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Psychology (17)
PSYC 001 (15)
Greg Feist (13)
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Department
Psychology
Course
PSYC 001
Professor
Greg Feist
Semester
Fall

Description
● Spirits & demons (mostly middle ages ● Trephination(small hole cut in skull to relieve spirits ● Witches: burning & floating tests ○ suspected witches were either burned stake or drowned (float test) ■ impurities float, if she sank, she’s pure (but dead) ! ● Went from this to insane asylums ○ very inhumane facilities ○ “crazies locked up” Biological treatments for psychological disorders: ● Therapies: ○ biological ■ drugs ● can treat but not cure everything ● monoamine oxidase(MAO) inhibitors ○ among first of pharmaceuticals to treat depression ■ usually result of low serotonin levels ○ MAO = enzyme converting serotonin > chemical form that lowers serotonin levels ■ inhibitors increase serotonin levels ○ reduce enzyme monoamine oxidase ■ this breaks down monoamine neurotransmitters ● i.e. norepinephrine, epinephrine, dopamine, serotonin ● inhibits action of enzyme > allows more of neurotransmitters to stay active in synapse for longer time > improves mood ○ interacts w/ many foods and common drugs to produce undesirable/dangerous side effects ■ i.e. life-threatening blood pressure increases ■ not presently prescribed for depression for this reason ■ new transdermal patch > allows administration of MAO inhibitor w/o having to enter digestive tract > provide benefits w/o food interaction risks ● tricyclic antidepressants ○ i.e. imipramine, amitriptyline ■ Elavil, Tofranil,Anafranil ○ popular for treating depression ○ used in chronic pain management,ADHD, bedwetting. ○ blocks serotonin & norepinephrine reuptake almost equally ■ make more respective neurotransmitters available in brain ■ b/c people w/ depression lack serotonin ○ unpleasant side effects ■ i.e. dry mouth, weight gain, irritability, confusion, constipation ■ comes from effects of norepinephrine ○ drugs targeting only serotonin offered hope for treatment w/ fewer side effects ● selective serotonin reuptake inhibitors (SSRIs) ○ used for depression ○ More serotonin available in synapse ■ serotonin released from presynaptic neuron > binds w/ serotonin-specific receptor sites on post-synaptic neuron > stimulate neuron firing ● Normal neurotransmitters that do not bind w/ postsynaptic neuron > taken back up into presynaptic neuron ○ called reuptake ■ looks like an escape route for the serotonin trying to return to presynaptic neuron ■ “reuptake channel” ○ SSRIs inhibit this > allows more serotonin to bind with postsynaptic neuron ○ destroyed by enzymes in synapse ○ i.e. Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Celexa (citalopram) ○ creates fewer unpleasant side effects compared to tricyclic antidepressants ■ > became more popular ● even among people who want to be happier ■ agitation, insomnia, nausea, increased likelihood in attempting suicides compared to other medication, orgasm difficulty ● used to treat premature ejaculation because of the latter ● people prescribed these medications may be so severely depressed, they would commit suicide regardless of the medication. Therefore, that suicide statistic may not be the fault of this medication ● widespread antidepressant usage may be associated with worldwide suicide rate decrease ○ debateable ○ prescribed for depression and anxiety disorders, especially OCD, autism and impulse control disorders ■ anxiety & depression are related ■ SSRIs are most effective drug treatment for OCD ○ Food interactions can have serious side effects ● Bupropione ○ widely used antidepressant ■ chemically unrelated to all previously mentioned ○ inhibits reuptake of norepinephrine and dopamine ■ both chemicals = arousal and positive emotion ○ (Zyban) also marketed as smoking cessation aid ● benzodiazepines & barbiturates ○ benzodiazepine i.e. Valium &Ativan (Lorazepam) ■ increase GABA ● inhibitory neurotransmitter ○ inhibits action potentials ■ effect increases relaxation ■ small amount of alcohol do same thing ■ both side effects are for drowsiness & addiction ○ for anxiety ○ both have calming effects ○ can be addictive ■ barbiturates > higher overdose risk ● lithium ○ mood stabilizer ○ long prescribed for stabilizing mania associated w/ bipolar disorder ■ bipolar disorders > challenging to treat ● manic episodes < require regulation ● depressive episodes < prevention ● shifts b/t episodes < controlled ● no one drug can do all of this ○ oftentimes utilizing combo drug therapies ■ most common drug for mania are atypical antipsychotics now ● also relates to schizophrenia ○ b/c lack of dopamine is one factor ● i.e. olanzapine, valproate, ○ doesn’t stop it from being produced ○ blocks dopamine effects ○ decrease delusions & hallucinations ● works on serotonin, norepinephrine & acetylcholine ● treats both positive and negative symptoms of schizophrenia ○ negative = flat emotion & not responding ○ ● side effect: small risk of fatal white blood cell reduction ■ traditional antipsychotics used to be used ● i.e. chlorpromazine ● binds to dopamine receptors w/o activating them ● side effects: tardive dyskinesia (twitching & shaking) ○ positive symptoms ○ are expressed vs. not expressed (negative) ○ don’t know how lithium works ■ influences many neurotransmitter systems in brain ● including glutamate ○ major excitatory neurotransmitter in brain ○ plays role in schizophrenia ○ can be unpleasant & dangerous ■ causes diarrhea, nausea, tremors, cognitive problems, kidney failures, brain damage, adverse cardiac effects ■ amount that can cause harm = amount for effective treatment ● hard to determine effective dosage ○ some people develop tolerance after years of treatment ■ makes drug less effective ■ physicians need to monitor lithium levels carefully w/ regular blood tests ○ Toxicity concerns > physicians favor drugs to treat mania phase ■ including drugs prescribed to prevent convulsions ● either alone or in combination with lithium ● Schizophrenia’s drug treatments ○ drugs > typical first choice for schizophrenia ■ no drugs before 1950s ○ 1952 > Henri Laborit, French physician > discovered phenothiazines ■ Diminished hallucinations, confusion, agitation, and paranoia in people with schizophrenia ■ accidentally discovered after looking for shock reduction method occurring after major surgery ● shock = body doesn’t receive enough blood. tissues deprived of oxygen) ■ block dopamine receptors in brain ■ schizophrenia resulted from dopamine excess in brain ● dopamine hypothesis ■ best known = chlorpromazinne (U.S.: Thorazine) ● haloperidol showed similar effects ■ called traditional antipsychotics ● first medication used to manage psychotic symptoms ○ had many unfortunate unpleasant side effects ■ fatigue, visual impairments, ■ tardive dyskinesia = repetitive involuntary jaw, tongue, face, and mouth movements, body tremors ■ problematic - continue for months after discontinued drug usage ■ newer drug treatments = atypical antipsychotics = don’t have side effects ● i.e. Clozapine ● considered first line of treatment ● preferentially block different type of dopamine receptor than traditional antipsychotics do ○ less likely > tardive dyskinesia ● affects activity of other neurotransmitters in brain ● serotonin excess occurs rarely ○ >tremor, diarrhea, delirium, neuromuscular rigidity, high body temperature ● can unfortunately produce dangerous side effects ○ i.e. Major weight gain, increased diabetes risk, white blood cell reduction, & rarely > particular type cancer ■ Effectiveness ● therapy only as good as effective ● SSRIs = tricyclics ○ both do reasonable job at regulating depression ○ preferable to MAO inhibitors ■ b/c undesirable, dangerous side effects ○ SSRIs = less side effects ■ more long-term tolerance = more long-term use ■ Fluoxetine (prozac) can harm certain neural growth and block synapse formation ● psychological therapies generally more effective & cost-effective ○ based on Romanian study of large, randomized trial where depression scores were measured after/before ○ can take up to 4 weeks to take effect ■ presumably how long synapses take to produce enough new receptor sites > use increased serotonin from SSRIs ○ recent studies show these popular drugs > not as effective as previously thought ■ biased ● i.e. 1/3 FDAstudies - mostly reporting negative results - were unpublished ○ effectiveness was overestimated (94% vs. 51%) ● most widely used prescription antidepressants not much better than placebos ○ for mild/moderate depression ○ beneficial for severe ● lithium still widely used for mania treatment ○ appears to have long-term effectiveness in bipolar disorder treatment ■ Evidence > effectiveness in treating “acute” phases of mania w/ regular usage > weak correlation ○ not superior to anticonvulsant/antipsychotic medications ■ in regular manic episodes ■ fewer toxic side effects than lithium ○ may be most effective > preventing relapse & suicide in bipolar disorder ■ many providers unaware of benefit ● schizophrenia treatment presents huge problem for mental health professionals ○ traditional & atypical antipsychotic drugs work best on positive symptoms ■ i.e. hallucinations and delusions ■ generally less effective on negative symptoms ● such as flattened affect & cognitive confusion characteristic of disorder ■ clozapine (Clorazil) appears to be effective in treating negative symptoms ● also has diabetes side effect ○ major problem = persuading continual drug usage ■ unpleasant/dangerous side effects > patients stop ● 74% people discontinue treatment ○ Glutamate > drives neurotransmitter system in schizophrenia ■ offers hope for development of more effective, less aversive drug therapies for disorder ● ECT = last resort ○ many patients report immediate relief ■ temporary benefits ● lasts as long as treatment is maintained ○ can have serious side effects ■ memory loss & confusion ■ one brain hemisphere treatment = less side effects & works better ○ ECT = pharmacological depression therapy > preventing relapse in people w/ major depressive disorder ■ each form only helped half of those studied ● Prevalent view; make treatment choices based on empirical evidence of efficacy - evidence-based therapies ○ very little research > which psychotherapies work best for various disorders ■ studies reveal > no difference b/t behavioral & psychodynamic therapy ○ people receiving therapy > better off mentally than most who don’t ■ current meta-analyses > continue to show most therapy = effective & few differences exist among general psychotherapy, cognitive-behavioral therapy, and psychodynamic therapy ● called dodo bird verdict ○ “everybody has won, and must have prizes.” ○ psychotherapy works > but kind of therapy one needs doesn’t appear to matter ● doesn’t mean no differences in effectiveness at all ○ usefulness depends on nature of disorder being treated & mental state of health ○ some conditions more responsive to psychological intervention than others ○ psychological disorder < best w/ psychodynamic psychotherapy ○ phobias < behavioral therapy ■ systematic desensitization ■ vivo exposure best for simple phobias, but people more likely to drop out ○ schizophrenia < drug therapy ■ long-term group therapy improves basic life skills of people w/ schizophrenia ■ disordered thinking to the point > difficult to teach them to work with feelings & thoughts in order to change behavior ○ mood disorders < psychological approaches more responsive ● approach needs to be matched carefully w/ disorder ○ length of treatment matters too ■ as therapy continues, effectiveness declines ● potency of treatment wears out after certain point ● or harder-to-treat cases stay in therapy longer ○ cognitive & cognitive-behavioral therapy shown > greatest effectiveness of any psychotherapy > treating various psychological disorders ■ especially effective for depression & anxiety disorders ■ effective as antidepressant > treating severe depression ● studies > fewer risks than drug therapy ○ psychotherapy can change the brain ○ psychosurgical ■ early 20th century physicians > experimented w/ surgery > disrupt brain signal transmissions of people suffering from psychosis ● prefrontal lobotomy = severed connections b/t prefrontal cortex and lower portion of brain ○ prefrontal cortex > thinking, working memory, planning action ○ lower portions of brain > emotion ○ went out of favor after traditional antipsychotic medication introduced ● believed ^ surgery > modify behavior & disengage disruptive thought patterns (Hallucinations & confused thinking included) ○ prefrontal lobotomy > profound personality changes ■ leaves patient listless/subject to seizures/vegetative state ■ i.e. Rosemary Kennedy > tried to treat erratic violent mood swings ● predicted calming effect ● mentally incapacitated in end ○ stared at walls for hours ○ lost ability to speak coherently ■ became widely regarded as inhumane and cruel ■ few, highly constrained forms of brain surgery are occasionally performed ● > last resort if unsuccessful in all treatments otherwise ● ○ electric & magnetic ■ other surgical method to stimulate/decrease brain activation ● electric current > eases psychological suffering ○ as medical practice > goes back to Romans ■ (ECT) Electroconvulsive Therapy: “shock therapy” ● effectively used for severe depression cases in people unresponsive to other therapies ● involves current passing through person’s brain to induce a seizure ○ administered via electrode connection to patient’s head and passing a 60V - 140V current through brain for (1/3 s) to (1/2 s) ■ non-lethal voltage b/c administered to head ■ same voltage to chest > lethal ○ treatment = electroconvulsive ■ b/c procedure = brief seizure including bodily convulsions ■ patients given an anesthetic and muscle relaxant prior to ECT today ● involves > 12 sessions ○ over several weeks ● some report immediate relief of depressive symptoms after treatment ○ scientists don’t fully understand how ECT works to relieve them ● downside > creates permanent memory loss & other cognitive damage b/c it destroys brain tissue ○ using ETC on just 1 side of brain appears to reduce memory loss risk ● comes from observation > people who have seizures become calm after having them ○ thought to be effective schizophrenia treatment ■ research demonstrates > ECT didn’t treat schizophrenia symptoms effectively ● disappeared as viable therapy for years ● resurfaced as treatment for severe depression ■ repetitive transcranial magnetic stimulation: ● particular brain structures > exposed to bursts of high-intensity magnetic fields instead of electricity. ○ not yet clear how magnetic stimulation is optimal and for what length of time ● reserved for people w/ severe depression and unresponsive to other therapies ● some people experience relief ○ preliminary success > treating negative symptoms of schizophrenia ● neurological & psychiatric breakthroughs > development of promising depression treatment ○ has roots in neurosurgery and electrical use to treat psychological disorders ○ psychological ■ psychotherapy ● psychological techniques used > modify maladaptive behaviors/thought patterns ○ help patients develop insight into their own behavior ● Engaged > self-development & psychological disorder treatments ● psychodynamic/psychoanalytic ○ involves talking over problems with psychiatrist ■ therapist + client(s) ■ self-development & psychological disorder treatment ○ psychoanalytic therapy (direct lineage > Freud) ■ original “talk therapy” ● oriented > major personality change w/ focus on uncovering unconscious motives ● especially dream interpretation ● requires 3-5 meetings/week ● classical/Freudian psychoanalysis is currently rare ○ influential today > inspiration for various perspectives in talk therapy ■ many offshoots since ○ psychodynamic therapy ■ offshoot of psychoanalytic therapy ■ focuses on ( symptom relief > major personality change ) ● > emotion & past experiences, how person defends/avoid stressful thoughts/feelings ■ 1-2 meetings/week ● therapist-client relationship = supportive partnership ○ listening in nonjudgmental manner ○ help client >gain insight > unconscious influences behind unwanted behaviors ■ explore unconscious aspects of self/motives ● “Dreams are the royal road to the unconscious” -Freud ● Therapist uses techniques ○ free association ■ >client recounts dream ■ >tries to take one image/idea say what comes to mind regardless of emotion
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