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Chapter 16 Notes .docx

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Mindi Foster

PSYCHOLOGY LECTURE – November 27,29 2012 FINAL EXAM: - Dec 13 at 7:00pm - 75 questions worth 25% based on the 8 chapters covered this term plus appendix A - 15 questions based on last 3 chapter 14, 15, 16 (5 each) - Final is worth 38% APPROACHES TO TREATMENT AND THERAPY Types of therapy  Range from pills to psychodynamic  Some are less popular today  Not mutuality exclusive, some can be combined very effectively (some cannot)  Three classes of therapies: Talk, Behaviour, Biology FIGURE 14.2 Biological Treatment (in order) - Drug treatment - Electro convulsive shock - Psychosurgery (last resort) – a one way street, can do things to brain but cannot undo them Drug Treatment - Psychoactive drugs have revolutionized the treatment of mental disorder - The number of people in institutions dropped Cautions: - Placebo effect  The apparent success of a treatment that is due to the patients expectation and hopes rather than to the drug or treatment itself  Meta-analysis (when you have a group of studies and you look at them altogether) indicate that clinicians considered medication hopeful yet patient ratings in treatment groups were no greater than patient ratings in placebo groups - High relapse and dropout rates  There may be short term success but many patients (50%-66%) stop taking medication due to side effects  Individuals who take antidepressants without learning to cope with problems are more likely to relapse - Dosage problem  Finding the therapeutic window or the amount of medication that is enough but not too much  Genetic differences  Drugs may be metabolized differently in: o Men and women, old and young, and in different ethnic groups o Groups may differ in tolerable dosages due to variation in metabolic rates, amount of body fat, number of type of drug receptors in the brain, smoking and eating habits - Long-term risks  Antipsychotic drugs can be dangerous, even fatal if taken for many years o Tardive dyskinesia  Antidepressants are assumed to be safe but no long term studies have been conducted  Many doctors and the public overlook the possibility if long-term dangers when a drug shows short run benefits - Ease of use  Over prescription – 200 million a year  Little harm  Cost effective  Drug treatments o Do not cure the disorder o Do not teach client coping & problem solving skills to deal with stress o Can bring symptoms under control & other therapeutic o Techniques can be incorporated FIGURE 17,18 Antipsychotic Drugs - Many block or reduce sensitivity of brain receptors that respond to dopamine - Some increase evels of serotonin, a neurotransmitter that inhibits dopamine activity - Can relieve positive symptoms Antidepressant Drugs - Monoamine oxidase inhibitors (MAOIs)  Elevate norepinephrine and serotonin in brain by blocking an enzyme that deactivates these neurotransmitters - Tricyclic antidepressants  Boost norepinephrine and serotonin in brain by preventing normal reuptake of theses substances - Selective serotonin reuptake inhibitors  (e.g Prozac) Problem for Drug therapy - Time course of action - Changes in brain have to change learned responses - Neurogenesis or other secondary effect Bipolar Disorder - Lithium Carbonate – mood stabilizer  Not sure how it works  Toxic side effect - Anti psychotics for acute episodes - Other mood stabilizers are being developed: valproic acid - Use of antidepressants in bipolar Tranquilizers: Anti anxiety - Increase the activity of the neurotransmitter gamma-amino butyric acid (GABA) - Developed for treatment of mild anxiety and often overprescribed by general physicians for patients who complain of any mood disorder - Designed to not impair alertness, but may induce dependence - Not effective for depression Drugs and Talk therapy - Both psychological & biological treatments affect brain functioning - PET scans  Both psychotherapy & drug therapy showed similar changes in blood flow for 3 brain areas Electroconvulsive Therapy - Electroconvulsive therapy (ECT)  Began with observation that schizophrenia & epilepsy rarely occur together  Therefore, seizure induction – help schizophrenia - Useful in treating severe depression  Particularly if risk of suicide  Effects can be immediate  60-70% - Procedure  Patient given sedative and muscle relaxant  Placed on well padded mattress  Shock less than 1 second causing seizure of CNS  May act by promoting neurogenesis Electroconvulsive Therapy - Criticisms of ECT  Possibility of relapse is high  Possibility of permanent memory loss  Possibility of permanent brain damage - Currently  # of treatments limited  MRI scans reveal no brain damage Psychosurgery - Method of last resort  Procedures that remove or destroy parts of brain  Least used of biomedical procedures - Lobotomy  Destroy nerve tracts to frontal lobes - Cingulotomy  Cut fibres that connect frontal lobes & limbic system  Useful in severe depression & OCD Psychodynamic Therapies - Psychoanalysis – based on Freudian principles - Goal: help patients achieve insight - Insight = conscious awareness of psychodynamics underlying problems  Adjust behaviour underlying problems learned in childhood - Free association
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