Transcript Types of Treatment

Types of Treatment
Biological Treatment
Drug Therapies:
Schizophrenia
Pre-Drug Therapy
• Prior to the discovery of
psychological drugs, hospitals had
few options with which to treat
patients
• Most early treatment techniques are
today considered archaic and
sometimes cruel
Post-Drug Therapy
• With the discovery of effective drug
treatments, patients were able to leave
the institutions
(deinstitutionalization).
Deinstitutionalization
• The release of patients from mental
hospitals to the community at large
• The development of drug therapies led to
an 80% decline in the number of
hospitalized mental patients from 1950 to
2000.
• Many of the former patients became part
of the homeless population.
Biomedical Therapies
• Widespread
use of
antipsychotic
medications
began in the
mid-1950’s
• Can be related
to number of
patients in
mental hospitals
Drug Therapies:
Antipsychotic Drugs
Antipsychotic Drugs
• A category of medications used primarily
to treat schizophrenia
• Reduces the levels of hallucinations and
delusions and distorted thinking
• Drugs work primarily by blocking the
activity of dopamine
• 2 Types: Typical and Atypical
Typical Antipsychotic Medications
• Typical antipsychotics (Thorazine)
– Effective against positive symptoms of
schizophrenia
– Have uncomfortable side effects
– Globally reduce brain dopamine levels
• Side effects include: dry mouth, blurred vision,
constipation, and tardive dyskinesia
• Tardive dyskinesia – a permanent condition of
muscle tremors Thorazine
• One of the first antipsychotic drugs
Schizophrenia Drug Therapy
• Insert “Schizophrenia” Video #34 from
Worth’s Digital Media Archive for
Psychology. (5:15)
• How does Augustine’s behavior change
after 4 weeks on medication?
Click HERE to view in a
separate window (5 min).
Shorter version: Effectiveness
of these drugs with a
schizophrenic (2 min)
Drawbacks of Antipsychotic
Medications
• The early antipsychotics didn’t actually cure
schizophrenia; psychotic symptoms often returned if a
person stopped taking the medication
• They were not effective in eliminating the negative
symptoms of schizophrenia
• They often produced unwanted side effects
• They globally altered brain levels of dopamine,
sometimes producing motor-related side effects; longterm use can cause tardive dyskinesia
• Patients go through a “revolving door” pattern of
hospitalization, discharge, and rehospitalization
• View some of the Drawbacks of Antipsychotic Drugs (1
min)
Atypical Antipsychotic Medications
• Newer drugs that may also be effective against
negative symptoms of schizophrenia
• Affect levels of serotonin as well as dopamine
• Much less likely to cause movement-related
side effects because they block dopamine
brain receptors far more selectively
• Produce (sometimes dramatic) improvement
in a significant proportion of patients who
have not responded to traditional
antipsychotic drugs
Drug Therapies:
Antidepressant Drugs
Antidepressant Drugs
• A category of medications used primarily to
treat major depression
• Work by influencing levels of serotonin in the
brain
• Many take about a month before they become
fully effective
• 2 classes of drugs called tricyclics and
MAO inhibitors
Tricyclics and MAO inhibitors
• Affect multiple neurotransmitter pathways
in the brain and work by increasing the
availability of noradrenaline and serotonin
• Effective for about 75% of patients
• Produce troubling side effects
– MAO inhibitors can lead to dangerously high
blood pressure, leading to stroke or even
death if people who are taking them consume
foods with a chemical found in cheese,
smoked meats, and red wine
– Tricyclics caused weight gain, dry mouth,
dizziness, sedation
Selective Serotonin Reuptake Inhibitors
• Classification of antidepressants which work by blocking
the reuptake of serotonin after it has been released
• Includes: Prozac, Zoloft, and Paxil
• No more effective than the older antidepressants
• Produce fewer, and milder, side effects
• Effexor, a dual reuptake inhibitor, affects levels of both
serotonin and norepinephrine.
– seems to be more effective than SSRIs in alleviating the
symptoms of depression
Electroconvulsive
Therapy
Insulin Therapy
• Depressed patients are given an overdose
of insulin to cause a convulsion.
• Difficulties in determining the proper
dosage of insulin led to a decline in use of
this therapy.
• Was replaced by Electroconvulsive
Therapy (ECT)
Electroconvulsive Therapy
• Used for severe depression
• Very effective for quick relief of symptoms
of severe depression (can be used until
medication begins to work)
• May have cognitive side effects such as
memory loss
• Very controversial treatment
ECT Facts
• Used when antidepressants fail
• About 100,000 patients a year receive ECT
• A series of 6 to 10 ECT treatments are
usually spaced over a few weeks
• Most (80%) patients report improvement
• Typically relieves symptoms within days but
benefits only last for a short time.
• Side effect is temporary or permanent memory
loss for the events leading up to the treatment
• How and why the process works is unknown
ECT
Electroconvulsive Therapy
• Insert “Electroconvulsive Therapy” Video
#37 from Worth’s Digital Media Archive
for Psychology. (5:05)
Click HERE to view
video in separate
window.
Drug Therapies:
Bipolar Disorder Drugs
Lithium
• Used to treat bipolar disorder (manic-depression)
• Used to interrupt acute manic attacks and prevent relapse
• Stabilizes the availability of glutamate within a
narrow, normal range, preventing both abnormal
highs and abnormal lows
• Very narrow difference between the therapeutic
dosage level and the toxic dosage level, requiring
careful monitoring of the patient’s lithium blood level
• Bipolar disorder can also be treated with an
anticonvulsant medicine called Depakote. It is useful
for treating patients who do not respond to lithium
and patients who rapidly cycle through bouts of
bipolar disorder several times a year
Depression & Mania
Patients and doctors talk about the experience and treatment of mania
and depression, emphasizing the importance of both medication and
psychotherapy. An animation segment illustrates what happens at the
brain synapses in people with depression and mania. (11:44)
Click HERE to view
video or on the screen
to the right.
Drug Therapies:
Antianxiety Drugs
Antianxiety Drugs:
Benzodiazepines
• A category of medication used to treat people
with anxiety disorders or suffering stress
• Include: Valium, Librium, and Xanax
• Take effect quickly, usually within an hour.
• Work by boosting levels of the neurotransmitter
GABA - a neurotransmitter that inhibits the
transmission of nerve impulses in the brain
and slows brain activity
• Can produce dependency, decreased
coordination, slow reaction time, decreased
alertness
• Can cause death if mixed with alcohol
Antianxiety medications:
Non-benzodiazepine—(Buspar)
• Believed to affect brain dopamine and
serotonin levels
• Relieves anxiety while maintaining
normal alertness; it does not cause the
drowsiness, sedation, and cognitive
impairment associated with the
benzodiazepines
• May take 2-3 weeks to work