Biological Therapies Flashcards
What are the 3 main types of biological therapies?
1) Antipsychotic drugs
2) Electroconvulsive Therapy (ECT)
3) Psychosurgery
How many different types of antipsychotic drugs are there?
2
What are the 2 different types of antipsychotic drugs?
Typical and atypical drugs
What are antipsychotic drugs in terms of dopamine?
Dopamine antagonists
Outline typical antipsychotic drugs
Primarily used to combat positive symptoms like hallucinations and thought disturbances - reduces the effect of dopamine - bind to dopamine receptors but do not stimulate them thus blocking their action
Name an example of a typical antipsychotic drug
Chlorpromazine
How much do typical antipsychotic drugs cost a year?
£10
Outline atypical antipsychotic drugs
Also used to combat positive symptoms but there are claims they have some beneficial effects on negative symptoms as well - thought to block serotonin receptors too - thought only temporarily occupy D2 receptors and rapidly dissociate to allow dopamine transmission hence recuing levels of side effects found when compared to conventional drugs
Name an example of an atypical antipsychotic drug
Clozapine
How much do atypical antipsychotic drugs costs a year?
£1500
Outline how ECT is given
Electric current is passed between 2 scalp electrodes to create a seizure - an electrode is placed above the temple of the non-dominant side of the brain and a second in the middle of the forehead (unilateral) - patient is injected with short-acting barbiturate so unconscious before electric shock is administered - given nerve-blocking agent, paralysing muscles to prevent them from contracting during treatment and fracturing - small amount of electric current of about 0.6A, lasting about half a second, passed through the brain - produces seizure lasting up to one minute which affects the entire brain - patient usually requires between 3-15 treatments
Outline psychosurgery for SZ
Involves damaging the brain to bring about behavioural changes - first used in the late 30s to sever connections between frontal lobes and rest of the brain - after, patients were calmer and displayed no symptoms of SZ but were sluggish, apathetic and no real quality of life
What is a big type of psychosurgery?
Ice-pick lobotomy
Outline ice-pick lobotomy
Involved instrument similar to an ice-pick - inserted under upper eye-lid and hammered up into the brain through orbital socket followed by rotation to sever connections - estimated 18,000 performed in the USA 1939-1951 but by 70s, died out due to drug therapies - some still carried out but only in very exceptional circumstances and using microelectrodes or lasers
What is a big issue of using antipsychotic drugs?
Ethical issues
What are the ethical issues of antipsychotic drugs?
There are side effects, death and psychosocial consequences associated with their use - when consequences are taken into account, cost-benefit analysis of advantage would most likely be negative
Name 2 positive points about typical antipsychotic drugs
1) Effectiveness in terms of relapse rates
2) Barlow & Durand (95)
What is the study for the effectiveness of typical antipsychotic drugs in terms of relapse rates?
Davis (80)
Outline Davis (80)
Analysed results of 29 studies and found significant difference between treatment and placebo groups reviewed demonstrating therapeutic effectiveness of drugs - 55% relapse with placebo and 19% on drugs
What is a negative of Davis (80)?
45% on placebo did benefit so figures are misleading
Name 4 negative points about typical antipsychotic drugs
1) Not fair to compare treatment conditions with placebo
2) Effectiveness in terms of other factors
3) Appropriateness - tardive dyskinesia
4) Appropriateness - motivation
Why is it not fair to compare treatment conditions with placebos for typical antipsychotic drugs?
Ross & Read argue not fair comparisons as with placebo, patient is in withdrawal state, flooded with dopamine as heightened sensitivity and increased numbers of dopamine receptors so total overwhelming of dopamine system so proportion relapse withdrawal
Explain effectiveness in terms of other factors in terms of typical antipsychotic drugs
Vaugh & Leff (76) found significant difference between treatment and placebo groups but only for those living with hostility and criticism in home environment - relapse rate 53% compared to 92% - individuals in more supportive home environments, no significant difference, 12% compared to 15%
What is tardive dyskinesia?
Uncontrollable movement of lips, tongue, face, hands feet, arms and legs
Explain tardive dyskinesia in regards to typical antipsychotic drugs
About 30% develop this and it is irreversible in 75% of cases
Outline appropriateness of typical antipsychotic drugs in terms of motivation
Ross & Read (04) taking drugs reinforces idea of ‘something is wrong with you’ preventing individual from thinking of possible stressors like life history or current circumstances which might be triggers so reducing motivation to look for possible solutions that might alleviate stressors and reduce suffering
Outline Barlow & Durand (95)
Report chlorpromazine effective in reducing SZ symptoms in about 60% of cases - appears to have most impact on positive symptoms and patients may still suffer from negative symptoms - suggest chlorpromazine effective by reducing dopamine suggesting high levels of dopamine contribute
What are 2 negative points about Barlow & Durand (95)?
1) 60% improve and not all
2) May still suffer from negative symptoms
Name 3 negative points about atypical drugs
1) Atypical vs typical
2) Only marginal support for them being particularly effective with negative symptoms - Leucht found one was ‘slightly worse’
3) Weight gain, high cholesterol and diabetes are more likely
Outline atypical vs typical drugs for the evaluation of atypical drugs
A meta-analysis by Leucht in 1999 revealed superiority of drugs compared to typical ones was only moderate - found 2 new drugs tested only ‘slightly’ more effective than typical drugs but another 2 new drugs no more effective
Name 3 positive points about atypical drugs
1) Particularly effective with negative symptoms
2) Lower likelihood Tardive Dyskinesia
3) Fewer side effects
Outline Jeste (99)
Found 30% after 9 months developed tardive dyskinesia with typical drugs but this was only 5% with atypical drugs
Outline fewer side effects for atypical drugs
May ultimately be more appropriate in treatment as many fewer side effects so patients are more likely to continue medications and thus see more benefits
Name 5 side effects of atypical drugs
1) Drowsiness
2) Muscle spasms
3) Blurred vision
4) Increased blood pressure
5) Dry mouth
What is the main study looking into the evaluation of ECT?
Tharyan & Adams (05)
Outline Tharyan & Adams (05)
Carried out review of 26 studies which included 798 ppts in total to assess whether ECT resulted in any meaningful benefit for SZ patients - when compared to placebo/stimulated ECT, more improved with real ECT but no indication this was maintained over medium/long term - when compared with antipsychotic drugs, results favoured medication groups - some limited evidence to suggest when combined with antipsychotic, resulted in greater improvement in mental state, concluded combination of ECT and medication may be more appropriate when rapid reduction of symptoms required, or when patients show limited response to medication alone
Outline ECT’s effectiveness
American Psychiatric Associated review in 2001 listed 19 studies that compared ECT with stimulated ECT - concluded ECT produced results no different from or worse than antipsychotic drugs - however Sanita (98) found no difference in symptom reduction between 36 SZ patients given either ECT or stimulated ECT
Outline ECT’s appropriateness
Due to significant risks associated with ECT like memory dysfunction, brain damage and even death, the use of this technique as treatment has declined - Read (04) in UK, decline 1979-99 with 59%
Name 2 positive points about psychosurgery
1) Studies using MRI have shown there is abnormal functioning in frontal lobes of SZs
2) Surgery that reduces functioning of frontal lobe may help to control symptoms of some sufferers
Name 3 negative points about psychosurgery
1) Drastic step as is damaging the brain justified to change behaviour?
2) Totally irreversible so side-effects are permanent
3) Side effects
Name 6 side effects of psychosurgery
1) Major memory loss
2) Emotional disturbance
3) Loss of creativity
4) Personality change
5) Lack of social inhibition
6) A lot of people have died as a result
What is the main study regarding the success of psychosurgery?
Tooth & Newton (61)
Outline Tooth & Newton (61)
Between 1942-54, 41% recovered/greatly improved, 28% minimally improved, 25% no change, 4% died and 2% were worse
What is the negative point about Tooth & Newton (61)?
What is meant by recovered - it is an inappropriate term
