Treatment - med/bio and Effectiveness

Question 1

ECT (Electroconvulsive Therapy) - aka? what?

Answer 1

• Aka electroshock therapy
• using a brief (less than a second) surge of electrical current through head to the brain to induce a mild seizure
• Very controversial, don’t really understand how it works, for whom, etc
• Used to treat severe depression, might also be useful for mania  very severe cases of depression or OCD where all medication fails, sometimes this is successful but we don’t know why  used when everything else fails, last resort
• Patient pretreated with muscle relaxants and under general anesthetic
• Risk of mortality is low
• Memory loss is the most common side effect, especially short term memory
• Othe minor side effects like headaches, muscle aches
• >90% patients who have had ECT say they would do it again, are happy they had it done
• ECT more effective than simulated ECT, placebo and antidepressant drugs like TCA and MAOIs

Question 2

ECT - treats? side effects? effectiveness?

Answer 2

• severe depression, might also be useful for mania, very severe cases of depression or OCD
• Risk of mortality is low
• Memory loss especially ST
• headaches, muscle aches
• more effective than simulated ECT, placebo and antidepressant drugs like TCA and MAOIs

Question 3

Transcranial Magnetic Stimulation (TMS) - what?

Answer 3

• Places a powerful pulsed magnet over a person’s scalp, which alters neuronal activity in the brain
• use of electricity to create weak currents that can depolarize neurons temporarily
• create magnetic field that induces weak electrical currents to the brain, cause some neurons to be excited without need for external electrodes like with ECT

Question 4

TMS

Answer 4

• particularly useful for treating depression that is unresponsive to medication
• TMS can also treat auditory hallucinations in schizophrenia
• coil near head of human being/animal (just above eyebrow) - usually prefrontal cortex for depression

Question 5

TMS - rTMS? safety? side effects? exceptions? effectiveness?

Answer 5

• rTMS: when you apply TMS several times (like 30) briefly within one session - repetitive
• Safe as far as we know
• non-invasive and less side effects than ECT
• mild headache, small risk of seizure, but no impact on memory or concentration
• Exceptions: pacemaker, seizures
• 25% complete remission, 50% significant improvement

Question 6

Psychosurgery - what? who? when? for what? significant side effects?

Answer 6

• operating on the brain to alter symptoms of severe psychological disorders
• surgical destruction of specific brain areas
• most controversial , started in 30s by Moniz
• rarely used, but for certain cases of OCD
• Significant side effects: extreme lethargy, childlike impulsivity

Question 7

Cingulotomy aka anterior capsulotomy

Answer 7

• destroying part of the cingulate cortex: cingulate gyrus and corpus callosum
• small legions to disrupt pathway between caudate nucleus and putamen
• Part of limbic system, which controls emotions
• part dealing with sorting out controlling emotions
• For some people, there is significant improvement but not everybody benefits

Question 8

Leukotomy (or, “leucotomy” - what?

Answer 8

• Leukotomy (or, “leucotomy”)
  o Sever connection between frontal lobes and other parts of the brain
• Prefrontal lobotomy
  o Cut out or destroy part of frontal lobe
  o Monix lobotomy: insert instrument into brain through eye socket/holes drilled in head  severs connections between frontal lobes and inner brain structures (like the thalamus, involved in emotion)
  -

Question 9

Prefrontal Lobotomy - what? Monix?

Answer 9

Prefrontal lobotomy
o Cut out or destroy part of frontal lobe
o Monix lobotomy: insert instrument into brain through eye socket/holes drilled in head  severs connections between frontal lobes and inner brain structures (like the thalamus, involved in emotion)
-

Question 10

Video - what tecnique did Walter Freeman pioneer? how long? how many? why stop?

Answer 10

• Trans-orbital lobotomy
• 3-4 minutes
• 150 in 1945
• 5 000 in 1949
• New drug Fluorizine, antipsychotic drug

Question 11

Other Methods - phototherapy? deep brain stimulation?

Answer 11

• repeated exposure to bright light - helpful to people with seasonal patterns to depression: SAD, depression in winter
• Deep brain stimulation - Non-destructive psychosurgery: small battery powered device implanted in brain
• o Treats OCD, Parkinson’s disease, severe depression

Question 12

Treatment Illusions (3)

Answer 12

1. Natural improvement
2. nonspecific treatment effects
3. reconstructive memory

Question 13

Treatment Illusions - Natural Improvement

Answer 13

a) Treatment illusions
- If you take a pill and get better, to what do you attribute your improvement?
- Natural improvement:
o Tendency of symptoms to return to their mean or average level
o mistakenly conclude that a treatment made you better when you would have gotten better anyways
o we usually turn to therapy/medication when symptoms are at their worse  symptoms would improve regardless of treatment
- nonspecific treatment effects
o attributing improvement to a feature of treatment, even thought that feature wasn’t really the active element that caused improvement  aka recovery but not related to the specific mechanisms by which treatment is supposed to work
o ex: you improve not because of medication but good relationship with doctor
o ex: simply knowing you are getting a treatment can be a nonspecific treatment effect
 placebo: inert substance/procedure applied with expectation that a healing response will be produced  sugar pills, etc
 up to 75% of antidepressant meds are due to placebo effect
- reconstructive memory
o client’s motivation to get well causes error in memory of original symptoms
o you think you improved when in fact you just mistakenly believe your symptoms before treatment were worse than they actually were

Question 14

TIs - nonspecific treatment effects

Answer 14

• attributing improvement to a feature of treatment, even thought that feature wasn’t really the active element that caused improvement
• aka recovery but not related to the specific mechanisms by which treatment is supposed to work
• ex: you improve not because of medication but good relationship with doctor
• ex: simply knowing you are getting a treatment can be a nonspecific treatment effect - placebo

Question 15

TIs - reconstructive memory

Answer 15

• reconstructive memory
  o client’s motivation to get well causes error in memory of original symptoms
  o you think you improved when in fact you just mistakenly believe your symptoms before treatment were worse than they actually were

Question 16

Treatment Studies: outcome vs. Process

Answer 16

• O: whether a particular treatment works,often in relation to some other treatment or control condition
• P: why a treatment works, or under what circumstances a treatment works

Question 17

Iatrogenic illness

Answer 17

• disorder or symptom that occurs as a result of medical/psychotherapeutic treatment
• Ex: therapist convinced that client has a disorder the client doesn’t have – client starts to show signs of that disorder and now has a iatrogenic illness

Question 18

5 Ethical Standards , APA

Answer 18

1. Striving to benefit clients and taking care to do no harm
2. Establishing relationships of trust with clients
3. Promoting accuracy, honesty and truthfulness
4. Seeking fairness in treatment, taking precautions to avoid biases
5. Respecting dignity and worth of all people

Question 19

Antipsychotic Medications - treat? what?

Answer 19

• Psychosis: general disorder associated with loss of reality
• hallucinations, delusions, thought disorders like OCD
• Medications: treat schizophrenia and related psychotic disorders

Question 20

Typical Antipsychotic Medications - typical means? examples? effects?

Answer 20

• “typical/conventional drugs” means first generation
• Used until mid-1990’s, but had severe side effects
• Originally a sedative but when given to schizophrenics, left them euphoric/docile
• Chlorpromazine (Thorazine) & Haloperidol (Haldol) & Thioridazine (Mellaril)

Question 21

Atypical antipsychoti drugs - means? examples? affects? vs. older?

Answer 21

• Atypical drugs, newer, much safer
• Clozapine (Clozaril) & Risperidone (Risperdal), olanzapine (Zyrexa)
• Appear to affect both dopamine and serotonin systems – blocks both types of receptors
• Blocking serotonin recpetors: useful because enhanced serotonin activity related to cognitive and perceptual disruptions, mood disturbances
• Work at least as well as older drugs for positive symptoms, but also work fairly well for negative symptoms

Question 22

How Antipsychotic Drugs work - postive and negative symptoms?

Answer 22

• we know what is happening at the neural level but not at the behavioural level
• Believed to block dopamine receptors in mesolimbic area of brain =reduces dopamine activity
• Dopamine over activity in mesolimbic related to positive symptoms (hallucinations, delusions) - antipsychotic medication works well for this
• Dopamine under activity in neocortical associated with negative schizophrenia (emotional numbing, social withdrawal, flat affect, depression, sadness) -med doesn’t work

Question 23

Antipsychotics - side effects? tardive dyskinesia?

Answer 23

• Not good for treating negative symptoms: flat affect, depression, sadness
• better for positive symptoms like hallucinations, elusions
• Hypotension, impotence, seizures
• Tardive dyskinesia: severe and permanent, market by repetitive involuntary movements often of the face/lips, extremities (like legs or torso) -like muscle spasms, tics

Question 24

Antianxiety Medications - treat? work by? main type? examples?

Answer 24

• treat problems with excessive fear or anxiety aka reduce person’s experience of fear/anxiety
• Reduce muscle tensions =relaxation
• Benzodiazepines: tranquilizer that facilitates action of GABA
  o Inhibitory neurotransmitter
  o Examples: Alprazolam (Xanax) & Diazepam (Valium) & Iorazepam (Ativan)
  o Take effect within minutes, effective for reducing symptoms
• Side Effects:
  o Tolerance: need for higher doses over time to achieve safe effects after long term use
  o Dependence, withdrawal  increased heart rate, shakiness, agitation, anxiety (symptoms drug tries to prevent)
  o Drowsiness, coordination, memory problems
  o Combined with alcohol: depresses respiration, potentially fatal
• Sometimes, antidepressants, like SSRIs, TCAs, & MAOIs are given as well
  o risk of dependence lower
  o downside is that antidepressants take longer to kick in so can’t be taken on an as-needed basis
• Other drug options (textbook)
  o If anxiety leads to insomnia: hypnotics like zolpidem (Ambien)
  o Generalized anxiety disorder: buspirone (Buspar)

Question 25

Antianxiety drugs - effectiveness, side effects of benzodiazepines?

Answer 25

• take effect within minutes, effective for reducing symptoms
• tolerance: need for higher doses over time to achieve safe effects after long term use
• Dependence, withdrawal =increased heart rate, shakiness, agitation, anxiety (symptoms drug tries to prevent)
• Drowsiness, coordination, memory problems
• Combined with alcohol: depresses respiration, potentially fatal

Question 26

Antianxiety meds - other options? pros cons? anxiety to insomnia drug? GAD drug?

Answer 26

• Sometimes, antidepressants, like SSRIs, TCAs, & MAOIs are given as well
• risk of dependence lower
• downside is that antidepressants take longer to kick in so can’t be taken on an as-needed basis
• If anxiety leads to insomnia: hypnotics like zolpidem (Ambien)
• Generalized anxiety disorder: buspirone (Buspar)

Question 27

Antidepressant medications - do what? MOAI? bad because?

Answer 27

• Drugs that help lift people’s moods
• MOAI (monoamine oxidase inhibitor)
• First introduced in 50s: Iproniaxid
• Prevents enzyme monoamine oxidase from breaking down neurotransmitters like norepinephrine, serotonin, dopamine
• Rarely prescribed: only used if other antidepressants ineffective
• can have fatal interaction with other drugs, blood pressure increase when take with foods with tyramine, other side effects like dizziness, loss of sexual interest, etc

Question 28

Antidepressants - TCA - stands for? when? examples? works by? side effects?

Answer 28

• TCA (Tricyclic antidepressants)
• Late 50’s
• Nortriptyline (Pamelor), imipramine (Tofranil, and amitriptyline (Elavil
• Block reuptake of norepinephrine and serotonin
• increases amount of neurotransmitter in synaptic space between neurons
• Side effects: dry mouth, constipation, difficulty urinating, bladder vision, racing heart
• Still prescribed, but less because of side effects

Question 29

Antidepressants - SSRIs - what? ex? work by? side effects?

Answer 29

• selective serotonin reuptake inhibitor
• Most commonly used today
• fluoxetine (Prozac), citalopram (Celexa) and paroxetine (Paxil)
• Block serotonin reuptake in brain = more serotonin available in synaptic space =neuron has better chance of recognizing and using this neurotransmitter and sending desired signal
• Hypotheses that lower levels of serotonin cause depression
• Side effects: nausea, dry mouth, headache, weight gain, loss of sexual interest/ability
• Serious interactions with other drugs, severe symptoms when discontinuing

Question 30

Antidepressants - other options and effects?

Answer 30

• SNRI – serotonin and norepinephrine reuptake inhibitor like Effexor (venlafaxine)
• Norepinephrine and dopamine reuptake inhibitor like Wellbutrin (ibupropion)
• less side effects than TCAs and MAOIs

Question 31

Antidepressants - take how low? can also treat? not recommended for? so use what?

Answer 31

• Can take up to a month before they affect mood
• Also can be used to treat anxiety disorders, eating disorders
• Not recommended for treating bipolar disorder - might trigger manic episode
• Instead treated with mood stabilizers: suppresses swings between mania and depression

 Lithium and valproate
 Lithium: possible long term kidney and thyroid problems, very precise useful range so needs close monitoring
 Valproate: most common for bipolar disorder, some side effects, less monitoring needed
- Side Effects
o Nausea, diarrhea, headaches, sexual dysfunction
o Can induce manic episodes in people who are bipolar
o Can increase suicide risk
o Other benign effects like dry mouth, weight gain (selective serotonin reuptake inhibitor)
o Most commonly used today
o Ex: fluoxetine (Prozac), citalopram (Celexa) and paroxetine (Paxil)
o Block serotonin reuptake in brain  more serotonin available in synaptic space  neuron has better chance of recognizing and using this neurotransmitter and sending desired signal
o Hypotheses that lower levels of serotonin cause depression
o “selective” because it works specifically on the serotonin system, not on norepinephrine like TCAs
o Side effects: nausea, dry mouth, headache, weight gain, loss of sexual interest/ability
o Serious interactions with other drugs, severe symptoms when discontinuing
- Other alternatives (textbook)
o SNRI – serotonin and norepinephrine reuptake inhibitor  Effexor (venlafaxine)
o Norepinephrine and dopamine reuptake inhibitor  Wellbutrin (ibupropion)
o These two new antidepressants appear to have less side effects than TCAs and MAOIs
- Other notes (textbook)
o Can take up to a month before they affect mood
o Also can be used to treat anxiety disorders, eating disorders
o Not recommended for treating bipolar disorder  might trigger manic episode
 Instead treated with mood stabilizers: suppresses swings between mania and depression
 Lithium and valproate
 Lithium: possible long term kidney and thyroid problems, very precise useful range so needs close monitoring
 Valproate: most common for bipolar disorder, some side effects, less monitoring needed
- Side Effects
o Nausea, diarrhea, headaches, sexual dysfunction
o Can induce manic episodes in people who are bipolar
o Can increase suicide risk
o Other benign effects like dry mouth, weight gain

Question 32

Antidepressants - side effects

Answer 32

o Nausea, diarrhea, headaches, sexual dysfunction
o Can induce manic episodes in people who are bipolar
o Can increase suicide risk
o Other benign effects like dry mouth, weight gain

Question 33

Herbal and Natural Products - examples? why use? why not good?

Answer 33

• Alternative medications: herbal, megavitamins, homeopathic or naturopathic remedies
• Easily available, over the counter, less expensive, perceived as “natural” alternatives to :drugs”
• Not considered medication by FDA/etc
• exempt from rigorous research to establish safety/effectiveness
• Little info on interactions with other drugs, tolerance, withdrawal symptoms, side effects, proper dosages, how they work over even whether they work or not, purity varies from brand to brand