Transcript Biological Therapies

Biological Therapies
Helping Professionals Who Can Administer
Biological Therapies
• Medical specialists
– Psychiatrists M.D.
– Neurosurgeon M.D.
• Other Medical Practitioners
– General practitioners M.D.
– Psychiatric nurses (M.S.N. + M.S in
psychopharmacology)
• Clinical psychologists Ph.D./Psy.D. ??
Assumptions of Biological Therapies
• Psychological phenomena are associated with
brain functions
• Psychopathology is associated with
abnormality of brain functions
• Intervention lies in changing brain function
• Easiest way to change brain function is with
drugs
– Influence rather than eliminating neural
connections
– May be reversible
Types of Biological Therapies
• Psychopharmacological
• Psychosurgical
• Other procedures (e.g.
electroconvulsive therapy)
Psychopharmacology:
Side Effects
• As with most biological therapies,
psychoactive drugs have side effects
– Don’t know enough about brain function
– Don’t know enough about mechanics of the drugs
• Main effects, side effects, toxic effects
• “therapeutic window” of psychoactive drugs is
very small
• State of the art for drug therapies is not
“cure”
– Enhancing therapeutic effects
– Minimizing toxic effects
Psychopharmocology: Antipsychotics
• Dopamine receptor blockers
– Based on “the dopamine hypothesis”
• Overactive dopamine systems result in positive symptoms of
schizophrenia
• Dopamine is involved in CNS control of behavioral attention and
activation of movement
• Appears to be a correlation between positive symptoms of
schizophrenia and attention to stimuli most can ignore
– Ongoing internal dialogue
– Aspects of the environment
– Unusual memory events
– Side effects of dopamine receptor blockers
• Tardive dyskinesia (involuntary muscle movement; ex. mouth,
lips, tongue)
• Parkinsonian tremors
Psychopharmacology:
Antidepressants
• 3 major categories
• Similar functions
• Increase synaptic level of
norepinephrine and/or serotonin
– Norepinephrine - ANS functions like
bronchodilation and heart rate; CNS control
of arousal and vigilance
– Serotonin - CNS mechanisms of sleep and
dreaming
Psychopharmacology:
Antidepressants (cont.)
• Tricyclics
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Mechanism is unclear
May sensitize monoamine receptors
Block reuptake of norepinephrine and serotonin after fired
1-6 weeks for antidepressant effects
• MAO Inhibitors
– Prevent the breakdown of neurotransmitters
– Keeps more around for uptake
– Dangerous interaction with tyramine (natural enzyme)
• Selective Serotonin Reuptake Inhibitors
(SSRI’s)
– Blocks reuptake of serotonin; more serotonin available
– Not so selective
– Associated with increased sleep and sexual difficulties
Next Generations of Antidepressants
• Wellbutrin
– Increases norepinephrine in synaptic cleft
– Reduces incidence of sexual dysfunction found in
SSRI’s
– May cause seizures
• Desyrel
– Counteracts some of the sleep difficulties found in
SSRI’s
– May cause constant erection
• Serzone
– Decreased sleep and sexual dysfunctions
– Other toxic effects unknown yet
Alternative Treatment for Mood
Disorders
• For Seasonal Affective Disorder (SAD) Light therapy
• For SAD - Melatonin
• For Dysthymia – St. John’s Wort (herb)
Psychopharmacology: Anxiety
• Anxiolytics
– Based on the assumption that anxiety disorders
are the result of excessive activity in neural
circuits of anxiety response/vigilance
– Too much GABA (Gamma Amino Butyric Acid)
• The central nervous system’s primary inhibitory
neurotransmitter; keeps general levels of neural activity
“in check”
– Benzodiazapines
– SSRI’s
– Buspirone
Psychopharmacology:
Psychostimulants
• Ritalin, Cylert, Dexedrine
• Used in the treatment of ADHD
• Stimulates the part of the brain that
selectively attends
Combined Therapies
• Debate is still on about whether
psychotherapy alone may be effective and in
the treatment of what disorders
• Many studies are showing that combination of
psychotherapy and pharmacological therapy
is more effective that drugs alone
• Meds used alone primarily for insurance
reasons
Psychosurgery
• “Frontal lobotomy” has been replaced
with more precise targeting of specific
areas of the brain
– Ex. Cingulotomy
• Disconnects the cingulate gyrus of the frontal
lobe from the limbic areas of the temporal lobe
• Still very controversial
• Only used as experimental treatment for severe
OCD that doesn’t respond to behavioral and
drug therapies
Other Biological Procedures
• Electroconvulsive therapy (ECT)
– Used to be known as shock treatment
– Administered only as last resort; only in severe,
unrelenting major depression unresponsive to
other therapies
– Treatment mechanics have improved; still unclear
about the mechanics of how it works
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Generally increases neurotransmitter turnover
Requires several treatments to influence symptoms
Side effects include memory loss
Recent experimentation with unilateral ECT suggests that
memory loss difficulties may be ameliorated with
continuing sophistication in the administration of ECT