Transcript February 16, Biological Theories Cont`d

TREATMENT
• BEFORE LOBOTOMY, ECT (SHOCK),
COMA - NOW DRUGS
• CHANGE NEUROCHEMISTRY OF
BRAIN
• CHANGE WHAT RECEPTORS ABSORB
SO ELEVATE OR LOWER LEVELS OF
NEUROTRANSMITTERS IN SYNAPSES
TREATMENTS
• ANTI-PSYCHOTICS
• LITHIUM FOR BIPOLAR
• PHENOTHIAZINES AND CLOZAPINE
FOR SCHIZOPHRENIA
• ILLNESS SPECIFIC
SSRI’S
• SELECTIVE SEROTONIN REUPTAKE
INHIBITORS - PROZAC, PAXIL,
XOLOFT (LATE 1980’S)
SSRI’S
• UNLIKE OLDER DRUGS,
SPECIFICALLY DESIGNED TO
PREVENT REUPTAKE OF SEROTONIN
• NOT ILLNESS SPECIFIC (NOT “ANTIDEPRESSANTS”)
Psychotropic Prescribing in USA
(IMS - S Units)
10000000
9000000
8000000
7000000
6000000
5000000
4000000
3000000
2000000
1000000
0
Antidepressant
Antipsychotic
1990 1992 1994 1996 1998 2000 2001
HUGE GROWTH
• 10% OF ADULT POPULATION NOW
TAKING AN SSRI
• 3 OF 7 BEST SELLING PRESCRIPTION
DRUGS OF ANY KIND ARE SSRI’s
• 300% INCREASE IN PAST 10 YEARS IN
NUMBER OF CHILDREN AND
ADOLESCENTS TAKING MEDICATION
ARE SSRI’S BETTER?
• NOT MORE EFFECTIVE THAN OLDER
DRUGS
• FEWER NEGATIVE SIDE EFFECTS
• NOT ADDICTING
• LESS RISK OF OVERDOSE
? ABOUT SSRI’S
• NOT MUCH BETTER THAN PLACEBOS
FOR LESS SEVERE CONDITIONS
• LONG-TERM EFFECTS?
• ONLY ELIMINATE SYMPTOMS, NOT
UNDERLYING PROBLEM?
• BETTER ALTERNATIVES?
• NOT GOOD FOR UNDER AGE 18?
STRENGTHS OF BIOLOGY
• BEST FOR PSYCHOTIC DISORDERS
• MORE KNOWLEDGE ABOUT BRAIN
• ADVANCES IN DRUG TREATMENTS
FOR MANY CONDITIONS
1. OVERSTATEMENTS
• MOST CONVINCING FOR PSYCHOSES
• LESS EVIDENCE FOR OTHERS
• ARE BRAIN STATES CAUSES OR
EFFECTS OF M.I.?
• CAUSES CAN BE SOCIAL OR PSYCH
AS WELL AS BIOLOGICAL
2. GENES NOT DESTINY
• ONLY A MINORITY OF PEOPLE WITH
GENETIC SUSCEPTIBILITY DEVELOP
DISORDER
• OFTEN NEED ENVIRONMENTAL
PRECIPITANT
• ENVIRONMENT CAN SUPPRESS MORMONS AND ALCOHOLISM
3. WHAT DOES A GENE DO?
• DIFFERENCE OF GENOTYPE AND
PHENOTYPE (APPEARANCE)
• CULTURE CAN SHAPE PHENOTYPE
• E.G. ANOREXIA
• GENES MAY HAVE GENERAL, NOT
SPECIFIC, EFFECTS
4. MOST M.I. NOT GENETIC
• MOST PEOPLE WHO GET A DISORDER
DO NOT HAVE GENETIC PROPENSITY
TO THE DISORDER
SCHIZ. IN DENMARK
• THOSE WITH 1ST DEGREE RELATIVES
HAVE 10x RATE OF SCHIZ
• BUT 90% OF PEOPLE WHO DO GET
SCHIZ DON’T HAVE SCHIZ
RELATIVES
• FAR MORE PEOPLE HAVE NO FAMILY
HISTORY OF SCHIZ SO DESPITE
LOWER % PRODUCE MORE CASES
CONCLUSION
• GENES AND BRAINS ARE IMPORTANT
• BUT, FAR FROM THE ENTIRE STORY
• AT PRESENT, INFLUENCE IS
OVERSTATED