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Abnormality: Biological treatments AS
- 2. Objectives • Understand the treatments that the Biological Approach uses to treat abnormal behaviour • Evaluate the treatments in terms of their effectiveness
- 3. • Brain injury • Infection • Neurotransmitters • Genetics Think BING !
- 5. Drugs • Some mental disturbances are associated with too much........ • or too little of a neurotransmitter.
- 6. Drugs • Neurotransmitters in the body help messages from your brain jump the gap between your nerve cells to travel to where they need to get to.
- 7. Drug TreatmentsDrug Treatments • There are four main groups toThere are four main groups to treat mental abnormality:treat mental abnormality: 1.1. Anti-depressantsAnti-depressants 2.2. Anti-anxiety (benzodiazepines)Anti-anxiety (benzodiazepines) 3.3. Anti-psychoticsAnti-psychotics 4.4. Anti-manicsAnti-manics
- 9. • One of the factors involved in schizophrenia is an excessive amount of dopamine • Too little serotonin is associated with depression and some anxiety disorders, especially obsessive- compulsive disorder. • Too little GABA is associated with anxiety and anxiety disorders Too much or too little of a particular neurotransmitter can lead to psychopathology
- 10. How do Anti-DepressantsHow do Anti-Depressants work?work? SSRI selective serotonin reuptake inhibitor
- 12. Do anti depressants work?Do anti depressants work? • 50-65%50-65% of patients given anof patients given an SSRI for three monthsSSRI for three months showed signs ofshowed signs of improvement in testsimprovement in tests • HOWEVER the other test groupHOWEVER the other test group were given awere given a PLACEBOPLACEBO (pretend drug) and this group(pretend drug) and this group showed ashowed a 25-30%25-30% improvementimprovement
- 13. Are there any issues withAre there any issues with SSRIs?SSRIs? • Side effectsSide effects = range from dry mouth to= range from dry mouth to suicidal thoughts (prozac)suicidal thoughts (prozac) • Not addictiveNot addictive …BUT person…BUT person can become psychologicallycan become psychologically dependentdependent on themon them
- 14. Do anti-anxiety drugs work?Do anti-anxiety drugs work? • 70% success rate for panic disorders70% success rate for panic disorders BUT highly addictive!BUT highly addictive!
- 15. Do anti-psychotic drugsDo anti-psychotic drugs work?work? • 60%60% success rate for symptoms ofsuccess rate for symptoms of hallucinationshallucinations and psychoticand psychotic episodesepisodes • BUT no effect on theBUT no effect on the symptoms ofsymptoms of socialsocial withdrawalwithdrawal • HOWEVER, they areHOWEVER, they are thethe onlyonly drugs thatdrugs that appear to work forappear to work for schizophreniaschizophrenia
- 16. Do anti-manic drugs work?Do anti-manic drugs work? Prior to the introduction of lithium carbonate,Prior to the introduction of lithium carbonate, there was athere was a 15% suicide rate15% suicide rate amongst peopleamongst people with bi-polar disorder.with bi-polar disorder. The drugs significantly reduced that rate.The drugs significantly reduced that rate. Success rate ofSuccess rate of 80%80% BUT many sufferersBUT many sufferers refuse to takerefuse to take thethe drug because it leaves them feeling ‘flat’drug because it leaves them feeling ‘flat’ Gitlin’s five year study found aGitlin’s five year study found a 70% relapse rate70% relapse rate
- 17. ECT • Electro Convulsive Therapy – Used when drugs fail to treat depressive disorders – Approximately 22,000 people receive in UK per year – Patient is given muscle relaxant and anaesthetic – 110mv shock to brain – causes seizure for 1 minute. 5-10 mins later the patient regains consciousness
- 19. ELECTRO-CONVULSIVE THERAPY (ECT)ELECTRO-CONVULSIVE THERAPY (ECT) • Used to treat severe depression • Modern techniques involve a mildModern techniques involve a mild current of between 70-130 volts,current of between 70-130 volts, whilst patient is under anaestheticwhilst patient is under anaesthetic and a muscle relaxant. Fewer spasmsand a muscle relaxant. Fewer spasms occur and the patient is at less risk ofoccur and the patient is at less risk of harmharm • Typically patients receive 6-9Typically patients receive 6-9 treatments over a monthtreatments over a month
- 20. Side effects of ECTSide effects of ECT • Memory loss in at least 1/3 ofMemory loss in at least 1/3 of patients, sometimes long term.patients, sometimes long term. • Cardiovascular change (e.g. irregularCardiovascular change (e.g. irregular heartbeat)heartbeat) • HeadachesHeadaches • EEG studies have shown generalEEG studies have shown general slowing of brain patterns followingslowing of brain patterns following ECT, which takes weeks to return toECT, which takes weeks to return to normalnormal • Dept of Health found 30% ECTDept of Health found 30% ECT patients suffered fear and anxietypatients suffered fear and anxiety following ECTfollowing ECT
- 21. Is it an appropriate treatment?Is it an appropriate treatment? • Doctors have little idea of WHY itDoctors have little idea of WHY it works, just because it works doesworks, just because it works does that make it appropriate?that make it appropriate? • However, it is quick compared withHowever, it is quick compared with drug therapy and sometimes mightdrug therapy and sometimes might be the only option if patients failsbe the only option if patients fails to respond to other treatments.to respond to other treatments.
- 22. Ethical Issues?Ethical Issues? • Dept of Health checked 700Dept of Health checked 700 patients who had beenpatients who had been ‘sectioned’. 59% had not‘sectioned’. 59% had not consented to treatmentconsented to treatment • Even where consent isEven where consent is obtained, is it fully informed?obtained, is it fully informed? Do patients know all of theDo patients know all of the side-effects?side-effects?
- 23. Is there a safer alternative?Is there a safer alternative? • Repetitive transcranial magneticRepetitive transcranial magnetic stimulation (rTMS)stimulation (rTMS) • Involves passing high intensityInvolves passing high intensity magnetic pulses through themagnetic pulses through the skullskull • Focuses on regions of the brainFocuses on regions of the brain which have been associatedwhich have been associated with depressionwith depression • Shows fewer side effects and isShows fewer side effects and is as effective as ECTas effective as ECT
- 26. Surgery • The final and most drastic treatment for abnormal behaviour in the Biological approach is brain surgery • Areas of the brain thought to be responsible for the behaviour are partially or completely removed.
- 27. Trepanning • In the Neolithic times, 40,000 years ago, man performed skull surgery. • This surgery, called trepanning was probably carried out to "liberate" demons and bad spirits which the ancient doctors believed were responsible for madness and brain disease. • Many skulls have signs of the skull structure healing; suggesting that those subjected to the surgery could and did survive.
- 28. Lobotomy • A leukotomy refers to what is now more commonly known as a prefrontal lobotomy. • The first human leukotomy was performed by Antonio Egas Moniz in 1936. He won the Nobel Prize for medicine in 1949 for this work. • The procedure was popularized in the US by Dr. Walter Freeman, who travelled the country performing "ice pick lobotomies" on patients with psychiatric disorders. • Eventually he began performing this procedure on anyone who wished to have one . Lobotomy: the severing of the connection between the frontal cortex and the lower parts of the brain. Prefrontal lobotomy: drilling two holes in the skull and inserting an instrument that severs nerves in the brain. Cingulotomy: an incision is made in the nerves of the brain and a MRI (Magnetic Resonance Imaging) scan aids the guidance of surgical instruments.
- 29. What is psychosurgery? • The systematic damage of the brain in order to change behaviour. • The mode of action involves the cutting of neural tissue in the brain and was designed to alter the symptoms of severe psychological disorders. • Psychosurgery is a treatment of last resort. "She is with me in body but her soul is in some way lost. The deeper feelings, the tenderness, are gone. She is hard, somehow."
- 31. Studies of Psychosurgery • As recently as the 1990s, psychosurgery was reported to be beneficial in some cases of severe anxiety, depression and obsessive- compulsive disorders (Beck and Cowley, 1990). • Another key advantage is that psychosurgical techniques reduce the risk of suicide in severe depression from 15 percent to one percent (Verkaik, 1995). • But psychosurgery produces inconsistent outcomes. Behaviour change occurs in some individuals and not in others, so it is difficult to predict who will be affected and how. • The main ethical problem with psychosurgery is that the procedures are irreversible because neural tissue has been destroyed.
- 32. Surgery XNo evidence it improved specific symptoms, just made the patient more manageable. XMajor ethical issues: irreversible procedure and unpredictable consequences. XCan the person with the disorder really give fully informed consent?
Notes de l'éditeur
- Brain injury – hitting the head might cause psychological disorders – people who knock their heads might become ‘different people’ afterwards Infection – infections such as syphilis can cause mental disorder type symptoms... Neurotransmitters – too much or too little of a neurotransmitter might produce disorders – high levels of dopamine are linked to schizophrenia Faulty genes might cause some diseases that have psychological effects e.g. Huntington’s disease leads to a wearing away of mental abilities
- If you are diagnosed with a psychological disorder, most likely that you will be treated with one of the many available drugs for psychological disorders. In last 50 years there has been an explosion of drugs targeted at psychological disorders.
- Neurotransmitters have been studied quite a bit in relation to psychology and human behavior. What we have found is that several neurotransmitters play a role in the way we behave, learn, the way we feel, and sleep. And, some play a role in mental illnesses. The following are those neurotransmitters which play a significant role in our mental health. Dopamine – correlated with movement, attention, and learning § Too much dopamine has been associated with schizophrenia, and too little is associated with some forms of depression as well as the muscular rigidity and tremors found in Parkinson’s disease. Drugs like cocaine increase dopamine levels and can induce schizophrenia –like symptoms. Serotonin – plays a role in mood, sleep, appetite, and impulsive and aggressive behavior § Too little serotonin is associated with depression and some anxiety disorders, especially obsessive-compulsive disorder. Some antidepressant medications increase the availability of serotonin at the receptor sites. GABA (Gamma-Amino Butyric Acid) – inhibits excitation and anxiety § Too little GABA is associated with anxiety and anxiety disorders. Some anti-anxiety medication increases GABA at the receptor sites.
- SSRI – selective serotonin reuptake inhibitor e.g. Prozac Selectively raise levels of serotonin. A depressive disorder is believed to be caused by a chemical imbalance in the brain. Messages are passed between two neurons (nerve cells) via a synapse, or small gap between the cells. The neuron sending the information releases neurotransmitters (including serotonin) into that gap. These neurotransmitters are recognized by receptors on the surface of the recipient cell, which relays the signal. Approximately 10% of the neurotransmitters are lost in this process, with the other 90% released from the receptors and taken up again by monoamine transporters (the reuptake process). Depression has been associated with a lack of stimulation of the recipient neuron at a synapse. To stimulate this cell, SSRIs block the reuptake of serotonin. As a result, it stays in the synaptic gap longer than it would normally, and has the chance to be recognized again (and again) by the receptors of the recipient cell, which can be fully stimulated. Normally, several weeks of continuous SSRI use are necessary for the antidepressant effects to fully manifest themselves. This delay is due to a side-effect of the initially high levels of serotonin within the synaptic gap. The body must first adapt to high levels of serotonin by down-regulating the sensitivity of the receptors, which can take up to 3 weeks.
- Benzodiazepines, ‘Benzos’ e.g. Valium, Temazepam, Xanax, Rohypnol Reduce anxiety by reducing arousal in the nervous system and acting as a muscle relaxant. A kind of sedative. Need a progressively higher dose in order to get the same effect. THERAPEUTIC ACTIONS OF BENZODIAZEPINES (IN SHORT-TERM USE) In short-term use, benzodiazepines can be valuable, sometimes even life-saving, across a wide range of clinical conditions. Nearly all the disadvantages of benzodiazepines result from long-term use (regular use for more than a few weeks). The UK Committee on Safety of Medicines in 1988 recommended that benzodiazepines should in general be reserved for short-term use (2-4 weeks only). Mechanisms of action. Anyone struggling to get off their benzodiazepines will be aware that the drugs have profound effects on the mind and body apart from the therapeutic actions. Directly or indirectly, benzodiazepines in fact influence almost every aspect of brain function. For those interested to know how and why, a short explanation follows of the mechanisms through which benzodiazepines are able to exert such widespread effects. All benzodiazepines act by enhancing the actions of a natural brain chemical, GABA (gamma-aminobutyric acid). GABA is a neurotransmitter, an agent which transmits messages from one brain cell (neuron) to another. The message that GABA transmits is an inhibitory one: it tells the neurons that it contacts to slow down or stop firing. Since about 40% of the millions of neurons all over the brain respond to GABA, this means that GABA has a general quietening influence on the brain: it is in some ways the body's natural hypnotic and tranquilliser. This natural action of GABA is augmented by benzodiazepines which thus exert an extra (often excessive) inhibitory influence on neurons (Fig. 1).
- Tranquilizer/sedative, reduce delusions and hallucinations What are antipsychotic medications? They are a range of medications that are used for some types of mental distress or disorder - mainly schizophrenia and manic depression (bipolar disorder ). They can also be used to help severe anxiety or depression . What can they help with? The experience of hearing voices (hallucinations). Ideas that distress you and don't seem to be based in reality (delusions). Difficulty in thinking clearly (thought disorder). The extreme mood swings of manic depression/bipolar disorder. How do they work? They all affect the action of a number of chemicals in the brain called neurotransmitters – chemicals which brain cells need to communicate with each other. Dopamine is the main neurotransmitter affected by these medications. If parts of the dopamine system become overactive, they seem to play a part in producing hallucinations, delusions and thought disorder. The drugs block the receptors for dopamine
- The medication used most often over the years to combat a manic "high" is lithium. Lithium is a very effective mood stabilizer It is unusual to find mania without a subsequent or preceding period of depression. Lithium evens out mood swings in both directions, so that it is used not just for acute manic attacks or flare-ups of the illness, but also as an ongoing treatment of bipolar disorder. Lithium can cause several side effects, and some of them may become serious. They include: Loss of coordination Excessive thirst Frequent urination Blackouts Seizures Slurred speech Fast, slow, irregular, or pounding heartbeat Hallucinations (seeing things or hearing voices that do not exist) Changes in vision Itching, rash Swelling of the eyes, face, lips, tongue, throat, hands, feet, ankles, or lower legs.
- Pg 12 of booklets
- ECT only recommended for patients with severe depression, resistant to other treatments. Indivs with depression may not fully grasp the nature and consequences of ECT and so cannot give fully informed consent.
- Repetitive transcranial magnetic stimulation induces remission in patients with treatment-resistant depression 4. May 2010 03:23 Daily transcranial magnetic stimulation—an intervention that uses magnetic currents to activate certain brain areas—appears to help induce remission in patients with treatment-resistant depression, according to a report in the May issue of Archives of General Psychiatry , one of the JAMA/Archives journals. Major depression is common, disabling and expensive, and more effective treatments are needed, according to background information in the article. Some patients experience little or no improvement after medication, psychotherapy or both. Transcranial magnetic stimulation has shown potential as a depression treatment, but there is concern regarding the quality of existing research. Mark S. George, M.D., of the Medical University of South Carolina, Charleston, and colleagues conducted a randomized controlled trial of repetitive transcranial magnetic stimulation among 190 patients with depression who were not taking medication. Of these, 92 were randomly assigned to receive the intervention, which involved stimulating the left prefrontal cortex with an electromagnetic coil for 37.5 minutes daily for three weeks. The other 98 received a sham treatment that mimicked the sensory experience of stimulation using a similar coil and scalp electrodes but with the magnetic field blocked. A total of 90 percent of patients in the sham group and 86 percent in the treatment group completed the study. Among these, depression remitted in 14.1 percent in the transcranial magnetic stimulation group, compared with 5.1 percent in the sham group. The odds of achieving remission were 4.2 times greater in the active treatment group. "One of the most important aspects of the study was ensuring that no one who knew the randomization status of the patient ever came in contact with the patient or interacted with the data," the authors write. "We developed a new active sham transcranial magnetic stimulation system that simulated the repetitive transcranial magnetic stimulation somatosensory experience and effectively masked the patients, the raters and, to a large extent, the treaters." At the end of the treatment phase, patients, treaters and clinical raters were asked to guess whether they were in the active or treatment group. Only treaters were able to guess at a rate more accurate than chance, and they were not very confident of their responses. The researchers calculated that for every 12 patients treated with transcranial magnetic stimulation, one would remit from depression. Most remissions occurred among individuals with low antidepressant treatment resistance. "The results of this study suggest that prefrontal repetitive transcranial magnetic stimulation is a monotherapy with few adverse effects and significant antidepressant effects for unipolar depressed patients who do not respond to medications or who cannot tolerate them," the authors conclude. SOURCE Archives of General Psychiatry
- The practice of trepanning didn’t die out with Neanderthals, it was widely used across the entire planet right up until 18C-19C. Indeed, it is still used today, though it is not recognised as a medical procedure to treat any kind of ailment, and those performing at largely doing so in a DIY manner – believing all kinds of benefits, from increase of blood circulation, altered state of consciousness (like drugs), or relief from depression.
- Frontal lobotomy used in 40s and 50s, particularly for patients with schizophrenia. Ice pick lobotomy – inserting a scalpel into a hole drilled through the skull and waggling it up and down. Quite literally.
- Psychosurgery is a treatment of last resort, used only in extreme cases when other treatment methods have failed and where, because of the disorder, the person is likely to cause harm to themselves or others.