Behavioral Therapies Psychological Treatment Part 2 Flashcards
What are the 4 major types of psychotropics?
- Antidepressants
- Antipsychotics
- Moodstabilizers ( anti-manic)
- Anxiolytics( anti-anxiety)
What is the rationale of using medication for psychological problems?
Altering brain chemistry will alter brain function
Give a brief history if psychotropics
Medications for mental illness have been used since the 1950s with the discovery that chlorpromazine (an antipsychotic drug) calmed patients
Describe antipsychotics
“Neuroleptic”
For psychotic behavior
- 1st generation (traditional) and atypical antipsychotics
- Common feature is reduction of dopamine through receptor blockade
- Motor abnormalities are noteworthy side effects
Describe Antidepressants
For unipolar depression and anxiety
- drugs increase serotonin, norepinephrine and dopamine
- there are 2 lines of drugs classified as antidepressants
Describe the 1st line of Antidepressants
SSRIs- (selective serotonin reuptake inhibitors)
SNRI-( serotonin-norepinephrine reuptake inhibitors)
Common side effects include GI distress, sexual dysfunction
Describe the 2nd line of Antidepressants
- TCAs(tricyclic antidepressants)
- MAOIs( monoamine oxidase inhibitors) this drug inhibits enzymes that degrades monoamines
Common side effects include blood pressure changes
Describe neurotransmitter reuptake
- Neurotransmitter (NT) in the synaptic cleft gets taken back up into the presynaptic cell through re-uptake channels for re-packaging into vessels or destruction
- This regulates the amount of NT in truths synaotic cleft
With less NT in the synaptic cleft there is less likelihood any will bind to the post synaptic cleft
Explain the functioning of reuptake inhibitors
- These drugs block reuptake channels on the pre-synaptic membrane
- This causes the NT to linger in the synaptic cleft and thereby increases the total number of NT molecules in the cleft
Explain the degrading enzymes (e.g. monoamines oxidase)
- Enzymes break down neurotransmitters that aren’t stored in vesicles in the presynaptic cell
- Therefore, less NT is available for loading into the vesicles
- If there is less NT in vesicles, then less NT gets released into the synaptic cleft
With less NT in the cleft, there is less likelihood of the NT binding to a postsynaptic receptor
Explain the functioning of inhibiting degrading enzyme (e.g.. Monoamine oxidase inhibitors)
- These drugs inhibit the enzyme degradation process
- Therefore, more NT is available to be packaged into vesicles in the presynaptic cell
- If there is more NT in vesicles, then more NT gets released into the synaptic cleft
Describe mood stabilizers
For bipolar disorders ( “manic depression “)
- drugs have variable mechanisms of action
- lithium
- selective anticonvulsants and antipsychotics
Describe anxiolytics
For anxiety
Consist of
- antidepressants
- benzodiazepines (diazepines)
- These drugs depress brain activity
- Use only short term due to addiction risk
How long does it take for psychotropics to take effect?
Typically takes 4-6 weeks before therapeutic effect are evident.
Benzodiazepines are an exception
List factors that lead to patient non-adherence
- impatience leading to premature drug continuation
- side effects(e.g. sexual, motor)
- symptoms of mental illness
- financial factors
List some examples of brain stimulation therapies
- Electroconvulsive therapies
- Repetitive transcranial magnetic simulation (rTMS)
- Magnetic Seizure therapy (experimental)
- Vague nerve stimulation (VNS)
- Deep brain stimulation (DBS)
Describe electroconvulsive therapy
The application of an electrical stimulus to the brain to induce a generalized seizure to improve the mood
- patient is given a muscle relax prevent injury and an anesthetic to reduce consciousness
Give the history of the ECT
- seizures were originally induced by using pharmological substances
- Cerletti and Bini(1938) used electricity to induce seizures for treatment of mental illness (electroshock therapy EST)
- Anesthetics/muscle relaxants were not used and problems with bone fractures resulted
Describe the mechanism of action of electroconvulsive therapy
- multiple and indiscriminate effects on brain chemistry
- difficult to isolate therapeutic effect
What are some indication ECT should be used?
- Treatment- resistant depression/mania
- severe depression or mania
- pregnant depressed patients( since antidepressants can cause dude effects to fetus)
What are the contraindications of electroconvulsive therapy ( ECT) ?
No absolute contraindication but caution if patient has vascular disease ( due to increased blood pressure during seizures)
Describe the procedure of ECT
Frontotemporal placement can be unilateral or bilateral
- Generalized seizure for atleast 30 seconds
- 3 treatments a week for 6-12 treatments
What are the initial side effects of electroconvulsive therapy?
- Cardiac arythmia, headache and confusion
- Some memory loss-for recent long-term memory and some learning problems surrounding ECT sessions
What are the long term side effects of ECT?
- No permanent memory system problems(still debated)
- Typical memory abilities normalize after a few months post-treatment
