The Biomedical Therapies

Therapies aimed at altering body chemistry.

Drug Therapies

Antipsychotics, Anti-anxiety, 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 tick-like 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 Gamma-aminobutyric 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 mindMyers: Psychology, Ninth EditionCopyright © 2010 by Worth Publishers

Psychosurgery

Psychosurgery

• Psychosurgery was popular even in Neolithic times.

• Although used sparingly today, about 200 such operations do take place in the US alone.

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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.

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.

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)

Psychosurgery

Psychosurgery is used today only as a last resort in alleviating psychological

disturbances. Psychosurgery is irreversible. Removal of brain tissue changes the mind.