1. Approaches to Treatment Examine biomedical, individual and group approaches to treatment. Evaluate the use of biomedical, individual and group approaches to the treatment of one disorder. Discuss the use of eclectic approaches to treatment. Discuss the relationship between etiology and therapeutic approach in relation to one disorder.

2. The Biomedical Approach Aim of therapies: To cure the underlying physical causes of a mental illness or to alleviate the symptoms of the causes. Techniques

3. Drug Therapy There are many drugs used to treat a wide variety of disorders. In the biomedical sphere, this is the most widely used approach at present. Treatment is based on the assumption that biological factors are involved (there is an association between brain chemistry changes and disorders), but not necessarily the cause of the disorder. Most drugs work as ‘neuroleptics’ by attempting to control the activity of brain neurotransmitters at the synapse. It is not clear why some drugs work on some people and not others and why people react so differently (have a variety of side effects. Therefore the treatment varies in type and dosage for each individual client.

4. Drug Therapy Approach in Affective Disorders – Antidepressants The Serotonin Hypothesis and use of SSRIs to treat depression. Prozac is an example of this – Antipsychotics (major tranquillizers /neuroleptics) Similar to above, these are targeted at Dopamine levels to help maintain control in situations of hallucination and mania Have been also used to treat Anxiety in specific disorders and cases, especially when aggressive behaviors are associated…but this is not common

5. 50-65% of patients given an SSRI for three months showed signs of improvement in tests HOWEVER the other test group were given a PLACEBO (pretend drug) and this group showed a 25-30% improvement Anti-depressants

6. Side effects = range from dry mouth to suicidal thoughts (prozac) Not addictive …BUT person can become psychologically dependent on them http://www.youtube.com/watch?v=twhvtzd6gXA

7. 60% success rate for symptoms of hallucinations and psychotic episodes BUT no effect on the symptoms of social withdrawal HOWEVER, they are the only drugs that appear to work for schizophrenia Anti-psychotics

8. Drug Therapy Approach in Eating Disorders As presented in your infographics/work, those with eating disorders have many similar symptoms to Affective (especially Depression) Biomedical Treatment therefore follows a similar path considering that its main goal is to focus on the maintenance of symptoms and causal factors.

9. Drug Therapy Approach in Anxiety Disorders Anxiolytics (anti-anxiety drugs) – Benzodiazepines – antihistamines – Barbiturates As in all biomedical treatment drugs, these are aimed at the symptoms and causal factors associated with disorders. For example, Benzodiazepines act on the neurotransmitter GABA to reduce hyperactivity or anxiety

10. Independent Work Read Crane pgs 172 and 173 and complete the table on Moodle. Use this time also to complete a key study sheet evaluating the NIMH study. Be ready to share, discuss and take a QUIZ in 20 minutes! Drugs and the motivation behind prescription article.

11. Key Studies to Consider: Drug Therapy – Antidepressant drugs are 60- 80% effective in the short term (Bernstein et al., 1994) Drug therapy counterclaim - Antidepressants are only 25% more effective than placebos according to Kirsch and Sapirstein (1998). Drug therapy vs exercise – Blumenthal et al. (1999) found that exercise was just as effective as SSRIs in a group of elderly patients

12. Key Studies to Consider: Ekin et al (1989) in three types of treatment AND a placebo group, all patients recovered at a rate of just over 50%. This means that it doesn’t matter which treatment is used…all seem to have the same rate of effect. For details, see Crane bottom half of pg 173.

13. Electroconvulsive Therapy (ECT) AKA Electroshock Therapy, is a type of psychiatric shock therapy involving the induction of an artificial seizure in a patient by passing electricity through the brain. It is most often used in cases of severe depression and Bipolar disorders where other attempts, particularly drug therapy, have falied. In the past, issues with constriction and ‘natural fight/convulsion’ Of muscles caused severe complications to teeth, spine and other areas, however today ETC is modified with muscle relaxers.

14. Electro-Convulsive Therapy (ECT) First used in 1938, originally as a treatment for schizophrenia – Original techniques involved a strong electrical current being passed through two electrodes attached to either side of the forehead, causing loss of consciousness and convulsive seizures Nowadays Used to treat severe depression Modern techniques involve a mild current of between 70-130 volts, whilst patient is under anaesthetic and a muscle relaxant. Fewer spasms occur and the patient is at less risk of harm Typically patients receive 6-9 treatments over a month

15. Memory loss in at least 1/3 of patients, sometimes long term Cardiovascular change (e.g. irregular heartbeat) Headaches EEG studies have shown general slowing of brain patterns following ECT, which takes weeks to return to normal Dept of Health found 30% ECT patients suffered fear and anxiety following ECT Side effects Electro-Convulsive Therapy (ECT)

16. Electroconvulsive Therapy Continued The most common adverse effects are confusion and memory loss for events surrounding the period of ECT treatment. Some of the confusion and disorientation seen upon awakening after ECT clear soon after electroshock, although many patients report ongoing and debilitating problems. It has long been associated with unethical use related to unruly patients, but… It has improved greatly over the last 30 years Again, It is not clear exactly HOW ETC works and why the response is so varied.

17. Psychosurgery By definition this is surgical procedure carried out on the brain to solve mental disorders…it is highly controversial and for the most part is now considered extremely unethical That said, it is also historically the oldest type of attempt with evidence dating to prehistoric attempts.

18. Evaluation Use the texts, your notes and the guide on Moodle to evaluate the biological approach Consider some of these ideas: – No blame – Stigma – Relinquishing responsibility – Research – Reductionist