2. Objectives
• Understand the treatments that the Biological
Approach uses to treat abnormal behaviour
• Evaluate the treatments in terms of their
effectiveness
8. Too much or too little of a particular
neurotransmitter can lead to
psychopathology
• 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
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. ELECTRO-CCOONNVVUULLSSIIVVEE TTHHEERRAAPPYY ((EECCTT))
• Used to treat severe depression
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hhaarrmm
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ttrreeaattmmeennttss oovveerr aa mmoonntthh
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. 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."
23. 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.
24. 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?
Editor's Notes
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
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.
