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Chapter 16

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Wilfrid Laurier University
Kathy Foxall

Chapter 16 Biological Treatments for Mental Disorders The Question of Drugs Drugs prescribed for mental disorders  Antipsychotic drugs/neuroleptics o SCHIZOPHRENIA, BIPOLAR o Ineffective for nonpsychotic disorders o Many psychoses thought to be caused by excess of neurotransmitter dopamine, use antipsychotic drugs to reduce sensitivity of brain receptors o Reduce agitation, delusion, and hallucination, however do very little for other symptoms o Often unpleasant/dangerous side effects o Tarive dyskinesia disease o Unacceptable risks for many groups (extreme weight gain)  Antidepressant drugs o Drugs used primarily in the treatment of mood disorders, especially depression and anxiety, and OCD o MAOI increase levels of serotonin, Tricyclic as well, SSRI target serotonin o Zyban/Wellbutrin used as aid to quit smoking o All three produce unpleasant physical reactions o St.John’s wort herb possible antidepressant, affects metabolism  Anti-anxiety drugs (tranquilizers) o Emotional problems o Increase neurotransmitter GABA o Overprescribed by physicians o Symptoms always return if medication is stopped, often overused/overdose o Betablockers lower heart rate and blood pressure  Special category of drug, salt called lithium carbonate o Used for bipolar disorder o Both short term effects (tremors) and long term problems (kidney damage) o Moderate neurotransmitter norepinephrine, protect from overstimulation by another transmitter o Lithium must be given in exact right dose  Cautions about drug treatment o Publication bias, tendency for journals to publish positive findings but not negative or ambiguous ones o Much data submitted to FDA goes unpublished if it is negative  e.g. nine unpublished studies of Paxil o the placebo effect  apparent success of medication or treatment due to patient’s expectations rather than drug or treatment itself  only 40% respond to specific biological effects of antidepressants o high relapse and dropout rates  likely to relapse due to unpleasant side effects o dosage problems  groups differ in dosages  therapeutic window  amount of a drug that is enough but not too much, taking into account the fact that the same dose of a drug may be metabolized differently in men and women, old people and young, and different ethnic groups o disregard for effective possibly better non medical treatment  organizations prefer to pay for one patient visit for prescription rather than 10 visits for psychotherapy o unknown long term risks  only tested for a few weeks before released on market  cost of bringing new drugs to market is high, manufacturers can’t wait  prescribe cocktails of medication, one for this, that etc. o untested off label uses  once drug approved, doctors permitted to prescribe for other conditions and populations than originally tested Direct Brain intervention  psychosurgery o surgical procedure that destroys selected areas of the brain believed to be involved in emotional disorders or violent impulsive behaviour o invented by Egas Moniz, use with caution o procedure left many people unable to care for themselves  Electroconvulsive therapy (ECT) o Procedure used in cases of prolonged and severe suicidal depression, in which a brief brain seizure is induced o Safe and effective, helped people who were suicidal o However usually short lived, depression always returned  TMS o Uses magnetic coil to stimulate prefrontal cortex o Lengthy process, used every day for four weeks Kinds of Psychotherapy Psychodynamic theory  Psychoanalysis o Theory of personality and a method of psychotherapy originally formulated by Sig Freud, emphasizes unconscious motives and conflicts  Transference o Psychodynamic therapies, a critical process in which the client transfers unconscious emotions or reactions, such as emotional feelings about his or her parents, onto the therapist o Women’s love for father transfer to analyst  Free association o Client lies on sofa, analyst out of view, client says whatever comes to mind  Depth therapies o Goal is to delve into the deep, unconscious processes believed to be the source of patients problems Behaviour and Cognitive Therapy Behavioural techniques Behaviour therapy o Therapy that applies principles of classical and operant condition to help people change self defeating or problematic behaviours  Graduated exposure o Person suffering from a phobia or panic attack taken into a feared situation or exposed to a traumatic memory until the anxiety subsides o Flooding  Behaviour therapy a form of exposure treatment in which the client is taken directly into the feared situation and remains there until his or her panic subsides  Systematic desensitization o Behaviour therapy a step by step process of desensitizing a client to a feared object or experience o Counterconditioning  Client relaxes while imagining or looking at a sequence of feared stimuli, arranged from least to most frightening o VR programs developed to desensitize clients to various phobias  Behavioural self monitoring o Behaviour therapy, a method of keeping careful data on the frequency and consequences of the behaviour to be changed  Skills straining o An effort to teach the client skills that he or she may lack, as well as new constructive behaviours to replace self-defeating ones o How to discipline children, how to manage anger, and teach people with schizophrenia how to get along in the world o Therapist changes rein-forcers Cognitive Techniques  Cognitive therapy o Form of therapy designed to identify and change irrational, unproductive ways of thinking and hence to reduce negative emotions o Learn to consider other explanations for people behaviour  Rational Emotive Behaviour Therapy o Form of cognitive therapy devised by Albert Ellis, designed to challenge the clients unrealistic thoughts  Points out people emotionally overgeneralize and catastrophize  Therapist challenges these thoughts and shows client why they are misguided o Aaron Beck  Don’t challenge, would ask you to test beliefs against evidence  Beliefs often unproductive or based on misinformation o Donald Meichanbaum  Stress inoculation  Designed to reduce anxiety  3 sta
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