Types of Treatment

Biological Treatment

Drug Therapies: Schizophrenia

Pre-Drug Therapy

• Prior to the discovery of psychological drugs, hospitals had few options with which to treat patients • Most early treatment techniques are today considered archaic and sometimes cruel

Post-Drug Therapy

• With the discovery of effective drug treatments, patients were able to leave the institutions (deinstitutionalization).

Deinstitutionalization

• The release of patients from mental hospitals to the community at large • The development of drug therapies led to an 80% decline in the number of hospitalized mental patients from 1950 to 2000.

• Many of the former patients became part of the homeless population.

Biomedical Therapies

• Widespread use of antipsychotic medications began in the mid-1950’s • Can be related to number of patients in mental hospitals

Drug Therapies: Antipsychotic Drugs

Antipsychotic Drugs

• A category of medications used primarily to treat schizophrenia • Reduces the levels of hallucinations and delusions and distorted thinking • Drugs work primarily by blocking the activity of dopamine • 2 Types: Typical and Atypical

Typical Antipsychotic Medications • Typical antipsychotics ( Thorazine ) – Effective against positive symptoms of schizophrenia – Have uncomfortable side effects – Globally reduce brain dopamine levels • Side effects include: dry mouth, blurred vision, constipation, and tardive dyskinesia • Tardive dyskinesia – a permanent condition of muscle tremors Thorazine • One of the first antipsychotic drugs

Schizophrenia Drug Therapy

• Insert “Schizophrenia” Video #34 from Worth’s Digital Media Archive for Psychology. (5:15) • How does Augustine’s behavior change after 4 weeks on medication?

Click HERE to view in a separate window (5 min).

Shorter version: Effectiveness of these drugs with a schizophrenic (2 min)

Drawbacks of Antipsychotic Medications

• The early antipsychotics didn’t actually cure schizophrenia; psychotic symptoms often returned if a person stopped taking the medication • They were not effective in eliminating the negative symptoms of schizophrenia • They often produced unwanted side effects • They globally altered brain levels of dopamine, sometimes producing motor-related side effects; long term use can cause tardive dyskinesia • Patients go through a “revolving door” pattern of hospitalization, discharge, and rehospitalization • View some of the Drawbacks of Antipsychotic Drugs (1 min)

Atypical Antipsychotic Medications • Newer drugs that may also be effective against negative symptoms of schizophrenia • Affect levels of serotonin as well as dopamine • Much less likely to cause movement-related side effects because they block dopamine brain receptors far more selectively • Produce (sometimes dramatic) improvement in a significant proportion of patients who have not responded to traditional antipsychotic drugs

Drug Therapies: Antidepressant Drugs

Antidepressant Drugs

• A category of medications used primarily to treat major depression • Work by influencing levels of serotonin in the brain • Many take about a month before they become fully effective • 2 classes of drugs called tricyclics and MAO inhibitors

Tricyclics and MAO inhibitors

• A ffect multiple neurotransmitter pathways in the brain and work by increasing the availability of noradrenaline and serotonin • Effective for about 75% of patients • Produce troubling side effects – MAO inhibitors can lead to dangerously high blood pressure, leading to stroke or even death if people who are taking them consume foods with a chemical found in cheese, smoked meats, and red wine – Tricyclics caused weight gain, dry mouth, dizziness, sedation

Selective Serotonin Reuptake Inhibitors • Classification of antidepressants which work by blocking the reuptake of serotonin after it has been released • Includes: Prozac, Zoloft, and Paxil • No more effective than the older antidepressants • Produce fewer, and milder, side effects • Effexor, a dual reuptake inhibitor, affects levels of both serotonin and norepinephrine. – seems to be more effective than SSRIs in alleviating the symptoms of depression

Electroconvulsive Therapy

Insulin Therapy

• Depressed patients are given an overdose of insulin to cause a convulsion.

• Difficulties in determining the proper dosage of insulin led to a decline in use of this therapy.

• Was replaced by Electroconvulsive Therapy (ECT)

Electroconvulsive Therapy

• Used for severe depression • Very effective for quick relief of symptoms of severe depression (can be used until medication begins to work) • May have cognitive side effects such as memory loss • Very controversial treatment

ECT Facts

• Used when antidepressants fail • About 100,000 patients a year receive ECT • A series of 6 to 10 ECT treatments are usually spaced over a few weeks • Most (80%) patients report improvement • Typically relieves symptoms within days but benefits only last for a short time.

• Side effect is temporary or permanent memory loss for the events leading up to the treatment • How and why the process works is unknown

ECT

Electroconvulsive Therapy

• Insert “Electroconvulsive Therapy” Video #37 from Worth’s Digital Media Archive for Psychology. (5:05) Click HERE to view video in separate window.

Drug Therapies: Bipolar Disorder Drugs

Lithium

• Used to treat bipolar disorder (manic-depression) • Used to interrupt acute manic attacks and prevent relapse • Stabilizes the availability of glutamate within a narrow, normal range, preventing both abnormal highs and abnormal lows • Very narrow difference between the therapeutic dosage level and the toxic dosage level, requiring careful monitoring of the patient’s lithium blood level • Bipolar disorder can also be treated with an anticonvulsant medicine called Depakote. It is useful for treating patients who do not respond to lithium and patients who rapidly cycle through bouts of bipolar disorder several times a year

Depression & Mania

Patients and doctors talk about the experience and treatment of mania and depression, emphasizing the importance of both medication and psychotherapy. An animation segment illustrates what happens at the brain synapses in people with depression and mania. (11:44) Click HERE to view video or on the screen to the right.

Drug Therapies: Antianxiety Drugs

Antianxiety Drugs: Benzodiazepines

• A category of medication used to treat people with anxiety disorders or suffering stress • Include: Valium, Librium, and Xanax • Take effect quickly, usually within an hour.

• Work by boosting levels of the neurotransmitter GABA a neurotransmitter that inhibits the transmission of nerve impulses in the brain and slows brain activity • Can produce dependency, decreased coordination, slow reaction time, decreased alertness • Can cause death if mixed with alcohol

Antianxiety medications: Non-benzodiazepine—(Buspar)

• Believed to affect brain dopamine and serotonin levels • Relieves anxiety while maintaining normal alertness; it does not cause the drowsiness, sedation, and cognitive impairment associated with the benzodiazepines • May take 2-3 weeks to work