Drug Therapy

How do biological assumptions apply to drug therapy?

The approach assumes that psychological disorder eg: depression, anxiety and schizophrenia have a physiological cause. This approach to therapy is known as the medical model and is based on view that mental illnesses are like physical illnesses and they have a physical cause characterised so can be treated in a physical way. Patients can be treated for these mental illnesses by through drug therapy.

What are 3 examples of mental illnesses treated with drug therapy?

• Schizophrenia: caused by excess dopamine within the brain, leading to symptoms such as hallucinations or delusions

• Depression: caused by a lack of serotonin, leaving the patient having low mood, and lacking a desire to engage in activities that they would usually find joy in

• Anxiety: caused by an imbalance of the emotional centres within the brain, leading to an overproduction of adrenaline and often a ‘fight or flight’ response- when they are in no real danger

What are the 6 steps in drug therapy?

1. Individual seeks help from a medical professional, telling them about how they feel and what their symptoms are

2. The medical professional makes a decision as to the type of mental illness that the individual displays

3. The medical professional will prescribe the most appropriate drug for the individual

4. Individual or a responsible person caring for them will pick up a prescription for the drugs & individual will take them. Usually swallowed with water, can be given by injection if needed

5. The individual takes drugs everyday and in 4 to 6 weeks they return to their medical professional for a checkup

6. Behaviour of the individual will be monitored and it will be decided if they are to continue with drug therapy alone or start a talking cure with drug therapy, change to another type of drug or stop drug therapy altogether

What are the 3 types of drugs

Antipsychotic

Antidepressant

Antianxiety

What are is a conventional antipsychotic drug?

Conventional/ typical (1st gen)

These were developed in 1950s eg: chlorpromazine

How they work:

• Schizophrenia is believed to be caused by excess dopamine within the brain

• The medication binds to dopamine receptors in the brain and blocks dopamine receptors but doesn’t stimulate them

• This reduces the flow of dopamine within the brain

Side effects:

Tardive dyskinesia (irreversible)

• Tongue protrusion

• Lip smacking

• Mouth puckering

• Lip grinning

• Excessive eye blinking

Tachycardia (rapid beats of heart)

Orthostatic hypotension (sudden fall in blood people)

These are common (in more than 1% of people)

What is an atypical psychotic drug?

Atypical/ 2nd gen

Eg: risperidone

how they work:

Work similarly to typical but only temporarily block dopamine receptor sites they will then dissociate to allow for normal dopamine flow

Because this is more temporary side effects are less prevalent

Side effects:

• Trouble pooping

• Yellow skin & eyes

• Dry mouth

• Dizziness

• Weight gain

• Trouble staying awake

• Change in menstrual cycle

• Hard to pee

• Weakened immune system

• Painful muscle contractions

• Enlarged breast tissue in males

Antidepressant drugs- how do they work?

Through selective-serotonin-reuptake inhibitors

How they work:

• Depression is believed to be caused by a lack of serotonin in the brain

• In a brain of someone who doesn’t have depression, serotonin is constantly being released and resorted at the synapse (this reabsorption leads to the serotonin getting broken down by an enzyme)

• Antidepressants known as SSRI’s are used to treat depression by causing an increase of serotonin in the brain

• SSRI’s work by binding to the pre-synaptic reuptake transporters in the neuron

• Thus stops the reuptake of serotonin, therefore less is absorbed

• This allows more serotonin to build up in the synaptic cleft, making more available within the brain

Side effects:

• Nausea

• Fatigue

• Drowsiness

• Worsening of symptoms

• Weight gain

how does benzodiazepine work? (Antianxiety drug)

How they work:

Bz works to calm the body’s stress responses

BZ’s:

• Slow activity of central nervous system (CNS)

• Done by enhancing activity of GABA (a neutransmitter that releases stress

Side effects:

• Drowsiness

• Light-headedness

• Confusion

How do beta-blockers work? (Antianxiety drug)

How BB’s work:

• they work by binding to receptors on the cells on the areas of the body that become aroused eg: the heart

• BB’s will block the receptors on these cells, slowing their function

• Therefore the heart will beat slower and blood pressure will fall, making the patient feel less anxious

Pros of drug therapy:

1. Research to support:

Kahn et al. (1986):

• Followed patients for 8 weeks, finding that BZ’s were more effective at treating anxiety compared to placebos

• This shows that drugs are effective when used in randomized control trials

Soomro et al. (2008)

• Reviewed 17 studies that used SSRI’s to treat OCD. Patients found them to be more effective than placebos in reducing the symptoms up to 3 months after treatment

In comparison to other therapies, it is relatively cheap for the patient, especially in the UK as we have the NHS

practitioner doesn’t need to invest as much time in the patient, only meet every few months to discuss progress

Ethical strength- it can protect patient from serious harm can then help them attend things like CBT to address cause of illness

Weaknesses of drug therapy:

Like other approaches it only treats the symptoms not the cause.

Many drugs have side effects nausea, headache & insomnia common side effects. No true long lasting dating of effectiveness of drug therapy most studies only last 3-4 months

Has multiple ethical weaknesses. Uses placebos when researching effectiveness- participants at risk of worsening symptoms

Informed consent can it really be given as patients may find it difficult to understand all the facts, they may not be in the right state of mind.