Lecture 11 - Drug therapy vs psychotherapy Flashcards
(15 cards)
Review of disorders
Schizophrenia
- personality disorders (e.g. schizoid, paranoid, etc)
Anxiety disorders
Mood disorders
- depression
- bipolar
Schizophrenia
Medication
- strong biological component (e.g. domaine hypothesis)
Reduced positive symptoms (e.g. delusions, hallucinations)
- typical, first-generation
- atypical, second-generation (slight better)
Revolving door pattern of hospitalisation
- is drug therapy enough?
Psychotherapy
- strategies to deal with maladaptive thoughts
- learn to tell difference between what is real and not
- often combined with medication
~ more effective than drug therapy alone
Common neurotransmitters
Acetylcholine -> transmitter at muscles, involved in learning etc
- Monamines -
Serotonin -> involved in mood, sleep and arosual, aggression, depression, objective-compulsive disorder, and alcoholism
Dopamine -> contributes to movement control and promotes reinforcing effects of food, sex and abused drugs; involved in sz and Parkinson’s disease
Norepinephrine -> a hormone reeled during stress. Functions as a neurotransmitter in the brain to increase arousal and attentiveness to events in the environment, involved in depression
Epinephrine -> a stress hormone related to norepinephrine; plays a minor role as a neurotransmitter in the brain
- Amino acids -
Glutamate -> the principle excitatory neurotransmitter in the brain and spinal. Vitally involved in learning and implicated in sz
Gamma-aminobutyric acid (GABA) -> the predominant inhibitory neurotransmitter. Its receptors respond to alcohol and the class of tranquillisers called benzodiazepines. Deficiency in GABA or receptors is one cause of epilepsy
Glycine -> inhibitory transmitter in the spinal cord and lower brain. The poison strychnine causes convulsions and death by affecting glycine activity
GLU vs GABA
Glutamate (GLU)
- excitatory neurotransmitter
- receptors found on 90% of neurones in brain
GABA
- inhibitory neurotransmitter
- receptors found on 30% of neurones in the brain (second place)
Primary facilitators of communication in the brain
Anxiety (and anxiolytics)
Increases activity in the brain
- amygdala
- thalamus
- hippocampus
Over excitation causes by excess neurotransmitters
- glutamate
- also epinephrine/norepinephrine (also excitatory)
Anxiolytics
- drug developed and prescribed to treat anxiety
- sedative and calming effects
- too much causes sleepiness, and death
- usually start working immediately
- however, some antidepressants relieve anxiety
- antidepressants may take weeks to become effective
Barbiturates
- powerful sedative effects (hypnotic)
- side effects include reduced respiration
~ too powerful, let to several accidental suicides
~ reduced prescription dramatically in the 1950s
~ however, replacements were deadly too
Benzodiazepines
- replaced barbiturates to treat anxiety
- increase effectiveness of GABA (inhibition)
- safer compared to barbiturates, but still deadly in high doses
- commonly prescribed today (e.g. Xanax)
Safe alternatives?
- Busprione (affects serotonin)
- anticonvulsant drugs (affects GABA)
- Beta blockers
~ anxiety as sensitivity to engaging “fight or flight”
~ these drugs block receptors for norepinephrine and epinephrine which trigger “fight or flight”
Beat blockers
- block physiological response to anxiety
- cognition remains mostly unaffected (e.g. less sedation)
- more common for less severe cases of anxiety
- examples include:
~ propranolol
~ acebutolol
~ bisoprolol
Other anxiety treatments
Psychotherapy
- specific phobias e.g. exposure therapy
- cognition behaviour therapy (CBT)
- lear how maladaptive thoughts contribute to anxiety
- may be used with education
- severe cases may require long-term use
Serotonin (5HT)
Mostly responsible for regulation in the brain
- mood
- appetite
- sleep (melatonin)
- sex
- biological
Also implicated in learning/memory
Depression
Potentially due to depletion of serotonin in the brain
- However, levels of serotonin are sometimes “normal”
Other neurotransmitters implicated
- epinephrine/norepinephrine (similar to anxiety)
- dopamine (reward)
~ anhedonia
~ inability to feel pressure
Antidepressants
- drug developed and predicted to treat depression
- used to help regulate mood
- are not always immediately effective
~ takes week to experience full effects
~ may feel happier at first doses
~ placebo effect?
Antidepressants
Monoamine Oxidase Inhibitors (MAOIs)
- monoamines are a cetrogry of neurotransmitter
- bind to enzymes to prevent breakdown of monamines
caused exaggerated heart rate, hypertension, sweating, etc
- avoid cheese
Tricyclis
- inhibit retake of norepinephrine and serotonin
- can eat cheese
- severe side effects
~ dry mouth/eyes
~ constipation/urinary retention
~ memory/cognitive impairments
- hypertension/weight gain
Selective serotonin reuptake inhibitors
- block repute of serotonin by serotonin
- leads to greater levels of serotonin in synapse
- often known:
~ fluoxetine (prozac)
~ sertraline (zoloft)
Side effects of SSRIs
- sexual dysfunction (low drive, impotence)
- emotional detachment, less extreme emotions
- discontinuation leads to hallucinations, seep disruption
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
- block reuptake of inhibitors and norepinephrine
- same side effects as SSRIs
- used when SSRIs may not be effective
Psychedelics as medicine?
Ketamine
- hallucinogen
- anaesthetic for animals
- experimental antidepressant drugs
~ second line after main antidepressants don’t work
Psilocybin
Main psychoactive component in hallucinogenic mushroom
- acts on serotonin receptors located on GABA neurones
- leads to hallucinations, but also may effect mood regulation
Depression
Issues with medication
- not as effective compared to certain types of therapy
- not effective for mil cases of depression
- placebo effect
Depression
- learn how maladaptive thoughts contribute to depression
- focus on strategies which challenge these thoughts
~ effective for most forms od depression (and better than medication alone)
~severe cases od depression likely require medication
Bipolar
Strong biological component
Main route of treatment
Lithium
~ not clear how it works
~ Cana be lethal
~ relapse if medication stops
Issues with treatments
Medication
- not always immediate (e.g. SSRIs)
- requires compliance form patient
- side effect
Psychotherapy
- some disorders have strong biological
Summary
Medication
- severe cases (e.g. depression, anxiety)
- strong biological component (e.g. sz, biological)
Psychotherapy
- main form of treatment
- often used with medication
~ short-term unless, severe
Clinical psychologist
- give psychotherapy
- cannot prescription medication
- PhD (academic)
Psychiatrist
- do not give psychotherapy
- can prescribe medication
- medical degree (same as your GP)
- work with clinical psychologist
