Ch. 8 Psychotherapeutic Drugs Flashcards
are psychological disorders also biological disorders?
the medical model of psychological disorders has supporters and detractors
FOR
- medicine can treat symptoms
- disorder risk is often hereditary
- this approach is destigmatizing
AGAINST
- there aren’t diagnostic biological markers for mental disorders
- reduces attention to environmental and personal factors
- medication might pre-empt using other strategies
what is a psychotherapeutic drug?
any drug that is used to treat a mental disorder. some disorders are treated with drugs routinely; others not so much.
some disorders respond very well to drugs; some do not.
all of these drugs have potential side effects. costs and benefits should be weighed, not necessarily just financial.
how has medication made a difference?
before the 1960s, patients might be institutionalized for life. laws passed in the 1970s changed approach to institutionalization. these are changes that have been good for some people, but not everyone. lifetime institutionalization is now rare.
what are the issues with psychotherapeutic drugs?
- potential for teratogenic effects
- anticholinergic effects initially
- palliative; controls symptoms, but cannot sure a disorder
- side effects
- “off-label” prescriptions; using a drugs for something it isn’t approved for, insurance may not cover it
what is the research of psychotherapeutic drugs?
- often discovered by accident
- carefully evaluate how data is controlled; a high dropout rate in the drug group should be scrutinized
- statistical significance doesn’t necessarily mean clinical significance
what are antipsychotics?
drugs that reduce some symptoms of psychotic disorders.
schizophrenia is the usual target for antipsychotics. changes in the DSM-5 have effectively placed disorganized symptoms in a separate category. schizophrenia often presents with cognitive symptoms that aren’t very responsive to antipsychotics.
what are the positive (present) symptoms of schizophrenia?
hallucinations, delusions, disorganized speech, disorganized behavior
what are the negative (absent) symptoms of schizophrenia?
flat or inappropriate affect, withdrawal, poverty of speech (mute)
what are the two types of antipsychotics?
traditional (first gen) and atypical (second gen)
what are traditional antipsychotics?
antipsychotics that block D2 receptors.
extrapyramidal side effects: Parkinson-like symptoms, sedation, shuffling, restlessness
- tardive dyskinesia
- anticholinergic symptoms
- works well in reducing hallucinations and delusions
- many patients don’t respond to them
- not lethal in overdose but there is a rare, possibly lethal, reaction called malignant neuroleptic syndrome
- sometimes used off-label as antihistamines or anti-nausea drugs
what do atypical antipsychotics do?
- post 1990s
- blocks several dopamine and serotonin receptors
- some decrease in negative as well as positive symptoms
- calming effects
side effects - sedation
- weight gain
- increased risk of diabetes type II with some drugs
- some extrapyramidal effects, less severe than with traditional drugs
what are the issues with antipsychotics?
both categories gave equally mediocre compliance rates. repository injections can get around compliance issues. traditional drugs are more of a “known” entity and less expensive. atypical drugs often work for non-responders of traditional drugs.
what are the symptoms of depression?
- depressed mood OR feeling numb
- crying
- guilt
- feeling hopeless
- loss of interests and motivation
- symptoms must be present for at least two weeks
- more common in women
- mild to moderate depression can respond to external treatments
anti-depressants
- placebo-controlled trials almost always have a placebo effect
- placebos often work at first, but lose effectiveness
- all anti-depressants carry a black-box warning that reflects concerns about children and adolescents
- effects usually emerge in 2-6 weeks
- anti-depressants (particularly SSRIs) are often used to treat anxiety disorders as well
- have anticholinergic effects
what are the categories of anti-depressants?
MAO-inhibitors, tricyclic anti-depressants, SSRIs, and “miscellaneous”