Biological Treatments

Objectives

• Understand the treatments that the Biological Approach uses to treat abnormal behaviour

• Evaluate the treatments in terms of their effectiveness

• Brain injury• Infection• Neurotransmitters• Genetics

ThinkBING !

Graduated Treatment

ECT

Drugs

Surgery

Drugs• Some mental disturbances are

associated with too much........

• or too little of a neurotransmitter.

Drugs

• Neurotransmitters in the body help messages from your brain jump the gap between your nerve cells to travel to where they need to get to.

Drug TreatmentsDrug Treatments

• There are four main groups to There are four main groups to treat mental abnormality:treat mental abnormality:

1.1. Anti-depressantsAnti-depressants2.2. Anti-anxiety (benzodiazepines)Anti-anxiety (benzodiazepines)3.3. Anti-psychoticsAnti-psychotics4.4. Anti-manicsAnti-manics

• One of the factors involved in schizophrenia is an excessive amount of dopamine

• Too little serotonin is associated with depression and some anxiety disorders, especially obsessive-compulsive disorder.

• Too little GABA is associated with anxiety and anxiety disorders

Too much or too little of a particular neurotransmitter can lead to

psychopathology

How do Anti-Depressants How do Anti-Depressants work?work?

SSRI selective serotonin reuptake inhibitor

Do anti depressants work?Do anti depressants work?

• 50-65%50-65% of patients given an of patients given an SSRI for three months SSRI for three months showed signs of showed signs of improvement in testsimprovement in tests

• HOWEVER the other test group HOWEVER the other test group were given a were given a PLACEBOPLACEBO (pretend drug) and this group (pretend drug) and this group showed a showed a 25-30%25-30% improvement improvement

Are there any issues with Are there any issues with SSRIs?SSRIs?

• Side effectsSide effects = range from dry mouth to = range from dry mouth to suicidal thoughts (prozac)suicidal thoughts (prozac)

• Not addictiveNot addictive …BUT person …BUT person can become psychologically can become psychologically dependentdependent on them on them

Do anti-anxiety drugs work?Do anti-anxiety drugs work?• 70% success rate for panic disorders70% success rate for panic disorders

BUT highly addictive!BUT highly addictive!

Do anti-psychotic drugs Do anti-psychotic drugs work?work?

• 60%60% success rate for symptoms of success rate for symptoms of hallucinationshallucinations and psychotic and psychotic episodesepisodes

• BUT no effect on theBUT no effect on thesymptoms of symptoms of socialsocialwithdrawalwithdrawal

• HOWEVER, they areHOWEVER, they arethe the onlyonly drugs that drugs thatappear to work for appear to work for schizophreniaschizophrenia

Do anti-manic drugs work?Do anti-manic drugs work?

Prior to the introduction of lithium carbonate, Prior to the introduction of lithium carbonate, there was a there was a 15% suicide rate15% suicide rate amongst people amongst people with bi-polar disorder. with bi-polar disorder. The drugs significantly reduced that rate.The drugs significantly reduced that rate.

Success rate of Success rate of 80%80%

BUT many sufferers BUT many sufferers refuse to takerefuse to take the the drug because it leaves them feeling ‘flat’drug because it leaves them feeling ‘flat’

Gitlin’s five year study found a Gitlin’s five year study found a 70% relapse rate70% relapse rate

ECT

• Electro Convulsive Therapy– Used when drugs fail to treat

depressive disorders– Approximately 22,000 people receive

in UK per year– Patient is given muscle relaxant and

anaesthetic – 110mv shock to brain – causes

seizure for 1 minute. 5-10 mins later the patient regains consciousness

ELECTRO-CONVULSIVE THERAPY (ECT)ELECTRO-CONVULSIVE THERAPY (ECT)

• Used to treat severe depression• Modern techniques involve a mild Modern techniques involve a mild

current of between 70-130 volts, current of between 70-130 volts, whilst patient is under anaesthetic whilst patient is under anaesthetic and a muscle relaxant. Fewer spasms and a muscle relaxant. Fewer spasms occur and the patient is at less risk of occur and the patient is at less risk of harmharm

• Typically patients receive 6-9 Typically patients receive 6-9 treatments over a monthtreatments over a month

Side effects of ECTSide effects of ECT• Memory loss in at least 1/3 of Memory loss in at least 1/3 of

patients, sometimes long term.patients, sometimes long term.• Cardiovascular change (e.g. irregular Cardiovascular change (e.g. irregular

heartbeat)heartbeat)• HeadachesHeadaches• EEG studies have shown general EEG studies have shown general

slowing of brain patterns following slowing of brain patterns following ECT, which takes weeks to return to ECT, which takes weeks to return to normalnormal

• Dept of Health found 30% ECT Dept of Health found 30% ECT patients suffered fear and anxiety patients suffered fear and anxiety following ECTfollowing ECT

Is it an appropriate treatment?Is it an appropriate treatment?

• Doctors have little idea of WHY it Doctors have little idea of WHY it works, just because it works does works, just because it works does that make it appropriate? that make it appropriate?

• However, it is quick compared with However, it is quick compared with drug therapy and sometimes might drug therapy and sometimes might be the only option if patients fails be the only option if patients fails to respond to other treatments.to respond to other treatments.

Ethical Issues?Ethical Issues?

• Dept of Health checked 700 Dept of Health checked 700 patients who had been patients who had been ‘sectioned’. 59% had not ‘sectioned’. 59% had not consented to treatmentconsented to treatment

• Even where consent is Even where consent is obtained, is it fully informed? obtained, is it fully informed? Do patients know all of the Do patients know all of the side-effects?side-effects?

Is there a safer alternative?Is there a safer alternative?

• Repetitive transcranial magnetic Repetitive transcranial magnetic stimulation (rTMS)stimulation (rTMS)

• Involves passing high intensity Involves passing high intensity magnetic pulses through the magnetic pulses through the skullskull

• Focuses on regions of the brain Focuses on regions of the brain which have been associated which have been associated with depressionwith depression

• Shows fewer side effects and is Shows fewer side effects and is as effective as ECTas effective as ECT

Surgery

• The final and most drastic treatment for abnormal behaviour in the Biological approach is brain surgery

• Areas of the brain thought to be responsible for the behaviour are partially or completely removed.

Trepanning• In the Neolithic times, 40,000

years ago, man performed skull surgery.

• This surgery, called trepanning was probably carried out to "liberate" demons and bad spirits which the ancient doctors believed were responsible for madness and brain disease.

• Many skulls have signs of the skull structure healing; suggesting that those subjected to the surgery could and did survive.

Lobotomy• A leukotomy refers to what is

now more commonly known as a prefrontal lobotomy.

• The first human leukotomy was performed by Antonio Egas Moniz in 1936. He won the Nobel Prize for medicine in 1949 for this work.

• The procedure was popularized in

the US by Dr. Walter Freeman, who travelled the country performing "ice pick lobotomies" on patients with psychiatric disorders.

• Eventually he began performing this procedure on anyone who wished to have one .

Lobotomy: the severing of the connection between the frontal cortex and the lower parts of the brain.Prefrontal lobotomy: drilling two holes in the skull and inserting an instrument that severs nerves in the brain.Cingulotomy: an incision is made in the nerves of the brain and a MRI (Magnetic Resonance Imaging) scan aids the guidance of surgical instruments.

What is psychosurgery?• The systematic damage of the

brain in order to change behaviour.

• The mode of action involves the cutting of neural tissue in the brain and was designed to alter the symptoms of severe psychological disorders.

• Psychosurgery is a treatment of last resort.

"She is with me in body but her soul is in some way lost. The deeper feelings, the tenderness, are gone. She is hard, somehow."

Studies of Psychosurgery • As recently as the 1990s, psychosurgery was

reported to be beneficial in some cases of severe anxiety, depression and obsessive-compulsive disorders (Beck and Cowley, 1990).

• Another key advantage is that psychosurgical techniques reduce the risk of suicide in severe depression from 15 percent to one percent (Verkaik, 1995).

• But psychosurgery produces inconsistent outcomes. Behaviour change occurs in some individuals and not in others, so it is difficult to predict who will be affected and how.

• The main ethical problem with psychosurgery is that the procedures are irreversible because neural tissue has been destroyed.

Surgery

XNo evidence it improved specific symptoms, just made the patient more manageable.

XMajor ethical issues: irreversible procedure and unpredictable consequences.

XCan the person with the disorder really give fully informed consent?