Stimulation

Electroconvulsive Therapy (ECT) Electroconvulsive therapy (ECT) is a biomedical treatment in which electric shock is used to produce a cortical seizure accompanied by convulsions. ECT is used for severely depressed patients who do not respond to drugs. The patient is anesthetized and given a muscle relaxant. Patients usually get a 100 volt shock that relieves them of depression. While the use of ECT peaked in the ‘40s and ‘50s, there has been a recent resurgence in this therapy.

Alternatives to ECT Repetitive Transcranial Magnetic Stimulation (rTMS) In rTMS, a pulsating magnetic coil is placed over prefrontal regions of the brain to treat depression with minimal side effects. Figure 15.8 Magnets for the mind Myers: Psychology, Ninth Edition Copyright © 2010 by Worth Publishers

Psychosurgery

Psychosurgery was popular even in Neolithic times. Although used sparingly today, about 200 such operations do take place in the US alone.

Psychosurgery Surgery that removes or destroys brain tissue in an effort to change behavior. Antônio Egas Moniz ( ) of Portugal developed the lobotomy (previously known as a prefrontal leucotomy) in the 1930s. He was also responsible for coining the term psychosurgery. The procedure involved drilling holes in the patient's head and destroying tissue in the frontal lobes by injecting alcohol. He later changed technique, using a surgical instrument called a leucotome that cut brain tissue by rotating a retractable wire loop. Advertisement for a Leucotome in the 1940's

“The Lobotomist” Walter Freeman, and American neurologist and psychiatrist, was inspired by Muniz’s work and began performing his own lobotomies. However, Freeman wanted to simplify the procedure so that it could be carried out by psychiatrists in mental asylums, which housed roughly 600,000 American inpatients at the time. Roughly modeling the work of an Italian psychiatrist (Amarro Fiamberti), Freeman decided to enter the frontal lobes through the eye sockets instead of through drilled holes in the skull. In 1945, he took an icepick from his own kitchen and began testing the idea on grapefruit and cadavers. This new "transorbital" lobotomy involved lifting the upper eyelid and placing the point of a thin surgical instrument under the eyelid and against the top of the eyesocket. A mallet was used to drive the leucotome through the thin layer of bone and into the brain. The leucotome was then swept from side to side, thus severing the nerve fibers connecting the frontal lobes to the thalamus. The leucotome was then withdrawn and the procedure repeated on the other side.

An early advertisement from the American Journal of Psychiatry promoting transorbital lobotomy. Rosemary Kennedy before she was lobotomized by Freeman at age 23. Her father sought the lobotomy to cure what he called “moodiness,” fits of irritability and rebelliousness. He might also have been afraid that she might embarrass the family by becoming pregnant out of wedlock during one of her many escapes from the convent where she was being educated and “cared for.” After the lobotomy, Rosemary was reduced to an infantile state and needed constant care. Watch The Lobtomist, a documentary about Walter Freeman and his procedures on PBS here: (Watch “Production Line Lobotomies” and “Howard Dully’s Story” in particular)

Psychosurgery Psychosurgery is used today only as a last resort in alleviating psychological disturbances. Psychosurgery is irreversible. Removal of brain tissue changes the mind.