Module 3.6 Biological

Biological Treatments Overview

  • Biological treatments manipulate physical aspects of the brain through various methods:
    • Psychosurgery
    • Electricity (e.g., electroconvulsive therapy, transcranial magnetic stimulation)
    • Psychopharmacology (medication treatments)

Electroconvulsive Therapy (ECT)

  • ECT involves deliberately inducing seizures by passing electricity through the brain.
  • Developed in 1938 by Italian physicians for treating schizophrenia,
    • Erroneous belief: schizophrenia rare in those with epilepsy.
    • Hypothesis: Epileptic seizures might prevent schizophrenia.
  • Observations at a slaughterhouse led to the idea of applying electric current to induce seizures in humans.
  • Procedure Details:
    • Typically a series of 6 to 12 sessions over a few weeks.
    • Approximately 100 volts of electric current delivered to the brain.
    • Target non-dominant hemisphere to reduce the risk of retrograde amnesia.
    • Passing electricity through both hemispheres is more effective but increases the risk of memory loss.

Impacts of ECT

  • Retrograde Amnesia:
    • Loss of memory for past events.
    • Less likely when targeting non-dominant hemisphere.
  • Low dose of ECT is less effective but has fewer memory impairments, while high doses yield better efficacy but with greater memory risks.

Psychosurgery

  • Involves surgical procedures to remove or alter parts of the brain.
  • Popularized in 1935, with prefrontal lobotomies being the most notable type.
    • Severed connections in the frontal lobes.
    • Used for emotional, aggression, and defiance issues.
  • Historical Context:
    • Scandinavian hospitals had a higher per capita lobotomy rate compared to the U.S.
    • Sweden: at least 4,500 lobotomies performed from 1944-1966, predominantly on women.
    • Reports of non-consensual surgeries.
  • Discrediting of Prefrontal Lobotomies:
    • Led to the adoption of cingulotomy for severe OCD cases.
    • Precise lesioning in the cingulate cortex.
    • Important to note: the prefrontal cortex is crucial for judgment, decision-making, and emotional processing, developed into mid to late 20s.
    • Psychosurgery is now regarded as a last-resort treatment when other options fail.

Psychopharmacology

  • Definition: Use of medications to treat psychological disturbances.
  • Recent advancements have led to many new medications targeting various emotional states and mental disorders.
  • Types of Psychotropic Medications:
    • Medications can cause rapid changes in thinking and mood (e.g., anxiolytics).
    • Antidepressants typically produce gradual effects, often taking 4 to 6 weeks to show benefits.

Differential Effects of Medications

  • Effects vary significantly between individuals with mental disorders and those without:
    • Antipsychotic medications help diminish delusions and hallucinations but can disorient non-affected individuals.
  • In the 1990s, prescriptions for psychostimulants for preschoolers tripled, reflecting an increase in the use of psychopharmacology.
  • Statistics:
    • 1 in 20 children on mental health medications.
    • Antidepressant prescriptions doubled in recent decades; more frequently prescribed than antihypertensive drugs as of 2005.
    • Current percentages: over 11% of American women and 5% of American men take antidepressants.

Considerations around Psychotropic Medications

  • Medication Safety and Effectiveness:
    • Medications undergo rigorous testing for safety and efficacy.
  • Medications alleviate symptoms but do not cure the underlying causes of mental illnesses:
    • Importance of symptom management is emphasized (comparison to pain relievers like Tylenol).
  • Long-Term Use:
    • Patients may require prolonged use to manage symptoms; some may continue for months or even a lifetime.
  • Side Effects:
    • All medications may have unpleasant side effects, leading to non-compliance and potential relapses.
  • Prescribing Patterns:
    • Most psychotropic medications prescribed by primary care physicians rather than psychiatrists, who may focus more on prescribing than on therapy.

Gender Disparities in Clinical Trials

  • Most medical research, including studies on psychotropic medications, is conducted primarily on male subjects.
    • Women often excluded from trials due to concerns about pregnancy and hormonal fluctuations affecting results.
  • This bias affects dosage calculations, particularly in pain medications like acetaminophen, which is metabolized differently by women (slower rate leading to increased risks).
  • Despite being the primary consumers of antidepressants, women's specific responses and metabolization remain under-researched, pointing to a pervasive issue in medical research practices.