Biological Treatment Biological treatments generally include the administering of medication. This is controversial. Why do you think that is?

Biological therapy Drugs are the most common form of biological therapy and are often the first thing administered to patients The assumption is that there is an underlying biological cause for abnormal behaviour This could be due to brain structure, genetics or hormones What might the positive side of this be? What might be the negative?

Phenelzine Actually a form of antidepressant MAOI – monoamine oxidase inhibitor Based on the theory that depression is caused by a deficit of neurotransmitters called monoamines Prevents the breakdown of monoamines therefore increasing their availability Has quite a few side effects, generally used when other medicines have not been effective There is now a new generation of MAOIs with fewer side effects Read: http://www.mayoclinic.org/diseases-conditions/depression/in-depth/maois/art-20043992

Neurobiology of Social Anxiety Disorder: Neurobiology of Social Anxiety Disorder: Dysregulation of neurotransmitter function in the brain is thought to play a key role in Social Phobia (SP). Specifically, dopamine (DA), serotonin (SE), and / or GABA dysfunction are hypothosised in most cases of SP. in varying degrees depending on the individual. So how does phenelzine work to treat social phobia? The MAOI antidepressant "phenelzine" boosts levels of all three There is strong evidence for dopamine dysfunction in Social Phobia

Using the information from the website complete the diagram on the next slide to fully understand how MAOI’s work.

MAO – Monoamine Oxidase S – Serotonin I – Inhibitor Presynaptic neuron Synaptic Cleft MAO – Monoamine Oxidase S – Serotonin I – Inhibitor Postsynaptic neuron

Physiology of Anxiety Fearful Stimuli Sympathetic nervous system (brain and spinal cord) releases hormones (i.e. adrenaline) Fight or flight response: Increased heart rate, enlarged pupil's, sweat Increased anxiety helps a person to prepare for an appropriate course of action

Atenolol Beta-Blocker Work by blocking the transmission of nerve impulses They blocking the effects of the hormone epinephrine, also known as adrenaline. When you take beta blockers, the heart beats more slowly and with less force, thereby reducing blood pressure

Read: http://patient.info/health/beta-blockers

Beta-blockers – How do they work? Using the information from the website complete the diagram by adding in the labels.

Receptor on cell surface Tissue cell Beta-blocker Receptor on cell surface Nerve ending Adrenaline

Complete the table How do they work Side effects MAOI Beta-blockers

Leibowitz (1988): Treatment of Social Phobia with Phenelzine Potential pitfalls?

Biological treatment Key study: Leibowitz (1988) Aim To see if the drug phenelzine can help treat patients with social phobia. To see if phenelzine is more effective than a placebo and atenolol in treating social phobia. Why use a placebo group?

Method A controlled experiment where patients were allocated to one of three conditions, and treated over 8 weeks. They were assessed for social phobia on several tests such as: The Hamilton Rating Scale for Anxiety Leibowitz Social Phobia Scale. This had common manifestations of social phobia and patients rated 1-4 for the fear produced and 1-4 for the steps taken to avoid the phobic situation.

Participants 80 patients meeting DSM criteria for social phobia aged 18–50 years. They were medically healthy and had not received phenelzine for at least two weeks before the trial. Each was assessed to see that there were no other disorders. Each signed a consent form before the research.

Design An independent design with patients being allocated randomly to one of four groups: one group was treated with phenelzine one group was given a matching placebo a second treatment group was given atenolol another group was given a matching placebo.

Procedure Patients were assessed at the beginning, and then given their drug or placebo, with gradual increases in dosage of phenelzine or atenolol in the treatment groups. Each patient was then reassessed. Independent evaluators were used to carry out clinical assessments in a double blind situation.

Findings After eight weeks significant differences were noted for the phenelzine groups, with better scores on the tests for anxiety compared to the placebo groups. There was no significant difference between the patients taking atenolol and those taking a placebo. Conclusions Phenelzine but not atenolol is effective in treating social phobia after eight weeks of treatment.

Plenary Outline 2 advantages to drug therapy 2 disadvantages Extension: Suggest a solution

Activity: 12 mins Evaluate the Leibowitz study Pair 1 Sample, generalisability, ethics Pair 2- reliability, methodology Pair 3 – usefulness, validity Pair 4 – nature/nurture, reductionism/holism,

Strengths and weaknesses of Biological Treatment