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Treatment of Psychological Disorders

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Psychology 1000

1 Treatment of Psychological Disorders Treatment  About 200 different forms of psychotherapy  Psychotherapy - treatment of emotional or behavioural problems through psychological techniques  Note: treatment through the usage of drugs is called somatic therapy Somatic therapy Somatic therapy  Typically used in conjunction with some form of talking therapy  Patient may be too down to talk  May be suicidal  Three types available: o Psychosurgery o Electroconvulsive therapy (ECT) o Drugs Psychosurgery  Prefrontal lobotomy o Brain surgery in the absence of obvious organic damage o Moniz (1935) reports a “calming effect” for prefrontal lobotomy o Simple, outpatient procedure o Separate pre-frontal lobes from rest of brain o Patients become more docile, but show a wide variety of problem which indicates that they suffer some type of IQ loss or lack of abilities in planning  More refined procedure: cingulectomy o Cut cingulum bundle (fibers connecting prefrontal lobes to limbic system) o Few side-effects (can influence strategy choice) o Seems effective for obsessive-compulsive disorder  Caution o Should be used only as a last resort o Never on patient who can not consent o Irreversible Electroconvulsive therapy (ECT)  Von Meduna (early 1900s) o Patients with epileptic seizures improved after attack  Cerletti (1937) uses electricity rather than drugs to induce seizure  Brief (less than 1 second) electrical current applied to head 2  Wild firing of neurons results in seizure and convulsions  Today, patients are anesthetised and partially paralyzed prior to treatment o Eliminates convulsion  Right hemisphere only o Less damage to verbal memory  3 to 12 sessions over several weeks  Only about 2.5% patients treated o Not helpful for schizophrenia, DID, and a variety of disorder but it was still administered since it was seen as a “wonder treatment” o Useful for severe major depression  Can cause permanent brain damage even at low dosage  Why do this? o Not sure why this has some effects o Might increase monoamines which might combat depression o Antidepressant drugs are slow acting… may need to respond quickly  Note: o Was used for many disorders (e.g. schizophrenia) o No useful effect o Last resort, consent required Drug therapy  Useful psychoactive drugs introduced only about 50 years ago  French drug company produced chlorpromazine by accident… dramatic effect on schizophrenia  Relieve symptoms by altering synaptic communication  Anti-anxiety o Tranquilizers  Calming effect  Lower excitability  Heavily prescribed o Benzodiazepine (Diazepam, Valium)  “Wonder drug” and treatment of choice, most popular drug in past  Binds at specific receptor site and increases the sensitivity of GABA o Patients with neuroses prone to dependency o Occasional use can be beneficial o Can help reduce withdrawal symptoms o Chronic use not recommended o Should include some other therapy  Anti depressants o “Mood elevators” o Alter neurotransmitters  Target the monoamines  NE, serortonin, dopamine o Extremely depressed patients become less sad, more optimistic 3 o Tricyclic (Elavil)  Inhibit the re-uptake of serotonin and NE o Mao inhibitor (Nardil)  Inhibits MAO… effectively leaving serotonin and NE in synapse  Need daily use  4 weeks for effectiveness  Tricyclics prescribe more often than MAO  because MAO has more side effects, and requires a special diet  Certain drugs effective for other disorders  Tricyclic  Clomipramine o Obsessive compulsive  Most common administered anti-depressant drug: o Group: atypical antidepressant o Generic name: fluoxetine o Trade name: prozac  Prozac o On market for 20 years o New “wonder drug” o Prescribed to more than 40 million (worldwide)  Up 16% last year o You can even get Prozac for your dog!!  very heavily prescribed o Inhibits reuptake of serotonin  SSRI o “Few” side-effects  Over 160 lawsuits to date  Anti Mania o Lithium carbonate (Eskalith) o Prescribed for bipolar disorder o Eliminate manic phase and depression does not return
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