Drugs and Behavior Exam 4 FINAL

How does the placebo effect work ?

Expectancy, Spontaneous remission, Regression to the mean, classical conditioning, neurotransmitter systems implicated, non-specific physiological regulatory mechanisms, specific physiological effects

Expectancy (placebo)

you expect an outcome so it happens

Spontaneous remission

get better with no help

regression to the mean

not doing as well after

think about being on sports magazine- you have a really good performance and get on the front cover and then you go back to a normal performance

classical conditioning

going to a doctor and getting a therapeutic effect (getting better at the doctors)

neurotransmitter systems implicated

placebo changes these

opioid, dopamine, endocannabinoid

Non-specific physiological regulatory mechanisms

endorphins, prefrontal cortex activity

Specific Physiological Effects

could be disease specific or mechanism or both

question on placebo ?

what might it trigger to cause an effect?

underlying mechanisms either specific or in general

what was the study done by Subieta on Placebo

14 men got salt water injected into jaw to cause pain

received a placebo that said “might reduce pain”

what were the results from the salt water injections with the placebo

needed more salt water over time to maintain the pain

what did PET scans show in the placebo groups of salt water

increase in activation of mu opioid endorphin system after placebo

*most pronounced differences in pain processing areas

pain processing areas

left dorsolateral prefrontal cortex

right anterior cingulate

anterior insular cortex

left nucleus accumbent

explain the study done by Sauro

patients were given a placebo and experienced pain relief then were given naloxone and the pain returned indicating the role of the opioid system in placebo effects

naloxone

drug that blocks the effects of opioids

what did the Sauro study show

effects of placebo may be due to release of natural opioids

where is placebo the strongest ?

for pain or mood

explain the Fuente-Fernandez study

placebo was given to people with parkinsons and a PET scan was done

what were the findings of the Fuente Fernandez Study

substantial release of endogenous dopamine in striatum of PD

Placebo effect in PD is powerful and is mediated through activation of the damaged nigrostriatal dopamine system

who is more likely to experience placebo

people with genetic variability

Nocebo

expectation of a negative outcome may lead to worsening of symptoms

why are studies on nocebo limited

ethical concerns

why is nocebo common in the real world

negative diagnosis leads to distress of a therapy

nocebo on new antidepressant

people do not think a pill will fix their problems

pill did not work for a friend

its a hard to treat diagnosis

neurochemical underpairing

CCK is activated and causes pain while DA is suppressed and cannot counteract the effects

drug set and setting terms

set —> expectations

setting —> environment plays a role in drug effect

Lab vs Real world

respond differently at home with friends vs in a lab with scientists

set and setting with alcohol

6 beers with friends at a bar is different than 6 beers alone at home

different effects

college bar experiment

free drinks at a bar → get drunk

researcher comes out and says its all non-alcoholic

surprised faces

weed placebo effects

placebo cigs and joints → not statistically different for frequent smokers

big difference between smoking and edible

what does the big difference between smoking and edible suggest

used to getting high by SMOKING weed (smell, movements, ect)

LSD Trip Toys

article on what to do and what not to do when on LSD

• what to do

• what to have

• what not to do

• ect

why is it important to know a persons culture

it plays a role in how people experiance drugs

cultural beliefs reguarding mental illness and its treatment can vary grately

side effects of lithium

white people see polydipsia and polyuria as bad and complain while chinese see these as positive effects associated with cleaning the body of toxins

polydipsia

excessive drinking

polyuria

excessive peeing

what do latinos and asians anticipate with meds

a fast response - not typically the case

chinese example of why clinicians should be familiar with preconceived notions

feel well → no doctor

blood is a nonrenewable vital resource → refuse routine blood work → prevention and bloodwork

muslim example of why clinicians should be familiar with preconceived notions

muslims avoid alcohol → medication with alcohol in it =bad

advantages of psychotherapy

you have to work through your issues and find root of problem

advantages of pharmacotherapy

know therapeutic dose

less stigmatized

disadvantages of psychotherapy

not trusting therapist

disadvantages of pharmacotherapy

side effects

pharmacotherapy compared to psychotherapy

tend to be less expensive?, increased risks of relapse when discontinuing pharm, “drugs” work faster, easier to avoid stigma, side effects, short-term problem turned into long-term one, medicalizing issues, availability differences

tend to be less expensive?

• drugs less expensive than therapy

• stop using drugs → relapse

• use drugs for a lifetime → becomes more expensive than psychotherapy

“drugs” work faster

electroconvulsive therapy

easier to avoid stigma

drugs are easier to hide than therapy

side effects

meds usually have more side effects and can be dangerous

short-term problem turned into long-term one

can lead to withdrawl

lifelong on drugs when could work through it and be done with it

medicalizing issues

makes them appear out of the hands of the patient

availability differences

different variables affecting if people can get pharm or psycho

• insurance

• time

• therapist schedule

• ect

are psychotherapy and pharmacotherapy mutually exclusive approaches?

no, different ways to reach the same goal

is combining psychotherapy with pharmacotherapy beneficial ?

generally better than one alone as they can complement each other.

reality of combination therapy

• complex issue

• often, but not always the best

  • mixed data with anxiety disorders

• insurance plans/avalibility/accesibility

  • not everyone can get both

what did the PET scans show after 12 weeks of taking Paroxetine and psychotherapy

they were normalized post treatment

Paroxetine PET scan

bilateral normalization in prefrontal cortex

therapy PET scans

right side prefrontal cortex normalization

PET scans for Paroxetine and Therapy (separate)

normalization of activity in left anterior cingulate gyrus and left temporal lobe

role of client choice

matched clients had a 58% chance of showing greater improvement in therapeutic outcomes compared to those who did not have a choice in therapy.

why is defining mental illness hard

mood changes are normal

sometimes emotions are overwhelming, unrealistic, and interfere with daily life

how many americans will meet criteria for a mental health disorder during their lifetime ?

about half, but this is an underestimate

even though mental illness is more visible in media, why do people not get treatment

it is still stigmatized and this turns people away from getting treatment

drug research issues

clinical trials vs real world effectiveness

community sample advantages

trend toward using e-tech

patient variability

comorbidity

neuropathology research

clinical trials vs real world effectiveness

more effective in trials than the real world

community sample advantages

collect real world data in a doctors office

trend toward using e-tech

daily electronic reports rather than relying on memory

patient variability

are all schizophrenics equal ?

• no, everyone has different symptoms and experiences

comorbidity

many people suffer from multiple conditions simultaneously

neuropathology research

are changes in the brain due to the combination or due to the drug

drug vs undrugged population

Major Depressive Disorder (MDD)

debilitating condition characterized by overhwelming sadness, feelings of worthlessness, and loss of interest in normally pleasurable activities

what is the most common disabling psychiatric illness in adult popultaion

MDD

what percent of adults were hospitalized from MDD

70%

what percent of adults commited suicide from MDD

40%

who is more likely to seek treatment

women hi

what is something in women that can affect mood ?

hormonal changes

one reason why depression is different in men and women

genetic components are different

what is the prevelance of MDD in the US

over 20% lifetime

prevelence of MDD in men in US

14.7%

prevelcne of MDD in women in US

26.1%

who has more than double the risk of mental health issues such as depression

lesbian, gay, bisexual adults when compared to heterosexual adults

who has more MDD

women

why might men have less depression

underdiagnosis due to different symptoms

MDD symptoms - men

rage, agression, irritability, substance abuse

MDD symptoms - women

sadness, guilt, anxiety, hopelessness

who is more likely to get a MDD diagnosis

younger people and older than compared to middle age people

what trend has been seen in the past decade with MDD

more frequent diagnosis in teens and young adults

why has prevalence of MDD increased in the past decade ?

• greater awareness

• less stigma

• societal changes - social media

• over-diagnosis - easier to prescribe meds

• COVID

• increased availability of pharmaceuticals

Causes of MDD

no one single cause

biological, psychological, social factors

why are there different ways to treat MDD

due to the different causes

comorbidity in MDD percent

50% of people with MDD also suffer from an anxiety disorder

why is comorbidity in MDD with anxiety important

treatment can decrease slightly

many with MDD have high rates of what

alcohol and other drug abuse

cardiovascular disease

obesity

what can help but not determine casuality

genetic predisposition

environmental factors

other factors

does comorbidity confirm causuality

no correlations do not confirm

biological factors of MDD

genetics, twin and adoption studies, genes do not equal destiny

genetics

kids with depressed parents are 4 times more likely to have mood disorder

twin and adoption studies

identical twins are more likely to have the same psych disorder than fraternal twins

Neurochemistry

monoamine theory

monoamine theory

low levels of serotonin, dopamine, norepinephrine

what do many drugs used to treat depression elevate

monoamine system activity