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Chapter 16

Psych 101 Detailed Textbook Notes: Chapter 16

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Wilfrid Laurier University
Kathy Foxall

Psych Chapter 16 BIOLOGICAL TREATMENTS FOR MENTAL DISORDERS The Question of Drugs  The most commonly used treatment is medication that alters the production of or response to neurotransmitters in the brain  Drugs commonly prescribed for mental disorders: 1. Antipsychotic Drugs  Defn: drugs used primarily in the treatment of schizophrenia and other psychotic disorders; they are often used off label and inappropriately for other disorders such as dementia and impulsive aggressiveness  Also called neuroleptics  Older meds like Chlorpromazine (Largactil) and Haloperidol (Haldol) as well as second gen ones such as Clozapine (Clozaril, Risperdal and Zyprexa) are primarily used to treat schizophrenia  Newer drugs are safer and more effective, but more expensive  Drugs will not work for other non-psychotic disorders – placebo group in aggressiveness experiment improved the most  Since psychoses are thought to be caused by an excess of dopamine, many drugs are designed to block or reduce the sensitivity of brain receptors that respond to dopamine – some increase serotonin (inhibits dopamine)  Can reduce agitation, delusions, hallucinations, and shorten episodes  Little relief from jumbled thoughts, difficulty concentrating, apathy, etc.  side effects like muscle rigidity, hand tremors, and involuntary muscle movements  These can dethlop into a neurological disorder called tardive dyskinesia o 1/4 of adults who take these drugs will develop this disorder  Zyprexa and Risperdal also have the immediate side effect of extreme weight gain 2. Antidepressant drugs  Defn: drugs used primarily in the treatment of mood disorders, especially depression and anxiety  Monoamine oxidase inhibitors (MAOIs) – raise levels of norepinephrine and serotonin by blocking the enzyme that inhibits them o Ex. Nardil o Interact with certain foods (cheese) o Have the most risks, least prescribed  Tricyclic antidepressants boost norepinephrine and serotonin levels by preventing the normal reuptake o Ex. Elavil, Tofranil  Selective serotonin reuptake inhibitors (SSRIs) work the same but only target serotonin o Ex. Prozac, Zoloft, Lexapro, Paxil, Celexa o Cautioned against prescribing to anyone under 18  Often prescribed for depression is Wellbutrin and under the name Zyban is also used to help quit smoking  All three classes are non-addictive  Side effects include dry mouth, headaches, constipation, nausea, restlessness, weight gain, decreased sexual desire and blocked or delayed orgasm (vary with each drug) 3. Anti-anxiety drugs (tranquilizers)  Defn: drugs commonly but often inappropriately prescribed for patients who complain of unhappiness, anxiety, or worry  Increase the activity of the neurotransmitter GABA  Ex. Valium and Xanax  Symptoms almost always return if the medication is stopped  Beta blockers are sometimes used to relieve acute anxiety o Caused by stage fright or athletic competition o Slow the heart rate and lower blood pressure o NOT approved for anxiety disorders 4. A special category of drug, a salt called lithium carbonate  Often helps people with bipolar disorder  May produce effects by moderating levels of norepinephrine or by protecting brain cells from being overstimulated by glutamate  Must be given in exactly the right dose – could be ineffective or fatal  Produces short-term side effects like tremors and long-term effects like kidney damage  Other drugs for people with bipolar disorder are Tegretol, Depakote  Some cautions about drug treatments o Publication bias o Ex. Paxil – tripled the risk of suicidal thoughts and attempts in young people o What you are not hearing from the drug companies: 1. The placebo effect  Defn: apparent success of a medication or treatment due to the patient’s expectations or hopes rather than to the drug or treatment itself  Only about half of all depressed patients respond positively to any given antidepressant, of those only 40% are responding to the specific biological effects of the drug  5000 patients, placebo effect accounted for more than 80% of the alleviation of symptoms  The psychological expectation of improvement produces some of the same brain changes as meds do 2. High relapse and dropout rates  Because of unpleasant side effects 3. Dosage problems  The challenge with drugs is to find the therapeutic window  Defn: the 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 people, and different ethnic groups  Dosage of antipsychotic drugs given to Americans was often 10 times higher than that in China  Black people and Asians need lower doses  Vary due to metabolic rates, amount of body fat, number or type of drug receptors, cultural practices 4. Disregard for effective, possibly better, nonmedical treatments  Study on kids with ADD shows that behavioural therapy is effective, most stopped taking Ritalin or other meds  Advertising directly to the consumers 5. Unknown long-term risks  Antidepressants are assumed to be safe, but the effects from taking them indefinitely are unknown  Drugs are only tested on a few hundred people for a few weeks or months  Due to the high cost of bringing new drugs to the market  Failure of these drugs to help clients leads psychiatrists to prescribe cocktails of medications 6. Untested off-label uses  Doctors are permitted to prescribe approved drugs to people other than who it was originally tested for  Antidepressants being marketed for social phobias  Prozac renamed Sarafem and marketed to women for “premenstrual dysphoric disorder”  Ritalin being prescribed to 2 and 3 year olds  Antidepressants given to preschoolers has doubled Direct Brain Intervention  Psychosurgery o Defn: any surgical procedure that destroys selected areas of the brain believed to be involved in emotional disorders or violent, impulsive behaviour o Antonio Muniz invented the operation called a leukotomy where he drilled two holes in the skull and cut nerve fibres running from the prefrontal lobes o Walter Freeman took the idea and ran with it – tragic results  Instead of operating on the brain, which proved unsuccessful, other prefer to stimulate it electrically  Oldest method is electroconvulsive therapy (ETC) or shock therapy o Defn: a procedure used in cases of prolonged and severe major depression, in which a brief brain seizure is induced  Current is turned on and the body convulses – safe and effective  Mood-improving effect is short-lived, depression returns KINDS OF PSYCHOTHERAPY Psychodynamic Therapy  Psychoanalysis o Defn: a theory of personality and a method of psychotherapy, originally formulated by Sigmund Freud, that emphasizes unconscious motives and conflicts  In orthodox psychoanalysis the client lies on the sofa with the analyst out of sight and says whatever comes to mind – technique called free association  Referred to as depth therapies because the goal is to delve into the deep unconscious  One modern approach is based on object-relations theory, which emphasizes the unconscious influence of their parents and how these affect reactions to separations and losses throughout life  Major element is transference o Defn: critical process in which the client transfers unconscious emotions or reactions onto the therapist o Ex. a man who is unconsciously angry at his mother for rejecting him might become furious with his analyst for going on vacation  Today most therapists reject the orthodox approach and face the client, are goal oriented, and limit the number of sessions Behaviour and Cognitive Therapy  Would ask a question such as what are the enforcers in the patient’s environment that are maintaining the behaviour?  Behavioural techniques o Behaviour therapy  Defn: a form of therapy that applies principles of classical and operant conditioning to help people change self-defeating or problematic behaviours o Some methods: 1. Exposure  Graduated exposure  Defn: in behaviour therapy, a method in which a person suffering from a phobia or panic attacks is gradually taken into the feared situation or exposed to a traumatic memory until the anxiety subsides  The client controls the degree of confrontation  Flooding  Defn: in behaviour therapy, a form of exposure treatment in which the client is taken directly into the feared situation and remains there until the panic subsides  More dramatic 2. Systematic desensitization  Defn: a step-by-step process of desensitizing a client to a feared object or experience; it is based on the classical conditioning procedure of counterconditioning  A stimulus for an unwanted response is paired with a stimulus that elicits a response incompatible with the undesirable one  Relaxation when looking at a sequence of feared stimuli arranged from least f
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