Transcript The Biomedical Therapies

THE BIOMEDICAL
THERAPIES
Therapies aimed at altering
body chemistry.
DRUG THERAPIES
Antipsychotics, Antianxiety, Antidepressants,
and Mood-Stabilizing
Medications
DRUG THERAPIES
With the advent of drugs, hospitalization in mental
institutions has rapidly declined.
However, many patients are left homeless on the streets
due to their ill-preparedness to cope independently out
in society.
PSYCHOPHARMACOLOGY
Psychopharmacology is the study of the effects of drugs on
mind and behavior.
Psychopharmatherapy is the treatment of mental disorders with
medication…drug therapy.
Drugs used to treat psychological disorders fall into 3 major
categories:
 Antipsychotic
 Anti-anxiety
 Antidepressant
 (Mood stabilizers do not fit well into any of these categories, but they are very important drugs in the treatment of bipolar
disorder.)
TESTING NEW DRUGS
When a new drug is released, there is always too much
enthusiasm.
New drugs must be tested using a double-blind
procedure to combat placebo and experimental
effects.
 Double blind – To test the effectiveness of a drug, patients are
tested with the drug and a placebo.
 Two groups of patients and medical health professionals are
unaware of who is taking the drug and who is taking the
placebo.
ANTIPSYCHOTIC DRUGS
Antipsychotic drugs (like Thorazine, Mellaril, and Haldol)
are used to gradually reduce psychotic symptoms,
including hyperactivity, mental confusion,
hallucinations, and delusions.
 Antipsychotic drugs appear to decrease activity at dopamine
synapses
 Sometimes producing unfortunate side-effects such as symptoms
of Parkinson’s disease and tardive dyskinesia, an incurable
neurological disorder marked by involuntary writhing and ticklike movements of the mouth, tongue, face, hands, or feet.
ANTI-ANXIETY DRUGS
Antianxiety drugs depress the
central nervous system and reduce
anxiety, apprehension,
nervousness, and tension by
elevating the levels of the Gammaaminobutyric acid (GABA)
neurotransmitter.
 Includes drugs like Valium, Xanax, Buspar,
Librium, and Ativan
Most widely abused drugs.
ANTIDEPRESSANT DRUGS
Antidepressants gradually elevate mood and help
bring people out of a depression. They improve the
mood by elevating levels of serotonin
Figure 15.12: Antidepressant
drugs’ mechanisms of action.
The three types of antidepressant
drugs all increase activity at serotonin
synapses, which is probably the
principal basis for their therapeutic
effects. However, they increase
serotonin activity in different ways,
with different spillover effects
(Marangell et al. 1999). Tricyclics and
MAO inhibitors have effects at a
much greater variety of synapses,
which presumably explains why they
have more side effects. The more
recently developed SSRIs are more
specific in targeting serotonin
synapses.
MOOD-STABILIZING
MEDICATIONS
Lithium Carbonate, a common salt, has been used to stabilize manic
episodes in bipolar disorders.
 It moderates the levels of norepinephrine and glutamate neurotransmitters.
It is very successful at preventing future episodes of mania and
depression, but it can be toxic and requires careful monitoring.
BRAIN STIMULATION
Electroconvulsive Therapy
and Repetitive Transcranial
Magnetic Stimulation
ELECTROCONVULSIVE THERAPY (ECT)
Electroconvulsive therapy (ECT) is a
biomedical treatment in which electric
shock is used to produce a cortical
seizure accompanied by convulsions.
ECT is used for severely depressed
patients who do not respond to drugs.
The patient is anesthetized and given a
muscle relaxant. Patients usually get a
100 volt shock that relieves them of
depression.
 While the use of ECT peaked in the ‘40s and
‘50s, there has been a recent resurgence in this
therapy.
Video: http://www.youtube.com/watch?v=9L2-B-aluCE
http://www.youtube.com/watch?v=TvXlxW-JP6Y
ALTERNATIVES TO ECT
Repetitive Transcranial
Magnetic Stimulation
(rTMS)
In rTMS, a pulsating
magnetic coil is placed
over prefrontal regions
of the brain to treat
depression with
minimal side effects.
Figure 15.8 Magnets for the mind
Myers: Psychology, Ninth Edition
Copyright © 2010 by Worth Publishers
PSYCHOSURGERY
PSYCHOSURGERY
• Psychosurgery was
popular even in
Neolithic times.
http://www.epub.org.br
• Although used
sparingly today, about
200 such operations
do take place in the
US alone.
PSYCHOSURGERY
Surgery that removes or destroys brain
tissue in an effort to change behavior.
Antônio Egas Moniz (1874-1955) of
Portugal developed the lobotomy
(previously known as a prefrontal
leucotomy) in the 1930s. He was also
responsible for coining the term
psychosurgery.
The procedure involved drilling holes in the
patient's head and destroying tissue in the
frontal lobes by injecting alcohol.
He later changed technique, using a surgical
instrument called a leucotome that cut brain
tissue by rotating a retractable wire loop.
Advertisement for a
Leucotome in the 1940's
“THE LOBOTOMIST”
Walter Freeman, and American neurologist and psychiatrist,
was inspired by Muniz’s work and began performing his own
lobotomies.
However, Freeman wanted to simplify the procedure so that it
could be carried out by psychiatrists in mental asylums, which
housed roughly 600,000 American inpatients at the time.
Roughly modeling the work of an Italian psychiatrist (Amarro
Fiamberti), Freeman decided to enter the frontal lobes
through the eye sockets instead of through drilled holes in the
skull.
In 1945, he took an icepick from his own kitchen and began
testing the idea on grapefruit and cadavers. This new
"transorbital" lobotomy involved lifting the upper eyelid and
placing the point of a thin surgical instrument under the eyelid
and against the top of the eyesocket. A mallet was used to
drive the leucotome through the thin layer of bone and into
the brain. The leucotome was then swept from side to side,
thus severing the nerve fibers connecting the frontal lobes to
the thalamus. The leucotome was then withdrawn and the
procedure repeated on the other side.
An early advertisement from the
American Journal of Psychiatry
promoting transorbital lobotomy.
Watch The Lobtomist, a documentary about Walter
Freeman and his procedures on PBS here:
http://www.pbs.org/wgbh/amex/lobotomist/program/.
(Watch “Production Line Lobotomies” and “Howard Dully’s
Story” in particular)
Rosemary Kennedy before she
was lobotomized by Freeman at
age 23. Her father sought the
lobotomy to cure what he called
“moodiness,” fits of irritability
and rebelliousness. He might
also have been afraid that she
might embarrass the family by
becoming pregnant out of
wedlock during one of her many
escapes from the convent
where she was being educated
and “cared for.” After the
lobotomy, Rosemary was
reduced to an infantile state and
needed constant care.
PSYCHOSURGERY
Psychosurgery is used today only as a last resort in
alleviating psychological disturbances.
Psychosurgery is irreversible. Removal of brain
tissue changes the mind.