PSY100H1 Chapter Notes - Chapter 5: Transcranial Magnetic Stimulation, Tricyclic Antidepressant, Hypericum Perforatum

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Published on 14 Apr 2013
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Chapter Five
Major sectors of mental health services
Speciality mental health sector: includes psychiatrists, psychologists,
psychiatric nurses and psychiatric social workers who are trained specifically to
treat people with mental disorders
General medical/primary care sector: includes health care professionals such as
internists, paediatricians and nurse practitioners; may not be specifically trained in
mental health treatment, but are often the initial point of contact or the only
source of mental health services
Human services sector: includes social services, school based counselling
services, residential rehabilitation services, criminal justice services and religious
professional counsellors
Voluntary support network sector: self-help groups such as AA; growing
component of mental health treatment; 3% of adult Canadian population have
attended an AA meeting; 37% of Canadians who suffer from mental disorders or
substance dependence use some kind of health care/community resource
Medication: prescribed by proponents of biological treatments
Psychotherapy: proposed by psychological and some social approaches; most
involve therapist (psychiatrist, clinical social worker, etc) talking to client about
symptoms and contributing factors; specific topic depends on therapist’s
theoretical approach
Biological treatments
Social impact: can treat people with severe psychological disturbances so can
lead normal lives and not be warehoused; do not work for everyone; have
significant side effects; worry that people will turn to drugs rather than deal with
difficult issues in lives causing psychological problems; ethical issues of changing
personalities with pills
Drug therapies: most discovered in roundabout ways; drugs thought to relieve
psychological symptoms by correcting imbalances of neurotransmitters,
compensating for structural deficits and effects of genetic abnormalities
Antipsychotic drugs: reduce symptoms of psychosis (loss of reality testing,
hallucinations, delusions)
Chlorpromazine: discovery incited beginning of modern drug treatment; now
used to treat symptoms of psychosis
Psychosis: loss of touch with reality, hallucinations and delusions
Phenothiazines: group of chemical compounds; chlorpromazine is one; first
synthesized in 1883 by August Bernthsen, who was working to produce synthetic
dyes; act as antihistamines and so initially useful in allergy treatment
o1940s: discover drugs can result in decrease in muscle tone, reduction of
nausea, sometimes euphoria/sedation; began to use to calm agitated
patients and reduce tremors in Parkinson’s patients
oPost WWII: Henri Laborit uses these as pre-surgery drugs to reduce post-
surgical shock (potentially fatal neuroendocrine response to stress);
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initially used promethazine but wanted drug with greater CNS effects so
got recently synthesized chlorpromazine
o1950s: Jean Delay and Pierre Deniker found chlorpromazine reduces
agitation, excitation, confusion and paranoia in psychotic patients; Delay
labelled drugs neuroleptics, as they depress activity of the nervous system
o1954: Drug marked by Smith Kline and French under name Thorazine
(little regulation of drug market so introduced before research into side
effects)
oSimilar drugs: Thioridazine (Mellaril); trifluoperazine (Stelazine); Paul
Janssen discovers butyrophenone (another class of drugs to reduce
psychotic symptoms) and haloperidol (Haldol) starts being marketed in
1957
Side effects: severe sedation, visual disturbances and tardive dyskinesia
(neurological disorder characterized by involuntary movements of the tongue,
face, mouth or jaw); atypical antipsychotics treat psychosis without some of
those side effects (clozapine and risperidone)
How they work: drugs reduce levels of dopamine or influence receptors for
dopamine in the brain; dopamine believed to increase or decrease salience to
internal and external experiences to produce delusions and hallucinations
Antidepressant drugs: reduce symptoms of depression (sadness, loss of appetite,
sleep disturbances)
oHydrazine: fuel used by Germans for rocket during WWII; in 1951,
discovered that two hydrazine compounds (isoniazid and iproniazid) were
effective in treating tuberculosis; euphoria side effect; Jean Delay
suspected those compounds would be useful as antidepressants
MAOIs: monoamine oxidase inhibitors; compounds part of this
class; trade names include Nardil and Parnate; drugs inhibit
enzyme monoamine oxidase in the brain, resulting in higher levels
of neurotransmitters like norepinephrine; side effects include
headaches, jaundice, rise in blood pressure; other drugs prescribed
more often
oTricyclic antidepressants: used most often until 1980s; Roland Kuhn
discovers imipramine in 1950s which energizes patients and elevates
mood; marketed as Tofranil in 1958; others include Elavil and Anafranil;
seemed more effective and had fewer dangerous side effects that MAOIs;
thought to work by inhibiting reuptake of norepinephrine, serotonin and
dopamine; called “dirty drugs” as affect so many neurotransmitter systems
oSSRIs: act more selectively on serotonin receptors than tricyclics;
includes fluoxetine (Prozac), introduced in 1986, Zoloft and Paxil; very
popular as side effects easier to tolerate (nausea, diarrhoea, headaches,
etc); individual tolerability of antidepressant medications more important
than specific antidepressant prescribed; useful for other psychological
problems (anxiety, eating disorders, impulse control); newer drugs include
venlafaxine (Effexor) and mirtazapine (Remeron) which target both
serotonin and norepinephrine
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Lithium: reduce symptoms of mania (agitation, excitement and grandiosity);
metallic element present in ocean, natural springs, animal and plant tissue
o19th century: used to treat rheumatism and gout; believed there was
possible relationship between these disorders and mania; recommended by
William Hammond
oJohn Cade: observed onset of mania in fellow prisoners as Japanese
POW and believed it might be excessive accumulation of metabolite;
discovered lithium had powerful calming effect on guinea pigs; research
largely went unnoticed
oMogens Schou: published series of studies on effectiveness of lithium in
1970 and only then was it legitimized as a treatment for mania
oDownsides: severe side effects (including death); other drugs called
anticonvulsants and calcium channel blockers used now (less side
effects)
Anti-anxiety drugs: reduce symptoms of anxiety (fearfulness, worry, tension);
anxiety and insomnia symptoms for which drugs most often prescribed
oBarbiturates: introduced at beginning of 20th century; suppress CNS and
decrease activity of variety of neurons; induce relaxation and sleep but are
quite addictive; withdrawal can cause life-threatening symptoms, like
delirium, convulsions and increased heart rate; ex: Nembutal
oBenzodiazepines: discovered in 1940s but not widely available until
1960s when sold under names like Librium, Valium, Xanax and Serax;
reduce symptoms of anxiety without interfering substantially with an
individual’s ability to function in daily life; most often used as sleeping
pills; recommended for short-term use but commonly used on long term
basis; also highly addictive; active metabolites remain in body for days
and can create toxic interaction effects with alcohol/other drugs
Herbal medicines: St. John’s wort (hypericum perforatum); European studies in
mid-1990s suggested it was an effective treatment for depression; reasonable
alternative in cases of mild/moderate depression but did not fare well in study of
severe depression; can be bought without prescription; side effects less severe
than that of antidepressant drugs; can interact with medications taken for medical
ailments (heart disease, seizures, cancers); may also interfere with HPA axis and
increase thyroid stimulating hormone (TSH) causing hypothyroidism
Phytomedicines: “natural” remedies for psychological problems; use dates back
to beginning of civilization; regular part of modern mainstream medicine in Asia
and parts of Western Europe; range from chamomile and peppermint to foxglove
oRauwolfia serpentine: used 3000 years ago by Hindu Ayurvedic healers
as treatment for insanity; rediscovered in 20th century and chemical
analysis of the root extracts of R. serpentina led to discovery of dopamine
and role in Parkinson’s and schizophrenia
oValerian: made from root of Valeriana officinalis, common herb native to
Europe and Asia; safe, mild sedative
oKava: psychoactive member of the pepper family, widely used in
Polynesia, Micronesia and Melanesia as a ceremonial tranquilizing
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Document Summary

Janssen discovers butyrophenone (another class of drugs to reduce psychotic symptoms) and haloperidol (haldol) starts being marketed in. William hammond: john cade: observed onset of mania in fellow prisoners as japanese. Polynesia, micronesia and melanesia as a ceremonial tranquilizing. In vivo exposure: clients asked to experience stimuli directly, rather than just imagining it; generally has stronger results: aversion therapy: makes situation/stimulus once reinforcing no longer reinforcing. Then investigate roots of these patterns: process: designed to be short term (12-20 weeks in duration with 1-2 sessions a week); treatment of depression, substance abuse, eating disorders, anxiety disorders; role of therapeutic alliance very important. Interpersonal and social approaches: uniqueness: view individual as part of larger system of relationships, influenced by social forces and cultures which must be addressed in therapy. Interpersonal therapists: work primarily with individuals to help them understand their place in their social system and change behaviours/roles within it.

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