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CH5 Textbook Notes

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- multiple caregivers are often involved in the treatment of any one individual
- the system of mental-health services has four major sectors
- specialty mental-health sector includes psychiatrists, psychologists, psychiatric nurses,
and psychiatric social workers trained specifically to treat people with mental disorders
- general medical or primary care sector includes health care professionals,
paediatricians, and nurse practitioners, who may not be specifically trained in mental-
health treatment but are often the initial point of contact
- human services sector includes social services, school-based counselling services,
residential rehabilitation services, criminal justice services, and religious professional
- voluntary support network sector consists of self-help groups e.g. Alcoholics Anonymous
- unfortunately, most people who might benefit from treatment arent getting any, typically delay
telling a health care professional about their symptoms several years after they first appear
- drug therapies and psychotherapy are increasingly being used together in an integrated
approach to disorders
Biological Treatments
Drug Therapies
- thought to relieve psychological symptoms by correcting imbalances of neurotransmitters in the
brain, or compensate for structure deficits or the effects of genetic abnormalities
Antipsychotic Drugs
- beginning of modern drug treatment is generally thought to have occurred with the discovery of
chlorpromazine, now used to treat symptoms of psychosis
- psychosis involves the loss of touch with reality, hallucinations (unreal perceptual experiences),
and delusions (fantastic, unrealistic beliefs)
- chlorpromazine belongs to a group of chemical compounds called phenothiazines
- 1883 while producing synthetic dyes, August Bernthsen synthesized a phenothiazine
- later discovered that it had a number of biological effects on humans, could act as
antihistamines so it was initially thought useful to treat allergies
- 1940s discovered phenothiazines result in decreased muscle tone, nausea reduction,
began to be used to calm agitated patients and to reduce tremors in Parkinson patients
- French surgeon, Henri Laborit began using a phenothiazine called promethazine as a
presurgery drug to reduce postsurgical shock, pain reduced so greatly in some patients,
they didnt require morphine
- Laborit returned to pharmaceutical company for one with greater central nervous system
effects and was suggested to use a newly synthesized compound, chlorpromazine

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- effects: reduces hallucinations and delusions in psychiatric patients, reduces agitation,
excitation, confusion, and paranoia in psychotic patients
- labelled a neuroleptic, it depresses the activity of the nervous system
- success of chlorpromazine led other drugs companies to develop and patent similar drugs
- 1950s Paul Janssen discovered butyrophenone, another class of drugs that reduced psychotic
- first in this class to be marketed was haloperidol (haldol) and proved at least as effective
as chlorpromazine
- both phenothiazines and butyrophenone produce a number of side effects including severe
sedation, visual disturbances, tardive dyskinesia a neurological disorder characterized by
involuntary movements of the tongue, face, mouth, or jaw
- new drugs e.g. clozapine, risperidone, which are part of the atypical antipsychotic class seem
to be effective in treating psychosis without serious side effects
- theories suggest that these drugs reduce levels of dopamine or influence receptors for
dopamine in the brain
- antipsychotic drugs, drugs that relieve the symptoms of psychosis, revolutionized treatment
and lives of people with psychosis
Antidepressant Drugs
- a fuel used by Germans during WWII was hydrazine, drug companies acquired leftovers after
the war believing that modifications of the chemical could make it useful for medical purposes
- 1951 two hydrazine compounds, isoniazid and iproniazid were effective in treating
tuberculosis and one of the side effects seemed to be euphoria
- French psychiatrist Jean Delay tested them as antidepressants–drugs to treat the
symptoms of depression–but proved unsuccessful probably because drug wasnt given
enough time to have any effect
- years later, enough research established isoniazid and proniazid as antidepressants,
part of a class of drugs called monoamine oxidase inhibitors (MAOIs)
- some trade names of MAOIs are Nardil and Parnate
- these drugs inhibit the enzyme monoamine oxidase which results in higher levels of a
number of neurotransmitters e.g. norepinephrine
- they have potentially dangerous side effects e.g. throbbing headaches, jaundice,
precipitous rise in blood pressure
- until the 1980s antidepressants most used were tricyclic antidepressants
- 1950s Swiss psychiatrist Roland Kuhn, in an attempt to improve sleep in mental patients
tried imipramine, which has a chemical structure similar to a phenothiazine
- it energized patients and elevated their moods
- quickly became favoured over MAOIs because they seemed more effective and had
fewer dangerous side effects, some side effects are sedation, dry mouth, blurred vision
- thought to inhibit the reuptake of the neurotransmitters norepinephrine, serotonin, and
perhaps dopamine

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- 1986 pharmaceutical company Eli Lilly introduced the drug fluoxetine under the trade name
Prozac, one of the selective serotonin reuptake inhibitors (SSRIs)
- other SSRIs include Zoloft and Paxil
- quickly became very popular, equally effective as tricyclic antidepressants but people
could tolerate the side effects of SSRIs better than tricyclics
- side effects include nausea, diarrhea, headache, tremor, daytime sedation, failure to
achieve orgasm, nervousness, and insomnia
- however Canadian research shows that nausea, diarrhea, insomnia, nervousness, and
agitation occurred significantly more often with the SSRIs than with trycyclics
- also seem useful in treatment of anxiety, poor impulse control, and eating disorders
- impact of media, wonder drugs”
- some of the newest antidepressant drugs target both serotonin and norepinephrine; include
venlafaxine (Effexor) and mirtazapine (Remeron)
Lithium and Other Mood Stabilizers
- lithium is a metallic element present in the sea, natural springs, animal and plant tissue
- 1871 William Hammand recommended lithium as a treatment for mania but got little attention
- during WWII, Australian physician John Cade was captured by the Japanese and spend three
and a half years in a military prison
- observed onset of mania in fellow prisoners and wondered if it was caused by an
excessive accumulation of a metabolite, but didnt know which it was
- after being released he experimented on guinea pigs
- discovered that lithium had a calming effect
- Cade experimented on himself to determine its safety then treated patients with lithium
- he published a report on the successful treatment but wasnt widely read outside of
Australia thus his work went mostly unnoticed
- 1970 Danish psychiatrist, Morgens Schou, published a series of studies on the
effectiveness of lithium after coming across Cades report in the 1950s
- there was reluctance in accepting lithium because of its severe side effects but Schous
paper convincing evidence of its effectiveness and there were no effective alternatives
- widely used in treatment of mania today
- other drugs known as the anticonvulsants, and calcium channel blockers are also used and
appear to have fewer side effects
Antianxiety Drugs
- symptoms for which drugs are most often prescribed for: anxiety and insomnia
- barbiturates: suppress the CNS by decreasing the activity of various types of neurons
- effective for inducing relaxation and sleep but are addictive and withdrawal can cause
life-threatening symptoms e.g. increased heart rate, delirium, convulsions
- benzodiazepines: discovered in 1940s, became widely available in the 1960s when drug
companies began selling under names e.g. Librium, Valium, Serax
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