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Abnormality: Biological treatments AS

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Abnormality: Biological treatments AS

  1. 1. Biological Treatments
  2. 2. Objectives • Understand the treatments that the Biological Approach uses to treat abnormal behaviour • Evaluate the treatments in terms of their effectiveness
  3. 3. • Brain injury • Infection • Neurotransmitters • Genetics Think BING !
  4. 4. Graduated Treatment ECT Drugs Surgery
  5. 5. Drugs • Some mental disturbances are associated with too much........ • or too little of a neurotransmitter.
  6. 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. 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
  8. 8. • 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
  9. 9. How do Anti-DepressantsHow do Anti-Depressants work?work? SSRI selective serotonin reuptake inhibitor
  10. 10. 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
  11. 11. 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
  12. 12. 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!
  13. 13. 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
  14. 14. 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
  15. 15. 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
  16. 16. 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
  17. 17. 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
  18. 18. 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.
  19. 19. 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?
  20. 20. 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
  21. 21. 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.
  22. 22. 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.
  23. 23. 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.
  24. 24. 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."
  25. 25. 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.
  26. 26. 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?

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