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chapter 41.doc

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Jon Houseman

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BIOLOGICAL THERAPIES: Electroconvulsive Therapy: • ECT is being used with increased frequency in Canada and elsewhere. One reason is that when it works, it is faster than antidepressants and psychotherapy. • ECT entails the deliberate induction of a seizure and momentary unconsciousness by passing a current between 70 and 130 volts through the patient’s brain. • Electrodes were formerly placed on each side of the forehead, allowing the current to pass through both hemispheres, a method known as bilateral ECT. • Today, unilateral ECT, in which the current passes through the non-dominant (right) cerebral hemisphere only is more commonly used. • The mechanism through which ECT works is unknown. It reduces metabolic activity and blood circulation to the brain and may thus ingibit aberrant brain activity. • Although we don’t know why, ECT may be the optimal treatment for extremely severe depression. • Risks: confusion and memory loss that can be prolonged. However, unilateral ECT to the non- dominant hemisphere erases fewer memories than does bilateral ECT and no detectable changes in brain structure result. • Clinicians typically resort to ECT only when the depression is unremitting and after less- drastic treatments have been tried and found wanting. • Full informed consent is crucial, given that some patients have indeed had negative experiences (full amnesia). • Rotman research institute in Toronto, reported on preliminary success in a small number of patients with a deep brain electrical stimulation procedure for treatment-resistant depression, a severely disabling disorder with no treatment options once ECT, medication and psychotherapy have failed. • Mayberg et al concluded that disrupting focal pathological activity in limbic-cortical circuits using electrical stimulation of the subgenual cingulate white matter can effectively reverse symptoms in otherwise treatment resistant depression. Drug Therapy: • Drugs are the most commonly used treatments – biological or otherwise – for mood disorders. • There is evidence of a better response among people with higher levels of social support. Specific Drug Therapies For Depression: • Three major categories of antidepressents: (1) Tricyclics, such as imipramine (Tofranil) an amitriptyline (Elavil) (2) Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) and Sertraline (Zoloft) (3) Monoamine Oxidase (MAO) inhibitors, such as tranyl-cypromine (Parnate) • Since the MAO inhibitors have by far the most serious side effects, the other two classes of drugs are more used. • The clinical effectiveness of all three types of drugs is similar. SSRIs have the advantage of producing fewer side effects. • Antidepressent meds are often used in combination with some kind of psychotherapy. Drug Therapy For Bipolar Disorder: • Carefully monitored dosages of the element lithium, taken in a salt form, lithium corbonate, much more effective for bipolar patients than for unipolar patients. • Responsiveness or non-responsiveness to lithium treatment seems to be an inherited family trait. • Discontinuation of lithium actually increases the risk of recurrence. Thus it is recommended that lithium be used continuously. Treatment for SAD: • Exposure to bright, white light (known as phototherapy) is a highly effective treatment for SAD. SUICIDE:  Suicide was not condemned in Western thought until the fourth century, when Saint Augustine proclaimed it a crime because it violated the Sixth Commandment, thou salt not kill. suicide ceased being criminal offence in Canada in 1972. • Suicidal ideation: refers to thoughts and intentions of killing oneself. • Suicide attempts: involve self injury behaviours intended to cause death but that do not lead to death • Suicide gestures: involve self-injury behaviours in which there is no intent to die. Rather there is an intent to give the appearance of an attempt in order to communicate with others. • Suicide: involves behaviours intended to cause death and death actually occurs. Suicide is tragic not only because a person dies unnecessarily but also because no other kind of death leaves loved ones with such enduring negative feelings that can include distress and emotional pain, guilt... (GO TO “Epidemiology and Facts about suicide in Canada” dotted points*** p.311) SUICIDE AND PSYCHOLOGICAL DISORDERS: 15% of people who have been diagnosed with MDD ultimately commit suicide. Valtonen & al assessed patients diagnosed with bipolar disorder and determined that hopelessness predicted suicidal behaviour during depressive phases, whereas a subjective rating of severity od depression and younger age predicted suicide attempts during mixed phases. A significant number of people who are not depressed make suicidal attemps, some with success – most notable people diagnosed with borderline personality disorder. PERSPECTIVES ON SUICIDE: Berkheim’s sociological Theory: • Durkheim distinguished three different kinds of suicide: o Egoistic suicide: committed by people who have few ties to family, society, or community. These people fel alienated from others and cut off from the social supports that are important to keep them functioning adaptively as social beings. o Altruistic Suicide: is viewed as a response to societal demands. Some people who commit suicide feel very much a part of a group and sacrifice themselves for
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