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• Understand the treatments that the Biological
Approach uses to treat abnormal behaviour
• Evaluate the treatments in terms of their
• Brain injury
• Some mental disturbances are
associated with too
• or too little of a neurotransmitter.
• 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.
Drug TreatmentsDrug Treatments
• There are four main groups toThere are four main groups to
treat mental abnormality:treat mental abnormality:
2.2. Anti-anxiety (benzodiazepines)Anti-anxiety (benzodiazepines)
• 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-
• Too little GABA is associated with anxiety and
Too much or too little of a particular
neurotransmitter can lead to
How do Anti-DepressantsHow do Anti-Depressants
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
Are there any issues withAre there any issues with
• 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
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!
Do anti-psychotic drugsDo anti-psychotic drugs
• 60%60% success rate for symptoms ofsuccess rate for symptoms of
hallucinationshallucinations and psychoticand psychotic
• BUT no effect on theBUT no effect on the
symptoms ofsymptoms of socialsocial
• HOWEVER, they areHOWEVER, they are
thethe onlyonly drugs thatdrugs that
appear to work forappear to work for
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
• Electro Convulsive Therapy
– Used when drugs fail to treat
– Approximately 22,000 people receive
in UK per year
– Patient is given muscle relaxant and
– 110mv shock to brain – causes
seizure for 1 minute. 5-10 mins later
the patient regains consciousness
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
• Typically patients receive 6-9Typically patients receive 6-9
treatments over a monthtreatments over a month
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
• 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
• Dept of Health found 30% ECTDept of Health found 30% ECT
patients suffered fear and anxietypatients suffered fear and anxiety
following ECTfollowing ECT
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.
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
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
• 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
• The final and most drastic
treatment for abnormal behaviour
in the Biological approach is brain
• Areas of the brain thought to be
responsible for the behaviour are
partially or completely removed.
• In the Neolithic times, 40,000
years ago, man performed skull
• 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
• A leukotomy refers to what is
now more commonly known as a
• The first human leukotomy was
performed by Antonio Egas Moniz
in 1936. He won the Nobel Prize
for medicine in 1949 for this
• The procedure was popularized in
the US by Dr. Walter Freeman,
who travelled the country
performing "ice pick lobotomies"
on patients with psychiatric
• 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
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
What is psychosurgery?
• The systematic damage of the
brain in order to change
• The mode of action involves
the cutting of neural tissue in
the brain and was designed
to alter the symptoms of
• 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."
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
• 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.
XNo evidence it improved specific
symptoms, just made the patient
XMajor ethical issues: irreversible
procedure and unpredictable
XCan the person with the disorder
really give fully informed consent?