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

2. 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?

3. 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:

4. 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

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

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

7. 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

8. 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

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

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

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

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

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

14. 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?

15. 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.

16. 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.

17. 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.

18. 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.

19. 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.

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

21. 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,

22. Strengths and weaknesses of Biological Treatment