Biological interventions for mental distress Flashcards
How might psychiatric drugs work? List 2 models
1) Disease-centred model
2) Drug-centred model
What is a disease-centred model of taking drugs/medication?
Correcting a defective/diseased brain, or a “chemical imbalance” in the brain
Drug treatment makes your brain more “normal” (assumption of abnormality)
Correcting a defective/diseased brain, or a “chemical imbalance” in the brain
Drug treatment makes your brain more “normal” (assumption of abnormality)
This is known as…?
A disease-centred model of taking drugs/medication
Correcting a defective/diseased brain, or a “chemical imbalance” in the brain
Does this follow the disease-centred or drug-centred model?
Disease-centred model
Drug treatment makes your brain more “normal” (assumption of abnormality)
Does this follow the disease-centred or drug-centred model?
Disease-centred model
Reverses the underlying abnormality/imbalance (akin to physical medicine e.g., insulin for diabetes)
Disease-centred model
Names of psychiatric drugs in the disease-centred model reinforce the notion of…… and suggest …..?
a. Reversing underlying abnormality/imbalance
b. Specificity (antidepressants, antipsychotics etc.)
What is the drug-centred model of taking medication/drugs?
All psychoactive drugs alter the functioning of the nervous system
All psychoactive drugs alter the functioning of the nervous system
This is known as…?
The drug-centred model of taking medication/drugs
According to the drug-centred model of taking medication/drugs, drugs create ……?
An abnormal brain state
According to the drug-centred model of taking medication/drugs, drugs create an abnormal brain state.
What does this mean?
Drugs superimpose onto the manifestations of distress
(alcohol use reduces anxiety in those who are socially anxious – i.e., alcohol deficiency is not being targeted or another chemical imbalance).
Drugs do not specifically and uniquely target psychiatric symptoms
Does this follow the disease-centred or drug-centred model?
Drug-centred model
Drugs create an abnormal brain state – superimposes onto manifestations of distress
Does this follow the disease-centred or drug-centred model?
Drug-centred model
Drugs normalise an abnormal brain state that is responsible for symptoms
Does this follow the disease-centred or drug-centred model?
Disease-centred model
Drugs create an abnormal brain state
Does this follow the disease-centred or drug-centred model?
Drug-centred model
Psychiatric drugs are psychoactive drugs.
Does this follow the disease-centred or drug-centred model?
Drug-centred model
Drugs as treatments of disease
Does this follow the disease-centred or drug-centred model?
Disease-centred model
Useful effects are a consequence of alterations to normal brain functioning
Does this follow the disease-centred or drug-centred model?
Drug-centred model
Therapeutic effects derived from effects on disease pathology
Does this follow the disease-centred or drug-centred model?
Disease-centred model
Examples: insulin for diabetes; salbutamol for asthma
Does this follow the disease-centred or drug-centred model?
Disease-centred model
Examples: alcohol for social anxiety
Does this follow the disease-centred or drug-centred model?
Drug-centred model
What are psychoactive drugs?
Chemical compounds that act on the CNS to produce changes in perception, mood, consciousness and behaviour
Chemical compounds that act on the CNS to produce changes in perception, mood, consciousness and behaviour
This is known as…?
Psychoactive drugs
Altered mental states vary across substances and their impact on particular ….?
Neurotransmitters
True or False?
Activation of brain systems is independent of the activity of individual neurons.
False
Activation of brain systems is dependent on the activity of individual neurons.
The activity of individual neurons is mediated by the …?
Amount of neurotransmitter available at the postsynaptic receptor site
What is the goal of drug therapies?
To modify the levels of neurotransmitters believed to be involved in symptoms
The goal of drug therapies is to modify the levels of neurotransmitters believed to be involved in symptoms
What are the 2 routes to achieve this?
1) Agonist drugs
2) Antagonist drugs
What do agonist drugs do?
Increases the action of a neurotransmitter by increasing its availability
Prevents re-uptake at the synapses to prevent degradation within the synaptic cleft or replacing low levels of a particular neurotransmitter with its pharmacological equivalent
What type of drugs increase the action of a neurotransmitter by increasing its availability?
Agonist drugs
What type of drugs prevent re-uptake at the synapses to prevent degradation within the synaptic cleft or replace low levels of a particular neurotransmitter with its pharmacological equivalent?
Agonist drugs
What do antagonist drugs do?
Inhibit the action of a neurotransmitter
Decreases the availability of the neurotransmitter or replaces the active transmitters with an inert chemical
What type of drugs inhibit the action of a neurotransmitter?
Antagonist drugs
What type of drugs decreases the availability of the neurotransmitter or replaces the active transmitters with an inert chemical?
Antagonist drugs
What are the main groups of psychiatric medication? List 6
1) Depressants (reduce arousal and stimulation, e.g., sedatives)
2) Stimulants (induce temporary improvements in either mental or physical functions, e.g., amphetamines, Ritalin)
3) Antidepressants
4) Antipsychotics
5) Mood stabilisers
6) Anxiolytics
What is the role of depressants?
Reduces arousal and stimulation
e.g. sedatives
What is the role of stimulants?
Induces temporary improvements in either mental or physical functions
e.g., amphetamines, Ritalin
How do antidepressants work as psychiatric medication?
They work by correcting deficiency of neurotransmitters (i.e., noradrenaline, serotonin) thought to underlie depressive symptoms.
Which type of drug works by correcting a deficiency of neurotransmitters (i.e., noradrenaline, serotonin) thought to underlie depressive symptoms?
Antidepressants
The use of antidepressants is recommended for…?
a. Severe to extreme depression
b. Moderate depression only
c. Mild to moderate depression
d. Moderate to severe depression
d. Moderate to severe depression
What is the main negative psychological effect of antidepressants?
May effectively distance someone from their current emotions/negative thoughts
May effectively distance someone from their current emotions/negative thoughts
This is a negative psychological effect of which type of drug?
Antidepressants
Drugs that increase serotonin activity are called…?
Selective serotonin reuptake inhibitors (SSRIs)
What are examples of Selective serotonin reuptake inhibitors (SSRIs)?
Fluoxetine (Prozac) and Citalopram
What are selective serotonin reuptake inhibitors (SSRIs)?
Drugs that increase serotonin activity
True or False?
There are more side effects of SSRIs compared to older medications
False
There are fewer side effects of SSRIs compared to older medications
How do SSRIs increase serotonin activity?
They block the reuptake of serotonin by limiting re-absorption in the presynaptic cell, therefore increasing levels of neurotransmitters in the synaptic cleft
What type of drugs block the reuptake of serotonin by limiting re-absorption in the presynaptic cell, therefore increasing levels of neurotransmitters in the synaptic cleft?
SSRIs
Antidepressants are commonly prescribed but their efficacy in mild/moderate of depression is disputed
True or False?
True
SSRIs are associated with mild adverse effects
True or False?
False
SSRIs are associated with serious adverse effects
SSRIs are associated with serious adverse effects such as…? List 4
1) Agitation
2) Nausea
3) Sickness
4) Increase in suicidality in young people under 25 years old
1) Agitation
2) Nausea
3) Sickness
4) Increase in suicidality in young people under 25 years old
These are serious adverse effects from which type of drug?
SSRIs
What are the withdrawal symptoms of SSRIs? list 7
- Anxiety
- Irritability
- Flu-like symptoms
- Insomnia
- Nausea
- Sensory disturbances
- Hyperarousal
- Anxiety
- Irritability
- Flu-like symptoms
- Insomnia
- Nausea
- Sensory disturbances
- Hyperarousal
These are the withdrawal effects of which type of drug?
SSRIs
How long can the withdrawal effects of SSRIs last?
Weeks or months
…..% of SSRI users experience withdrawal effects and of these, …….% describe them as severe
a. 56%
b. 46%
…..% report feeling addicted to SSRIs
40%
What are drug therapies for psychosis/schizophrenia? List 3
1) Antipsychotics
2) Mood stabilisers
3) Anxiolytics
What does the dopamine hypothesis of schizophrenia propose?
Theories have focused on abnormal dopamine functioning
What do drug therapies for psychosis/schizophrenia aim to do?
To increase dopamine receptor sites (D2 receptors) on the post-synaptic terminal rather than increase the levels of the neurotransmitter
To make people “supersensitive” to normal levels of dopamine
True or False?
Drugs for psychosis/schizophrenia increase the levels of the neurotransmitter to make people “supersensitive” to normal levels of dopamine
False
They increase dopamine receptor sites (D2 receptors) on the post-synaptic terminal rather than increase the levels of the neurotransmitter
To make people “supersensitive” to normal levels of dopamine
What can antipsychotics help reduce?
The impact of psychotic symptoms but people continue to experience distressing symptoms despite antipsychotic medications
What type of drug therapy is this?
It can reduce the impact of psychotic symptoms but people continue to experience distressing symptoms despite antipsychotic medications
Antipsychotics
What are the 3 main side effects of antipsychotics?
1) Block dopamine D2 receptors, reducing dopamine signalling
2) Transient Parkinson’s-like symptoms
2) Increase appetite/weight gain
What happens when antipsychotics block dopamine D2 receptors and reduce dopamine signalling?
There would be reduced activity of dopamine in the basal ganglia, which controls movement and influences thought, emotion and motivation
What are the transient Parkinson’s-like symptoms derived from antipsychotics? List 3
- Stiffness in arms and legs
- Flat facial expressions)
- Tardive dyskinesia (characterised by repetitive, involuntary, purposeless movements)
What are the side effects of atypical antipsychotics such as clozapine, olanzapine, and quetiapine?
Less movement side effects but increase appetite/weight gain
Mood stabilisers are prescribed to individuals with…? List 2 types of patients
1) Bipolar disorder
2) Intense and sustained mood swings (e.g., borderline personality disorder, schizoaffective disorder).
What types of substances fall under mood stabilisers? List 4
- Lithium
- Carbamazepine
- Sodium valproate (anticonvulsants)
- Some new antipsychotics (olanzapine)
Patient studies indicate relapse rates are higher in those who take mood stabilisers, but the mechanism of action is poorly understood
True or False?
False
Patient studies indicate relapse rates are higher in those who don’t take mood stabilisers, but the mechanism of action poorly understood
All mood stabilisers have sedative effects that likely impact …?
Mania symptoms
True or False?
Healthy volunteer studies show lithium improves mental abilities
False
Healthy volunteer studies show lithium impairs mental abilities/dulling
What are the 4 main side effects of mood stabilisers?
1) Hypothyroidism
2) Impaired renal function
3) Lethargy
4) Weight gain
What is a primary type of drug which falls under anxiolytics?
Benzodiazepines (e.g., diazepam)
What are Benzodiazepines (e.g., diazepam)?
Drugs that enhance the action of gamma
amino butyric acid (GABA - inhibitory neurotransmitter)
Drugs that enhance the action of gamma
amino butyric acid (GABA - inhibitory neurotransmitter)
This is known as…?
Benzodiazepines (e.g., diazepam)
What do Benzodiazepines (e.g., diazepam) impact and what type of effects do they produce?
Impact:
- Regions of the limbic system
Effects:
- Muscle-relaxing effects
- Reduction of alertness/hypervigilance
- Sedation (i.e., they counteract physical/somatic signs of anxiety)
What type of drugs produce these effects:
- Muscle-relaxing effects
- Reduction of alertness/hypervigilance
- Sedation (i.e., they counteract physical/somatic signs of anxiety)
Benzodiazepines (e.g., diazepam)
What types of drugs impact regions of the limbic system?
Benzodiazepines (e.g., diazepam)
True or False?
Benzodiazepines (e.g., diazepam) have severe withdrawal effects (gradual withdrawal over extended periods of time required)
True
What are the 5 main side effects of Benzodiazepines (e.g., diazepam)?
- Drowsiness
- Memory loss
- Depression
- Acute rage
- Aggressive behaviour
What are the 6 main criticisms of drug therapies?
1) Distressing, debilitating side effects, and decreased life expectancy
2) Many patients are over-medicated
3) Withdrawal symptoms and relapse following drug discontinuation
4) Patients are offered no alternatives other than taking drugs
5) There is little evidence for the disease-centred model
6) Drugs are a temporary fix, not a cure
….% of people accessing mental health services are prescribed two or more medications
90%
For those on antipsychotics, ….% take more than one (even though national clinical guidelines recommend only one at any one time).
43%
….% of people were prescribed more than the safe maximum daily dose of antipsychotic medication.
36%
True or False?
There is plenty of consistent, independent evidence that there are specific abnormalities in dopamine for people with schizophrenia or serotonin in people with depression
False
There is no consistent, independent evidence that there are specific abnormalities in dopamine for people with schizophrenia, or serotonin in people with depression
True or False?
There is no consistent evidence that specific drugs work better for specific disorders
False
Even though drugs are a temporary fix and not a cure, they may act as a barrier to addressing other factors that may be involved in …?
The maintenance of mental health difficulties (interpersonal difficulties, trauma, other psychosocial factors)
What is Electroconvulsive therapy (ECT)?
Invasive medical interventions (such “psychosurgery”/prefrontal lobotomy developed by Egas Moniz)
Invasive medical interventions (such “psychosurgery”/prefrontal lobotomy developed by Egas Moniz)
This is known as…?
Electroconvulsive therapy (ECT)
Who developed Electroconvulsive therapy (ECT)?
2 psychiatrists:
Ugo Cerletti and Lucio Bini in the 1930s
How did Ugo Cerletti and Lucio Bini develop Electroconvulsive therapy (ECT)?
After witnessing how pigs were stunned with electroshocks in abattoirs, often causing seizure
What did Ugo Cerletti and Lucio Bini assume about seizures and what they can help with?
That having seizures could prevent/cure schizophrenia since many believed that those diagnosed with epilepsy were immune to the disorder
What happens in Electroconvulsive therapy (ECT)?
Brief discharge of an electric current through the brain with the aim of inducing a controlled epileptic convulsion
Used while the patient was fully conscious, now used with general anaesthesia with muscle relaxants to prevent injury (i.e., bone fractures)
How long are Electroconvulsive therapies (ECT)?
2 x week for 3-6 weeks (over 6-12 sessions in total)
Are Electroconvulsive therapies (ECT) conducted when patients are conscious or unconscious?
Conscious
In Electroconvulsive therapy (ECT), an electric current goes through the brain in order to…?
Induce a controlled epileptic convulsion
How many people in the UK undergo Electroconvulsive therapy (ECT)?
Approximately 2,500 people
Most recipients of Electroconvulsive therapy (ECT) are…?
a. Male over 60 years old
b. Female over 60 years old
Female over 60 years old (67%)
NICE (National Institute for Health and Care Excellence) recommends Electroconvulsive therapy (ECT) to be used in …? List 3 types of disorders
- Treatment-resistant depression
- Mania
- Catatonia
Any disorder where there is a high risk of suicide
Is Electroconvulsive therapy (ECT) effective?
ECT is effective in certain groups but a number of uncertainties remain
e.g., long-term outcomes
True or False?
Evidence suggests that ECT prevents suicide deaths
False
No evidence suggests that ECT prevents suicide deaths
True or False?
Less than 1/3 of ECT given without consent
False
More than 1/3 of ECT given without consent
What are the adverse effects of ECT? List 2
- Permanent memory loss
- Major adverse cardiac events
Why does ECT remain controversial? List 3 points
1) More than 1/3 of ECT given without consent
2) Adverse effects, e.g., permanent memory loss, major adverse cardiac events
3) Mechanism unknown (assumed to be serotonin sensitivity in post-synaptic neurons)
True or False?
Psychiatric medications are the least common intervention for mental health difficulties
False
Psychiatric medications are the most common intervention for mental health difficulties
Do psychiatric medications work in a…?
a. Drug-centred way
b. Disease-centred way
a. Drug-centred way
True or False?
Some people can experience substantial side effects from psychiatric drugs
True
True or False?
It is clear that drugs do help everyone, all the time
False
It is clear that they do help some people, some of the time, but their widespread use is criticised on multiple grounds
True or False?
ECT continues to be controversial
True
