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PSYC1000 - Module 54

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University of Guelph
PSYC 1000
Harvey Marmurek

Course: PSYC*1000 (DE) Professor: Harvey Marmurek Schedule: Summer, 2012 Textbook: Psychology – Tenth Edition in Modules authored by David G. Myers Textbook ISBN: 9781464102615 Module 54: The Biomedical Therapies Biomedical therapy can be used by physically changing the brain’s functioning by altering its chemistry with drugs, or affecting its circuitry with electroconvulsive shock, magnetic impulses or psychosurgery. Drug Therapies What are the drug therapies? How do double-blind studies help researchers evaluate a drug’s effectiveness? Most widely used biomedical treatments today are the drug therapies. Since the 1950s, discoveries in psychopharmacolgy (the study of drug effects on mind and behaviour) have revolutionized the treatment of people with severe disorders, liberating hundreds of thousands from hospital confinement. Initially there is a wave of enthusiasm when a new treatment comes out, but it often diminishes after researchers subtract the rate of (1) normal recovery among untreated persons and (2) recovery due to the placebo effect, which arises from the positive expectations of patients and mental health workers alike. Anti-psychotic drugs: Such as chlorpromaxine (Thorazine) dampened responsiveness to irrelevant stimuli, providing most help to patients experiencing positive symptoms of schizophrenia. The molecules of most conventional anti-psychotic drugs are similar enough to molecules of the neurotransmitter dopamine to occupy its receptor sites and blocks its activity. This finding reinforces the idea that an overactive dopamine system contributes to schizophrenia. Anti-psychotics also have powerful side effects. Some produce sluggishness, tremors, and twitches similar to those of Parkinson’s disease. Long-term use of anti-psychotics can produce tardive dykinesia, with involuntary movements of the facial muscles, tongue, and limbs. Although not more effective in controlling schiz symptoms, many of the newer generation anti-psychotics, such as risperidone (Risperdal) and olanzapien (Zyprexa) have fewer of these effects. These drugs, however, may increase the risk of obesity and diabetes. Anti-anxiety drugs: Like alcohol, Xanax or Ativan, depress central nervous system activity; used in combination with psychological therapy. One anti-anxiety drug, the antibiotic D-cycloserine, acts upon a receptor that, in combination with behavioural treatments, facilitates the extinction of learned fears. Experiments indicate that the drug enhances the benefits of exposure therapy and helps relieve the symptoms of PTSD and OCD. Criticized that they reduce symptoms without resolving underlying problems. Can cause physiological dependence. The rate of out-patient treatment for anxiety disorders has nearly doubled over the dozen years of the end of the 20 century. Increased 52-70% of psychiatric patients receiving medication. New standard drug treatment for anxiety disorders- anti-depressants. Anti-depressant drugs: named for their ability to lift people up from a state of depression, and this was their main use until recently. Being used to treat OCD, anxiety. They work by increasing the availability of norepinephrine or serotonin, neurotransmitters that elevate arousal and mood and appear scarce during depression. Fluoxetine (Prozac) partially blocks the reabsorption and removal of serotonin from synapses. Because they slow the synaptic vacuuming up of serotonin, Prozac and its cousins Zoloft and Paxil are called selective-serotonin-reuptake-inhibitors (SSRIs). Other antidepressant drugs work by blocking the reabsorptoin or breakdown of both norepinephrine and serotonin. Though effective, these dual-action drugs have more potential side effects, such as dry mouth, weight gain, hypertension, or dizzy spells. Administering them by means of a patch, bypassing the intestines and liver, helps reduce such side effects. After the introduction of SSRIs, the percentage of patients receiving medication for depression jumped dramatically, from 70% in 1987 to 89% in 2001. Although drugs begin to influence neurotransmission within hours, their full psychological effect often requires four weeks. One possible reason for the delay is that increased serotonin promotes neurogensis – the birth of new brain cells – perhaps reversing stress- induced loss of neurons. Mood-stabilizing medications: for those suffering the emotional highs and lows of bipolar disorder, the simple salt lithium can be an effective mood stabilizer. After suffering mood swings for years, about 7 in 10 people with bipolar disorder benefit from a long-term daily dose of this cheap salt, which helps prevent or ease manic episodes and, to a lesser extent, lifts depression. It also protects neural health, thus reducing bipolar patients’ vulnerability to future dementia. Lithium also reduces bipolar patients’ risk of suicide. Lithium amounts in drinking water have also correlated with lower suicide rates and lower crime rates. And so does Depakote, a drug originally used to treat epilepsy and more recently found effective in the control of manic episodes associated with bipolar disorder. The drugs given most often to treat depression are called anti-depressants. The drugs that are more commonly given to treat anxiety disorders are called anti-depressants. Schizophrenia is often treated with anti-psychotic drugs. How do researchers evaluate the effectiveness of particular drug therapies? Researchers assign people to treatment and no-treatment conditions to see if those who receive the drug therapy improve more than those who don’t. Double-blind controlled studies are most effective. If neither the therapist nor the client knows which participants have received the drug treatment, then any difference between the treated and untreated groups will reflect the drug treatment’s actual effect. Brain Stimulation How are brain stimulation and psychosurgery used in treating specific disorders? Electroconvulsive Therapy: (ECT) introduced in 1938 patient strapped to table and jolted with roughly 100V of electricity to the brain, producing racking convulsions and brief unconsciousness. Today, the patient receives a general anaesthetic and a muscle relaxant (to prevent injury from convulsions) before a psychiatrist delivers 30 to 60 seconds of electrical current. Within 30 minutes, the patient awakens and remembers nothing of the treatment or of the preceding hours. After three such sessions each week for two to four weeks, 80% or more improve markedly, showing some memory loss for the treatment period but no discernible brain damage. The results of ECT in treating severe depression are among the most positive treatment effects in all of medicine. Some think of it as rebooting the cerebral computer. Some believe the shock-induced seizures calm neural centres where overactivity produces depression. It also appears to boost the production of new brain cells. Skeptics – placebo effect. ECT now administered with briefer pulses, sometimes only to the brain’s right side and with less memory disruption. 4 in 10 ECT-treated patients relapse into depression within six months. Alternative Neurostimulation Therapies Magnetic Stimulation: Repeated pulses surge through a magnetic coil held close to a person’s skull. Painless, called repetitive transcranial magnetic stimulation (rTMS) – performed on awake patients over several weeks. No seizures, memory loss or other serious side effects. Modest positive benefits. Unclear on
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