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HSCI 214 > Lecture 5 > Flashcards

Lecture 5 Flashcards

1
Q

All of the following were procedures used to treat madness in the 18th century, except ____

A) Trepanning
B) Beatings
C) Counter-spells
D) Psychoanalysis

A

D

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2
Q

Define psychopharmaceuticals

A
  • medications that are psychoactive (meaning they impact mood, thoughts, or behaviour)
  • they are prescribed for psychiatric reasons
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3
Q

When did the use of psychopharmaceuticals grow greatly?

A
  • grown since mid-20th century
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4
Q

What are the 3 different views or roles of medication in recovery processes?

A
  • drugs cured depression and addressed a chemical imbalance
  • drugs aided recovery process, allowing progress and breakthroughs to be made in therapy
  • potential placebo effect
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5
Q

explain the potential placebo effect

A
  • belief it would help was enough to actually help when combined with therapy and lifestyle changes
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6
Q

define psychoactive drugs

A
  • substances that affect feelings, thoughts, and behaviors

Review:
- have been used throughout human history (a long long history)
- ex. alcohol, caffeine, and cannabis too

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7
Q

What re-shaped our thoughts about these psychoactive drugs?

A
  • emergence of a global consumer culture and the development of the psychopharmaceutical industry
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8
Q

Which country has been instrumental in the development of the psychopharmaceutical industry and a key market for it?

A

US

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9
Q

define Patent Medicine

A
  • type of branding that’s not regulated
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10
Q

What was alcohol in US

A
  • prescribed as medicine and used informally for therapeutic and recreational purposes

EXTRA
Later concerns about alcohol risks and harms became so intense that it was prohibited and made illegal under an amendment to the US Constitution – health concerns but not solely a medical problem, but a social one (with moral dimensions) focused on harms to families and communities stemming from alcohol

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11
Q

What was morphine sold and marketed for?

A
  • sold and marketed to relieve pain and nervous irritation, quiet restlessness, promote sleep
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12
Q

what was cocaine sold and marketed as?

A
  • sold and marketed as brain tonic and stimulant
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13
Q

Review morphine and cocaine

A
  • Morphine and cocaine were exclusively produced by pharmaceutical industry,
    almost always advertised as therapeutic
  • Some companies were more “ethical”- targeted only physicians, used tested ingredients and noted contents of products
  • Also “patent” medicines (think brand name) sector of the market: secret ingredients, trying new substances advertised extensively directly to consumers
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14
Q

What were the unregulated sales of psychoactive substances associated with?

A
  • associated with an epidemic of addiction to opiates and cocaine in the late 19th century
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15
Q

What was the Reform movement?

A
  • to formalize and narrow what was deemed medicine and “therapeutic” to protect consumers
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16
Q

How do we increase medical regulation of substances?

A
  • raise educational and licensing standards for physicians
  • create legal monopoly on treatment of illness for physicians
  • start regulations for the pharmaceutical industry
17
Q

How did they regulate psychoactive substances in the public?

A
  • the sale of drugs by non-physicians was criminalized
  • legal access to psychoactive drugs was limited to those receiving medical treatment
  • even alcohol was subject to legal prohibition in the US and Canada
18
Q

What are some examples of the introduction of legislation formalized reforms? - acts brought stronger regulations for psychoactive durgs

A
  • US 1906 Food and Drug Act : requirement to disclose substances in labeling
  • US 1914 Harrison Anti-Narcotic Act : physician prescription for sale of cocaine and opiates
  • Canada Opium and Narcotic Drug Act 1929
  • Britain Dangerous Drugs Act 1920
19
Q

explain immediate impact and implications of the regulation of these drugs

A
  • reduced physician’s prescribing of psychoactive drugs, “non-medical” sales became illegal and criminalized
  • access to psychoactive drugs became officially managed by physicians and medical industry (substances were now fully medicalized)
20
Q

What happened after the consumption of opiates and cocaine as medicine declined?

A
  • new types of drugs became populat
21
Q

What were the most widely used substanced by the 1950s in the US?

A
  • Barbiturate sedatives (1900s) and Amphetamine stimulants (1930s)
  • accounted for 25% of all presriptions

EXTRA
- these drugs were sold for conditions like anxiety, insomnia, depression but were not thought of as “psychiatric drugs” at the time as they were not thought as curing mental illness

22
Q

What are 5 things that the widespread use of barbiturates and amphetamines revealed?

A
  • High prevalence of emotional and psychological suffering among people not institutionalized
  • Appetite for relief using psychopharmaceuticals
  • Meeting above appetite can be profitable for manufacturers and professionals involved
  • Curative claims are less important than the perception of few side effects (despite high rates of overdose from barbiturates)
  • Adverse public health effects of unrestricted psychopharmaceutical use can be considerable (e.g., high barbiturate overdose rates)
23
Q

What is the most recent pharma-driven epidemic? and what was it prescribed for

A
  • oxycodone
  • increasingly prescribed for pain, partially due to aggressive marketing and under-appreciation of risks related to the drug
24
Q

What are the 2 major reasons why psychoactive drugs began to be described and understood as psychiatric medications following WWII

A
  1. psychiatry as a profession began to expand beyond asylums and into the consumer realm (also treating milder conditions)
    - this happened gradually as 2/3 psychiatrists still worked in hospitals
  2. a number of new psychoactive medications became available
25
Q

What is THorazine and to who was it effective for?

A
  • a (major) tranquilizer
  • effective for many experiencing psychosis
26
Q

What drugs are mood elevators?

A
  • monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants were effective for even severely depressed patients
27
Q

What was Miltown?

A
  • first “blockbuster” pharma drug with high consumption and large cultural impact
28
Q

What were 3 important changes to psychiatry in the 50s and 60s?

A
  • Shift from institution to community (partially due to use of thorazine and antidepressants), even individuals experiencing severe symptoms could be cared for outside hospital
  • Increasing predominance and adoption of the biological model among some psychiatrists seeing effectiveness of medications as providing support for neurochemical basis of mental illness, BUT psychodynamic (and Freudian) beliefs continued (emphasis on psychotherapy) among psychiatrists
  • Marketing depicted medications as an adjunct for physicians to help patients make
    progress in psychotherapy, not an inherent cure
    ◦ This was because most psychiatrists supported Freudian views
29
Q

What was miltown marketed as

A
  • anti-anxiety medication
  • huge sale and initially a reputation for being safe and non-addictive
  • this helped create a demand for the drug, as well as reinforced the perception that treatment of anxiety was legitimate and that psychiatry was an important profession helping people to live better lives
30
Q

What were the lessons behind miltown

A
  • benefits overstated, risks/side effects harms understated, sales and profits, large consumer demand
31
Q

explain miltown again…

A
  • “minor” tranquilizer
  • viewed as non-addictive and safe : revolutionary scientific advancement
  • agent to combat anxiety: multilevel mass marketing campaign, popular media profile, massive sales
  • overshadowed antipsychotics and antidepressants because it was widely prescribed by GPs

Psychopharmacology not in inherent opposition to psychologically focused psychiatry: Miltown reinforced by psychodynamic psychiatry’s message that anxiety matters and boosted importance of psychiatry as profession
- GPs prescribed more than 80% of the miltown sold

32
Q

how is Miltown the same “story” as barbiturates earlier?

A
  • widespread demand
  • accompanying profit potential
  • perceived lack of risk or side effects was as important as curative claims
  • later revelations about dangers of the medication (addictiveness nad toxicity)

HSCI 214 (25 decks)

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