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CH5 Textbook Notes

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University of Toronto St. George

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 www.notesolution.com - 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 antidepressantsdrugs to treat the symptoms of depressionbut 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 www.notesolution.com
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