Treatment of Disorders 1: Big Questions, Biomedical

What are the two main families of treatment?

• Biomedical treatments: Directly alter brain function.

• Psychotherapy: Uses therapist interaction for support/relief.

What are the three different ways treatments aim to help clients?

• Direct intervention: Addresses the cause to cure the disorder.

  • Problem: we have few good theories of underlying causes of disorders (lack of direct interventions)

• Symptom support: Reduces symptoms without treating the cause.

  • We don’t know the cause but we know the symptoms that are the most inherent

• Insight: Helps patients understand causes and decide how to cope.

  • Why and when patients started feeling and behaving in some way

Why is self-report unreliable in assessing treatment effectiveness?

Patients may misremember past symptoms.

• Personal liking for the therapist can bias perception.

• Cognitive dissonance when treatment doesn’t seem to be working → are they improving because of the techniques of the treatment or because they are being supported by their clinician?

Why might symptoms improve without treatment?

Natural improvement: Symptoms sometimes resolve on their own.

• People seek treatment at peak severity, making improvement seem larger.

• Did your symptoms improve due to the treatment or did they improve naturally?

What is the placebo and nocebo effect in treatment?

Placebo: When an inert treatment (e.g., sugar pill) leads to symptom improvement due to expectation of healing. → is the treatment just a placebo due to people expecting it to work?

Nocebo: When negative expectations about treatment worsen symptoms.

• Opposite of placebo → amplify the negative by paying more attention to them

• Treatment can actually work but nocebo is counteracting the effectiveness

What is the difference between efficacy and effectiveness?

• Efficacy: How well treatment works in ideal conditions.

• Effectiveness: How well treatment works in real-world conditions.

Why is efficacy always higher than effectiveness?

• Cost and accessibility issues.

• Potential side effects.

• Stigma around treatment.

• Nocebo effects.

What is a Randomized Control Trial (RCT)?

A “gold standard” experiment assessing treatment efficacy in medicine and psychology.

• Random assign people to 3 groups: treatment, active control, inactive control

• Clinical interviews/questionaires to assess initial symptoms of participants → should be similar

• Treatment group: new treatment

• Active control: receives either standard treatment (best available treatment at the moment) OR “mock” treatment (placebo treatment that does nothing)

• Inactive control: do nothing

• Bring all groups back in after x amount of time and reassess symptoms → comparing symptom decrease in treatment group to active and inactive groups (want treatment group to be better than the two other groups)

What is the role of an inactive control in treatment experiments?

• Measures improvement from doing nothing.

• Accounts for natural improvement and patient bias.

What is the role of an active control in treatment experiments?

• Compares new treatment to a standard or mock treatment.

• Helps measure placebo and nocebo effects.

What is the goal of biomedical approaches?

To alter brain function using drugs, stimulation, or surgery.

Direct intervention (directly solving brain problem leading to disorder) or symptom alleviation

What are the advantages of biomedical treatments?

• Highly effective.

• Relatively cheap and easy to administer.

• Few side effects.

Which disorders are biomedical approaches commonly used for?

Anxiety, depression, bipolar disorder, schizophrenia, neurodevelopmental disorders. → almost all clinical orders in general

What is the primary function of serotonin?

Regulates well-being, appetite, and sleep.

What is the primary function of dopamine?

Increases brain activity, especially in reward and pleasure areas.

What is the primary function of GABA?

Inhibits neuronal activity (more GABA = less activity).

What is the primary function of norepinephrine?

Increases arousal and alertness, especially during stress.

What are the two types of antipsychotics?

Conventional (block dopamine, treat positive symptoms like hallucinations and delusions) and atypical (block dopamine & serotonin, fewer side effects).

What conditions are antipsychotics used for?

Schizophrenia, bipolar disorder, treatment-resistant depression.

What are common side effects of antipsychotics?

Weight gain, involuntary muscle movements, diabetes, drug interactions.

What are the three major types of anxiolytics

Benzodiazepines (increase GABA), beta blockers (block norepinephrine; for heart conditions primarily but also can help with anxiety), buspirone (increase serotonin).

What are anxiolytics used for?

Anxiety, PTSD, OCD, sleep disorders.

What are limitations of anxiolytics?

Only reduce symptoms, tolerance builds up, withdrawal effects.

What are the three main types of antidepressants?

SSRIs (increase serotonin), bupropion (increase norepinephrine & dopamine), SNRIs (increase serotonin & norepinephrine).

What conditions are antidepressants used for?

Depression, anxiety, PTSD, OCD, addiction.

What is a major limitation of antidepressants?

Takes 1-3 months to start working, dosage may need adjustments.

What are the two major types of mood stabilizers?

Lithium (reduces epinephrine, increases serotonin) and anticonvulsants (increase GABA & norepinephrine).

Primarily used for bipolar disorder

What are potential side effects of mood stabilizers?

Kidney/thyroid damage, drowsiness, muscle weakness.

What do psychostimulants do?

Increase norepinephrine, serotonin, dopamine to boost attention and wakefulness.

What conditions are psychostimulants used for?

ADHD, depression, eating disorders.

What are risks of psychostimulants?

Addiction, tolerance buildup, potential for overdose.

As a concept, “effectiveness” is most common to:

a) Sensitivity

b) Reliability

c) Internal validity

d) External validity

d) is correct → external validity = how generalizable are my results to the general population?

The neurotransmitter we would expect to be most dysfunctional in panic disorder is:

a) GABA

b) Serotonin

c) Dopamine

d) Norepinephrine

d) is correct → panic disorder = physiological response to panic (norepinephrine has to do with physiological response)