WK 8 MH Flashcards
BIOMEDICAL TREATMENTS FOR MENTAL DISTRESS
Disease centred model of psychiatric drugs
correcting a defective/diseased brain or a chemical imbalance
makes brain more “normal”
Drugs as treatment for disease
Drug-centred model to psychiatric drugs
psychiatric drugs are psychoactive drugs and alter functioning of nervous system
Drugs Create an abnormal brain state -
Superimposes onto manifestations of distress. e,g, alcohol used to treat social anxiety is not targeting an alcohol deficiency
Useful effects are are a consequence of alterations to normal brain functioning
Drugs do not specifically target psychiatric symptoms
psychoactive drugs
Chemical compounds act on CNS to produce changes in perception, mood, consciousness, behaviour
Activation of brain systems is
dependent on activity of individual
neurons.
* This activity is mediated by
the amount of NT available at post synaptic site
The goal of drug therapies is to modify
the levels of neurotransmitters believed to be
involved in symptoms.
2 routes of drug therapies / drugs
Agonist drugs
Antagonist drugs
Agonist drugs
Increase the action of a neurotransmitter
by increasing its availability by
preventing re-uptake at the synapses,
preventing degradation within the
synaptic cleft or replacing low levels of a
particular neurotransmitter with its
pharmacological equivalent
Antagonist drugs
Inhibit the action of a neurotransmitter
by decreasing the availability of the
neurotransmitter or replacing the active
transmitters with an inert chemical
Antidepressants associated with serious adverse effects e.g.
, agitation, nausea, sickness,
increase in suicidality in young people (< 25 years old).
typical withdrawal effects of antidepressants
- anxiety,
- irritability
- insomnia,
- hyperarousal
- sensory disturbances,
- flu-like symptoms,
- nausea
Antidepressants
__% experience withdrawal effects, of these __% describe them as severe.
¡ 40% report feeling ______.
56
46
addicted
Dopamine hypothesis of
schizophrenia:
increased dopamine receptor sites (D2 receptors) on post-synaptic terminal, making people “supersensitive” to normal levels of dopamine.
Side effects of antipsychotics
block dopamine D2 receptors, reducing dopamine signalling = reduced activity of dopamine in basal ganglia, which controls movement and influences thought, emotion and motivation
Transient Parkinsons-like symptoms (e.g. stiffness in arms and legs, flat facial expressions)
also tardive dyskinesia (repetititive involuntary purposeless movements)
side effects of atypical antipsychotics
less movement side effects but increase appetite/weight gain
Mood stabilisers prescribed to
diagnoses of Bipolar dosprder , but also intense and sustained mood swings (e.g. BPD)
MOOD STABILISERS
Patient studies indicate ______ rates higher in those who don’t take mood stabilisers,
but mechanism of action poorly understood.
relapse
MOOD STABILISERS
. All have ____ effects
that likely impact on mania symptoms.
¡ Healthy volunteer studies show lithium…
sedative
impairs mental abilities/dulling.
Side-effects of MOOD stabilisers
hypothyroidism, impaired renal function, lethargy, weight gain
drugs for anxiety
ANXIOLYTICS
Benzodiazepines (e.g., diazepam) – drugs that enhance the action of
gamma amino butyric acid (GABA - inhibitory neurotransmitter).
Benzodiazepines Impact regions of the ______ ______, producing muscle relaxing effects, reduction of alertness/hypervigilance, and sedation (i.e., they counteract
physical/somatic signs of anxiety).
limbic system
side effects of benzodiazephines/anxiolytics
drowsiness
memory loss
depression
acute rage
aggressive behaviour
Reliance on medication: report on polymedication by Royal College of Psychiatrists
(2007):
__% of people accessing mental health services are prescribed two or more
medications.
90%
CRITICISMS OF DRUG THERAPIES
Withdrawal symptoms and relapse following drug discontinuation
Patients are offered no alternatives other than taking drugs
¡ There is little evidence for the disease-centred model:
Temporary fix, not a cure
Only __% offered psychological therapies that have
been proved to be effective to improve severe mental health difficulties (mostly for schiz tho)
10
There is little evidence for the disease-centred model:
e.g.
no consistant evidence that people with schizophrenia have specific abnormalities in dopamine or depressed people with serotonin
no consistent evidence specific drugs work better for specific problems
Electroconvulsive therapy
origins
It was assumed that seizures could prevent/cure schizophrenia, since
many believed that those diagnosed with epilepsy were immune to the
disorder (we know this is incorrect now…).
ELECTROCONVULSIVE THERAPY (ECT)
Brief discharge of an electric current
through the brain with the aim of
inducing a controlled epileptic
convulsion.
¡ Used while patient was fully conscious,
now used with general anaesthesia
with muscle relaxants to prevent injury.
¡ 2 x week for 3-6 weeks (over 6-12
sessions in total).
ELECTROCONVULSIVE THERAPY (ECT)
how many ppl in Uk
2500
NICE (National Institute for Health and Care Excellence)
recommends its [ETC] use in
treatment-resistant depression, mania or catatonia, where there is a high risk of suicide
adverse effects of ECT
permanent memory loss, major adverse cardiac events
