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CHAPTER 5 TREATMENTS FOR ABNORMALITY
- 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
counsellors
- 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
symptoms
- 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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Document Summary

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 counsellors. Voluntary support network sector consists of self-help groups e. g. alcoholics anonymous. Unfortunately, most people who might benefit from treatment aren"t 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.

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